Thursday, March 26, 2009

Use of Chemical Restraints in Nursing Homes

The Nursing Home Patients Bill of Rights (NHPBR) is a federal law that mandates the type of care nursing home patients, residing in nursing homes that receive Medicare or Medicaid, must receive. The NHPBR states under Title 42 Code of Federal Regulations 483.13, subsection (a) that nursing center residents have “the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms.”

In a tragic case of nursing home abuse by nursing facility staff, three nursing center staff employees of Kern Valley Healthcare District violated the NHPBR and criminal statutes prohibiting elder abuse. The three staff members included the center’s one-time medical director, the former nursing director, and the former chief pharmacist. In a criminal complaint filed by the California Attorney General, it alleged that the nursing director administered these drugs to practically all the residents, except the most docile. The medical director allegedly approved the nursing director’s requests for medicating the residents. Additionally, the chief pharmacist complied with the requests for medication on the basis that the nursing director had experience working at psychiatric hospitals.

All three victims died unnecessarily. Fannie May Brinkley could have lived another couple years, but due to the anti-seizure drug, Depakote, she was given, and the lack of care by staff, she died. As for Joseph Shepter, he was given Depakote and two other drugs, and as a result lost 20 percent of his body weight. Thereafter, his health deteriorated, resulting in an infection and pneumonia; he eventually died as a result of his illness. As for Alexander Zaiko, he died after he was given Zyprexa, and Depakote.

In addition to these three residents, 20 other residents were given psychotropic drugs. Consequently, these individuals experienced numerous side effects, including severe weight loss, slurred speech, loss of cognition, tremors, and psychosis

The three nursing staff members are facing criminal charges, including charges for administering shots by force and without consent, and charges of assault with a deadly weapon.

NHPBR Protects Rights of Residents

The NHPBR has provisions that ensure the proper care of nursing home residents. Nursing facilities must have enough staff to make sure that residents have the highest practicable level of physical and mental well being. It also has provisions regulating pharmacists. Pharmacists are required to review the resident’s drug regimen periodically and report any irregularities in the resident’s drug regimen to the doctor or the nursing director.

Steps to Take if You Discover Elder Abuse

Besides contacting an attorney who is qualified and experienced in handling elder abuse cases, it is important to take immediate steps in preserving evidence that will later be useful. It is important to take photos of any noticeable physical injuries or conditions, writing down information about the incidents of abuse, and obtaining a copy of the medical chart from the nursing home.

The improper use of chemical restraints against nursing home residents is both wrong and criminally punishable. Although under reasonable circumstances a licensed physician may suggest chemical restraints after other methods have been exhausted, they cannot be used for the sake of convenience of the nursing staff. If someone you know and care about has been improperly restrained and injured as a result, contact an elder abuse lawyer immediately.

Wednesday, February 18, 2009

Nursing Facility Resident Dies of Fire-Related Injuries

A 74 year-old female resident of the Lemon Grove Care and Rehabilitation Center near San Diego, California caught fire while smoking at the facility’s patio on March 31, 2008. Less than two weeks later, the woman died of burn-related injuries she suffered to her face, head, chest, fingers, and arms.

The California Department of Public Health’s investigative report regarding the incident showed that the woman had been smoking in the patio-gazebo area, which had been designated for smoking. According to the report, no staff member was supervising her, even though a prior plan of care by the facility indicated that the woman was a potential risk for smoking-related injuries, and thus needed to be monitored to assess compliance with the facility’s smoking policy.

The woman had been sitting on her electric scooter and shielded herself from the wind by placing a jacket over her head, while trying to light her cigarette at the same time. However, her jacket caught on fire as she tried to light her cigarette. To see the Department’s investigative report, click on the following link:

Lemon Grove Care and Rehabilitation Center
Prior to this incident, Lemon Grove received three minor citations, one dating from 2005, and another two dating from 2008. Lemon Grove provides a full range of nursing services, ranging from physical, occupational, speech, and intravenous therapies, to assisting patients who are recovering from serious illnesses or injuries. Residents receive both long and short-term care from this facility.

Type of Care Nursing Residents Should Receive
The Department of Public Health cited the center with violating 42 CFR 483.25(h)(2) of the Federal Code. Title 42 CFR 483.25, subsection (h) states, “The facility must ensure that (1) the resident environment remains as free of accident hazards as is possible; and (2) each resident receives adequate supervision and assistance devices to prevent accidents.” To view the entire statute, click the following link:

Lemon Grove Received the Highest Penalty Under State Law
In this incident, Lemon Grove received an “AA” citation and was fined $80,000 by the Department of Public Health. “AA” citations are issued when a resident has died at a facility and the facility’s violation of the law was the proximate cause of the death. The “AA” citation is the most severe violation a nursing facility can receive under state law. Fines for “AA” citations range from $25,000 to $100,000. Moreover, if a facility receives two “AA” citations in less than two years, the process for revoking the facility’s license automatically starts.

Other less severe citations a nursing facility can receive are “A” citations and “B” citations. “A” citations are issued by the Department of Public Health when patients face imminent danger, or the probability of death or serious harm due to the facility’s violations. Such fines range from $2,000 to $20,000. “B” citations are issued for violations that concern health, safety, or security, but do not rise to the level of “A” or “AA” citations.

If you have a loved one who is not being properly cared for at a nursing center, it is important that you contact a San Diego elder abuse attorney to protect his or her rights. If you have a question or comment, please respond to this posting, but keep in mind that your responses will not be confidential. You can also call or e-mail us if you would like to discuss the matter in confidence. Thanks for reading our blog.

Tuesday, January 6, 2009

Medicare Releases Nursing Home Rating System

The Centers for Medicare and Medicaid Services created a rating system for comparing nursing homes throughout the United States. The ratings are searchable through the Centers for Medicare and Medicaid Services website, through a Nursing Home Compare search engine. The ratings are based on three categories:

  • Health Inspections
  • Staffing
  • Quality

These three categories are each given an individual a star rating on a one to five scale. The ratings are then combined to create an overall ranking for each nursing home on a one to five star scale.

Rating San Diego Area Nursing Homes
A search of the database for nursing homes within a 25 mile radius of San Diego reveals that, out of the 59 nursing homes identified, 22 received overall ratings of four or five stars. An additional 19 nursing homes received three star ratings. The remaining 18 nursing homes received one or two stars.

San Diego area nursing homes are made up of 10 not-for-profit or government run nursing homes, with the remaining facilities being run for-profit. Overall, the for-profit nursing homes performed poorly compared with the not-for-profit or government run facilities. All of the nursing homes that received a one star rating are run for-profit. In addition, of those nursing homes receiving two stars, only one was a not-for-profit nursing home. USA Today reports that not-for-profit nursing homes received higher overall ratings than for-profit nursing homes under the rating system. As a result, the performance of San Diego for-profit nursing homes compared to not-for-profit nursing homes parallels the national results.

How to Use the Rating System
Those looking for a nursing home for themselves or a loved one should not rely solely on this new rating system. Instead, the ratings can provide a starting point to identify some possible facilities.

Choosing a nursing home in an area close to a person’s family and friends often improves the quality of an individual’s experience in a nursing home. With that in mind, the database can also be used to locate nursing homes in a specific area. You should always visit a nursing home to determine whether it will meet the resident’s needs and ensure that the facility provides the proper quality of care for each of its residents.

With complaints against California nursing homes to the California Department of Public Health increasing from 5,742 in 2004 to 6,950 in 2008, the importance of researching a nursing home continues to be an important part of ensuring proper elder care.

Thank you for reading my blog. If you have a question or comment, feel free to respond to this posting, but keep in mind your response will not be confidential. If you or a loved one have been the victim of abuse, negligence, or neglect by a nursing home, contact a qualified elder law attorney to find out your legal rights and options. You can also contact me to discuss your matter confidentially.

Monday, December 8, 2008

New Laws to Take Effect in 2009 to Assist California Elders

As 2009 quickly approaches, several new laws affecting elder and nursing home abuse will take effect on January 1. Hopefully, they will help protect elders from financial abuse and encourage and make it easier for nursing home residents and their families to report theft and abuse in nursing homes.

Several Laws Aim to Protect Elders from Financial Abuse
Financial abuse is one of the greatest threats to elders. Whether it is by family members, nursing homes and their staff, or scam artists who are complete strangers, elders are particularly vulnerable because of their often poor health and mental state. The most important law taking effect at the start of 2009 will amend the Elder Abuse and Dependent Adult Civil Protection Act. The law’s goal is to make it easier for elders and their families to recover from financial abuse due to undue influence. Undue influence occurs when someone pressures an elder to give away money that he or she would not normally have voluntarily given.

This law also makes it easier for families to sue by extending the statute of limitations to four years. Therefore, if you believe a family member has made a financial decision due to undue influence, you now have four years in which to sue for recovery. An extra year can be very helpful because it can often take some time to discover that financial abuse has occurred.

Law Hopes to Encourage Reporting of Property Theft in Nursing Homes
Supporters of another important law taking effect January 1 hope that it will encourage elders and their relatives to report stolen property – primarily cash and valuables like jewelry – to the local police and ombudsman offices, and not just to the nursing home administration. The new law would require local police and the ombudsman to immediately report suspected or known theft and abuse to the local District Attorney’s Office.

According to San Diego County Deputy District Attorney Paul Greenwood, nursing home staff will often keep reported thefts quiet and handle such matters internally instead of going to the police. This means that property is often never recovered, because many nursing homes say that most property is simply lost and misplaced by elderly residents, as opposed to being stolen by staff.

The best way to prevent elders’ valuables from being stolen is to remove them from the nursing home and store them in a secure place. Also, family members should immediately report any missing items to the nursing home administration, but if the property is not recovered within a day, they should contact the police directly.

Thank you for reading my blog. If you have a question or comment, feel free to respond to this posting, but keep in mind your response will not be confidential. If you or a loved one have been the victim of abuse, negligence, or neglect by a nursing home, contact an attorney to find out your legal rights and options. You can also contact me to discuss your matter confidentially.

Thursday, November 13, 2008

$3.8 Million Budget Cut to the Ombudsman Program May Put California Elders at Risk

On September 23, 2008, Governor Arnold Schwarzenegger signed the 2008-2009 California budget. A small line in this budget included a $3.8 million budget cut to the funding of the state’s long-term care ombudsman program. Retroactive to July 1, the cut removes almost half of the state’s funding for this program.

The California ombudsman program, which is mandated by both state and federal law, sends volunteers into nursing home and other long-term care facilities to monitor and investigate patient treatment and to respond to and settle complaints about nursing home abuse or neglect. State-certified volunteers do much of the work, which includes visiting nursing homes and responding to complaints by patients and their relatives. Advocates of the program say the ombudsmen help protect vulnerable elders, most of whom who have no friends or relatives to visit them and monitor their treatment.

The budget cut came just days after the Inspector General of the Department of Health and Human Services released a federal government report about nursing home abuse and neglect nationwide. While 90 percent of nursing homes around the country were found to be deficient in some way, the report revealed that a staggering 99 percent of California’s nursing homes are violating federal standards.

Budget Cut Already Forcing California Ombudsman Program Office Closures
Because the budget cut was retroactive to July 1, 2008, the effects on the ombudsman program offices are being felt immediately. Already, one of the nearly three dozen county and local offices has had to close; others have had to cut their staffs in half due to losing over half of their annual budgets. Some offices now have just two staffers left to respond to thousands of annual complaints across hundreds of facilities. One office in Northern California has even seen its budget cut completely.

These office closures will potentially have a devastating impact on the way California’s elders are treated in nursing homes around the state. Considering the federal report’s findings about the state of California’s nursing homes, many groups are concerned that already vulnerable elders are at an enormous risk for abuse and neglect that will go unreported.

Outrage in California’s Senior Citizen Community
Many advocacy and senior citizen groups have already expressed anger at this budget cut. Seniors Organizing Seniors, one of the groups that organized a protest in Sacramento, is especially concerned about the cut to the ombudsman program because of the increasing number in nursing home abuse and neglect complaints. California Advocates for Nursing Home Reform (CANHR) (http://www.canhr.org/index.html), the statewide advocacy group for nursing home patients, agrees. CANHR has also questioned the cuts because funding for the statewide ombudsman office, which oversees the program on a state level but provides no services to nursing home residents, was not cut, and none of the state office’s funds have been redirected to the local offices that are now struggling.

Seniors have vowed to keep protesting and fighting until Governor Schwarzenegger reinstates the funding to this and other programs that were cut in the budget.

Thank you for reading my blog. If you suspect that a loved one has been a victim of nursing home abuse or neglect, contact me for immediate assistance.

Wednesday, October 15, 2008

Update on Investigation of Elder Abuse at Calabasas Nursing Home

Investigation of Death Led to Allegations of Senior Abuse

In a prior blog entry, we followed the investigation into the death of Elmore Kittower, an 80 year-old resident of Silverado Senior Living in Calabasas. Kittower’s widow, Rita, was told by a woman claiming to be a nursing home employee that her husband had been beaten and suffocated by another employee at the nursing home. This led to an investigation by the Los Angeles County Sheriff’s Department and resulted in a finding that the trauma to the body was consistent with an assault.

The Los Angeles Times reported this week that the investigation of Silverado has been expanded to include the examination of the possible abuse of three other elderly residents of the nursing home. Cesar Ulloa, a former Silverado caregiver, is alleged to have abused the three other residents. Ulloa has been charged with four counts of elder abuse and one count of torture. Ulloa entered a not guilty plea, when he was arraigned in Los Angeles Superior Court.

An autopsy performed on Kittower, the resident whose death sparked the investigation, revealed that he died due to lung blood clot. However, the report also indicated that “blunt force trauma” played a role in his death. Moreover, Kittower’s body had multiple bruises and evidence of a recently partially healed rib fracture.

Another resident of Silverado that was allegedly harmed was the mother of Keith Stubbs. Stubbs was told by authorities that his mother was awakened and forced out of bed by having her chest jumped on. Stubbs’ mother had a brain condition that prevented her from being able to speak, preventing her from reporting any possible abuse.

Ulloa’s other alleged victims are two other Silverado residents, Richard McDonough and Robert Turner. Turner’s nephew, Richard Skowronek, indicates that he was told by authorities that, at the very least, his uncle was punched in his stomach.

A spokesman for Silverado, Mark Mostow, said that the company screens its potential employees, which includes background checks, and that all employees undergo an elder-abuse reporting program that the California Department of Justice conducts. Mostow indicated that Ulloa, who Silverado fired last year, seemed to have a friendly and outgoing demeanor that was well received by the families of residents of Silverado.

Stubbs indicated that he did not suspect that his mother had been abused. However, in retrospect Stubbs noted he started seeing bruises on his mother’s arms and neck even prior to Ulloa beginning work at the nursing home, and that more recently he noticed that his mother recoiled when visiting loved ones touched her, which she had not done previously.

The California Office of the Attorney General reports that between 2005 and 2006, there were 108 criminal filings and 60 convictions involving elder abuse, and 25 civil complaints filed and 22 civil judgments. A total of $4,806,652 was awarded in those years in restitution and penalties, from both criminal and civil cases.

Families of nursing home residents must be vigilant in their observations to protect their loved ones from possible abuse. The California Attorney General’s Crime and Violence Prevention Center suggests that you look for the following possible indicators of abuse:

Physical indicators

  • Unexplained bruises or welts
  • Poor skin condition or poor skin hygiene
  • Untreated medical condition
  • Cuts, pinch marks, skin tears, lacerations or puncture wounds
  • Bruises or welts in various stages of healing

Behavior Indicators

  • Confusion, withdrawal, fear, or anger

Social Indicators

  • Interaction or activity within the family is restricted or prohibited
  • Not given the opportunity to speak for him/herself or see others without the care-giver present

Financial Indicators

  • Lack of amenities - TV, personal grooming items, appropriate clothing

For further information on the warning signs of elder abuse, visit the California Attorney General’s Crime and Violence Prevention Center at www.safestate.org.

Thanks for reading my blog. If you suspect that a loved one has been a victim of nursing home abuse or neglect, contact me for immediate assistance.

Monday, September 29, 2008

Governor Schwarzenegger Signs Elder Abuse Bills into Law

California Governor Arnold Schwarzenegger signed several bills designed to protect the elderly into law this week. The new laws provide a plan for the elderly in the event of a disaster and offer greater protection for the elderly from financial elder abuse. The following is a brief synopsis of these new laws:

Two bills targeting nursing home and residential care facilities were signed this week:AB 2370 is aimed at preventing nursing homes from hiking their rates without notice. The law requires residential care facilities to annually post information regarding recent rate increases, requires the disclosure of rate increase information to new residents, and, upon request, to requires the disclosure of rate increase information to prospective residents.

AB 749 is designed to protect the elderly in the event of a disaster or major power outage. The law requires residential care facilities to have a comprehensive emergency plan by March 1, 2009 that provides that the facility will be self-reliant if necessary for at least 72 hours. The plan must be available to residents and emergency personnel.

The following bills are designed to offer greater protection from physical abuse to the elderly and their families:

AB 2100 is designed to encourage people to come forward with suspicions of elder abuse. The law requires ombudspersons at long-term care facilities to report cases of alleged or suspected physical abuse, including sexual abuse, and financial abuse to the local district attorney’s office.

AB 225 applies to restraining orders issued in elder abuse cases. The law extends the protection of a restraining order to include named family members, household members and conservators of the elder abuse victim.

The following three bills are aimed at those who run scams targeting the elderly or are engaged in financial elder abuse:

SB 1136 makes it a misdemeanor to charge an “unconscionable fee” to qualify a person for a public social service benefit, including Medi-Cal.

AB 2149 regulates the use of “expertise” designations and requires advisors to take training courses before holding themselves out as having specialized knowledge regarding the financial needs of seniors. The bill is designed to prevent the elderly from falling prey to unscrupulous financial advisors who claim to be experts on financial planning for the elderly.

SB 1140 extends the statute of limitations for a claim for damages due to financial elder abuse to four years from the plaintiff discovers, or should have discovered, the abuse. Presently, the statute of limitations on such a claim is three years. In addition, the definition of financial abuse of an elder is expanded to include the action of taking, appropriating, obtaining or retaining, real or personal property by undue influence.

Thanks for reading my blog. If you suspect that a loved one has been the victim of physical, financial or sexual elder abuse, contact me for assistance.