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

Newport News Dailypress.com had an article about a suspicious death of a resident of a nursing home.  There appears to be a link between his death and medicine he got the day before.

A nurse who gave unauthorized medicine last week to a nursing home resident who later died has been fired.  Police are considering whether the medication caused or contributed to the death of John P. Stratton, 76, of Newport News, who was staying at the James River Convalescent and Rehabilitation Center.  Stratton was given the medicine on May 5, and died about 4 a.m. on May 6.

The nurse's decision to give Stratton the medicine was not an accident.   "She intentionally gave him the medication," police said. "Her intent in giving it to him will have to come out later."

Police are trying to find out whether Stratton was given an increased dose of a medicine he was prescribed, or medicine he wasn't supposed to get at all.

Joseph Law, James River Convalescent's administrator, said the nurse — whom he declined to identify — was fired after an internal investigation. The actual reason for her firing, Law said, was separate from the issue surrounding Stratton's death. "The nurse was terminated because of facility protocol," Law said. "During our investigation some other information was discovered." He did not elaborate. What a bunch of nonsense. Clearly the facility does not want to admit what happened or what they found out in their "internal investigation". 

It could take a month or longer for the toxicology results.  The examination will include any possible interaction between the medicine the nurse gave him and other drugs Stratton was taking.

One of Stratton's daughters, Denise Barnes of Newport News, said the family doesn't know what drug or drugs the nurse gave her father.   A staffer at the home brought to his attention the possible link between the medication and Stratton's death. He then called police and state agencies.

I'm surprised they didn't fire the staffer who refused to cover it up.

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Tucson Citizen had an article about a recent jury verdict where a jury awarded a Tucson family $6 million for a death involving an 81-year-old relative who died of a morphine overdose.  Mary Culpepper and two other relatives were awarded $2 million each.  Culpepper sued Manor Care, TMC, a doctor, nurse and pharmacy over the Dec. 8, 2003, death of her mother, Sylvia Culpepper.

She was admitted to TMC on Dec. 2, 2003, suffering from sciatica, a painful nerve condition.
On Dec. 4, 2003, she was prescribed 15 milligrams of morphine twice a day. Two days later, her dosage increased to 30 milligrams, twice a day.   When Culpepper was transferred from TMC to Manor Care, prescription orders contained both dosages.

The Manor Care staff failed to note the discrepancy in the prescriptions and gave her both dosages, both twice a day causing her death.  An autopsy determined that Culpepper died of acute morphine intoxication.

According to the jury's verdicts, the doctor, nurse and pharmacy weren't to blame for the death. The nursing home had the ultimate rersponsibility for the medications given to the resident at their facility.

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Journal of Clinical Nursing has an article about a recent study linking the use of sleeping pills containing benzodiazepines to increase falls in nursing homes.
Older patients taking benzodiazepines were 2.9 times more likely to fall   Obviously, patients who fall suffer severe injuries.   Some older patients have impaired cognitive function or limited functional ability and physical strength stemming from chronic physical ailments, increasing their risk of a fall, often when walking or being moved.

In addition, older patients are take multiple medications, whose side effects increase the patients' chances of a fall.  Physical restraints may be used to decrease the possibility of falling and being injured.

"Even if no physical injury occurs, fall victims may develop a fear of falling again and thus reduce their activities as a result," the authors wrote. "This can lead to unnecessary dependency, loss of function, decreased socialization, and a poor quality of life."

The researchers found that use of sleeping pills containing benzodiazepines was significantly associated with fractures supporting the findings of most previous studies.

Patients using wheelchairs and bed rails were less likely to fall, but neither of the associations reached statistical significance. Nevertheless, "the use of these might be regarded as protective or preventative strategies," the researchers said.

Bed rails can cause injuries if patients climb over them, and physically restraining an already agitated individual can increase fear and worsen behavior, they said.   "In addition, restraints can lead to serious complications, including circulatory obstruction, skin tears, incontinence, fractures, and dislocations," they wrote. "These restraints should be used with care and consideration." 

The Study recognized that restraints cannot completely eliminate falls in nursing homes and that they may not be appropriate in every situation, but concluded that "our results support the hypothesis that they might be protective when used selectively together with fewer sedatives, especially benzodiazepines."

Primary source: Journal of Clinical Nursing
Source reference:
Fonad E, et al "Falls and fall risk among nursing home residents"J Clin Nurs 2008; 17: 126-134.

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The Chicago Tribune has a story about the suspicious deaths possibly caused by morphine overdose at a nursing home.  McHenry County prosecutors acknowledge the suspicious deaths at the Woodstock Residence nursing home in Woodstock have been difficult to pursue.  Three bodies were exhumed last year, and tissue samples were sent to a Pennsylvania lab for analysis.

The bodies of three others whose deaths investigators consider suspicious could not be examined because they were cremated.  Alissa Nataupsky, administrator of the Woodstock Residence, has denied any wrongdoing at the home and has said the investigation was triggered by a former employee.

When Cole, 78, died in September 2006, the cause of death was listed as pneumonia. Cole had been living at the Woodstock Residence for two months.

If lab results do not conclusively show that morphine overdoses caused the deaths of the three former residents whose bodies were exhumed, a grand jury might be used to further investigate the case, a law enforcement source said. 

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The New York Times has an interesting and scary article about how the elderly are given dangerous and unnecessary medications.   The article relays a story about a 78-year-old woman who was found unconscious on the floor of her apartment by a neighbor.
Her medical history included high blood pressure, coronary artery disease, atrial fibrillation, congestive heart failure and osteoarthritis. She also had a cold with a productive cough. For each condition, she had been prescribed a different drug, and she was taking a few over-the-counter remedies on her own. These were the medications:

¶Lopressor to control high blood pressure.
¶Digitalis to help the heart pump and control its rhythm.
¶Coumadin to prevent a stroke caused by blood clots.
¶Furosemide, a potent diuretic to lower blood pressure.
¶Lipitor to lower serum cholesterol.
¶Baby aspirin to reduce cardiac risk from blood clots.
¶Celebrex for arthritis pain.
¶Paxil for depression and anxiety.
¶Valium, as needed, to help her sleep.
¶Levofloxacin, an antibiotic for the cough.
¶Ibuprofen for body aches.
¶Cough medicine.

This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking.

The woman described above passed out because she had a bleeding stomach ulcer from a combination of drugs that irritate the stomach, Celebrex, ibuprofen and aspirin, and thin the blood, coumadin and aspirin, made worse by an antibiotic that raises blood levels of coumadin.

She recovered after a transfusion of two units of packed red blood cells and was sent home with strict instructions to stop the Celebrex, ibuprofen and aspirin and advice to “contact her internist and psychiatrist regarding possible medication changes that might decrease the risk for future adverse events,” Dr. Michael Stern reported in the June issue of Emergency Medicine.

Dr. Stern, a specialist in geriatric emergency medicine at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that the elderly took about 40 percent of prescribed drugs, roughly twice what younger adults take, and that they suffered twice as many adverse drug reactions as younger people.

“The average community-dwelling older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications,” Dr. Stern reported. Polypharmacy is responsible for up to 28 percent of hospital admissions and, he added, if it were classified as such, it would be the fifth leading cause of death in the United States.

The Effects of Aging

Various drugs taken by the elderly can interact dangerously. Some drugs use the same metabolic pathway and, thus, compete with one another, which can result in hazardous blood levels of one or more drugs. Some drugs cause effects like dehydration that reduce kidney function and the ability to eliminate drug metabolites. The combined effects of some drugs can be more potent than the prescriber intended.

Major organ systems function less efficiently in older people. The heart’s ability to pump blood declines with age, as does absorption by the gut, the breakdown of drugs by the liver and the ability of the kidneys to excrete them. With aging, the percentage of lean body mass declines, and body fat increases. Thus, aging affects how much of a drug reaches the bloodstream, how well it is distributed in the body and how effectively it is cleared from the system.

Drugs like digitalis and coumadin, which are primarily distributed in lean tissues, are likely to reach higher blood levels in people older than 65. So the prescribed dosages should be lowered to reduce the risk of toxic side effects. Other drugs, like Valium and barbiturates, that are distributed in fatty tissue can accumulate in the elderly body and remain active longer, increasing side effects like sedation.

Aging also results in fewer protein binding sites for drugs, resulting in a higher blood level of the drug that loses the competition for sites.

Furthermore, aging can affect the responses to certain medications. This is especially true for those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Dr. Stern wrote.

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The New York Times has an interesting and scary article about how the elderly are given dangerous and unnecessary medications.   The article relays a story about a 78-year-old woman who was found unconscious on the floor of her apartment by a neighbor.
Her medical history included high blood pressure, coronary artery disease, atrial fibrillation, congestive heart failure and osteoarthritis. She also had a cold with a productive cough. For each condition, she had been prescribed a different drug, and she was taking a few over-the-counter remedies on her own. These were the medications:

¶Lopressor to control high blood pressure.
¶Digitalis to help the heart pump and control its rhythm.
¶Coumadin to prevent a stroke caused by blood clots.
¶Furosemide, a potent diuretic to lower blood pressure.
¶Lipitor to lower serum cholesterol.
¶Baby aspirin to reduce cardiac risk from blood clots.
¶Celebrex for arthritis pain.
¶Paxil for depression and anxiety.
¶Valium, as needed, to help her sleep.
¶Levofloxacin, an antibiotic for the cough.
¶Ibuprofen for body aches.
¶Cough medicine.

This is what doctors call polypharmacy, otherwise known as a “poisonous cocktail” of many drugs that can interact in dangerous ways and cause side effects that can be far worse than the diseases they are treating. Elderly people are especially vulnerable because they often have several medical problems for which they see different doctors, each prescribing drugs, often without knowing what else the patient is taking.

The woman described above passed out because she had a bleeding stomach ulcer from a combination of drugs that irritate the stomach, Celebrex, ibuprofen and aspirin, and thin the blood, coumadin and aspirin, made worse by an antibiotic that raises blood levels of coumadin.

She recovered after a transfusion of two units of packed red blood cells and was sent home with strict instructions to stop the Celebrex, ibuprofen and aspirin and advice to “contact her internist and psychiatrist regarding possible medication changes that might decrease the risk for future adverse events,” Dr. Michael Stern reported in the June issue of Emergency Medicine.

Dr. Stern, a specialist in geriatric emergency medicine at New York Presbyterian Hospital/Weill Cornell Medical Center, noted that the elderly took about 40 percent of prescribed drugs, roughly twice what younger adults take, and that they suffered twice as many adverse drug reactions as younger people.

“The average community-dwelling older adult takes 4.5 prescription drugs and 2.1 over-the-counter medications,” Dr. Stern reported. Polypharmacy is responsible for up to 28 percent of hospital admissions and, he added, if it were classified as such, it would be the fifth leading cause of death in the United States.

The Effects of Aging

Various drugs taken by the elderly can interact dangerously. Some drugs use the same metabolic pathway and, thus, compete with one another, which can result in hazardous blood levels of one or more drugs. Some drugs cause effects like dehydration that reduce kidney function and the ability to eliminate drug metabolites. The combined effects of some drugs can be more potent than the prescriber intended.

Major organ systems function less efficiently in older people. The heart’s ability to pump blood declines with age, as does absorption by the gut, the breakdown of drugs by the liver and the ability of the kidneys to excrete them. With aging, the percentage of lean body mass declines, and body fat increases. Thus, aging affects how much of a drug reaches the bloodstream, how well it is distributed in the body and how effectively it is cleared from the system.

Drugs like digitalis and coumadin, which are primarily distributed in lean tissues, are likely to reach higher blood levels in people older than 65. So the prescribed dosages should be lowered to reduce the risk of toxic side effects. Other drugs, like Valium and barbiturates, that are distributed in fatty tissue can accumulate in the elderly body and remain active longer, increasing side effects like sedation.

Aging also results in fewer protein binding sites for drugs, resulting in a higher blood level of the drug that loses the competition for sites.

Furthermore, aging can affect the responses to certain medications. This is especially true for those that influence blood pressure and the brain. Drugs like Valium, antidepressants and antihistamines can cause effects like delirium, agitation, sleepiness, depression and worsening dementia in older people, Dr. Stern wrote.

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This article shows how some employees will not cover up neglect and abuse in nursing homes unlie the majority who are more loyal to their corporate masters than the residents they are bound to protect.

June Dankert was 87 and in good health when she died May 10. For the previous two years, she lived at the Tendercare Nursing Home in Hastings.  Her family said she wrote dozens of letters to loved ones each week to help keep her mind sharp.

After the funeral, an anonymous phone call raised questions.

June's daughter, Kay Trantham, told 24 Hour News 8 a woman from Tendercare called to tell the family how Dankert really died.  "When you go into a coma with no apparent reason, you do wonder," Trantham said. "Apparently, she was given her roommate's hospice medication."

The caller told Trantham there was a delay in getting her mother to the hospital, followed by a cover-up.

Documents obtained by 24 Hour News 8 from the state Department of Community Health divulge more, and confirm dates and stories about "resident number 402" - Dankert's resident number in paperwork provided from the state to Trantham.

The investigation shows multiple citations because Resident 402 was given medication meant for someone else. Resident 402 soon lapsed into a coma and died. Family and emergency room doctors were not notified of the mistake.

Records also show conflicting nurse notes on May 9, from the early morning to the afternoon when Resident 402 was finally taken to the hospital.

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 I saw this story and thought of all the residents who suffered pain as a result of his intentional act. This is why supervision of nursing home employees is crucial.

A 40-year-old nurse who pleaded guilty to switching out painkillers meant for nursing home patients has been sentenced to just over five years in prison.

Michael Paul Smith of Falmouth was charged with tampering consumer products and health care fraud.  Smith may face mandatory exclusion from working in any federal health care program.

Prosecutors say he removed pills containing oxycodone and morphine by separating the cardboard backing from blistercards and substituted the pills for similar-looking medication nearly two years ago.

He was employed at the Odd Fellows Nursing Home in Worcester at the time.

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The family of Florence Pierpoint, a 79-year old nursing home patient who was killed while in the care of a Tacoma nursing home, filed a lawsuit after a medical examiner ruled her death a homicide caused by a morphine overdose.

The complaint  includes charges that the facility's staff failed to administer medications according to the physician's orders and neglected to monitor Pierpoint's condition. 

Pierpoint was transported to the facility after returning from a stay at a local hospital where she was treated for pneumonia she acquired in the nursing home.

On November 2, 2004, records show a sudden and drastic decline in Pierpoint's condition, noting confusion and disorientation. The nursing home's response was to administer additional doses of morphine and Xanax, a powerful anti-anxiety drug.  Later that day, Nisqually staff reported that Pierpoint was becoming increasingly restless and they administered additional morphine.

"I noticed my mom's dramatic slide, from awake and aware to nearly comatose," said Linda Fox, Pierpoint's daughter. "I raised these issues with Nisqually's staff, but they chose to ignore my pleas."

Pierpoint died less than one hour after the additional morphine was administered.

"Florence's family is adamant that the nursing home and the responsible staff be held accountable for their actions," Meyers said. "Their deepest fear is that other patients could be at risk." 

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