South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Orange County Register reported the jury verdcit in conservative Orange County of $3.1 million to Barbara Lefforge who suffered a brain-damaging morphine overdose at St. Edna skilled nursing home.   Lefforge went to St. Edna on Sept. 17, 2007, to recuperate from tendon repair surgery.  Her doctor, Kobayashi, mistakenly recommended 50 mg of morphine for pain instead of 50 mg of Demerol.  The mistake clearly should have been caught by staff at St. Edna's. The pharmacist warned that the dosage was too high.  But nurses at the facility, unable to immediately retrieve the full dose, obtained 30 mg from an office emergency kit and gave it to Lefforge.  The woman suffered an overdose but was not monitored or taken to the hospital until the next morning, causing brain injury.

St. Edna Subacute & Rehabilitation Center is one of 25 homes in California owned by Covenant Care.  After two days of deliberation, the jury found that St. Edna was 90 percent responsible for the damages and Kobayashi was 10 percent responsible. Jurors awarded Lefforge $2 million for pain and suffering and $1.1 million in medical costs, Wacker said.  The unanimous jury also awarded punitive damages -- which will be set on Tuesday --who was barely at the hospital 5 1/2 hours when the overdose occurred.

Covenant Care facilities are among hundreds of California skilled nursing centers that received $880 million in additional compensation from the state since 2004 to increase staffing and wages at homes that serve Medi-Cal patients. An analysis by the non-profit newsroom California Watch found 232 of those homes statewide slashed staff and let nursing ratios fall below the state minimum.  St. Edna and 12 other homes in the Aliso Viejo-based Covenant Care chain stood out: they accepted $15 million in additional compensation from the state -- but still cut caregivers.

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The Toldeo Blade reported a significant verdict in a recent nursing home trial in Michigan.  The family of Burr Needham,  who died in 2002 of a morphine overdose while undergoing physical therapy at Mercy Memorial Nursing Center, has been compensated $4.85 million by a jury aftera three-week trial with the jury finding that a doctor and nurses were negligent.

Mr. Needham's family filed a civil lawsuit in 2005 against the home, contending that Dr. Arun Gupta and five nurses were responsible for the overdose of the painkiller administered to Mr. Needham after he entered the center April 26, 2002. 

The Wayne County medical examiner said the May 2, 2002, death of Mr. Needham was caused by acute morphine intoxication and ruled his death a homicide. The jury determined that nursing home staff were professionally negligent in the care and treatment of the 76-year-old man.

Court records showed that the jury awarded $3 million of the judgement to Mrs. Needham for the noneconomic loss of society and companionship she experienced in the loss of her husband. 
The panel decided that Mr. Needham should get $1.5 million for the pain and suffering he experienced in the nursing home. The remaining $350,000 was awarded to the family to pay for damages that Mrs. Needham incurred, including burial costs and the loss of gifts and valuables she would have received until her death on Oct. 24, 2007.

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WLWT out of Indiana had an article about nursing home employees named Gale Willman and Jody Holton accused of taking prescription pills from their patients and selling them.  Police investigators said Gale Willman, a licensed practical nurse, and Jody Holton, the assistant director of nursing at Woodland Hills Care Center, worked together to steal hydrocodone and oxycodone.  Willman and Holton have both been released on bond and have already found other nursing jobs.

A similar situation occurred at Woodland Hills previously, with nurse Heather White sentenced to a year in jail for stealing ocycodone from a patient.  Prosecutors said 87-year-old Anna Jordan slipped into coma and later died after White stole her pain medication.  The pain and torment included profuse sweating, excruciating headaches and having to be held down as she tried to jump off her bed, all because of withdrawal from oxycodone. White served only six months of her sentence.

The family members are shocked at the latest incident.

"I'm disgusted by it. It makes me question how many more people must be seriously injured or die before something is done at this facility," Jordan said.

Albright and Jordan said they believe monitoring at nursing homes should be stricter and random drug testing should be used. They said there should be investigations if someone suspects prescription drugs are being stolen or misused..

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The News & observer had an article about the tragic death of nursing home resident Rachel Holliday.  Angela Almore was arrested and accused of murdering Holliday after an investigation found that Almore gave Holliday morphine that was not prescribed or needed. The indictments allege that Almore intentionally caused each to "ingest morphine that proximately caused serious bodily injury."  Almore has been a registered nurse for four years, and was responsible for taking care of  84-year-old Alzheimer's patient holliday at Britthaven of Chapel Hill.

A medical examiner reported that Holliday died of pneumonia from asphyxiation, and that the levels of morphine in her system likely contributed to her death.  The report listed "morphine toxicity" as a contributing factor to her death, noting that tests done at UNC Hospitals before her death determined she had a morphine level of more than 50,000 nanograms per milliliter of urine.

Almore was also charged with six counts of felony patient abuse related to other Britthaven patients who were hospitalized after they became lethargic. Tests indicated they had been given morphine, even though none had been prescribed the powerful pain medication. All but Holliday survived.

Nursing homes that receive Medicare and Medicaid funding must follow specific regulations about how medications are bought, stored, ordered and distributed. If the nursing home's oversight was lacking, it must correct the problems and could face fines and be held liable for the death of holliday.

See other article about these incidents here and here.

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WAAYTV.com reported that Investigators arrested a licensed practical nurse on charges that include stealing narcotics intended for patients at Holston Manor Nursing Home. A Tennessee Bureau of Investigation statement says its Medicaid fraud unit and Scott County, Va., investigators arrested 33-year-old Summer Brook Lane.

Lane is charged with one count of abuse, neglect or exploitation of a dependent adult, obtaining a controlled substance by fraud, deceit or theft and theft of property under $500.

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The News observer had an article on the investigation into the death of a nursing home resident at Britthaven of Chapel Hill.   Rachel Holliday died in February from toxic levels of morphine in her body.   A medical examiner's report said Holliday had not been prescribed any opiate painkillers.  The State Bureau of Investigation is looking into her death after several residents tested positive for opiates following her death.

UNC Hospitals caregivers found more than 50,000 nanograms of morphine per milliliter in Holliday's urine. More than 2,000 nanograms would trigger a positive result in employment screenings, based on federal guidelines.

The nursing home has had regulatory issues in the past few years and had been labeled a "special focus facility" for its substandard care. During inspections in 2008 and 2009, the nursing home was found to have put some residents in jeopardy by failing to protect them from abuse.

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The Concord Monitor had an article about the U.S. Drug Enforcement Administration's recent enforcement against the practice of nurses taking doctors' orders orally to order patients' narcotics and anti-psychotics by phone. Pharmacies are required to have written authorization from a doctor before filling prescriptions for narcotics such as Percocet, OxyContin and Vicodin.

The move is aimed at protecting nursing home residents by preventing nursing home staff from diverting or dispensing the powerful painkillers without doctor authorization.  Of course, the nursing home industry does not want to pay doctors so they are whining about the DEA's enforcement.

Few nursing homes have pharmacies on site or doctors on staff.   However, federal regulations and professional standards mandate licensed staff to treat residents' pain immediately.

 See NY Times article on this issue here.

The DEA changed the standard to make it easier for nursing homes to give narcotics to residents by allowing nurses to dispense controlled painkillers to nursing home patients if the patient's doctor electronically transmits a prescription to a pharmacist.   See article from Wisconsin Rapid Tribune.

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USA Today had an interesting and controversial article on two new studies that show the bones of some post-menopausal women who take bisphosphonates (Actonel, Boniva, Fosamax, Reclast) to ward off osteoporosis can stop rejuvenating and become brittle after prolonged use.   Bisphosphonates are among the top-selling drugs in the USA,with annual sales exceeding $3.5 billion.

Osteoporosis is a health risk for the aging population. An estimated 10 million Americans have the disease and almost 34 million have low bone mass, putting them at risk for spine and hip fractures.   Studying bone biopsies in women who suffered femur fractures, lead researcher Dr. Joseph Lane found the quality of the bone diminished after long-term bisphosphonate use.

Dr. Rosenwasser's research notes that bone densitometry (DXA) scans show a buckling potential in the femur area of the hip in patients being treated for osteoporosis with bisphosphonates. His studies note the decline after four years of use or more. "It can be thought of as a brittleness," Rosenwasser says. "Think of it as not a lack of quantity of bone mineral but of quality of organization."

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KSAX.com had an article written for the web by Megan Matthews on the tragic and preventable death of a nursing home resident at Fair Oaks Lodge after an employee accidentally gave her the wrong medication, according to a Minnesota Department of Health investigation.  An employee accidentally gave the Alzheimer patient another patient's medicine on June 1, 2009. The mistake caused a drop in blood pressure, and the woman was taken to the hospital where she died six days later in intensive care.

CEO Joel Beiswenger did not accept responsibility but said  "It was just one of those things that happened. Nobody intended to do anything, and it was the human making the tragic error," Beiswenger said.

But the same medicine mistake has happened before; twice to two other patients, which means the nursing home made three significant medication errors from May 27 to June 12, 2009.

The other two patients survived, but the state held Fair Oaks Lodge responsible for neglect, and the nursing home had to improve their procedures and be audited.

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The Star-Tribune had an article about serious medication mistakes three times within 16 days at Fair Oaks Lodge nursing home, sending three residents to the hospital and causing the death of one of them. The "significant medication errors" at Fair  Oaks Lodge in Wadena indicated a systems failure at the facility, prompting state Health Department investigators to place blame for
the mistakes with the home. In addition, state investigators who visited the facility 2 1/2 months after the death observed a medication error rate of 18 percent during one evening's staff rounds.

In 2008, state records show, there were 253 allegations of medication errors, up from 199 a year
earlier. Homes themselves report the vast majority of medication errors so the underreporting affects the numbers.

Fair Oaks Lodge is owned and operated by Tri-County Hospital in Wadena. Tri-County is
a private, not-for-profit health care organization that employs nearly 350 people. Joel Beiswenger, CEO of Tri-County Health Care, said the organization is considering an appeal, but added that in communications with relatives of the resident who died, "we acknowledged that an error occurred."

According to the report, the resident who died, an 82-year-old Alzheimer's patient, was mistakenly given three medications on June 1. Her blood pressure quickly dropped and "her pupils were fixed and nonresponsive." She was taken by ambulance to an emergency room, then admitted to an
intensive care unit. Three days later, she was taken off life support and died.

The state report also found:

• The first improperly medicated patient was given his scheduled dose of Tylenol at 3:45 p.m. on May 27 and then another 500 milligrams only two hours and five minutes later. Along with the second dose of Tylenol, he was given a medication to treat hypertension.

Within minutes, the resident "became unresponsive for approximately two to three minutes," the report said. An aide said he gave the resident his medication early because the man "liked to go to bed early."  The aide told investigators that was standard practice in that unit at the time.

• In the case of the woman who died, a trained medication aide mistakenly gave her drugs for the central nervous system, the heart and an antipsychotic medication.

• In the third instance, on June 12, a trained medication aide set up the drugs, but a nurse then gave them to the wrong resident. The resident spent four to six hours in the emergency room.

 

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