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

St. Louis Today had an article about a criminal enterprise masquerading as a nursing home.  Luckily they got caught and the company pleaded guilty to fraud and will pay $1.6 million in fines and restitution.

When the Texas-based Cathedral Rock Corp. bought 11 Missouri and Illinois nursing homes in 2001, owner and CEO C. Kent Harrington told employees that residents were the first priority and would get "extra-special treatment."

The real priority was packing elderly and disabled clients into those homes — including five in the St. Louis area that were understaffed and provided substandard care, according to court documents and federal prosecutors.   Until 2005, the services "were grossly inadequate" and represented "a complete failure of care," Assistant U.S. Attorney Dorothy McMurtry said in court.

It also settled a whistle-blower civil lawsuit filed by nurses in 2003 that triggered what officials said was a relatively rare criminal prosecution of a nursing home over poor care.

Five Cathedral Rock-owned companies that ran those homes agreed to pay $1 million in criminal fines and penalties, and $628,000 in the civil settlement.  The companies will be formally sentenced in April, likely to some term of probation in addition to the fines and penalties.  So no one is going to jail for defrauding the government, stealing from medicare and medicaid, and directly causing the deaths of dozens of residents!

Among the claims was that the homes' staff doctored patient charts, falsified drug records and failed to give necessary medications. Some residents suffered from bed sores. Others wandered away. One ended up on a roof. One was found days later. One died after falling from a window.  The homes were repeatedly cited by regulators, fined and penalized.   Officials said the homes filed corrective plans but then failed to comply or "misrepresented" their efforts to comply.

"FTB (fill the beds) is everything," read a 2004 e-mail from a Cathedral Rock regional vice president to another executive. "Whereas compliance is important and cost control is as well, CENSUS is to be your primary focus," the e-mail read.

In 2004, Cathedral Rock had 2,600 beds in 25 nursing homes and assisted-living facilities in Missouri, Illinois, Texas, Ohio and South Carolina, Harrington said at the time.

Its website currently lists 1,308 beds in 15 homes in Texas and New Mexico. A spokesman said it no longer operates facilities in Missouri or Illinois.

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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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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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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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State regulators have fined a West Palm Beach nursing home $16,000 after a patient was found injured on the floor with maggots crawling out of his leg cast.

The state issued the fine in March against Azalea Court.  The nursing home somehow denies responsibility and has appealed the penalty.  They will probably either argue that the maggots were benficial or that the family put them there so they can sue!

An August 2008 report states that the 120-bed facility failed to provide the necessary care and services to a resident with the cast on his lower leg, which led to an infestation of maggots. The report says the patient's leg was supposed to be treated every three days, but the documentation proved that the nursing home only cared for the wound about once a week.

If this isn't evidence of neglect and understaffing, I'm not sure what it!

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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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Inevitably in most of our nrsing home cases, numerous documents that are intended to show the care, treatment, and services provided to the resident are missing, lost, or never done by the staff.  This occurs because the care was not provided or understaffing caused the staff not to have time to document or poorly trained and supervised staff.  Despite the fact that all nurses were taught and accept the axiom that "If it wasn't documented, it wasn't done", the insurance companies, nursing home industry, and their defense counsel always say the missing information is not relevant and does not show that the care wasn't given but rather wasn't documented.  Hopefully, the new Medicare reimbursement policies will preclude this frivolous argument.

McKnight's has an article discussing the new Medicare reimbursement policies and the necessity of documentation to prove care provided.  Nursing homes will have a greater role in ensuring accurate documentation of care.    Compliance officers' experience in billing and coding could be easily transferred to the area of quality-of-care forms.  Physicians and care workers will need to learn the appropriate language from compliance officers to best fill out the claims forms.

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