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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North Carolina's  Department of Health and Human Services issued a recommendation for $20,000 in penalties against Britthaven of Chapel Hill nursing home where a nurse is accused of murder and patient abuse related to morphine overdoses. Incredibly $20,000 represents the federal maximum the two centers can legally fine the facility for the violations that occurred.

The violations are connected to the activities by Angela Almore. Almore was a registered nurse at the facility charged with second-degree murder and patient-abuse surrounding Rachel Holliday’s death.  Holliday died of pneumonia from asphyxiation; the morphine levels in her body were believed to have contributed to her death.  Injuries involving morphine and six other patients are also involved.  Prosecutors say Almore drugged patients to make them more manageable.  Of note, none of the patients were prescribed the potent pain reliever.

See articles here and here.

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The News & Observer had an article about the civil lawsuits that have been filed against Britthaven after a Britthaven nurse heads to court on murder charges in the morphine-related death of a patient, and serious injuries to two other patients.  Registered nurse Angela Almore ihas been charged with second-degree murder and patient-abuse charges related to the death of 84-year-old Rachel Holliday and morphine-induced injuries to six other patients.   A medical examiner reported that Holliday died of pneumonia and that the levels of morphine in her system likely contributed to her death. None of the patients had been prescribed morphine.

The case of Jadwiga Orlowski v. Britthaven Inc. is one of the cases pending.  The suit accuses Britthaven of negligence, including failure to monitor Orlowski, who suffered from dementia according to the complaint, and not providing a bed with side rails.

Her husband, Marian Orlowski, died of pneumonia on July 16 at age 86.  Orlowski was a former distinguished professor in pharmacology at The Mount Sinai School of Medicine in New York, was nominated for a Nobel prize in 2004 for his pioneering drug treatment for blood-plasma cancer.

"Later on that same day, Dr. Marian Orlowski was found on the floor of his room," states a legal complaint filed by the Orlowskis' attorney, Carmaletta Henson. "He had fallen and sustained serious personal injuries, including a fracture to his left hip."

Britthaven of Chapel Hill is one of four "special focus facilities" in the state. This designation by the federal Centers for Medicare and Medicaid Services notes a pattern of substandard care. Chapel Hill Health and Rehabilitation, along with the Brian Centers in Goldsboro and Gastonia (owned by SavaSeniorCare), are also on the list.

Last year, CMS ordered Britthaven of Chapel Hill to pay $216,400 in fines because it was out of compliance with Medicare requirements. Those penalties stem from the case of Mary Lou Barthazon, a 95-year-old woman who likely broke both thigh bones near her knees on Sept. 30, 2007, when a nursing assistant dropped her while trying to lift her from a chair to her bed, according to a federal judge.  The nursing assistant ignored Barthazon's care plan, which required a mechanical lift.  Her fractures went untreated for two weeks because the nursing assistant did not report the incident. Barthazon's daughter, Anne Blanchard, insisted Barthazon go to the emergency room on Oct. 14. She died four days later.

Blanchard has sued Britthaven, alleging negligence and wrongful death. In her motion to dismiss the lawsuit, Britthaven lawyer Pamela Robertson denies "that defendants had a duty to supervise or control the clinical care, treatment or judgment of any healthcare provider."

Robertson's motion also denies "that either state or federal nursing home standards, policies, regulations, rules or standards of participation establish the standards of health care applicable to Britthaven of Chapel Hill."

Britthaven tried to avoid a trial by forcing the case to arbitration. Superior Court Judge Abraham Penn Jones concluded that the contract was signed under duress as both she and her mother were suffering serious health problems and her 23-year-old daughter had only months earlier suffered partial paralysis in a rollerblading accident. Wrote Jones, "The contract is ... procedurally and substantively unconscionable."

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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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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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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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NBC News had a scary story about nursing home employees stealing morphine.  How could a health care provider take away pain medication from a vulnerable adult and replace it with water?

A 30 ml morphine bottle was emptied and replaced with water at a Fort Myers nursing home.  The executive director of Magnolia Court Nursing Home contacted deputies after she discovered the medicine was missing on April 1st.   Only eleven people had access to the cabinet since March 26th.   They should give each one of them a polygraph test and a drug test.

Medications especially narcotics should be kept under the lock and key.

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The Morning Call had a story about another nursing home employee stealing narcotics from the residents.  State police in Pennsylvania have arrested a Bethlehem woman named Heather L. wolters for stealing drugs from a nursing home where she worked. She was employed as a nurse at the Lehigh Center nursing home in Lower Macungie Township when police say she stole 10 vials of injectible Hydromorphone from a computerized medication dispensing system.

A derivative of morphine, Hydromorphone is used as an alternative to morphine in cases of analgesia, and as a cough suppressant. Wolters was charged with numerous counts of possession of a controlled substance, theft by unlawful taking or disposition, theft by deception and receiving stolen property.

How could this happen?  Doesn't the nursing home conduct a narcotics count after every shift?  If so, one or more of the residents are not getting their medication.  If not, they are negligent in dispensing medications.

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The PostStar.com had an article about a registered nurse working at a nursing home despite being convicted and sent to prison for selling prescription drugs he stole from the hospital where he had worked.  How could he keep his license?  Why would a nursing home hire him for a job where he could steal drugs again?

Bradley Winslow is on parole until August 2009, and said Tuesday he did not lose his nursing license, and was not disciplined by the state, for the January 2007 conviction for third-degree criminal sale of a controlled substance.

He said he "fully disclosed" the conviction when applying for a job at the nursing home, and that the nursing home was aware of his conviction when they looked into his background.

Winslow was a nurse at Saratoga Hospital when he was arrested in July 2005 on charges he sold stolen morphine to an informant for the state Department of Health. He had taken the morphine while working at the hospital. The informant was a doctor who later died of a heroin overdose.

Winslow said he was not disciplined by the state, a comment that was corroborated by the Web site of the state Office of Professions, which lists disciplinary actions against licensed professionals in New York, including nurses. His name is not included among those subjected to disciplinary cases.

Jane Briggs, a spokeswoman for the state Education Department, which oversees the Office of Professions, said the agency could not discuss Winslow’s disciplinary history because it was "pending." She could not explain why the matter would still be "pending" 23 months after he was sent to prison, though.

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The Post-Tribune had an article written by Mark Taylor about the negligent care provided to a resident in a hospital.  The article described the resident, Donna Durham, as an active, energetic widow with sparkling green eyes and silver hair who worked as a top real estate agent and home appraiser until June 12, the day she arrived at  the hospital for surgery. 

Prior to the surgery, the Dunham family had apprised hospital staff of their mother’s allergy to codeine and morphine.  It was entered in her medical chart.  It was identified on the red tag she wore on her wrist. And in the final presurgery meeting with physicians, Dunham’s children say they reminded anesthesiologist Dr. Nageswar Yelavarthi that their mother was allergic to morphine.

In spite of those warnings he allegedly ordered a nurse to administer the potent narcotic to which Dunham was allergic, according to Pinnacle medical records obtained by Dunham family attorney George Galanos. Yelavarthi allegedly told the nurse that he and the staff could deal with the expected allergic reactions, such as nausea and vomiting, a nurse’s note states.

By 12:08 p.m., Dunham was in respiratory arrest and having difficulty breathing.  Medical records indicate Pinnacle staff attempted to stabilize Dunham and around 12:30 p.m. began attempts to transfer her to an acute-care hospital. 

Dunham's doctor, Dr. Kucharzyk,  did not complete a spine fellowship and does not have the additional training required to perform spinal procedures.  According to the Patient Compensation Fund of the Indiana Department of Insurance, Kucharzyk has been named in at least 14 medical malpractice lawsuits.  Kucharzyk never disclosed this information to the family.

Nonetheless, Kucharzyk held surgical privileges in back surgery at Pinnacle.

After Dunham went into respiratory distress at 12:08 pm., Pinnacle staff connected her to a ventilator to breathe for her.   Anesthesiologist Yelavarthi gave her an antidote to the morphine, but it didn’t work.

Kucharzyk was enlisted to attempt to transfer Dunham to Methodist or Saint Anthony. But he said he did not hold full privileges at Methodist or Saint Anthony and wasn’t successful in arranging a transfer. Kucharzyk soon after told Pinnacle staff, “He would not be following the patient,” according to Dunham’s medical records.

Khalid contacted Methodist to alert staff there about Dunham’s condition and the sequence of events, and at 1:01 p.m. Superior Ambulance arrived at Pinnacle to transport Dunham to Methodist.  Again at 1:20 p.m., Pinnacle staff contacted Methodist and were told that Methodist could not accept Dunham until case management reviewed her insurance “to make sure she was not a (patient) ‘dump’,” hospital slang for a patient unable to pay, according to Pinnacle records.

Patient dumping is when a hospital transfers a patient to another health-care facility because of the person’s inability to pay. It’s a practice that is illegal, as is delaying care while considering payment or insurance information.

The Pinnacle staff continued working on Dunham even as they attempted to transfer her to Methodist, a hospital with an intensive-care unit better equipped to handle such emergencies.

Finally at 2:30 p.m., nearly 150 minutes after Dunham had gone into respiratory distress, Superior transported her to Methodist.  Dunham arrived at Methodist still in distress and deteriorated rapidly.

Methodist’s ER staff worked on her until 3:30 p.m., when she was pronounced dead of heart failure.  A Methodist ER nurse asked the family if Pinnacle ever explained their mother’s condition when it transferred her.

Cheryl Harrell said Kucharzyk phoned that evening.   “He asked what happened and acted like he didn’t know anything had gone wrong,” she said. “He said when he left she was fine.”

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