Wheelchair Crash Results in Lawsuit

The Times-Tribune reported a lawsuit filed on behalf of former Jewish Home resident Elizabeth LaCoste against the Scranton nursing home, claiming aides were negligent when they left Mrs. LaCoste unattended in her wheelchair, which rolled away and crashed, throwing her onto the street. Mrs. LaCoste suffered a broken collarbone, a head injury, bruises and abrasions.

The preventable incident occurred after Mrs. LaCoste and several other residents had been driven from the nursing home to center city Scranton to watch a musical performance. Sometime between 1 and 1:30 p.m., Mrs. LaCoste was left alone and unsupervised in her wheelchair on a sidewalk that pitched toward Spruce Street. The wheelchair rolled toward the street and jumped the curb, heaving her out of the wheelchair and onto the street.  She suffered significant injuries and died months later.

 

Lawsuits against Britthaven

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."


 

Woman Drowns in Bathtub

Chicago Breaking News Center and Chicago Sun-Times had articles on the tragic case of Jean Engstrom who drowned in a bathtub while unsupervised at Warren Park Nursing Pavilion.  Chicago police are conducting a death investigation into the drowning. 

An autopsy conducted determined that Jean Engstrom, 51, drowned according to the Cook County medical examiner's office. But officials could not indicate from the autopsy whether the woman's death was a homicide or an accident.   The woman was mentally ill and lived at the Warren Park Nursing Pavilion.  Police were called to the nursing home after staff members found the woman in a bathtub with the water running. They tried to revive her and called paramedics to the home who then took her to the hospital where she died.

Since the woman was mentally ill, she most likely needed supervision.  I wonder if a staff member started the bath (that is why the water was still running) and walked away.  I hope it was an accident.
 

Broken femur leads to lawsuit

The Madison-St. Clair Record had an article about a lawsuit filed on behalf of Wealthie Lee Lockett against The Lincoln Home and Weiss Management Group for acts of negligence resulting in a broken thigh bone.  The lawsuit contends that employees continuously violated Lockett's rights from Jan. 18, 2008, through her death on Dec. 18, 2008.

During her stay at the nursing home, Lockett sustained a comminuted left femur fracture, among other injuries, causing her to suffer severe and repeated pain, mental anguish and emotional distress and to become further debilitated and disabled. Employees at The Lincoln Home failed to evaluate Lockett to ensure she received adequate supervision, failed to provide her with adequate care, failed to provide her with immediate treatment by trained personnel, failed to notify her physician of significant changes in her physical condition, failed to ensure that they established a nursing care plan based on her needs, failed to provide necessary services to maintain Lockett's highest state of well-being and failed to appropriately update her plan following her fracture.

Weiss Management, which owned The Lincoln Home, also allegedly performed a number of negligent acts, including its failure to operate the home in such a way that provided Lockett with adequate supervision, its failure to operate the home in such a way as to protect Lockett from neglect, its failure to properly monitor its employees and staff, its failure to screen and evaluate the references of nursing staff, its failure to terminate employees at the home who were known to be careless and incompetent, its failure to provide nursing personnel duties consistent with their education, its failure to prevent and correct problems at the nursing home and its failure to discharge its legal obligations, the suit states.

 

Fatal Fall

The Orange County Register had an article about the lawsuit filed on behalf of Oliver J. Shrock who was neglected at Kindred Healthcare Center of Orange.  The nursing home was fined $85,000 for their neglect and maltreatment.

Oliver J. Shrock's death on July 18, 2009 – four days after he suffered a fall and fatal head injuries  was labeled by the state as an "AA" citation – the worst violation that the state can issue against a skilled nursing facility.  The state concluded that the center disregarded Shrock's safety by not listening to the family's warnings, and not implementing safety measures, such as the use of a bed alarm.

Shrock's daughters, Kathleen S. Sakoguchi and Deborah Anne Whitman, sued the center and its former owner, Kentucky-based Kindred Healthcare Operating Inc.. Shrock's family told the center that Shrock – who was dependent on staff for most needs – was at high risk for falls, according to the lawsuit.

He fell soon after arriving at the center, but wasn't injured significantly. The center installed a bed alarm to help prevent future falls and placed mats on the floor to limit possible injuries.  But these measures weren't always in place when Sakoguchi visited her father, and she repeatedly had to tell staff to attach the bed alarm. The fall that caused his death happened on July 14, when Shrock was preparing to go home.

"A nurse assistant discovered Shrock on the floor bleeding from his head and she did not know how long he had been lying on the floor,'' according to the suit.  Shrock was taken to a hospital, and died four days later.

 

Poor supervision led to mistreatment

WCCO reported that a Minnesota nursing home was cited for four deficiencies of federal nursing care standards.  A report says the department cited the Good Samaritan Society's Bethany home in December 2008.  A Minnesota Health Department investigation found poor supervision at a Brainerd nursing home allowed workers to allegedly mistreat residents.

The report says in a two-month period in late 2008, workers allegedly told residents to relieve themselves in their briefs and talked in a derogatory manner to residents.  The investigation focused on one worker who eventually was fired, but that workers indicated as many as 20 others also committed similar acts.

Management has a duty to properly hire and train staff and supervise them.  How could the Administrator and DON not know what was going on?
 

Resident to Resident Assault

The Chicago Tribune (once again) had a great article on the lack of supervision in Fox River Pavilion nursing home which caused the sexual assault of a disabled resident by another resident with a history of violent behavior and mental issues.  The victim's family filed a lawsuit.

The suit alleges that Graves, 39, sexually assaulted and beat the woman in his room at the home. The suit says Graves has been arrested multiple times and suffers from bipolar disorder and other mental issues. The nursing home should have more closely monitored or restricted Graves, and it failed to provide additional security or therapies that may have treated his anti-social behavior.

The woman, who the lawsuit said suffers from dementia, went to a nurse's station after she was assaulted and was "in a bruised, battered and bloodied condition," according to the suit.

In February, state and federal officials terminated funding to the home after investigating that case and others. State reports say a lack of staffing contributed to resident-on-resident attacks, and that staff failed to properly monitor and treat aggressive mentally ill felons housed there.

 See related article from the Beacon News about the family's lawsuit.

Backlogs of Complaints

There were several articles about the lack of investigation by Texas regulators on nursing home complaints.  The Star-Telegram ran an article.  MySanAntonionews.com ran article.  Also American Statesman had one too.

Interviews with families and advocates and a review of thousands of pages of public records by the San Antonio Express-News show some of the city's most frail and vulnerable residents are suffering at the hands of their caregivers. Yet state officials allow troubled nursing homes to continue operating with little or no penalty.

The lack of oversight comes at a human cost. Elderly residents were left for hours in their own urine and feces. Infestations of cockroaches and rats plagued some facilities. Employees yelled insults at residents and handled them roughly. Nursing home staff stole medication and administered the wrong drugs to residents. State inspectors found dirty feeding tubes and broken medical equipment.

The state received nearly 16,200 reports of poor treatment last year in Texas, but most — about four out of five — were unsubstantiated by investigators, who often arrive at the nursing home weeks after receiving the complaint.   When investigators do cite facilities for serious problems, nursing home operators rarely face sanctions. In some cases, the state repeatedly threatened to suspend or revoke the licenses of facilities with chronic problems, yet Texas rarely took action against those nursing homes. Often, a facility promises to do better, state regulators back off, and problems crop up again in a troubling cycle.

Meanwhile, serious complaints against nursing homes have increased in Texas . Complaints about problems that put residents in “immediate jeopardy,” the most serious type of complaint, rose 26 percent since 2006, to more than 950. Complaints of “actual harm,” the second most urgent type of complaint, rose by 10 percent since 2006, to nearly 6,300.

Faced with alarming delays in investigating nursing home complaints, the state is creating teams to speed up scrutiny. State nursing home investigators blew their deadlines to investigate complaints of "high potential of harm" against residents in 66 percent of investigations in fiscal 2009.   In such complaints, mental, physical or psychosocial harm is possible, though not imminent, and an investigation must be initiated within 14 days. 

In response, the Texas Department of Aging and Disability Services will put together teams to speed the state's response. Next month, the department will begin to hire 35 new investigators.

Complaint investigation teams are being set up statewide. Made up of nurses, nutritionists, social workers and general investigators, the teams will be dedicated solely to conducting investigations of complaints and self-reported incidents.

This month, the department plans a two-week blitz to investigate 1,550 complaints at more than 300 facilities, a department spokeswoman said.

The department regulates 1,196 nursing homes statewide and investigated 16,200 complaints and incidents last year.

 

Home fails to protect from assault

KnoxNews.com had an article about a lawsuit filed against Ashbury Place for failing to protect Katheryn Hill from a known sexual predator living at the nursing home.  The Hill family wants to know why she shared a floor at the nursing home with a convicted sex offender, James Charles Strickland

"They let him roam the floor with everybody else," said David Boyd, the family's lawyer. "He had free rein to assault her."

Hill was living at Asbury Place when Strickland came to her room March 13, 2009, and tried to rape her. Hill called for help, and a worker pulled Strickland off her.  No information about how he was able to get in the room unnoticed by the staff.  Strickland had been previously convicted of rape and incest. 

Federal guidelines require that any nursing homes accepting such patients be able to protect the other patients.  Asbury Place staff knew about Strickland's convictions but did nothing to separate him from other residents or keep an eye on him.  He died about four months later without being charged by police.  Hill's daughter pulled her from the home after the assault and has cared for her at home since then.

 "They moved him immediately after this incident and notified police," Boyd said. "But our beef with Asbury is that they didn't have anything in place to tell the families about him being there or any plan to watch him."

State law bars sex offenders from living near schools or being around children. No such bans exist for nursing homes, said Andrea Turner, spokeswoman for the Tennessee Department of Health.

 

 

 

Another wandering death

San Jose Mercury News had an article about a nursing home resident who was able to walk out of a nursing home.  Rosemary Nelson  was reported missing from a Concord nursing home over the weekend has been found dead.   Concord police say 63-year-old Nelson was found in a small culvert around 8 a.m. Nelson was reported missing Saturday night from a skilled nursing facility about three miles away from where her body was found.

Though officers had searched the area, police say Nelson's body was discovered in an area that was difficult to see from a nearby road. The coroner's office says Nelson died from exposure.

 

 

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