Maryland Nursing Home Lawyer Blog

Nursing Home Fined by State Authorities for Overmedicating Patient

April 23, 2013 | Lebowitz & Mzhen

Last month, a northern California nursing home received a severe citation and $100,000 fine for allegedly overmedicating an 82-year-old stroke patient with a blood thinning drug. These penalties were imposed following an investigation into the circumstances surrounding the patient’s 2011 death while in the facility’s care.

According to a representative of the organization that filed the complaint with state regulators on behalf of the family, the unidentified patient entered the care facility a year after a stroke left him partially paralyzed. The patient was receiving the drug Coumadin as part of his treatment plan.

The complaint focuses on an incident in May 2011, in which the patient fell from his wheelchair, and according to nursing home records, hit his head and sustained a black eye and other facial bruises. While experts stated the fall should have resulted in the man’s immediate hospitalization, it wasn’t until his daughter insisted that this action was taken four days later. At that point, the man was found to have low blood pressure, multiple organ failure, and a subdural hematoma. Additionally, and most shockingly, hospital admission records indicate that the man’s blood thinner medication levels were allegedly 18 times the normal levels. He died shortly thereafter.

According to the organization helping the family, in 2010 the company who owned the nursing home at the time of the man’s death was required to pay $29.1 million in connection with the death of a different patient in another facility that it owned.

Syracuse Nursing Home Faces Federal Sanctions for Substandard Care

April 16, 2013 | Lebowitz & Mzhen

Rosewood Heights, a 242 bed nursing home in Syracuse, New York was recently cited for 26 violations relating to patient care and safety standards. According to the December 2012 inspection report, which was recently published on the New York Health Department’s website, three of the violations were classified as “immediate jeopardy,” which is the most serious type of infraction. Additionally, 12 of the citations were for recurring issues. As a result, the federal Centers for Medicare and Medicaid (CMS) fined the facility $10,000 due to the infractions. (The state Health Department inspects nursing homes on behalf of CMS.)

Because the facility has been repeatedly cited for serious violations and persistent poor quality for more than three years, it was put on the CMS’s Special Focus Facility list in March 2012. Fewer than 1% of the nation’s nursing homes are on this list. Rosewood was informed that it had 18 to 24 months to improve the violations, or else face the potential loss of federal funding. Unfortunately, the latest inspection did not reflect improved conditions.

According to the report, among the most serious problems identified were several safety lapses related to feeding. Although luckily no one was injured or died as a result, there were pervasive lapses of supervision over patients with physiological feeding restrictions.

The most serious lapses included:

A woman who had suffered from dementia, and had also suffered from a stroke, was on a strictly liquid diet. An inspector found the resident being fed two chicken patty sandwiches by friends. Relatives also regularly fed the woman solid foods which were not within her dietary restrictions.
A resident who was posed with the risk of choking if he did not sit upright at meals was witnessed being fed lunch by a nurse while lying flat in bed.
A patient who had doctor’s orders to have meat and other large pieces of food pre-cut by staff was served whole hot dogs in his room, and left to eat without any supervision

The report cited the facility for failure to properly train staff and adequately supervise residents. According to the report, the home provided “substandard” care to a total of eight residents.

Additional violations included:

Failure of staff to wash hands, and in some cases not wearing gloves to feed residents.
Serving residents food that was not the proper temperature
Dirty floors in some resident rooms

Three Connecticut Nursing Homes Face Fines for Negligent Care

April 9, 2013 | Lebowitz & Mzhen

Three Connecticut nursing homes are facing fines for serious lapses in care related to residents who as a result were injured or suffered a further deterioration in health due to improper wound treatment.

In the first incident, according to a state inspection report, the rehabilitation center failed to provide adequate care to a resident for so long that a wound on her leg became “infested with maggots.” The resident had been diagnosed with dementia and other psychological affects, and some time after she developed leg sores, began to refuse treatment, including medications. There had reportedly been a recommendation that she be transferred to an inpatient psychiatric facility, following a psychiatric examination, but the attending physician did not think it was in her best interests. The Department of Public Health imposed a $1,020 fine for the facility’s failure to develop an alternative plan for treatment in the face of the patient’s ongoing refusal for care.

Another facility was also cited with a $1,020 fine for lapses in care related to two patients: one suffered a fall, resulting in a pelvic fracture, and the other was not properly treated for constipation.

The third facility was fined a total of $2,180 for two separate incidents. In one case, a resident had lost over a tenth of her body weight due to apparently losing his/her dentures, and was thus having difficulty chewing. However, the facility’s dietitian was never made aware of the difficulty, which could have resulted in an alternative nutrition plan. The other incident involved a resident who suffered an injury as a result of a transfer from a bed to a wheelchair without the use of a mechanical lift, which was required as a part of the patient’s care plan.

Estate Sues, Claims Nursing Home’s Negligence Led to Wrongful Death

March 27, 2013 | Lebowitz & Mzhen

A former nursing home resident’s estate has filed suit against the facility the man was living in when he died, accusing the facility of negligence which caused the man to suffer several falls while in its care, which ultimately led to his death.

The suit was filed on behalf of the estate of a former resident who died in September of last year at an Edwardsville, Illinois care facility. The suit alleges that the man was a resident in the facility from July 7, 2012 until the time of his death, which was the result of a subdural hematoma.

The suit specifically alleges that, “The cause of death was a subdural hematoma; said medical condition was a direct result of multiple falls by the decedent, at the Eden Village facility.” According to the complaint, the man suffered falls on at least four separate occasions from the end of July through August. In addition to the falls leading to his death, the estate alleges that the falls caused the plaintiff extensive pain and suffering, and were the ultimate cause of his death.

As a resident, the man required daily living assistance and rehabilitation. Subject to these requirements, the suit claims that the facility failed to care the decedent in a way which encouraged the maintenance and of his quality of life and dignity.
In addition to the wrongful death claims, the suit also alleges various other claims based on negligence. The estate is seeking at least $50,000 in damages for two of its claims.

Former Nursing Home Employee Charged with Stealing from 100 Year Old Patient

March 20, 2013 | Lebowitz & Mzhen

This week a former Wyoming nursing home employee pleaded no contest to obtaining goods by false pretenses. Malgorzata Burns, who was formerly a certified nursing assistant, has been accused of stealing thousands of dollars from an elderly resident with dementia who was under her care.

During his statement the District Attorney explained how Burns allegedly used the 100 year old victim’s money to pay various credit card and other bills. He said she also forged four checks, totaling $7,200. He explained that the victim was a patient living at the care center where Burns worked. According to the statement, the man suffers from “aggressive and ongoing dementia.”

Subject to the plea deal, Burns could serve up to ten years in prison. Prosecutors are also seeking to have the woman repay $13,000. Furthermore, as part of the agreement, prosecutors will dismiss charges of forgery and exploiting a vulnerable adult. Further complicating the situation for Burns, is the fact that she is a legal resident from Poland, meaning that a felony conviction could affect her ability to remain in the country.

The misdeeds were initially discovered by an employee of a non-profit guardian organization, who noticed suspicious activity in the man’s bank accounts. Such discrepancies included several online payments to a cable and internet provider, and for credit cards that did not belong to the man. The District Attorney further stated that the man does not even know how to use the Internet.

According to a document from the Wyoming State Board of Nursing, Burns had worked at the facility since December 2009, but resigned last June after the allegations arose. Her nursing assistant certification was suspended by the Board shortly thereafter in August.

Maryland Attorney General Announces $48 Million Settlement over Unapproved Bed Sore Ointment

March 13, 2013 | Lebowitz & Mzhen

The Maryland Attorney General announced last month Maryland has reached an agreement with

with Healthpoint and DFB Pharmaceuticals, its partner. The settlement, to which fifteen additional states and the federal government are also plaintiffs, is a result of allegations that Healthpoint was responsible for causing false claims to be submitted to the Maryland Medicaid programs for one of its products called Xenaderm. Xenaderm is a skin ointment that was prescribed to many nursing home, and potentially other, patients for the treatment of bed sores. However, the drug has not received the required approval from the Food and Drug Administration (FDA).

The various complaints related to the settlement alleged that Healthpoint unlawfully marketed Xenaderm without FDA approval. The allegations further claimed that this marketing was modeled upon a drug created some time before 1962, which itself had received review from the FDA. The FDA ruled in the1970s that the principal ingredient in Xenaderm was “less than effective” for treating bed sores, its intended use. The defendant(s) allegedly misrepresented the drug’s regulatory status repeatedly in reports that it submitted to both federal and state agencies.

Subject to terms of the $48 million settlement, which is to be awarded to 47 states and the federal government, defendants Healthpoint and DFB Pharmaceuticals will have to pay roughly $33 million to settle Medicaid-based claims nationally. Maryland itself will receive nearly $350,000 in refunds to the state’s Medicaid program, which accounts for the improper payments on behalf of both the state and federal governments.

Family Files Wrongful Death Suit Against Nursing Home

March 6, 2013 | Lebowitz & Mzhen

The family of an Indiana woman, who is believed to have died due to the injuries she suffered as a result of an altercation related to her Alzheimer’s and dementia, has filed a wrongful death lawsuit against the nursing home where she was living when she died. The suit accuses the nursing home of being negligent, and thus at least partly responsible for the woman’s death.

According to the local coroner’s office, the woman’s cause of death was a failure to thrive due to subdural and subarachnoid hematomas, which were the result of blunt force trauma that she suffered after a fall during an altercation with another resident.

The report from the Department of Health and Human Services Centers for Medicare & Medicaid, which was linked to in the story written by a local newspaper, concluded that among other things:

“Based on observation, interviews and record review, the facility failed to provide supervision to prevent falls and prevent a resident altercation which resulted in a fall, injury, hospitalization and death.” (page 8/28)

From the report, it also appears that this was not the woman’s first altercation.

The woman was a resident of the Alzheimer’s unit in the nursing facility, and she additionally suffered from dementia. The woman’s relatives claim that their motivation for filing suit was at least partly attributable to feeling as though the nursing care facility expressed no remorse or compassion following the incident.

Planning Ahead: Medicare Does Not Cover Nursing Home Long Term Care

February 26, 2013 | Lebowitz & Mzhen

When we talk about nursing homes, we must differentiate between whether we are referring to a short term stay related to medical care, such as in a rehabilitation care facility, or rather we are discussing a residential stay. The latter, which involves living in a nursing home or assisted living facility, is properly referred to as “long term care.”

Many people mistakenly believe that Medicare will pay for this long term care because Medicare willpay for skilled rehabilitation care within a Skilled Nursing Facility (SNF). However, there are strict requirements for when Medicare benefits will cover skilled care within a SNF. If you meet certain eligibility and Medicare plan requirements, then you may be able to have up to 100 days of care (per benefit period) in a SNF covered by your Medicare Plan. You will want to check with your plan, as a co-payment may be required after a certain number of days.

Medicare will cover skilled care only if all of the following are true:

You have the Medicare Part A (hospital insurance);
You have days left within your current benefit period available to use;
You have a qualifying hospital stay– more than 3 days excluding discharge (and with other limitations), and you enter the SNF within 30 days of discharge;
Your doctor orders the services of a SNF, which require the skills of trained professionals, such as occupational therapists, registered nurses, speech therapists, etc.;
You require the skilled care on a daily basis, and those specialized services are such that they can only be conducted on an inpatient basis;
You need the skilled services for a medical condition that was either (1) treated during your qualifying 3 day hospital stay; or (2) began while you were already staying in a SNF for a medical condition arising out of the hospital stay. (For example, the original stay in the SNF was for surgery, but you suffered a stroke while in the SNF);
The skilled services must be both reasonable and necessary, in terms of the diagnosis or treatment for your condition; and
You can get these skilled services in an SNF that is certified by Medicare.

It is important to keep in mind, however, that once a patient is eligible for SNF coverage, it does not mean that coverage will continue. If a patient refuses his or her daily skilled treatment or care, they may lose their Medicare SNF coverage.

Federal Law Protects Nursing Home Residents from Bed Sores

February 19, 2013 | Lebowitz & Mzhen

Pressure sores or ulcers, which are commonly referred to as bed sores, are probably among themost common sort of potential new injury incurred by nursing home patients who are incapable of moving about freely. While they can be annoying or painful, they can also become infected and lead to a vast array of additional complications for nursing home residents. Perhaps most importantly, they can be prevented.

It’s for this reason that federal law makers have passed regulations for nursing home facilities which address this problematic complication.

42 CFR § 483.20 entitled “Resident Assessment” requires a comprehensive assessment of the resident. While this blog post focuses on the skin care assessment and bed sore prevention, the facility is required to assess 17 other factors, all related to the patient’s condition upon entering the facility. The facility has 14 days from the person’s arrival to complete this assessment, and it then has 7 days from the completion of the assessment to develop a care plan addressing the patient’s various needs.

42 CFR § 483.25 Quality of Care, explicitly addresses what must be done in regards to bed sores specifically. It states that based upon the comprehensive assessment, the facility must ensure that:

A resident who enters the facility without bed sores does not develop them (unless the person’s individual medical condition makes them unavoidable); and
A resident who does have bed sores must receive proper treatment and/or services to promote the healing process, prevent infections from developing, and prevent new sores from happening.

Nursing Home Closes Amid Allegations of Abuse, Neglect, and Other Deficiencies

February 12, 2013 | Lebowitz & Mzhen

A Toledo, Ohio nursing home closed in January 2013 after losing its Medicare and Medicaid provider status, receiving notice of federal fines approaching $140,000, and facing loss of its state license. Ongoing concerns regarding the quality of care led to multiple investigations by state and federal officials. The alleged, unreported assault of a resident in mid-2012 led to a push by state officials to shut the facility down.

Two state agencies opened investigations of Liberty Nursing Center of Toledo after the alleged sexual assault of a resident. The facility provides elder care and treats patients with severe mental illness. According to the Toledo Blade, nurses found a male patient on top of a female patient in her room on July 26, 2012, in what appeared to be an act of assault. The male patient had a diagnosis of schizoaffective disorder and a history of sexual aggression. The facility allegedly transferred the male patient to a hospital after notifying his psychiatrist. After determining that the male patient did not make sexual contact with the female patient, however, an administrator allegedly instructed staff to “clean up” the patient. She did not receive any examination after the alleged assault, and no further action was taken, including notification of law enforcement, health officials, or the woman’s guardian.

The Ohio Department of Health (ODOH) notified Liberty on August 9 that it intended to revoke the facility’s license, which would force it to close. It cited the July incident, along with other allegations of abuse, neglect, and deficiencies in quality of care. Several residents have left the facility without permission or supervision in recent years, according to ODOH.