Florida is Making Nursing Homes Unsafe

In Jacksonville, a woman tries desperately to get justice for her mother’s sexual assault at a nursing home. Sandra Banning went before the Senate Judiciary Committee this month to try and improve the way nursing home cases were conducted in the state of Florida.  The Senate is attempting to pass more tort reform that protects nursing homes from accountability and responsibility.   It raises the threshold for those suing nursing homes to seek damages for excessive misconduct, or “punitive damages.”  The bill (SB 1384) would require that before a person seeks punitive damages, a judge must first grant permission and require a detailed hearing to vet evidence used.  In other words, the victim has to disclose his strategy and trial tactics in a mini-trial to convince the judge, and then have another trial in front of the jury.  What a waste of judicial time and money.

Banning told the tragic story of how her mother was raped in a nursing home when a man used his wheelchair to block the door.  Sandra Banning was awarded a $750,000 judgment but it was never paid by the nursing home corporation. Florida has a state trust fund where 50% of punitive damages are required to go into this fund to assist with reform. However, since that bill was enacted in 2001, there have been zero successful punitive damages claims brought against nursing homes. The bill has two more stops before the Senate can completely come to a decision on it.  See article at the Florida Times-Union.

Punitive Awarded Against Emeritus

The Sacramento Bee reported on the conclusion of the wrongful death and abuse trial against Emeritus Corp.  At the end of the liability phase of the trial, the jury awarded the plaintiffs $3.875 million for Joan Boice's pain and suffering. That award, however, had been capped at $250,000 by Judge Judy Holzer Hersher under state law that applies to medical malpractice cases. 

The second phase of the trial is the jury hearing evidence related to punitive damages.  The jury decided yes and awarded the family $23,000,000.81.  The 81 cents was for the resident's age.  A clear rebuke to Defendants harping on her age during the trial.

"It took the panel less than a day of deliberations following two days of testimony to decide what the damages should be in the punitive phase of the trial. The same jury on Monday came back with a finding of liability against Emeritus and found that the Seattle-based corporation acted with malice, oppression and fraud in its treatment of Joan Boice. The woman died in February 2009, three months after she left Emeritus at Emerald Hills in Auburn with bed sores spreading over portions of her body."

Testimony at the trial showed that Emeritus at times had no caregivers on duty during the overnight shift during Boice's three-month stay at Emerald Hills.



Oppose Tort Reform

The National Consumer Voice for Quality Long Term care wrote a great article on why Americans should oppose tort reform.

"In the legal system, a tort is defined as a civil wrong against an individual or a violation of an individual’s rights for which some kind of compensation – or damages - may be obtained.  In nursing home cases, the most common damages are noneconomic damages and punitive damages. Noneconomic damages are to compensate for pain and suffering, while punitive damages are designed to punish the person or entity that committed the wrong and stop further harm from occurring.  Tort reform refers to efforts by state and federal legislatures to place limitations on the amount of damages that can be recovered by individuals in certain cases involving personal injury or the improper care or treatment of a patient by a health care provider. Tort reform would limit the amount of damages nursing home residents - who are among the most
frequent and vulnerable victims of abuse and neglect in health care institutions – could receive. Several states have passed tort reform laws, and there are efforts to pass a national law to cap damages.

Tort reform would harm long-term care consumers by:
                Making long-term care facilities less accountable for harmful actions
Government studies have repeatedly shown that state inspection agencies fail to cite or penalize
facilities for harming residents, even when they find serious injuries; moreover, many serious
problems are never cited at all. Often the courts are the only branch of government that holds nursing homes accountable. By reducing damages, tort reform would lessen the degree of nursing home accountability. Less accountability could lead to more, not fewer, injuries.

                Limiting consumer access to the civil justice system
Many residents who have been abused or neglected - or their families - do not file suit because they are unable to find attorneys willing to take their cases. Lawyers are increasingly unable to accept cases because the amount awarded for damages under tort reform will not offset the high cost of handling the lawsuit. As a result, residents or their families are left with no legal representation and are shut out of the civil justice system.

                Limiting compensation for long-term care consumers
Noneconomic damages are often the only compensation most nursing home and other long-term care facility residents receive. A recent study found that eighty percent of nursing home awards are for noneconomic damages for residents’ pain and suffering because most residents do not have earned income to replace. Noneconomic damages compensate residents for very real injuries–such as the loss of a limb due to a deep and infected pressure ulcer, the loss of mobility due to a preventable fall, or severe pain and permanent impairment. They also compensate for the loss of a spouse or parent. These are very real damages and should not be subject to arbitrary limitations.

              Protecting corporations, not consumers
Damages, particularly punitive damages, must be large enough to deter future poor care. Tort reform proposals protect the pocketbooks of health care providers, including multi-million dollar corporations operating nursing homes, by decreasing the amount of damages they are required to pay. If corporate behavior is to change, the size of the damages must get the attention of the corporate boardroom; otherwise, corporations simply see the amount as the “cost of doing business.”


$8 Million Verdict in Improper Transfer Case

The Louisville Courier Jornal reported the jury's verdict in a recent two week nursing home neglect trial against Treyton Oak Towers.  The jury awarded $8 million in damages to the estate of a retired surgeon whose legs were broken becuase of neglect.  Dr. David Griffin died less than two months after he was improperly transferred from a chair into his bed causing fractures.  The plaintiffs claimed Griffin was transferred without a lift and by only one nursing assistant, in violation of the nursing home’s care plan, which required two assistants.

The worse part is that Defendants tried to cover up what happened.  Employees were ordered to change medical records to cover the incident up.  This happens all the time in nursing homes. 

The verdict was returned after the jury deliberated for about two hours and included $2 million for pain and suffering, $1 million for violating the state nursing home statute and $5 million in punitive damages.

South Carolina is Less Safe Today

The amount a jury of your peers can award in punitive damages as protected in the Constitution was arbitrarily limited by the South Carolina Republican Legislature today.  Funny how they love the Constitution except the Seventh Amendment.  The House limited punitive damage awards in the typical case at $500,000, or three times the actual damages, whichever is greater.

This is the first time in the grand history of South Carolina that politicians have taken away the right to punitive damages.  Of course, the award of punitive damages is extremely rare but the threat of punitives helps deter reckless and abusive behavior. 

There was no need for this drastic remedy.  Columbia Regional Business recently reported that South Carolina ranks as the eighth best state in which to do business based on a survey of more than 500 CEOs asked about taxation, regulation, workforce, living environment and other factors impacting a state’s business-friendliness. That’s up two spots without limiting punitive damages on the annual survey by Chief Executive magazine.

A court could lift the cap if the defendant's conduct could bring a felony conviction or was motivated by unreasonable financial gain. Of course, this is not well defined and will lead to costly litigation and appeals to determine what is "unreasonable financial gain".  Even then, punitive awards are limited to $2 million, or four times the actual damages.  There would be no cap at all if the defendant intended to cause harm, was guilty of a felony tied to the incident or was under the influence of drugs or alcohol. 

I'm sure the lobbyists for the insurance companies, nursing home industry, and other big corporations are happy.

It is a sad day for the rest of us.


Litigation does not affect overall health care costs

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.


Nursing home covered up death of resident

WNBC.com had a story about how a nursing home lied to a resident's family regarding her death at the facility.  This typeof cover up oftens happens in nursing homes. The staff is typically the only ones who really know what happened to a resident.   The staff are worried about their job or are instructed by their corporate masters to mislead or cover up the neglect and abuse.

Olive Chase was 94 when she died at Sunrise at Fleetwood, an expensive assisted-living home in Mount Vernon, in February 2007.  The nursing home told Chase's son that she had died in her sleep. The nursing home created an elaborate story that his mother had breakfast, was left alone at one point, and the aide returned to find she had died peacefully in her sleep.  The staff said Chase was sleeping at 7:30 a.m., but was "unresponsive" four hours later. Days after Chase was cremated, however, her family got a tip from someone with second hand knowledge of her death that the woman did not die peacefully.

Bob Chase, son of the woman who died, spoke with some of the staff and to the source who was the first nurse on the scene after his mother's death.   The nurse saw Olive's head caught between the bars of her hospital bed with her feet hanging off the side. The nurse said it appeared as if she struggled and then died of strangulation.

"Her tongue was protruding. It was purple," the nurse said.

The nurse said one of the maintenance workers then lifted Olive's legs while she held onto one of her shoulders.

"We brought her up, laid her flat on her bed," said the nurse. "I brushed her hair. This nursing coordinator told us, 'Don't say anything.'"

The nurse said the last person to treat Olive for a bedsore raised the bed for the treatment but did not lower it after, despite instructions to do so. Olive was known to wander, the nurse said.

"We had a sign on the top of the bed, readily visible, stating to lower the bed at its lowest level when finishing care," the nurse said.

An anonymous call to the state Department of Health days after Olive's death reported that the woman appeared to have died of asphyxiation after her head was caught in the bars, which triggered an investigation. The department concluded the caller's complaint was valid. The department found that Olive's body had been rearranged after her death, but it was not reported that way in Sunrise's records.

Verdict upheld in nursing home fall case

Trial Judge Denies Defendant’s Post-Trial Motions, Upholds Jury Verdict for Plaintiff in
Fall/Injury Case (Hawkins v. SSC Hendersonville Operating Company, LLC, d/b/a
The Brian Center Health and Rehabilitation)

On February 21, 2008 the trial Judge (the Honorable Judge Dennis Winner)  DENIED all of Defendant’s post-trial Motions in the fall/injury case, leaving intact the jury verdict of $800,000 ($200,000 in actual damages, $600,000 in punitive damages).

The case was tried in Superior Court in Hendersonville, North Carolina from November 6-16, 2007. Plaintiff proved that the Defendant failed to provide the reasonable and necessary care to prevent decedent, Neal Hawkins, from falling on three separate occasions in one day when it was documented he was a significant fall risk, and was suffering from a significant change in his condition.  Defendant failed to care plan or intervene for the known risk.

On February 11, 2006 Mr. Hawkins fell three times in a single day,  fracturing his hip on the last fall. The facility did not discovery the severe fracture for seven (7) more days. Mr. Hawkins underwent hip surgery. Five (5) weeks later he died of pneumonia. After nearly two (2) weeks of trial, the jury returned a verdict of $200,000 actual damages, plus $600,000 in punitive damages.

Defendant filed post-trial Motions on various alleged issues, seeking to eliminate the punitive damages award, challenging Plaintiff’s expert opinions regarding North Carolina’s "community standards" rule, and objecting to the Judge’s jury instructions. The trial Judge received Memoranda from both parties, heard oral arguments, and has entirely DENIED all of Defendant’s post-trial Motions. Defendant has indicated that they may appeal.

How damage caps affect justice

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."

Jury compensates family of neglected resident with $3 million

Resident's family obtained a $3 million verdict against a regional nursing home operator named Sharo Shirshekan in Missouri.   The case involved pressue ulcers on both heels of the resident.  The feet had to be amputated because of the neglect.  Defendants attempted to blame the resident's pre-exisiting conditions including peripheral vascular disease.  However, the jury realized that PVD does not cause pressure ulcers, neglect does.

 The jury returned $500,000 in actual damages for pain and suffering in the first stage and then $2.5 million in punitive damages against Mr. Shirshekan and his operating company in the second stage.