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

Milwaukee-Wisconsin Journal Sentinel had an article about the horrible care and fraudulent documentation at Mount Carmel Health and Rehabilitation including 35 violations of regulations for minimum care.  "Records also show, however, that the 35 citations issued so far this year to Mount Carmel are close to the 40 citations issued in all of 2009 and more than the 25 issued in 2008, according to the state Department of Health Services."

Staff at the state's largest nursing home recorded on charts that a 41-year-old brain-damaged resident was in his bed watching TV when he was sitting in jail. The man spent five days in custody,  Staff had continued to mark on charts that he was at the facility through the night and into the morning of May 17. 

The man wandered away from Mount Carmel and was arrested for "prowling" more than four miles away.  The nursing home was aware that he was a wandering risk and were ordered by phyisicians to check on him every 15 minutes. The other violations cited this year include failing to communicate with a recent amputee and failing to provide for five residents at risk of falling, including one who was hospitalized for a broken jaw after falling out of his wheelchair.

Licensed for 473 beds, Mount Carmel is the largest of the 397 nursing homes in Wisconsin, according to the Department of Health Services. In January 2009, Kindred Health Care, a Louisville, Ky., for-profit company resumed operation of Mount Carmel. After operating with a probationary license for one year, Kindred was given a full license in January of this year.

The citations issued this year include two identifying "actual harm" to residents and five for violations that constitute a "direct threat to health, safety and welfare," state records show.

Other citations
Among other things, Mount Carmel was accused of:

• Failing to provide appropriate supervision and assistive devices to five out of 10 residents identified by Mount Carmel as being at risk for falls.

Three of the five had fallen since last December, including one who suffered a broken jaw and an eye socket "blowout." A hospital that treated the woman reported the incident to the state but Mount Carmel, which was required to report the incident, did not.

• Failing to assess and treat pain, depression and other problems experienced by a 51-year-old woman.

• Sixteen of 32 residents reviewed were not treated "in a manner that maintained their dignity."

Two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; and an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

The September inspection also found that after a resident complained of hip pain, Mount Carmel did not notify a physician for two hours and 15 minutes. The doctor ordered an X-ray, but the order was not relayed by a nurse for 2 1/2 hours. The X-ray revealed a broken hip.

The article had a Summary of violations Mount Carmel Health and Rehabilitation Center in Greenfield was cited for 35 state and federal violations so far this year. Among them:

March 2010: A 51-year-old resident who had her right leg amputated below the knee in December 2009 did not have staples removed as of March and no adequate assessment or treatment of the resident's "phantom pain" in the leg had been done.

Mount Carmel also was cited for failing to communicate with the resident, who did not speak English, in Spanish. Among other things, staff was not aware that the resident experienced phantom pain and that she had been dropped by staff. A registered nurse told an investigator she didn't need a Spanish interpreter because relied on documents and the resident's gestures and facial expressions.

Also in March, an investigator found that 16 of 32 residents reviewed were not treated "in a manner that maintained their dignity." Two had been transported in shower chairs with bare legs or buttocks exposed; two were kept in a small alcove near an exit; at least six were kept in an old nursing station or in a hallway for extended periods; an incontinent resident said staff turned off his call light four times after he sounded it and had a bowel movement before any staff took him to the toilet.

January 2010: A federal investigator finds that, going back to December, five out of 10 residents identified by Mount Carmel as being at risk for falls did not receive appropriate supervision and assistive devices, and that three of them fell. A 92-year-old resident who needed supervision was dropped off at a medical appointment by herself. .

Dec. 3, 2009: A resident who lacks the ability to move in bed, is found on the floor next to her bed. She suffers a broken jaw and an eye socket "blowout," according to a federal investigator. The hospital reported the injuries to the state Office of Caregiver Quality, but Mount Carmel, which is required to make a report, did not. When the investigator asked a Mount Carmel administrator on Jan. 11, five weeks after the incident, whether Mount Carmel had reported the incident to the state, the administrator said no report had been made because Mount Carmel "felt they knew how the incident occurred."

Nov. 5, 2009: Resident suffers laceration to left palm requiring sutures in a hospital emergency room. Hospital reports the injury to the state, but Mount Carmel did not. Mount Carmel could not determine how the incident occurred.

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A resident's chart is required to be complete, accurate, and legible.  The chart is a legal-medical document that is used to communicate among shifts, to document the resident's condition and to prove the care actually provided.  Often times the charts are false, fraudulent, or simply misleading.  In The Pittsburgh Channel's article, the facility falsely documented and forged a family member's signature for reimbursement.

Team 4 investigative reporter Paul Van Osdol reported that 77-year-old Gene Cable checked into Scottdale Manor last November. Just six days later, he was dead.   Cable's daughter, Rita Wilson, wanted to find out what happened, so she requested his medical records. When she got them, she was shocked. After Cable died, one of the first documents to catch the eye of his daughter was a Medicaid reimbursement form with what appears to be her signature.

"This was a document you were supposed to sign?" Van Osdol asked.

"Yes," Wilson said.

"You never did?" Van Osdol asked.

"No. I swear to God. I didn't sign that," Wilson said.

Wilson said she also saw a nurse's notes showing that her father supposedly went to the bathroom "when he was dead. And he was continent. That means he physically got up and went to the bathroom when he was dead."

Wilson complained to the administrator of Scottdale Manor Rehabilitation Center. She says administrator Brian Bazylak told her they took disciplinary action against the employee who allegedly forged her name and the employee who entered the inaccurate nursing notes.  Did they report them to the Board of Nursing?  Did they even fire them?  Did they audit all the other charts?

Attorney Peter Giglione, who has sued numerous nursing homes, says he is not surprised by what happened to Wilson. "We've had a couple cases tried here in Allegheny County where we've had staff members charting on our client after they're dead," Giglione said.

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The Charelston Gazette had an interesting article about a former employee of Broadmore Estates who has sued the Putnam County assisted-living facility for allegedly overlooking alcohol and substance abuse by its employees, and ignoring state regulations for drug distribution.  Lynn Gomez of Elkview filed the lawsuit in Putnam County Circuit Court on against Broadmore and the facility's director, Delores Miles.  Gomez alleges in her lawsuit that she was ostracized and lost her job because of several complaints she brought to Miles about drug abuse and employee conduct.

Gomez was hired in February as a registered nurse and as director of wellness at Broadmore's assisted-living facility in Hurricane.    When she began working, Broadmore's patient charts and medical records were in disarray, the facility was understaffed and staff members did not follow state regulations for drug distribution.

She also alleges that, within her first few weeks at Broadmore, she was approached by a staff member and a pharmaceutical representative about a nurse who consistently came to work drunk or with alcohol on her breath.  Gomez alleges that the nurse approached her and stated "Lortabs do nothing for her and that she had already had four Percocet that day."

Gomez states that she approached Miles about the woman's statement and was told the nurse "had been on drugs for a long period of time, and could practice while on the medications." She also was told the nurse had been off work for a medical condition, the lawsuit states.

Gomez alleges that the nurse falsified patient charts, saying she had administered drugs that she actually had not, and that Miles falsified documents to reflect that the drugs had been properly administered and were accounted for.

The nurse eventually was fired after an outside pharmaceutical representative discovered that the nurse had falsified drug distribution records, the lawsuit states.

Gomez wants back pay, compensation for emotional and mental stress and attorney's fees.
 

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PressConnects.com had a great article affirming the need for litigation; the article explains how a lawsuit initiated a change in policy and quality of care at several nursing homes.  The change was a result of the Rockfrod Incident.

Ortiz, bed-ridden from dementia, was a patient at a Rochester nursing home. His son, Felix Ortiz, suspected that his father was being neglected.

"I would walk into the nursing home and some of the workers were just sitting around, looking at their Avon books and not going into patients' rooms," Felix Ortiz said. "In my dad's room, it smelled like feces and urine. When you've been around your loved one all your life, you can tell what he's thinking, and I could see in his eyes that something wasn't right. There was a sadness."

In the spring of 2005, Ortiz's family authorized the state Attorney General's Office to install a hidden surveillance camera in his room. It documented that Ortiz wasn't being turned every two hours to prevent pressure sores, wasn't being given proper hydration, and was left lying for hours in his own waste while caregivers made bogus notations on his chart that proper care was being provided.  An investigation showed that supervision at the nursing home was so lax that employees who were supposed to be delivering care in some cases were sleeping, smoking, watching movies and leaving the nursing home for personal reasons while on the clock.

Eventually, 14 employees were convicted of criminal charges for falsely attesting that they had provided care to Ortiz, who died in June 2006. But his case now has a far-reaching effect on other nursing home patients across New York.

Under the settlement of a civil lawsuit brought by the Attorney General's Office against the company that formerly owned the nursing home, nine other nursing homes from Buffalo to the Bronx owned by the same company will install electronic point-of-care devices that require employees to document care as it's delivered, generating a central computer record to verify the care.

Point-of-care technology uses electronic devices to allow health-care facilities to record services, such as the dispensing of medication or the turning of bed-ridden patients, in real time. The information is used to create electronic medical records not only for patients' medical charts, but to help generate billing information for medical insurance. The point-of-care systems "will help insure that documented, consistent, high-quality care is given to each resident and allow us to capture care data in nearly real time and alert supervisors when a step is missed," the company said in a statement.

All nursing homes should be required to install electronic point-of-care devices in every patient's room.  The new system will allow caregivers to record resident information in their rooms instead of having to walk back to their station, thus saving time. The less time they spend with paperwork, the more time caregivers can spend with patients,  Many hospitals and some nursing homes currently use the technology. 

Felix Ortiz said the settlement is a tribute to his father, a retired factory worker and laborer who was known to his family for his physical strength. "He would be proud," he said. "To be part of a whole new revolution, saving lives and helping people -- that's the ultimate right there."

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The Buffalo News had a story about 3 nursing home employees who were only disciplined when the employees did not check on a resident or failed to report him missing for over 11 hours.  The Health Department found that the employees, over an 11-hour period, each noticed that Trent Lockridge was not in his room but did not report it.  The resident either fell, was pushed, or jumped from his second-floor room in Dosberg Manor on the night of Feb. 17, but his body was not found until the next morning.

The Health Department required that the facility discipline the employees involved, put in place new policies for ensuring the whereabouts of all residents and train its employees in the new system.

Health Department investigators visited Dosberg Manor after Lockridge’s death, interviewing staff members and reviewing facility records. Their report found that the first employee had responded to a Feb. 17 call from Lockridge’s roommate requesting help in closing the window. The employee noted that the window was wide open, Lockridge’s glasses were on the nightstand, and his walker was near the window. She neither investigated the fact that he was not in the room nor told anyone about it.  In fact, when first questioned by department investigators, she lied and told them that she had seen Lockridge in his room at 9:40 p.m. She later confessed to a co-worker that this was not the case, the report states.

The second employee, who went into the room at 11 p. m. as part of a daily census of residents, assumed that Lockridge had been hospitalized but did not follow up on this or attempt to confirm it.

The third employee, who was assigned to Lockridge’s floor, stopped by the room at midnight as part of her rounds and also noticed that Lockridge was not in his bed, according to the report. Further, Lockridge’s medical records reflected that staff had helped him take a dose of medicine at 6:30 a. m. Feb. 18, when he was still missing. He was not reported missing until 6:45 a. m., when a nurse said she couldn’t find him. His body had been outside for at least 11 hours in freezing temperatures.

The report concludes that the employees should have notified a supervisor when they saw that Lockridge was missing and that the window was open. It does not name them.  Neither the Weinberg Campus nor the Health Department would say what disciplinary action was taken. Weinberg has agreed to put in place a new system for keeping track of Dosberg Manor residents and to train employees in the new procedures.

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