Nursing Home Abuse Lawyer Blog

Illinois Governor Pat Quinn signed Senate Bill 326 into law at 2:00 p.m. today. The new legislation is designed to improve the quality of life in nearly 800 nursing homes in Illinois.

Among other things, the new legislation will require nursing home owners to hire more staff members to care for residents, the number of nursing home inspectors will nearly double by 2013, and hospitals would have to initiate criminal background checks prior to transferring patients into nursing homes.

A July 25, 2010 fire at a Missouri retirement home claimed the lives of two residents and injured five others.

Firefighters responded to a call at the Danford Hall Apartments in St. Joseph, Missouri on Sunday evening. The fire began in the southeast section of the second floor and raced down the hallway of the facility, which is home to more than 40 residents in 38 apartments.

The five injured residents suffered from injuries ranging from smoke inhalation to minor burns. The deceased residents were identified as eighty-nine year old Ellis Stephens and his eighty-six year old wife, Iris Stephens.

The cause of the fire remains under investigation.

Connie Jean Beckerman, a former bookkeeper at Perry Oaks Nursing and Rehabilitation Center in Perryville, Missouri has pleaded guilty to stealing from the facility's residents.

Beckerman reportedly stole more than $14,500 between September 2006 and October 2007 by forging the nursing home administrator's signature on checks written for cash. Most of Beckerman's victims were Medicaid residents at the facility.

Beckerman pleaded guilty to one count each of forgery, stealing by deceit, and abuse of a person receiving health care funds by taking the funds. Her sentencing is set for August 13, 2010.

A surprise inspection yesterday at an Illinois nursing home yielded an unusual find: a Missouri fugitive.

Illinois Attorney General Lisa Madigan, accompanied by St. Clair County Sheriff Mearl Justus, Illinois State Police officials, officials from the Illinois Department of Public Health, the Illinois Department on Aging, and the Illinois Department of Professional Regulation, made the unannounced inspection at Virgil Calvert Nursing & Rehabilitation Center in East St. Louis, Illinois on Thursday, June 24, 2010 around 10:00 a.m. The facility experienced problems earlier this year with health and safety issues.

During a review of resident backgrounds at the facility, investigators uncovered that resident Rothford Darden, 61, was wanted on an active Missouri drug warrant. Darden was taken into custody by St. Clair County Sheriff's Deputies. According to Attorney General spokeswoman Cara Smith, "He knew he was wanted. He seemed perfectly able-bodied. These nursing homes have been turning out to be the perfect place for hiding out. We've found wanted people in every one" (that has been checked so far). According to Madigan's office, in the twelve facilities inspected to date, 61 people under active warrants were living in the facilities and 17 arrests were made immediately at the facilities.

By law, nursing homes are required to perform background checks on their residents and staff and make arrangements if housing residents with criminal histories, such as sexual offenders and others who could harm fellow residents.

In the fifth of our series on 6 common causes of bed sores, Chicago attorney Jonathan Rosenfeld focuses his attention on turning and repositioning. If a nursing home resident or hospital patient is prone to the development of bed sores, that patient must be turned and repositioned regularly. Jonathan addresses that issue in detail today on his nursing home abuse blog. To read his important entry, go here.

After a lengthy investigation, the Missouri Department of Health and Senior Services (DHSS) uncovered serious violations after investigating allegations of physical, sexual, and verbal abuse of residents at K. F. Jammer Manor, a Missouri veterans' nursing home located in University City.

The DHSS began investigating the facility in April 2010. According to a recently released 21-page report, one resident made two allegations of rape, but facility staff failed to call police or call the hotline, as required by law. The resident affected called 911 and reported the incidents. The same resident alleged that she and a facility housekeeper were involved in a sexual relationship. According to the report, "During an interview the Director of Nursing said the resident alleged he/she had a sexual relationship with Housekeeper #1. Due to the resident's allegations, staff moved the housekeeper to the facility's other location. The Director of Nursing did not report any allegation of rape or a sexual relationship because, according to the report, she did not believe they happened.

In another instance, a staff member sent a text message to another staff member about a manger who reportedly gave a resident $3.00 in exchange for oral sex. According to the Director of Nursing, she did not tell anyone about the message, talk to the resident, investigate the alleged message, or do anything related to the message.

The same investigation found that facility staff failed to protect two residents who were spit on, had hair pulled, had water thrown on them, and were constantly called racially charged names or degrading names.

The Veterans Administration (VA) began moving its 36 residents from the facility back in April 2010, when the allegations were first reported. Currently, there are two residents remaining at the facility. The VA assisted its residents in finding other facilities. Of the two residents remaining, one resident desired to stay, but now that resident's legal guardian has requested a move to a different facility. The second resident is in the process of relocation.

The University City Police are investigating the allegations of rape. The Director of Nursing is no longer employed at the facility.

This is part 4 of a series Jonathan Rosenfeld and I are doing regarding 6 common causes of bed sores in nursing home and hospital patients. Today, we are discussing contractures.

What are contractures? People who are physically inactive for long periods of time are at risk for developing contractures. Obviously, many nursing home residents suffer from inactivity due to mental infirmities or physical limitations. As a direct result of physical inactivity and the failure to regularly move a limb or joint through its full range of motion, muscle fibers begin to break down and joints begin to stiffen, which can lead to the affected limb slowly pulling toward the body and becoming rigid. It is not uncommon to see nursing home residents with contracted hands, arms, or legs, oftentimes leaving them in the "fetal position" making it very difficult to give them the care they require.

Are contractures preventable? Contractures are very painful and the process of restoring a person's range of motion can be excruciating. Consequently, prevention is substantially better than restoration. Sadly, many nursing home residents who suffer from contractions do so because some nursing home facilities lack a sufficient number of staff members or the staff members fail to provide the proper preventive measures. To prevent contractures, the nursing staff should properly assess the resident's risk for contractures and implement an individualized care plan. The purpose of the care plan is to make all nurses aware of the methods to use for that particular resident to prevent the resident from developing contractures. Periodically, the resident should be re-assessed and an updated care plan prepared, if needed.

Using the following methods can help prevent or lessen the severity of contractures:

EXERCISE

Range of motion exercises are arguably the most important weapon in preventing contractures. For residents in nursing homes, facility staff need to take the time to properly exercise and stretch the limbs and joints of immobile residents. Passive range of motion exercises (those which involve gently rotating the at-risk body parts clockwise and counterclockwise) should be performed at least twice a day. For example, to prevent hand contractures, each finger should be gently stretched and rotated as far as possible. Properly trained nurses and nurse aides should understand the dangers of contractures, the simple exercises that can be done to prevent them and the short amount of time it takes to perform these exercises. Nurse aides can perform some of these exercises while bathing the individual or while changing their clothes. Physical therapists, obviously, are more aware of the dangers of contractures and the exercises used to prevent them. For those residents at risk of developing contractures, nurses should seek assistance from the physical therapy staff.

POSITIONING

The position of nursing home residents is crucial. If a nursing home resident can sit in a chair, staff should make sure that the resident is properly seated with their feet resting comfortably on a flat surface, such as a foot lift. Dangling feet can lead to "tip-toe" contractures. To prevent leg contractures, the resident should not be allowed to sleep with her legs in a bent or twisted position. Rather, pillows or cushions should be placed between the legs to help prevent contractures.

SPLINTING

Splinting devices can be very useful in helping prevent painful and debilitating contractures. Examples of such devices include special boots and wrist splints can be used to help prevent fingers and toes from drawing up and stiffening. Knee and elbow braces are also an option to help keep those joints from stiffening in place, but will still allow the resident free range of motion.

Contractures can develop quickly and frequently affect the hands, feet, legs, and arms. In the event of a person who has severely contracted, restoration, if possible, can take up to one year and can be an excruciating process of the affected person. Splinting devices can help prevent your loved one from having to go through the pain of trying to reverse contractures.

If you have a loved one who is at risk for contractures or who has contractures, what should the nursing staff do?

According to nurse Suzanne Frederick, "Nurses should follow the nursing process by properly assessing the resident's risk for contractures and implementing an individualized care plan to prevent and/or treat the limited range of motion or contracture. Once a resident is recognized as at risk for contractures through proper assessments, the nursing staff should implement a range of motion exercise program for the resident based on his/her functional ability. The consistent implementation of the range of motion exercise program should be documented in order to evaluate the resident's response to this treatment."

In addition to common sense nursing practices, nursing homes should follow the federal regulations that apply to residents who have or who are at risk for contractures. For example, federal regulation 42 CFR §483.25(e)(2) states:

"Based on the comprehensive assessment of a resident, the facility must ensure
that -- A resident with a limited range of motion receives appropriate treatment and
services to increase range of motion and/or to prevent further decrease in range of
motion."

If you have a loved one who is at risk for contractures or who has contractures, what should you do?

• Insist that your loved one receive stretching exercises twice daily.
• Insist that all necessary preventive devices are used.
• Visit often and make sure that staff members are attentive to the needs of your loved one.
• Be respectful, but firm that your loved one receives the care they deserve.

Unlike some problems and physical limitations that can be easily reversed, contractures are an especially troublesome issue given the difficulty associated with reversing the process. Family members should not hesitate to ensure that their loved ones receive the care they need and are required.

In the third installment of our series on 6 Common Causes of Bed Sores, Chicago attorney Jonathan Rosenfeld addresses the important issue of how the lack of cleanliness and incontinence contributes to the development and worsening of bed sores. He also provides 4 important tips to caregivers on how to keep a resident clean and how to reduce the danger to a resident who may be prone to episodes of incontinence.

This is the second in a six part Series I am doing with Chicago, Illinois attorney Jonathan Rosenfeld on 6 common causes of bed sore development.

Some studies have shows that 35 to 85 percent of nursing home residents are malnourished. The causes vary as to why so many nursing home residents suffer from malnourishment. In most cases, the cause of malnourishment is not that nursing homes don't provide proper diets; in most cases they do. Rather, the root cause appears to be an inadequate level of food intake by the nursing home resident. So, what causes nursing home residents to take in less food than they need? Cognitive and physical impairments can certainly affect a resident's ability to eat. Swallowing disorders (dysphagia), poor oral health, medications, and changes to taste and smell can all contribute to a lack of desire to eat. However, many of these impairments can be overcome with an attentive and active nursing home staff. For example, a 1988 study of nursing home residents determined that 55% had some degree of dysphagia that affected their food intake. Yet, only 22% of those residents had been assessed by the nursing home and referred for evaluation to a speech therapist. In short, nearly 80% of those in the study found to have mild to profound dysphagia were not recognized by the nursing home staff as having any correctable problems with respect to nutrition intake. While the two may seem polar opposites, insufficient staffing within nursing homes can also have a direct effect on nutrition deficiencies of nursing home residents.

In many nursing homes, staff members fall woefully short of standards set forth in the Nursing Home Reform Act of 1987 (also known as the Omnibus Budget Reconciliation Act of 1987 or "OBRA"). While the law requires that the nutritional needs of nursing home residents be met, oftentimes, the results simply do not match the requirements.

It is well known that the lack of adequate nutrition can result in malnourishment which, in turn, can lead to a host of physical and mental problems, including increasing the risk of developing bed sores. (For more general information on bed sores, visit Terry Law Firm, LLC or visit Jonathan Rosenfeld's Nursing Homes Abuse Blog.) In fact, according to nutritionist Janet McKee of Nutritious Lifestyles, Inc., "Involuntary weight loss of 4% or greater is correlated with negative outcomes and the development of pressure ulcers in the geriatric population." When a person becomes malnourished, they tend to lose body fat, which provides a barrier between the skin and bone in our bodies. That barrier allows blood to freely flow throughout the body. When the body fat disappears and pressure is placed on that area of the body, the flow of blood is inhibited. When blood flow is depressed, the skin begins to die, creating the beginnings of a bed sore.

How Can Bed Sores Caused By Nutritional Deficiencies Be Treated?

When nutritional deficiencies are the likely cause of a bed sore, the best way to treat the problem is to fix the problem. Obviously, when a resident has developed a bed sore, the bed sore must be treated by a health care provider proficient in wound care. Nutritionally, there must be a thorough review of the resident nutritional needs, taking into account the nutrients being lost through the wound itself. Janet McKee states that "adequate protein intake is an essential component for skin integrity and pressure wound healing. Accordingly, protein recommendations to promote healing are 1.2 - 1.5 grams protein per kilogram of current body weight." Only the nursing home facilities can arrange for the resident to receive a full nutritional assessment so the bed sore can be properly healed.

One of the big fallacies surrounding bed sores is that once you have one, it is virtually impossible to heal. That is simply not true. With proper nursing care and nutrition, even deep, Stage IV bed sores can be healed.

Beginning on Monday, June 7, 2010, Jonathon Rosenfeld and I will do a series of blog entries on 6 common factors that result in bed sores. Bed sores are devastating injuries that commonly affect elderly residents in nursing homes and hospitals. In most cases, bed sores can be prevented. However, prevention measures take time, patience, and persistence, all of which require attentive caregivers. All too often, nursing home owners are unwilling to provide the budget necessary to have a sufficient staff that can tend to the needs of nursing home residents, including measures necessary to prevent the development of bed sores.

The six factors that we will address are:

(1) Dehydration
(2) Nutrition
(3) Incontinence/cleanliness
(4) Contractures
(5) Turning and repositioning
(6) Lack of pressure relieving devices

Throughout this blog series, bed sores may be referred to as pressure sores, pressure ulcers, and decubitus ulcers. Keep in mind that each of those terms are usually used interchangeably when discussing bed sores. Bed sores are typically discussed by stages. Stage 1 is the earliest stage of a bed sore and the easiest to correct. Essentially, a Stage 1 bed sore presents as a red spot on the skin, usually over a bony prominence. Stage 2 bed sores usually present as a shallow open wound with a pink bed. If caught quickly, Stage 2 bed sores can easily be healed. A Stage 3 bed sore is an open wound where subcutaneous fat can be visualized. While a Stage 3 wound can have tunneling and undermining, bone and tendons are typically not yet visible. Stage 4 bed sores are the most serious and most difficult to heal. With a Stage 4 bed sore, one can often see the bone in addition to tunneling, eschar and slough. For pictures and more information on bed sores in general, visit the Terry Law Firm website here or Jonathon Rosenfeld's Nursing Home Abuse blog here.

A Missouri nursing home nurse has been charged with abusing an elderly nursing home resident.

Kelley Smith, a nurse at Brookview Nursing Home in St. Louis, Missouri, reportedly became angry at a 72 year old defenseless resident in January 2010 and scratched him on his face multiple times. She has been charged with elder abuse in the third degree, a Class A misdemeanor.

We discussed the tragic death of a resident of Hunter Acres Caring Center nursing home facility in Sikeston, Missouri in our previous blog.

The death of a seventy-one-year-old resident of the facility after being struck by a train has prompted the Department of Health and Senior Services (DHSS) to investigate the facility and how the the female resident was able to walk away from the facility undetected - creating a situation of "imminent jeopardy", one of the most serious violations that can be assessed by the DHSS.

Due to the ongoing investigation, representatives for the DHSS cannot discuss specifics of the situation, but Kit Wagar, a spokesman for the DHSS, acknowledged that it was their understanding that the victim was able to elope during the morning shift change. He said, "One of the things we're told that is unfortunate is that the woman left the facility during a shift change. And there's always a little bit of confusion at the facility as people are coming and going from work. And this was not noticed immediately and that's one of the reasons that there should be steps in place to account for that."

According to the Vice President for Operating Services at the facility, Bill Mitchell, the facility is equipped with both door alarms and magnetic locks and is very secure.

After the investigation, the DHSS will issue a report with the findings of its investigation. The state and federal governments will then determine what fines and/or other disciplinary actions, if any, the facility will be assessed in this situation. The facility is required by state regulation to resolve any care and safety violations found by the DHSS through a Plan of Correction.

The Terry Law Firm handles cases involving nursing home abuse and neglect. If you are interested in learning more about nursing home abuse and neglect, click here to order our new FREE book "5 Things You Must Know About Nursing Home Abuse and Neglect in Missouri".

A resident of a Sikeston nursing home eloped on Thursday, March 18, 2010 from the Hunter Acres Caring Center in Sikeston, Missouri. The facility, owned by Don Bedell, is reportedly equipped with door sensors and alarms, so at this point, it is unknown how the woman managed to walk away.

This tragedy happened around 7:15 a.m. on Thursday when the 71 year-old woman left the facility and walked to the train tracks. According to the Sikeston Public Safety Chief Drew Juden, the woman was sitting by the tracks when a BNSF train came through. The engineer of the 113 car train blew the horn, slammed on the emergency brakes, and reportedly did everything to try and stop the train prior to hitting the woman. A train that length usually takes approximately 1/2 mile to stop.

After the train struck the woman, she was airlifted to St. Francis Medical Center and was later pronounced dead by the Scott County Coroner.

Having grown up in Cape Girardeau, which is just thirty miles north of Sikeston, I find this story particularly disturbing. I am familiar with most of the nursing homes in Southeast Missouri and their owners. When an event like this happens, one must wonder whether the ownership had provided enough financing for sufficient staff members. Door alarms are good, but if there are not enough staff members to hear or respond to the alarm, they really do little good.

My sincere condolences go to the family.

Three nursing home groups in Missouri regularly make payday loans to their employees at high interest rates which are repaid through payroll deduction. Members of these groups, headquartered in Sikeston, Missouri, include the following: James and Judy Lincoln, Mathias Dasal, Gary Crane, Timothy Drake, and Don Bedell. These individuals operate a combined total of 92 nursing home facilities.

Missouri legislators have become increasingly intolerant of predatory lending in Missouri nursing homes and have introduced House Bill Number 1509 which, if passed, will make it illegal for nursing home payday lenders "to facilitate, encourage, solicit, advertise, or provide unsecured loans of $500 or less on the premises of any nursing home property or any residential care facility, assisted living facility, intermediate care facility, or skilled nursing facility.

House Bill 1509 was sponsored by Mary Still (D-Boone) and co-sponsored by John Burnett (D-Kansas City).

House Bill 1509 is not yet law and faces several hurdles before it reaches the governor's desk.

Dr. David Quang Pham, DPM, pleaded guilty to one count of obstruction of criminal investigation of healthcare offenses relating to false billing to Medicare and Medicaid. The offense carries a maximum penalty of five years in prison and/or fines up to $250,000.

Dr. Pham treated residents at nursing homes and residences for elderly adults. The facilities he provided services to were: Abbey Care Center, Alexian Court Apartments, Beverly Farm (IL), Claru Deville Nursing Center, Columbia Convalescent Center (IL), Creve Coeur Manor, Delmar Gardens of Chesterfield, Four Fountains Convalescent Center (IL), Grand Manor Nursing and Rehabilitation, Hillside Manor Healthcare and Rehab Center, Normandy Nursing Center, Ozark Manor Residential Care Center, Parkview Apartments, Rancho Manor Health Care and Rehab Center, Rosewood Care Center (IL), St. Paul's Home (IL), St. Elizabeth Healthcare, The Cedars at the JCA, and University Forest Nursing Care Center.

After discovering he was being investigated for health care fraud, Dr. Pham created false treatment notes to support the claim that services that had been provided, when in fact they had not. Responding to a subpoena from the United States Department of Health and Human Services, Office of the Inspector General, these notes were provided. Dr. Pham, a podiatrist, allegedly submitted claims for treating the feet of patients who had undergone amputation prior to the date of service. He also falsely claimed to have provided services to nursing home residents who were hospitalized on the dates he reportedly provided his services. Dr. Pham's assistant, who is unlicensed as a physician or a nurse, was also allowed to provide services. Reportedly, Dr. Pham submitted false claims and medical records to Medicare and Medicaid for at least five years.

A St. Louis County, Missouri nursing home was forced to close its doors and relocate its residents after county officials found unsanitary and unsafe conditions at the facility.

Whispering Oaks nursing home "had among its problems no running water, overflowing toilets, human waste on the floor and a fire risk caused by an inoperable sprinkler system", according to a news release from County Executive Charlie A. Dooley. According to Metro West Fire Officials, the well that supplied water to the facility had frozen.

Forty to fifty residents were transferred, some of whom relocated to the The Loving Care Home, located in St. Louis City.

According to the Missouri Department of Natural Resources (DNR), the DNR asked the state attorney general to take appropriate action after the facility's water failed to meet state water standards and the water system had been improperly modified. The DNR "contacted the business owners of this site multiple times but has not received an adequate response".

The facility has also had problems in the past. In May 2007, a resident died after suffering an asthma attack. An investigation revealed that facility staff were not trained on how to appropriately respond to the situation. In 2008, a variety of complaints led to an investigation that revealed that residents had been yelled at, cursed at, threatened, and touched in appropriately by a former staff member.

A Missouri nursing home may not be allowed to reopen if the Missouri Attorney General has anything to say about it.

The Missouri Attorney General's Office filed emergency requests on January 14, 2010 in St. Louis County Circuit Court requesting that Whispering Oaks nursing home remain closed and be fined up to $400 per day until the home comes into compliance with state drinking water laws. Additionally, the state health department had already been trying to close the facility after repeated problems with fire and safety violations, inadequate supervision, and improper handling of prescription drugs.

Naren Chaganti, the facility's owner, alleges that a company that operates a cell phone tower located on top of the facility's water tank dislodged the heat shield that kept the tank from freezing. The owner also said that he had removed space heaters from the facility's water pump room after a request to do so by the state health department. Twenty-nine of the facility's residents were transferred to Loving Care Home in St. Louis City, which is owned by Chaganti's brother, Surendra Chaganti.

Chaganti, who practices law in California, is unsure if he will reopen the facility.

C. Kent Harrington, the owner of the Cathedral Rock nursing homes in St. Louis, Missouri, pleaded guilty January 7, 2010 to criminal charges and admitted to knowingly providing substandard care to his nursing home residents. He has agreed to pay $1.6 million as part of a global settlement.

Two whistle-blowing employees filed a civil lawsuit in 2003 against Cathedral Rock Corp and its affiliated companies. A criminal health care fraud charge has also been filed against Harrington, but that charge has been deferred as part of the global settlement of criminal charges that generated from the initial lawsuit.

U.S. Attorney Dorothy McMurtry alleged that staff at the facilities falsified drug records and doctored charts, as well as inflating the hours billed Medicaid and Medicare for patient care. Services provided at the facilities were alleged to be grossly inadequate. McMurtry also alleged that Harrington and other upper level staff members knew of the insufficient care.

Cathedral Rock operated Spring Place Care Center and McLaran Care Center in St. Louis, Oak Forest Skilled Care in Ballwin, Cathedral Gardens Care Center in North St. Louis County, and Blanchette Place Care Center in St Charles. Spring Place closed in 2004, McLaran was no longer operated by Cathedral Rock as of 2005, and Cathedral Rock "ceased operating" the other three facilities as of December 31, 2009.

Sheriff's deputies were called to the Baisch Nursing Center in DeSoto, Missouri on Saturday, October 24, 2009, after receiving a report that gunshots had been fired at the facility.

After arriving at the facility, deputies found 70 year old James Stallings screaming at his wife, 68 year old Carolyn Stallings, a dietitian at the nursing home facility. Stallings shoved his wife to the ground and, at one point, got into a vehicle while holding a gun to his wife's stomach. Carolyn Stallings managed to break free of James Stallings' hold and tried to escape, but James Stallings shot her in the back. A tactical officer at the scene shot James Stallings, killing him instantly. Carolyn Stallings was immediately flown to a hospital, where she died.

The Stallings' had separated and Carolyn Stallings had obtained a protection order against her husband. Her son, Randy Crews, told KMOV-TV that he was not surprised about the violence from his stepfather, saying, "He had told her many times that if she ever tried to leave, he would kill her and himself if he had to. I knew when I got here today he wouldn't leave alive."

The facility went into lockdown mode after a co-worker of the victim was fired upon by James Stallings and saw what was happening.