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

The South Carolina House has passed another "tort reform" measure which is not necessary, most likely unconstitutional, and clearly arbitrary.  The Sun News had an article and it is very interesting what critics and proponents said.  The bill will place an arbitrary cap on how much a jury could award against reckless or intentional conduct.  The measure limits the amount juries could award to deter or punish a business for gross negligence. Punitive damages could be $350,000 or three times compensatory damages, whichever is greater.  The purpose of punitive damages is to deter or punish.

Opponents said multi-million-dollar lawsuit awards are extremely rare in South Carolina.  The executive director of the South Carolina trial lawyers' association said a review of verdicts from courts in the state's three largest counties - Richland, Charleston and Greenville - shows how extraordinary it is for a jury to award punitive amounts at all in this state. Of the 136 personal injury verdicts in those counties in 2007 and 2008, juries awarded punitive damages in seven of them, and only two of those involved more than $7,000, said Mike Hemlepp, executive director of South Carolina Association for Justice. He noted an amount seen as unfair could be decreased either by the trial judge or an appeal.

"Is there any evidence they're saying, 'We're not coming because of tort law?'" asked Rep. Bakari Sellers, D-Denmark. "Tort reform is something people want until it's their family member or friend who gets injured."

House Judiciary Chairman Jim Harrison, R-Columbia, acknowledged those numbers don't indicate a problem.

Rep. Doug Jennings, D-Bennettsville, argued punitive awards are meant to discourage companies and people from blatantly disregarding how their actions may injure others, but the limits mean they won't be discouraged from changing their ways.

Hemlepp said the measure is designed to squash cases from going to court. Civil lawsuits often involve clients who can't pay lawyer fees upfront, which means lawyers won't take frivolous cases. But since lawyers often get paid by taking one-third to 40 percent of the award, capping punitive damages means fewer cases will be taken.

The vote comes five years after the Legislature capped pain-and-suffering awards for medical malpractice lawsuits at $350,000.  Todd Atwater, CEO of the South Carolina Medical Association, said the rates of medical malpractice insurance are going down, as are the number of claims.

 

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PRWeb summarized a story from the NY Post about punitive damages against a nursing home in New York.   The New York Post reported that in December 2009, a Brooklyn nursing home was found guilty of negligence in the case of a patient who developed numerous and avoidable bedsores while under the home’s care. The jury awarded the patient’s family close to $4 million for pain and suffering, plus an additional $15 million as punishment for trying to cover up the poor patient care.

Elder abuse is prevalent in nursing homes around the country, and with serious consequences for patients. Older adults who are victims of elder abuse are more than twice as likely to die prematurely as are adults who are treated properly, according to a study published in the August 5, 2009 issue of the Journal of the American Medical Association.

Mistreatment can take many different forms, including physical, emotional, psychological or sexual abuse; neglect; withholding food and water; or denying visits from family and friends.  Family members and friends of nursing home residents must be vigilant in looking for signs of possible abuse or neglect.  These can include personality changes, depression, anxiety, unexplained or unusual bruises and injuries, rapid weight loss, poor grooming, and potentially unsafe conditions.
The National Center on Elder Abuse defines institutional elder abuse as “any of several forms of maltreatment of an older person by someone who has a special relationship with the elder (a spouse, a sibling, a child, a friend, or a caregiver)” that occur in residential facilities for older persons, including nursing homes. Its website, www.ncea.aoa.gov, explains that “perpetrators of institutional abuse usually are persons who have a legal or contractual obligation to provide elder victims with care and protection (e.g., paid caregivers, staff, professionals).

Looking exclusively at falls, the Centers for Disease Control and Prevention noted that an average nursing home with 100 beds reports 100 to 200 falls each year, representing up to 75 percent of residents. Many falls were caused by environmental hazards like wet floors, poor lighting, incorrect bed height and improper wheelchair use.

A November 2009 report from the University of California, San Francisco, stated that 26 percent of the nation’s nursing facilities were cited in 2008 for poor quality of care, 44 percent of nursing homes failed to ensure a safe environment for residents, 36 percent had food sanitation regulations violations and 33 percent of facilities received deficiencies for failure to meet quality standards.

 

 

 

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Fox News ran a NY Post article on the verdict against a Brooklyn nursing home.  Brooklyn Queens Nursing Home will have to compensate the family of a 76-year-old patient neglected so badly that he left with more than 20 bedsores. The verdict of nearly $19 million, handed down by a jury, is the first in the state against a nursing home that includes punitive damages.

"It was horrible," said Margaret Whitehurst, who pulled her father, John Danzy, from the home after just nine months. "He walked in on two legs and a cane. He was 237 pounds. When we got him back, he was 148 pounds and he had holes all over his body."  She and her siblings moved Danzy, a retired truck driver and butcher, to another nursing home. He died as a result to an infection caused by the bedsores.

A Brooklyn jury deliberated two full days following the four-week trial before finding the Cypress Hills facility delivered substandard care.  The panel awarded $3.75 million for Danzy's pain and suffering, but tacked on $15 million in punitive damages, based in part  that the home had doctored records to try to cover up the neglect.

An FBI expert testified that about 100 different skin-check notes showing "G" for "good" had been penned over to show "B" for "broken" — an effort by the home to claim it hadn't missed the horrific sores.  "Someone went back and wrote B's over the G's to cover their tracks, so they falsified the records, he said. "We believe that once they found out they were being sued, they went back and said, 'How could we have G's here when they guy has 20 sores?' "

The nursing home restrained the Alzheimer's-stricken Danzy to keep him from wandering off, but left him alone for long periods.  Medical standards require that bedridden or restrained patients be moved every two hours to prevent such sores, but that Brooklyn-Queens only moved Danzy every four hours — if at all.

 

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Alex Nussbaum of Bloomberg had a great article about health care spending and the lack of need for tort reform. Some highlights from the article are below:

Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, said Amitabh Chandra, a Harvard University economist. Chandra estimated the cost at $12 per person in the U.S., or about $3.6 billion, in a 2005 study. Insurer WellPoint Inc. said last month that liability wasn’t driving premiums.

“Medical malpractice dollars are a red herring,” Chandra said in a telephone interview. “No serious economist thinks that saving money in med mal is the way to improve productivity in the system. There’s so many other sources of inefficiency.”

About 10 percent of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing due to defensive medicine, according to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers’ group America’s Health Insurance Plans.  The figures were taken from a March 2003 study by the U.S. Department of Health and Human Services that estimated the direct cost of medical malpractice was 2 percent of the nation’s health-care spending and said "defensive" medical practices accounted for 5 percent to 9 percent of the overall expense.

A 2004 report by the Congressional Budget Office also pegged medical malpractice costs at 2 percent of U.S. health spending and “even significant reductions” would do little to reduce the growth of health-care expenses.

The proportion of medical malpractice verdicts among the top jury awards in the U.S. has declined during the past 20 years, according to data compiled by Bloomberg. Of the top 25 awards so far this year, only one was a malpractice case. At least 30 states cap damages in medical suits, primarily for “pain and suffering” awards.

The development of new drugs and medical procedures, and their growth in price, has been a bigger factor in costs, said Chandra, citing his research and that of other economists. Studies haven’t found a link between increasing procedures, such as Caesarian-section births, and areas with rising malpractice damages, he said.

Medical malpractice is “not a major driver” of spending trends in recent years, Indianapolis-based WellPoint, the largest U.S. insurer by enrollment, said in May 27 report. The report cited advances in medical technology, increasing regulation and rising obesity as more significant reasons for rising costs.

The U.S. Institute of Medicine found a decade ago that medical errors kill 98,000 Americans a year, said Les Weisbrod, president of the lawyers’ association. “By taking away the rights of people to hold wrongdoers accountable, the quality of health care will suffer tremendously,” he said.

 

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The Tennessean reported on Murfreesboro-based National Healthcare Corp's CEO defending the ridiculous legislation to impose limitations on the amount of damages a victim of neglect, abuse, or negligence can be compensated for their injuries and pain and suffering.

Critics have labeled the bill the "Kill Old People Cheap Act."

"If we could lower our liability expense, we could put more into staffing," NHC President Steve Flatt said.  However, in all the states with caps on damages, the staffing remained the same!  These nursing homes have insurance and staffing is not affected by potential liability.  If they staffed properly to begin with then there would be less victims of neglect and negligence.  Flatt said his company saw a 20 percent loss in profits, going from $45 million in 2007 to $36 million in 2008. Opponents of the bill contend the nursing home industry spent between $700,000 to $850,000 to lobby for last year's version of the legislation.

 Daniel Clayton, a Nashville attorney and president of the Tennessee Association for Justice, says while the legislation falls short.   "There's not one word in their legislation that requires the nursing homes to improve the quality of care," he said. "We're (ranked) 47th in the country in quality of care of nursing homes by the federal government." "Quality of care comes first," said Clayton. "The legislation that they are proposing is to make good care optional. Good care should not be optional. It should be mandatory.

Opponents see the legislation as a way to enhance profits by the industry.

"This bill is all about the nursing-home industry trying to avoid full responsibility when it neglects or abuses a vulnerable resident. Caps don't improve care. If care improves, lawsuits go down."

NAACP Tennessee President Gloria Sweet-Love says the legislation comes at a time when state and federal reports have uncovered severe staffing and quality of care deficiencies. The CMS report uncovered that 49 percent of Tennessee Nursing Homes scored the poorest possible rating for staffing levels.

A report from the Government Accountability Office uncovered that Tennessee was one of nine states nationwide where health inspectors missed more that 25 percent of serious health and safety violations.  And a report recently released by AARP reconfirmed the poor state of Tennessee Nursing homes and found that tort restrictions have little impact on improving the quality of care in nursing homes.

The legislation would place arbitrary caps on non-economic and punitive damages in addition to making every negligent act that occurs in a nursing home protected under the Medical Malpractice Act.   "The nursing home industry's effort to conceal its true intentions is despicable and should be rejected by anyone who has ever had a loved one in a nursing home," Sweet-Love said.

"We need laws to protect our nursing home residents, not ones designed to protect the profits of greedy nursing home operators."

"If the nursing home industry would spend its money on more nursing staff, rather than on high-priced insiders, the quality of care in nursing homes would improve," Sweet-Love, the NAACP official, states in the news release. "The industry chooses to spend their resources on backroom conversations aimed at passing a law that immunizes the industry from negligent and abusive acts against helpless residents."

 

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Mark N. Geller is a Memphis attorney with Nahon, Saharovich & Trotz PLC. He leads the firm's nursing home practice group. He wrote the following column which can be found here:

The federal government's Medicare program recently released a rating system that ranks the quality of care for residents in nursing homes. Among our nation's 50 states, Tennessee ranked third from the bottom in its percentage of nursing homes that received the report's highest five-star rating -- ahead of only Louisiana and Georgia.

According to this rating system, Tennessee also had the fourth-highest percentage of poor-performing nursing homes in the nation (those that received the lowest possible rating of one star), behind Louisiana, Georgia and Virginia.

On the surface, these results are bad enough for Tennessee's elderly population and their families. Unfortunately, though, the Medicare Nursing Home Compare report fails to capture the true extent of how poorly our fellow Tennesseans who live in nursing homes are being cared for right now.

In fairness to the nursing home community, four nursing homes within 50 miles of Memphis were given the highest ranking by Medicare's report, and they stand out among the best in the country. (To view the full report, go to medicare.gov.)

As an attorney who practices in the area of nursing home litigation, I witness almost daily the substandard level of care many elderly Tennesseans must endure. I have seen the wide range of poor nursing home care across this state; poor care that sometimes includes leaving people in their own excrement for long periods of time, which results in bed sores and even death. There are cases -- and they're not uncommon -- in which elderly nursing home residents have been left begging for food and water, but have been ignored. Or cases -- including one recently in Memphis -- where elderly residents have wandered out of their nursing facility unsupervised and were severely injured.

Even this bare recitation of facts pales next to actually hearing a family's story. Family members have spoken about how they begged and pleaded for care that never came. They have talked about the heartrending suffering their loved ones go through in their last days of life.

Despite these stories and the objective data ranking Tennessee among the worst in the nation for nursing home care, Tennessee legislators recently sponsored bills (HB2243 and SB2160) to reform lawsuits against the nursing home industry by putting a monetary value on human life.

The bills set the price of a human life at $300,000. If they become law, that would be the maximum amount of noneconomic damages that could be awarded to plaintiffs in lawsuits against a nursing home. In addition, if a jury concludes that the nursing home's actions were so wrong that they warrant the award of punitive damages, that amount would be limited as well, by a formula that uses calculations provided by the nursing home itself relating to its level of patient care.

These proposals, which are under review in legislative committees, are bad bills that are primarily focused on limiting the compensation that a family can recover if a jury finds that a nursing home acted improperly. They would protect nursing homes from liability. Nothing in them would protect nursing home residents.

There is no serious measure within these bills that sets out minimum standards for proper care of nursing home residents. The proposals fail to provide measures to protect the residents from negligent or improper care. They have no provisions to require nursing homes to maintain proper staffing levels or even treat their residents well.

Tennessee's low ranking in the nursing home industry is easy to understand. Typically, nursing homes are operated by multibillion-dollar, multistate corporations whose main purpose is to make as much money as possible for their shareholders. Of course, there's nothing wrong with making money. What is wrong is that many nursing home chains too often cut operational costs to increase profits. Such cuts are unconscionable when they are done at the expense of their stated business goals: the comfort and well-being of the elderly.

When a nursing home's budget is cut, the nursing home must function with less supplies, equipment and staff. Less staff means fewer people to provide care to the residents. Eventually, it reaches a point at which the staff, no matter how caring or qualified they may be, are simply unable to meet the needs of the residents.

Life is precious and should be treasured. Every human being deserves to be treated with dignity and respect.

Making money is perfectly acceptable so long as you are doing your job first. Here, the primary job should be to provide skilled and humane care to the residents of Tennessee's nursing homes and to make sure their needs are being met.

The state should legislate serious standards of care for nursing homes. And nursing home operators should be held accountable if they fail to live up to those standards.
 

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MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal.

Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA. More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia.

A Texas doctor has been ordered to pay $7.5 million to a former maintenance man who lost his arms and legs to an MRSA infection.  Judge Jim Jordan ordered Dr. Meenakshi S. Prabhakar to pay David Fitzgerald after a Dallas County jury found in Fitzgerald's favor in his medical malpractice lawsuit.  Prabhakar treated Fitzgerald in 2003 when he developed an infection following surgery.

The jury wanted to compensate Fitzgerald for injuries in the amount of $17.5 million, but because of arbitrary and unconstitutional caps on medical malpractice cases he cannot collect about $10 million the jury awarded for pain, mental anguish and physical impairment.

Linda Turley, Fitzgerald's attorney, called the caps a "tragic unfairness" to Fitzgerald, who "can't bathe by himself, can't get out of the house by himself and will need assistance for the rest of his life,"  Fitzgerald, 53, now must live with his brother in East Texas.

One of the insurance company's defense lawyers for Prabhakar, admitted Fitzgerald was treated with antibiotics but not the one that treats MRSA, which is a type of hospital-acquired infection that can be deadly if not treated quickly.

 

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The American jury is at the heart of the justice system.  The right to a jury trial is a constitutional right.  But the GOP in Tennesse want to limit the amount a jury may award in cases involving the abuse and neglect of America's most vulnerable citizens.  Arbitrary caps on damages do not work.  If they want to prevent lawsuits, they should require better care including increasing staffing and training.  Advocates for the elderly told a special committee studying the effects of litigation on the nursing home industry that better care would prevent lawsuits.

The main discussion at the committe meeting was on whether caps should be placed on damages in lawsuits against nursing homes. Senate Speaker Ron Ramsey has made malpractice caps for nursing homes part of his legislative agenda for the year. The Republican said limiting damages is necessary because he believes the industry is being targeted by lawyers.

But Daniel Clayton, president of the Tennessee Association of Justice, told the committee that the focus should be on improvement of care rather than capping damages. "If care is good, lawsuits will go down," Clayton said. "If care is bad, lawsuits will go up." Last month, the Centers for Medicare and Medicaid Services released a report that ranked Tennessee's nursing homes worst in the nation and gave 30 percent of them the worst rating possible.  Why would you provide immunity to an industry that is hurting your voters and constituents?

The ratings are based on state inspections, staffing levels and quality measures, such as the percentage of residents with pressure sores, urinary tract infections and declining mobility. Each nursing home was given an overall score of one to five stars, with five stars being the best. The ratings are based on as much as three years of data, ending in November 2008.

Only Louisiana and Georgia ranked lower than Tennessee in the report, which evaluated 16,000 nursing homes nationwide.

Patrick Willard, AARP Tennessee's advocacy director, said his group is studying litigation of nursing homes and preliminary results show the state ranks below the national level when it comes to staffing at nursing homes. "If your staffing level is below the national level, you're more than likely to be sued," he said.

Committee member Charles Curtiss agreed. The Sparta Democrat said his mother has been in two nursing homes, and he noticed their staffing was not up to standard. "I'm not for saying we're going to cap liability, and then let the service be exactly as it is today," Curtiss said. "If they're going to give the operators a break, then certainly we've got to get something for those people who are in the nursing homes, and that would have to be better care."

Rep. Henry Fincher said he's against capping damages, and shows his disdain for the idea in calling it "the kill old people act." "I don't think that limiting liability is the way to make sure that people are treated better," said the Cookeville Democrat.

"If you take away people's chance to recover damages for wrong things done to them, you're protecting the wrongdoer. It turns the whole idea of responsibility on its head."

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The Atlanta Journal constitution wrote a story about a Georgia Judge finding tort reform caps to be unconstitutional.  The cap on monetary awards in a medical malpractice case was found to be unconstitutional.

Superior Court Judge Marvin Arrington wrote in an order that the legislative cap of $350,000 for noneconomic damages such as pain and suffering was unconstitutional because it gave special protections to the medical profession. This meant people injured by doctors had less protection than those injured by others.

"It is absurd to say that if you get injured by a product that the jury can decide your noneconomic damages, but if you get injured by medical malpractice, it can't," said Trent Speckhals, one of the lawyers for Cheon Park, the plaintiff in the case.

The legislature approved the $350,000 cap in 2005 as part of a civil-justice tort reform law over the opposition of the Georgia Trial Lawyers Association and consumer groups.   In 2006, the Georgia Supreme Court stuck down another provision of tort reform when it ruled that defendants couldn't decide in which county their medical-malpractice case was tried.

In his written opinion, Arrington complained that limiting the caps meant that in many cases, large jury awards would be issued only to wealthy people who could point to the loss of large incomes.

"The statute effectively puts substantial limitations on the rights of the poor and middle class to recovery while leaving the right to virtually unlimited recoveries unimpeded for the wealthy," Arrington said. "The disabled manager of a hedge fund, a corporate CEO, an entertainer or such other person whose income is in the tens of millions of dollars has a claim under Georgia law that would dwarf the amount awarded in any case for pain and suffering."

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Here is an interesting article about a pro tort reform doctor who has had a change of heart after experiencing first hand the law of unintended consequences as a result of tort reform.  Here is an excerpt from that article.

Dave Stewart's mother went to the hospital for surgery in April. Four days later, she was dead.
To Stewart, an anesthesiologist, it seemed a classic case of medical malpractice. After the operation, his mother developed sharp abdominal pain that she described as "10 on a scale of 1 to 10," according to her medical records.

The hospital failed to diagnose the cause of her pain and continued to treat her with narcotics. Her vital signs became unstable and she was moved to the intensive care unit, but she died of complications from an untreated bowel obstruction. Stewart and his two sisters wanted to sue, and they approached two dozen lawyers. One after another declined to take the case, always for the same reason: It wasn't worth the money.

In 1975, California enacted legislation capping malpractice payments after an outcry from doctors and insurers that oversized awards and skyrocketing insurance rates were driving physicians out of the state. The law limited the amount of money for "pain and suffering" -- usually the physical and emotional stress caused from an injury -- to $250,000.  Proponents say it discourages "frivolous" lawsuits.   The cap on pain and suffering has never been raised nor tied to inflation.

Yet a Times analysis of state court records, physician payment data and insurer financial records suggests that the cap is increasingly preventing families such as the Stewarts from getting their day in court.

Some malpractice victims and their families say the benefits of the law have swung too far in favor of doctors. Without accountability, some ask, what will keep physicians from making careless mistakes?

On average, California juries (which are rarely informed of the cap during trials) awarded $800,000 in malpractice death cases from 1995 to 1999, but the amounts were later reduced to $250,000 under the law. This suggests that medical malpractice victims and their families could be reaping much larger payouts than the law allows.

Recent malpractice premium increases may have had more to do with insurers' business models and financial investments -- including documented losses in their investment portfolios in recent years -- than with their core businesses.

Stewart, of San Diego, said he had long been a MICRA advocate, believing it was in the best interest of doctors and patients. Not anymore.

After he and his family got over the initial shock of losing their mother, they wanted justice. Most attorneys turned them down over the phone, although three agreed to meet in person. Last summer, the entire family and their 80-year-old father made the trip to San Francisco and Oakland for meetings.

One lawyer said he would take the case only if the family paid the expected $50,000 in trial costs upfront.

San Francisco lawyer Brad Corsiglia at first seemed interested but later sent a letter dated July 11, 2007, that read: "As you can understand, with a cap of $250,000, we are limited in the type of case we can take on a contingency fee basis to only those cases that involve catastrophic economic losses."

"In 1975 you could buy a house for that money, and today what does it get you?" asked Stewart, whose parents would have celebrated their 54th anniversary last month. "Every year MICRA stays the same is another year that people who have been wronged will be denied the same justice."

Some state courts have struck down malpractice caps that didn't rise over time. Last month, an Illinois circuit court judge ruled unconstitutional a 2005 state law that caps noneconomic damages in medical liability cases.

In 2006, a Louisiana appeals court ruled that its state malpractice cap, established in 1975, did not adequately compensate patients and needed to be raised to $1.6 million. The ruling was overturned this year by the state's Supreme Court.

Some families who succeed at trial in California are often surprised at how little money they see in the end.

Becky Dessenberger's 2-year-old son, Jacob, died at Children's Hospital in Oakland in 2004 after surgery to repair a foot. Her son, who was suffering from bronchitis, was given a high dose of pain medication though the drug is known to cause slower breathing. He died the next day.

In 2006 the family settled with the hospital, which acknowledged no wrongdoing, for just under the $250,000 cap. After deducting for trial costs and lawyer fees, Dessenberger, 36, of Suisun City, said the family received "a little over" $100,000.

Dessenberger said no money would help ease her grief, but the small amount felt to her and her family like a slap in the face.

"Because he was a baby, this is all he was worth," she said. "I think it is horrible. I don't think it's fair."

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