Nursing Home Abuse Lawyer Blog

Grant Park Care Center in Washington, D.C. is not a place to send your loved one. At least, that's what Jerry Kasunic, a Long-Term Care Ombudsman says. He frequently sees residents from Grant Park coming into the Emergency Room in critical condition. They come in with kidney problems, severe pneumonia, malnutrition and, according to Kasunic, "they've been just flat out neglected while in the nursing home". Kasunic's staff "has actually filed over 100 complaints with the Department of Health"; he says Grant Park is one of the worst he's seen and "the neglect and abuse we have seen there is unattended wound care and dehydration that has led to malnutrition".

February and May 2008 inspection reports from the D.C. Department of Health show an overabundance of deficiencies, including "nurse failed to notify physician of resident dehydration, resident with weight changes, and of anemia".

The point? The D.C. City Health Department needs to get more aggressive in their policing of nursing home facilities.

We discussed the sexual assault of a 43 year old comatose patient in our previous blog. Mark Albright, a former licensed practical nurse at the facility, pled guilty to the sexual assault and faces up to 20 years in prison when he is sentenced in March 2009. Albright was discovered with his mouth on the woman's breast when another employee entered her room.

Long Term Care of St. Petersburg faces a possible loss of their operating license. The Florida Agency for Health Care Administration has ordered the nursing home not to accept any new patients for the second time in two and a half years due to failure to meeting standards of care. The agency cited deficiencies that included patients not receiving prescribed medications and controlled substances not being properly secured. The Florida Agency for Health Care Administration has not issued a closure date, but instead has ordered the nursing home to begin patient evaluation to determine suitable facility placement for the residents. If the facility closes, it will affect 103 patients.

Derrick Webster, the acting director of the facility, says he is appealing the decision, yet no appeal of the record is on file.

We discussed Etowah Health Care Center and the abuse suffered by a resident at the hands of a facility employee in our previous blog.

On Monday, November 24, 2008, admissions to Etowah Health Care Center were suspended and the facility was slapped with fines for violation of resident rights as a result of the abuse of an elderly blind woman. The state levied a $1,500 fine against the facility and the facility faces a $3,550 per day fine until the situation is remedied from the federal government.

Joyce Stanley, former facility employee, was charged with willful and physical abuse after she hit the elderly woman with a clipboard and an incontinence pad and pulled her hair and slapped her. Stanley was fired from the facility following the investigation.

Investigators were concerned that other nurses knew of the abuse but did not report it timely. A special monitor has been appointed to review facility operations.

Blanche Fenton moved to the Cambridge Retirement Residence, a nursing home facility in Springfield, Missouri, in September 2008. Unfortunately, the eighty-eight year old woman trusted the wrong person. The wrong person? An employee of Cambridge Retirement Residence who helped her move.

Police became involved in mid-November, when Ms. Fenton's brother contacted them and reported items missing from his sister's home. Missing items included cassette tapes, a slow cooker, a tweed coat, trinkets and jewelry - valued at more than $20,000. Neighbors reported seeing a woman in a maroon car "possibly five to ten times" since September.

Two days later, neighbors called police, reporting that the woman was at the house again. Police stopped her while she was backing out of the driveway. The woman alleged that she was "a friend of Fenton, had a key to the residence, and had the right to be there". She said she was taking Ms. Fenton's winter clothes to her, but there were no clothes in the car. Police contacted Ms. Fenton, who confirmed that the woman did not have permission to take her property.

Pawn shop records indicated that three of Ms. Fenton's rings had already been pawned and the rest of Ms. Fenton's jewelry remains missing. Some of Ms. Fenton's other possessions were located at the suspect's home. The suspect in this crime could face second-degree burglary charges.

This situation could have been avoided. While facility administrators say they hired the woman in compliance with corporate standards, it seems that the employee had an outstanding warrant in Jasper County. She was booked in Jasper County and has bonded out.

The woman was fired on October 6, 2008 after the facility learned that she failed to disclose a 2002 stealing conviction in Greene County. Cambridge manager, Lisa Burdick, says that the woman was suspected of stealing money from facility residents, but it was never proven. In fact, Ms. Fenton's wallet was missing once she moved into the facility. Once the woman was fired, the thefts stopped.

We discussed the tragic abuse situation at the Good Samaritan nursing home in Albert Lea, Minnesota in our blogs of September 22, September 19, and
September 16, 2008. If you will recall, four teenage girls targeted residents suffering from Alzheimer's disease, dementia, or similar disease because "they don't have their minds". To "make work fun or to get a good laugh", the accused aides would close the curtain by the resident's bed to remain unseen and abuse the defenseless residents in a variety of ways, including spitting in a resident's mouth, groping of genitals, hitting and/or touching residents in the breast or genital area, sitting on the lap of a female resident in a wheelchair with bare buttocks, sticking fingers in mouths or noses to keep residents from screaming, and taunting them.

The teenagers will be charged within the next few days by Freeborn County Attorney Craig Nelson. The teenagers' names will be made public at that time. The Minnesota Attorney General, formerly involved in this case, will not be representing the Minnesota Department of Health in a civil appeals case tied to the Good Samaritan abuse allegation.

The teenagers have been disqualified from working at any licensed or unlicensed care facility in Minnesota. Three of the four suspects have challenged this ruling.

Mary Ann Flynn resided at Lexington Health Care Center of Streamwood in Streamwood, Illinois. She moved there in 2006 suffering from dementia, chronic obstructive pulmonary disorder, and hypertension. She should have been safe there.

On November 24, 2006, Ms. Flynn was attacked by another resident of the facility, who was known to have violent tendencies. Prior to being attacked, Ms. Flynn was threatened repeatedly by Vonda Messino - some of the threats were even made before nursing home staff. Ms. Flynn was bruised from the attack and suffered a stroke. The suit alleges that the attack led to her death.

Other allegations made in the suit were the following:

- Failure to hire adequately trained nursing to provide care to prevent residents from attacking other residents;

- Failure to transfer Ms. Flynn to a medical facility to protect her;

- Failure to protect Ms. Flynn from abuse and neglect;

- Failure to provide services with professional standards;

- Failure to timely inform Ms. Flynn's family of the attack;

- Failure to maintain records;

- Failure to provide adequate care; and

- Failure to notify family of changes in condition.

The resident initiating the attack, Vonda Messino, has also been named in the suit.

We discussed the charges of abuse and neglect at Key West Convalescent Center in our previous blog. The Key West facility faces closure on December 11, 2008 and its 78 residents are being pressured to find a home. The facility was notified that it lost its Medicare and Medicaid funding on November 7 due to nearly four years of continues poor surveys for patient care, safety, and administration. The facility has been on a "special focus facility" list since January 2005. While most facilities are given 18 to 24 months to improve, this facility was given 46 months to improve. Unfortunately, it has shown little improvement.

The most recent survey produced a 179 page report that cited instances of abuse as well as safety and administrative violations. Included in the allegations of abuse was the accusation of a 39 year old AIDS patient who was treated roughly by facility employees while being cleaned. He asked them to stop, but they refused.

It may be for the best that the facility is closing. Steve Torrence formerly served on a community board that dealt with the facility and his mother-in-law was a resident there. He said that "the fault of all this is the nursing home owners. They have done little until recently to put money back into the nursing home. Too little, too late. They failed the residents." Torrence said that for years the owners failed to upgrade or fix dilapidated equipment, beds, and wheelchairs.

Amanda Thaler, a Certified Nurse Assistant, and and Sheldon Stoddard, a Dietary Technician, have been arrested for their roles in the theft of an 89 year old nursing home resident's engagement and family rings.

Thaler, charged with petty larceny, took two rings belonging to the resident on October 6, 2008. The engagement ring, given to the resident in 1940 by her husband, and the family ring were both loose on the resident's hand. Thaler offered to have them "fixed" so they would not fall off the resident's hand and took them. Approximately half an hour later, the resident requested the return of the rings, a request that Thaler ignored. Later on, the resident called out to Thaler in the facility dining room and asked her to return the rings. Thaler returned the family ring, keeping the engagement ring. When pushed to return the engagement ring, Thaler responded that she felt ill and needed to leave.

Thaler caller her boyfriend, Stoddard, and asked him to pick her up at the facility. She gave him the ring and they went together to a pawn shop and pawned the ring for $15. Stoddard has been charged with criminal possession.

The ring was recovered and is being held as evidence.

Meadowlawn Health Care Center of Davenport, an Iowa nursing home that is now closed, has been sued for a second time since it closed in late 2007.

Harold Edwards resided at the facility from November 2006 through March 2007. He was discharged from the facility and dropped off at an unfurnished apartment with only $30 to his name and a four day supply of medication. Nine days later, he was hospitalized with congestive heart failure. His hospitalization resulted in the installation of a cardiac defibrillator.
His lawsuit against Petersen Health Care, the owners of the defunct facility, accuses the facility of wrongful discharge, breach of contract, dependent adult abuse, failure to properly administer medications, insufficient staff, and inappropriate behavior when he complained about the care he received. He also is alleging emotional distress after seeing other residents harmed.

Trina Curtis also sued Petersen Health Care on behalf of her deceased mother, Janet Martin. That lawsuit alleges that staff failed to properly manage Ms. Martin's wounds and refer her to appropriate medical care. Ms. Martin developed "uncontrolled health issues", which included life-threatening medical complications from her wounds and improper diet and hydration. She died on January 24, 2006, a mere three weeks after leaving Meadowlawn.

Meadowlawn Health Care Center of Davenport closed in September 2007 after its Medicare and Medicaid funding were revoked and its license was in jeopardy. It had received several fines in the past, including a $12,000 fine for moving residents out with little or no notice as the facility was closing.

We discussed Glenwood Resource Center's inability to provide quality care for its residents in previous blogs. Glenwood was hit with its third - and largest - fine this year in the amount of $27,500. The fine would have been significantly less except that Iowa triples fines for serious offense violations. In this instance, the State of Iowa found that the facility provided inadequate nursing care by failing to provide physician-ordered services.

This time, the facility failed to provide a resident with physician-ordered oxygen. This incident involved two different shifts and two different nurses. Inspectors discovered that neither nurse noticed that a patient's oxygen tank was turned off for four and a half hours.

Four weeks later, the same resident was found in bed, pointing to his/her chest. The resident's fingers were blue. The patient's oxygen line was disconnected. The nurse suctioned the resident's airway and reconnected the oxygen. This same resident had been hospitalized in the past year for a collapsed lung and bowel obstruction.

The spokesperson for the Iowa Department of Human Services said that "caretaker mistakes are not acceptable".

Glenwood was fined in April 2008 after a nurse failed to take action in response to respiratory distress, which resulted in a resident death. The facility was also fined in August 2008 for hundreds of medication errors and other problems.

Santa Rosa Care Center, a nursing home located in Tucson, Arizona, was hit with a $17,500 fine from the state in response to more than twenty-four violations discovered in an April 2008 investigation. The facility also paid a $7,000 federal fine and had its Medicare payments suspended until corrections were made to prevent "substandard quality of care".

The violations included:

- A "do not resuscitate" (DNR) order was improperly documented.

- A resident who fell was given Tylenol for ankle pain, even though the resident equated the pain as an "8" on a "10" point scale; the resident was diagnosed with a fractured ankle nearly a week after the fall.

- A resident suffering from dementia with a history of "sexually inappropriate behaviors" was discovered exhibiting such behavior and the victim's physician and family were not notified.

- A staff member said that if residents don't object or resist, staff considers sexual activity to be consensual even if the resident's ability to consent was not assessed.

- Residents and visitors to the facility complained of urine odors.

- A resident suffered a seizure and fell to the floor and was unconscious for approximately ten minutes. The resident's condition deteriorated and he became confused and needed assistance with walking and eating. The resident's medical provider was notified for ten days and it was later determined that the resident had suffered interacranial bleeding as result of the fall.

Santa Rosa Health Care Center is no stranger to violations of care. In fact, according to an article by the Arizona Daily Star, it ranks second for complaints on how the staff treats residents and has more abuse/neglect citations than any other Tucson nursing home.

An early 2006 inspection revealed that multiple residents were afraid of the staff. One aide pointed his middle finger at a resident and pretended that he would poke the resident in the eye. A male nurse would twist resident's arms and put residents in chokeholds or headlocks. One resident began to cry and shake while describing a scene that occurred in the facility's dining room. A man refused to take off his hat while eating. A nurse knocked the hat off of the resident's head. He stood up to leave the table and a staff member twisted the man's arm behind his back to force him to sit down again.

Other employees at the facility acknowledged to inspectors that they knew of the abuse but were afraid of retaliation. They stated that nurses were in such demand that a nurse told them that the administrator would not believe a lower-level employee.

The facility also received two more citations for harming residents in 2006. In one incident, a resident did not receive her anti-anxiety medications for two months, even though staff documented chronic episodes of yelling, cursing, removing clothing, and pacing. In the second incident, the facility was cited for not creating a Care Plan to keep a resident who had a history of falls safe. This resident, who entered the facility with a history of falls, broke an ankle after a fall in March. She fell again in September in the shower and bruised her hand and tore her skin. She was sent to the emergency room four days later with bleeding and bruising. She fell six more times during the first two weeks of October.

George King, Sr. was a resident of Heartland of Charleston Nursing Home in Charleston, West Virginia. Mr. King, 73, as an Alzheimer's patient suffering from dementia and required assistance daily. He was reported missing on October 25, 2008. Police found his body on October 26, 2008 near train tracks. He had been hit and killed by a CSX train.

His family has filed a wrongful death lawsuit alleging that Heartland of Charleston failed to properly monitor Mr. King. The suit alleges that "George King Sr. could not care for himself or be allowed to walk outside the facility and the staff of the facility at Heartland of Charleston was aware of this fact". The suit also alleges that facility workers failed to follow protocols for missing residents, failed to adequately supervise Mr. King, searched for him in the wrong area (because he was confused with another resident who had left the facility on a prior date), and and failed to utilize all available resources to locate him.

Whispering Pines Nursing Center has been in the public eye lately. You might recall that we previously blogged about this facility when resident Carol Crow was assaulted. On July 11, 2008, Carol Crow was found with two black eyes and covered with bruises on her face, neck, and shoulders. Nursing home staff told Mrs. Crow's family that she had fallen in her room, but Mrs. Crow told her family an entirely different story. Mrs. Crow reported that a man knocked her down, got on top of her, and beat her until she was unconscious. While Mrs. Crow does have early onset Alzheimer's disease, she was very clear about what happened to her.

The facility reported the incident to DHS, but officials from the Long Term Care Investigations Unit did not open an investigation. A complaint about the assault triggered an investigation by officials from the Oklahoma Health Department. The investigation revealed sixteen serious deficiencies, two of which were failing to fully investigate abuse allegations and endangering patients' health.

The Health Department is recommending that the facility not be allowed to accept any new Medicare and Medicaid patients until the deficiencies are corrected. If the facility is not in compliance within six months, Medicare and Medicaid payments could be halted. Federal regulators are being asked to fine the facility $3,000 per day until the deficiencies are corrected.

The new Administrator of Whispering Pines, Sue Horton, has only been on the job for three weeks and has yet to read the 370 page report about these serious deficiencies.

Ruby Meyers, 93, became a resident of Blossom South Nursing Home and Rehabilitation in 2005, when she fractured her right leg and was placed in a leg brace. Pressure sores developed under the leg brace that were not properly treated by the facility and became infected. Ruby Myers' leg was amputated in December 2007.

Ms. Myers died on November 15, 2008 at Protestant Episcopal Church Home. Her family has filed a lawsuit against Blossom South alleging improper treatment of the fracture. Now, wrongful death is being considered as an addition to the lawsuit.

Blossom South Nursing Home and Rehabilitation, located in Rochester, New York, has a long record of penalties for violating patient care standards. In this instance, they were hit with a $2,000 fine - the maximum amount the health department can levy against the facility for each violation of state and federal regulations. The facility was also penalized for an April 2008 inspection in which it was determined that the facility had not corrected previously identified problems. The facility has been cut off from new Medicare and Medicaid admissions until all identified problems are rectified, the staff undergoes retraining, and the administrators file a plan of correction. The state has also recommended that the federal government levy heavier fines against the facility.

The Crossings, a nursing home facility located in Minoa, New York, was hit with a $13,300 fine from The Centers for Medicare and Medicaid for substandard quality of care.

On October 15, 2007, an elderly 89 year old resident was served blueberry pancakes and sausage for dinner. A nurse's aide cut the meal into bite-sized pieces for the resident. Shortly thereafter, the aide noticed the woman's mouth was open, she was not breathing, and her lips were blue. The aide failed to call a "code blue", which is an announcement that alerts facility staff to the emergency and calls them to assist. It also is designed to activate the 911 system. Tragically, the aide also did not begin the Heimlich maneuver. An LPN who arrived at the scene did not perform either of the procedural steps. The registered nurse supervisor who came to assist also did not immediately call a "code blue" or 911.

The woman was subsequently taken to a hospital, where she died. An ensuing investigation revealed that the staff had not been properly trained on "code blue" drills, which put all residents in immediate jeopardy and placed the residents in harm's way.

On September 11, 2002, at patient from Pavilion of Forest Park was transported via ambulance to the emergency room, where hospital staff discovered a large area of decubitus ulcers. The patient, Shirley Massey, 48, subsequently died from her wounds.

In September 2005, a Cook County Grand Jury indicted companies, Forest Park, L.L.C. and Care Centers, Inc., doing business as The Pavilion of Forest Park and Jason Garti, the facility's former medical director and wound care doctor with multiple charges of gross neglect that led to Ms. Massey's death.

On November 18, 2008, the corporate owner of the nursing home plead guilty to the charges and was ordered to pay a $25,000 fine and $75,000 in investigation and court costs.

The nursing home was sold to another company in July 2007.

Kurt Johnson, 49, faces three counts of second-degree sexual assault for fondling three patients. Johnson worked at Golden Living Center - Wisconsin Dells as a nursing home worker. In 2007, three co-workers reported seeing him fondle three patients' breasts between September and December 2007. Two of the assaulted patients were patients in the Alzheimer's unit.

Johnson faces up to 120 years in prison and a $300,000 fine.

Liberty Nursing Center in Toledo, Ohio was cited in an April 2008 state report as placing its residents in an "immediate jeopardy" situation.

Ralph Kasczmerak was a resident of Liberty Nursing Center for two years following a stroke. He went there for rehab but says he "spent two years of hell dealing with Liberty Nursing Center". Every time he asked for something, the staff made him feel as though he was creating problems for them. Worse yet, when an employee stole his pain medication. The facility had hired an employee knowing he had lost his nursing license and instead of investigating where the missing medication had gone, the facility chose to blame their resident. Kasczmerak was accused of selling his own pain medication!

Worse things were discovered in an inspection. Residents with mental illnesses were allowed to beat, bite, and push on each other, as well as other residents. The facility never reported this abuse to the State.

When the facility Administrator Carla Brumby was questioned why she allowed the abuse to go on, she said that her staff minimized the injuries appropriately. She also defended her decision to hire an individual whose nursing license had been revoked by stating, "I try not to judge people based on their past. I try to look to the future."

Friendship Manor, a nursing home facility in Grinnell, Iowa, was hit recently with one of the largest fines ever imposed against an Iowa nursing home - $112,650.00. The history of events leading up to the levy of the fine is tragic.

Ruth Louden was an active 89 year old woman, who lived alone in an apartment in Grinnell, Iowa. She still drove herself and had recently returned from a trip to California, where she traveled by herself to visit with her daughter. Unfortunately, on February 16, 2008, she fell at home, injuring her left ankle. The injury? A minor bone fracture. While any injury would be serious for a woman of her age, Ruth's injury was relatively minor and did not even require a cast. Instead, doctors put her leg in a medical stocking and a brace and sent her to Friendship manor for short-term therapy. Friendship Manor was where things began going wrong.

The staff at Friendship Manor had written orders to monitor the circulation in Ruth's leg and to check her skin every shift for signs of redness or swelling. Ruth complained to facility staff of "horrible" and "excruciating" pain for the next four weeks. The staff provided Ruth with pain medication but never pulled back her stocking to examine her leg and never evaluated the cause of the pain.

On March 20 - a month after Ruth's fall - a physical therapy aide noticed that Ruth's leg smelled like "rotting meat". Blood was seeping through the stocking. Ruth was taken to the hospital and physicians there found that the wound dressing that had been put on a month earlier looked like it had never been touched. Ruth was diagnosed with gangrene and doctors wanted to amputate her leg. It was her leg or her life. Ruth's leg was amputated below her knee, however, she died on June 24, 2008.

Iowa's Department of Inspections and Appeals investigated and found that during Ruth's stay at Friendship Manor - 25 days - no one ever removed her stocking to check her leg and no physician ever examined her. Sadly, Ruth's doctors told state inspectors that Ruth's bone fracture was nearly "nonexistent" and that her amputation was avoidable. The owners of the facility were fined $4,050 for each day of Ruth's stay at the facility and, due to other problems, a $150 per day fine was imposed for 76 days that the facility failed to correct identified problems.

Friendship Manor is no stranger to serious problems. In May 2007, the facility lost its Medicaid funding and it was fined $2,500 after a resident was injured in a fall. In February 2008, the facility was slapped with a $350 fine for failing to provide rehabilitation services to residents due to short staffing.

Friendship Manor is owned and managed by two for-profit South Dakota companies. Their president is Tim Boyle. Boyle, a real estate developer, has appealed the fine arguing that the facility was under doctors' orders to keep the stocking on Ms. Louden's leg. Doctors informed state inspectors that facility staff would be expected to understand that temporary removal of the stocking would be necessary to examine the leg.

Interestingly, Boyle is the board president of The Iowa Healthcare Association and is using his position to tell legislators that the Iowa Department of Inspections and Appeals is "too aggressive in its enforcement of health and safety regulations". He has prepared written presentations for legislators and using his position as board president, is stating that the "inspections department is flogging nursing homes and blocking seniors' access to health care, in part by imposing huge fines against the owners and prohibiting new admissions until care problems are addressed". The executive director of The Iowa Healthcare Association, Steve Ackerson, is using the incident involving Friendship Manor as part of the pitch to Iowa legislators - while omitting Friendship Manor's alleged negligence that triggered the record-breaking fine.

Friendship Manor is claiming financial hardship stating that "this fine threatens the existence of the facility", but has failed to provide any financial information to back up that claim.

Key West Convalescent Center faces possible closure after recent investigations from the Department of Health and Human Services and the Florida Agency for Health Care Administration (AHCA) resulted in Medicare and Medicaid pulling the facility's funding, effective December 11, 2008.

The investigative team had nine inspectors from Tallahassee, Miami, and Fort Myers. One incident of abuse involved a 39 year old HIV patient, who reported to surveyors that he had been hurt by two nursing assistants while being washed. The AHCA representatives reviewed the incident, confirmed that it represented abuse, and noted that the incident was improperly documented. The report read "this system failure jeopardized all the residents in the facility." The patient's condition is such that he is provided morphine twice a day and Lortab as needed. Both are very strong painkillers. The facility Administrator, Mark Hunter, said the patient had several large, open sores on his body and was covered with fecal matter. "You've got to keep them clean. That's a fine line between abuse and neglect..."

Mark Hunter, the facility Administrator, said of the investigation, "It sure felt like they were down here to shut us down. They were pretty much on an agenda." He said, "The only hope that we have right now is to hand this building to another operator."

The facility closure will affect 80 residents, most of whom are life long residents of Key West, Florida. The nearest convalescent center is twenty miles away on Plantation Key and only has approximately 20 beds available.

We discussed Oklahoma's abuse reporting requirements in a previous blog.

Wes Bledsoe and A Perfect Cause have been working to increase accountability at state-regulated nursing homes. It seems that Oklahoma is listening.

As of July 2008, the Oklahoma Health Department requires that nursing home employees call law enforcement if any criminal activity is suspected. The new requirements will make sure that abuse is documented and those committing criminal acts will be held responsible.

Henry Hartsell of Oklahoma Protective Health Services says, "It is a self-reporting requirement...but there's a facility license that's potentially at jeopardy if the facility fails to report as required." Doctors, nurses, and other licensed workers are also at risk for having their licenses suspended or revoked for failure to report.

We discussed the tragic accident that ended Sister Mary Murray's life in a previous blog. On August 31, 2008, Sister Mary was found in her room "conscious but bleeding profusely from her forehead, face, and left eye" after an unbolted closet had fallen on her head. The wardrobe was still on top of her. The nun, who suffered from dementia and heart disease, was taken to Good Samaritan Hospital and then transferred to Westchester Medical Center, where she died.

Sister Mary's family was led to believe that it was a horrible accident until an Eyewitness News investigation revealed the cover up of previous accidents involving the closets. Two other individuals were previously injured in two separate incidents after the closets fell off the wall due to the facility's negligence in failing to bolt the facility's 300 closets to the wall. These incidents were not reported to the health department and Sister Mary's family was not told of the them. Ironically, after other individuals were injured, still no one bolted the closets to the wall. Daniel Murray, Sister Mary's guardian, said, "It went beyond negligence. It was more of a callous disregard of the safety of the most vulnerable among us, the elderly and the infirmed."

No one at Summit Park has been disciplined, although the State Department of Health fined the facility $17,000 due to "immediate jeopardy to resident health and safety". When Eyewitness News Investigator asked the Administrator of Summit Park Nursing Home why it took the death of Sister Mary to get the closets bolted down, the Administrator refused to answer.

The Rockland County District Attorney's Office has handed the case over to the attorney general for review.

The Kansas District Attorney is watching out for our elderly. Rather, she is watching those who are "watching" our elderly. Citing a noted increase of "fiduciary abuse and exploitation", the Financial Abuse Specialist Team (FAST) was formed in October 2008. In fact, since July 1, 2008, 107 reports of suspected abuse have been reported and it is expected that number will climb significantly.

The Goal of FAST is to go after criminals and warn people through education about potential scams. FAST relies on the assistance of volunteers, such as bank tellers, postal employees, federal agents, and mental health specialists, as well as the Kansas Department of Social and Rehabilitation Services employees. These volunteers watch for elderly people doing things out of their normal routine, such as coming into banks regularly to make withdrawals with the assistance of a non-relative who does all of the talking or making unexplained withdrawals from savings accounts. These are signs that the elderly person may be taken advantage of. The scam artists find their prey by first working the telephones to locate vulnerable elderly people.

A financial crimes investigative team compiles the evidence and prosecutes the crimes. One such prosecution was the case of Mildred Patterson. In early 2004, Ray Patterson, Mrs. Patterson's son who lives in California, began to suspect that her caregiver, John Hartley, was taking money from his mother. Patterson alerted the authorities, but there was nothing in place at the district attorney's office at that time to prosecute a quick investigation. John Hartley was arrested in January 2008. Foulston's office estimates that he had taken as much as $67,000 from Mrs. Patterson through the use of her credit cards and taking items from her. He pled guilty and is currently on probation.

Kansas residents can contact FAST via email at FAST@sedgwick.gov.

Nelson Nursing Home in Fairfield, Iowa was a thirty-three year veteran in the nursing home industry. The facility closed recently and has relocated its forty-four residents.

In August 2008, an inspection of the facility revealed that many of the facility's window air conditioning units in the residents' rooms did not work. In fact, the inspection found that air conditioners in sixteen of the thirty-two rooms showed "significant and visible mold growth". The home had broken toilets, the units were dirty and poorly maintained, and there was evidence of "mold spores everywhere". Employees were also being paid approximately two weeks behind. A physician provided the State of Iowa with a written statement in which he said it was "appropriate" that the residents be placed elsewhere.

The facility faced a $5,000 state fine due to the mold problem.

The facility also faced significant problems in 2007. It was fined $11,500 for a series of alleged incidents involving inadequate care and/or supervision for a resident's broken arm, a second resident's broken ankle, a serious head injury sustained by a third resident, and a hip fracture sustained by a fourth resident.

Eric Larrabee, a former nursing home worker at Skaalen Sunset Home in Stoughton, Wisconsin, was charged with patient abuse on November 10, 2008. Larrabee is accused of slapping an 85 year old hospice patient only ten days before she died on February 20, 2008 at Skaalen Sunset Home. Allegedly, another worker at the facility heard Larrabee yell at the woman to be quiet before seeing him slap her with his open hand. Larrabee admitted that he struck the resident due to frustration but maintains that he only tapped her face.

Larrabee is due in court on November 24, 2008.

Why are U.S. nursing homes eligible for bonuses despite violations? Thirty-six states have eighty-one bonus programs for quality-of-care. These bonuses are taxpayer funded and are approved by the Centers for Medicare and Medicaid Services - the same watchdog that investigates and cites facilities for federal and state regulation violations. Interestingly, a nursing home facility can receive these bonuses despite receiving violations for health and safety standards.

The Des Moines Register reviewed eight bonus programs in seven states. These states do not disqualify a facility from receiving a bonus that is directly related to quality of care if it has received violations for state or federal regulations. A prime example is Grace Living Center in Norman, Oklahoma. This facility received nearly $96,000 in bonuses in the past year and apparently is considered a "five-star" nursing home by the State of Oklahoma. Ironically, federal records show that the facility has been cited for more violations than is the state and national average. Additionally, Medicare ranks the facility as below average on eleven of the nineteen national quality measures. A Eufaula, Oklahoma nursing home scored zero on a scale of one to five for compliance with federal and state regulations, but Oklahoma's Focus on Excellence program awarded the owners with a $50,000 bonus after the program gave the facility "three stars".

The Register also reported that sixteeen of twenty-three Iowa facilities that received major fines last year qualified for bonuses from Iowa's Medicare-Medicaid program. Two of the facilities were on the federal list of the nation's worst nursing homes and a third facility had been threatened with loss of license for substandard care. Iowa officials have since begun revising the program. Today, homes that have caused "actual harm" to residents are to receive smaller bonuses and homes that have put residents in "immediate jeopardy" of death or injury are ineligible for bonuses.

The Iowa Department of Human Services tried to do away with the bonus program last year. They felt that the state should not pay nursing homes additional funds to do what is expected of them. The bonuses will continue at least through June 2009.

The Centers for Medicare and Medicaid said that the law does not require that Medicaid-funded bonuses be linked to quality of care and therefore, the agency cannot require it.

Epifania Fitzgerald was in charge of caring for twenty-one assisted living patients in Pinellas County, Florida. Instead, she put one of her patients in charge and left the facility, returning two and a half hours later. She was met by Pinellas County deputies who had been called to the facility by a 911 call placed by another resident after an 88 year old woman had slipped and fallen in the bathroom.

Fitzgerald has been charged with one count of abuse and neglect of the elderly and one count of possession of Vicodin. She remained in jail on November 1, 2008 with a bond of $12,000. Authorities will not identify the facility involved.

Joyce Stanley, a certified nursing assistant at Etowah Health Care Center in Etowah, Tennessee, was arrested November 5, 2008 and is being held in lieu of $20,000 bond. She faces charges of willful and physical abuse after hitting a seventy-four year old blind woman with a clipboard and an incontinence pad. Ms. Stanley also felt the need to slap the victim and pull her hair. Fortunately, the nursing home resident was not seriously injured. The victim and four workers at the nursing home reported Stanley.

Stanley has been suspended by the facility. She has been a certified nursing assistant since 2002 and is not listed on Tennessee's Abuse Registry, which tracks offenses. Citing a "continued pattern of behavior", a police spokesman maintained that the charges were warranted.

JOYCE STANLEY PHOTO

A string of errors led to the filing of a lawsuit on October 31, 2008 against the Health Center at Standifer Place in the tragic death of Robert Young. That suit seeks damages for wrongful death, mental anguish, and pain and suffering. A similar lawsuit was filed on November 3, 2008 against the Tennessee Department of Human Services and social worker Vickey Frierson, the individual handling Mr. Young's case for the "negligence" shown by the Department after Mr. Young's death

Robert A. Young, a 33 year old man suffering from cerebral palsy, was a resident at the Health Center at Standifer Place, a Chattanooga, Tennessee nursing home. He was believed to have suffered a seizure and fell, fracturing his skull. He was taken to Erlanger Hospital and died a week later on November 12, 2007. Due to the explanation of how Mr. Young's injuries were sustained, the Hamilton County Medical Examiner's Office did not perform an autopsy. Erlanger Hospital repeatedly tried to locate Mr. Young's family through Adult Protective Services, but Adult Protective Services failed to respond. Instead, the agency made arrangements for Mr. Young's burial in a pauper's grave in Ruth Cofer Cemetery.

Mr. Young's family, completely unaware of his injury and subsequent death, was not told of his death for more than a month. Each time someone called the facility to check on him, "Standifer Place told each person, on each call, that Mr. Young was OK, and to come see him". When family members finally found out about Mr. Young's death, they began pushing for answers. Allegedly, Vickey Frierson, Mr. Young's caseworker, callously asked, "What do you want me to do about it?"

The family continued to press for answers and asked Dr. Frank King to review Mr. Young's medical records. Dr. King recommended exhumation of the body after he could not find any documentation of seizure or any other incident that would have led to the skull fracture contained in those records. The court-ordered exhumation of Mr. Young's body occurred in May 2008 and the Medical Examiner determined that Mr. Young died of "blunt force trauma" to the head. A homicide investigation into Mr. Young's injuries and the circumstances surrounding the incident is ongoing.

Christian Health Care: Springfield East has been cited with Missouri's most severe noncompliance citation after an investigation into the February 17 death of a resident revealed glaring deficiencies in the care of the deceased resident, as well as other residents.

The deceased resident bgan vomiting a dark foul-smelling substance during the night on February 16, 2008 and continued to be sick through the night. The resident complained of being sick and asked to be transferred from the bed to a wheelchair. At first, the resident's requests were denied, but eventually the resident was assisted into a sitting position in bed. After that, "the resident began to make gurgling sounds as if his/her lungs were filled with fluid". The resident died shortly after 7:00 a.m. on February 17, 2008.

The facility failed to notify the on call physician of the situation and a doctor at the facility who was not on call that weeked said "he would expect staff to notify him if a resident had dark, foul smelling (vomit)". Christian Health Care was also cited for failing to adequately report changes in vital signs and failing "to provide appropriate nursing interventions to address the change in condition" of the deceased resident.

Other deficiencies cited were giving inconsistent insulin dosage to one patient and failing to obtain a urinalysis on a patient who might have had a urinary tract infection.

The facility's ability to receive Medicaid and Medicare payments was revoked in March 2008 and the facility had 23 days to fix serious deficiencies. The facility came into compliance and sanctions were removed on April 15, 2008.

To learn more about what you can do to combat nursing home abuse and neglect, visit our website at www.nursinghomejustice.com .

We had discussed the class action lawsuit filed in Seattle, Washington on our previous blog. Now, a second class action lawsuit has been filed, this time in Minnesota involving eight Extendicare homes.

Laura Bernstein lives at the Texas Terrace Nursing Home in St. Louis Park, Minnesota. She filed a federal lawsuit on Thursday, October 30, 2008 against Extendicare alleging consumer fraud. The suit represents at least 1,400 residents in the eight Extendicare homes involved. Ms. Bernstein says that Extendicare promises more than it delivers, resulting in poor resident care and hundreds of rule violations, all while the corporations involved in the nursing home continue to earn money. State inspectors have cited the involved homes for 218 violations in the past two years, which is far above the state average of ten per year. The suite alleges that Extendicare lured clients with promises of care it could not provide and that Extendicare sought out "high-need" residents in order to increase profit. Generally, nursing homes are paid more for residents with greater medical needs.

The Minnesota class-action suit seeks restitution of approximately 40% of private pay fees, a change in Extendicare policies, and a court-appointed monitor to ensure Extendicare complies.

Amy Wiffler, the Director of Operations for Extendicare in Minnesota said, "I'm in these sites every day and I know first-hand the good things we're doing for residents in those buildings."

Rehabilitation Center of Independence in Independence, Missouri and Two Rivers Psychiatric Hospital in Kansas City, Missouri have both obtained temporary restraining orders after the State of Missouri found significant deficiencies at both facilities and recommended that Medicare and Medicaid funding be terminated at both facilities until they are in compliance with state and federal regulations.

The Rehabilitation Center indicated that the majority of its citations were related to paperwork and one had to do with giving medication to a resident. Concerning the medication issue, the facility spokeswoman said, "Regarding this particular issue, we believe that the medication was appropriately administered, but that there is a respectful and legitimate difference in the interpretation of the nursing notes documenting the administration of the medication". Of the facility's 86 residents, there are only 14 private pay residents. Many residents have been long-term residents and almost all are confused, suffer from dementia, or have psychiatric disabilities.

The Two Rivers Center was cited for failure to follow policies for patients at high risk for falls and a patient suicide. That case has been sent to mediation and the facility currently remains open.

Julie Brookhart, spokeswoman for the Centers of Medicare and Medicaid, stated that surveyors typically find six or seven deficiencies "every time they go in" to a Missouri nursing home and "if the facility doesn't respond in a certain amount of time, then they are put on the termination track but for the most part, they come into compliance and they are not terminated".

We have had multiple blogs concerning The Terrace and Westside Health Care Center and the deplorable conditions the residents endured at these facilities.

Abe Fischer, the owner of both The Terrace and Westside Health Care Center, has appealed the State of Ohio's decision to close The Terrace, the remaining facility, on November 20, 2008. A judge has set the appeal hearing for November 25, 2008 and the facility will be allowed to remain open until the appeal is heard and decided.

While Fischer has made the corrections, the City is concerned that he will be unable to keep the facility up to standard. Currently, the remaining facility has approximately 30 residents and 17 employees.

Medford Multicare Center is in the news again. We had discussed the tragic abuse the residents were suffering in previous blogs.

Now, four more workers have been caught mistreating patients and falsifying records, two of whom were caught on hidden camera. CNA Marie Pierre, charged using evidence obtained through a hidden camera, is accused of failing to turn an 84 year old man to prevent painful bed sores or to change his briefs as necessary. LPN Janet Coleman, also charged using evidence obtained through a hidden camera, did not clean a patient's gastrotomy tube or treat his ears from chafing from oxygen tubes. LPN Kim Purdum, while completing physician's orders for a patient with chronic pulmonary disease, failed to include a doctor's order for daily blood tests to monitor Coumadin dosage. When the patient later suffered internal bleeding and was hospitalized, she changed the records to include the doctor's order. CNA Paulette George was arrested following an investigation of a family complaint. She was responsible for showering a resident twice a week, but instead gave bed baths for a month. All involved were charged with multiple counts of endangering the welfare of disabled persons and falsifying records. They all pled not guilty and were released without bail.

The Department of Health has cited the facility for deficient care at almost twice the state average. Concerning this facility, Attorney General Andrew Cuomo has stated, "Let me be clear that this is an ongoing, expanding investigation".