February 16, 2015

Westchester Nursing Home Cited for Failure to Prevent Pressure Ulcers

Dumont Center for Rehabilitation and Nursing Care, a Westchester Nursing Home located in New Rochelle, was cited by the Department of Health in a September, 2014 deficiency report. Among the numerous failures uncovered by the DOH were failure to prevent the development of pressure ulcers.

The resident was admitted to the nursing home as a known risk for the development of pressure ulcers. Her assessment revealed that she did not have any pressure sores of Stage I or higher. Approximately nine months into her stay at the facility, the resident fell while walking without the use of her walker. After being transferred to the hospital post-fall, it was discovered that she had fractured her hip and needed surgery. Following the surgery and recovery time in the hospital, she was sent back to Dumont.

As she continued recuperation from the surgery, the resident developed a Deep Tissue Injury to her right heel. At the time of its discovery, the sore was unstageable. Although the nursing home had initiated a careplan to prevent pressure ulcers from developing, a review of the CNA Accountability records showed that interventions had been ordered, but not implemented. Only after the sore had developed did the Accountability records show a pillow to elevate the heel and a low air loss mattress. Additionally, an "EZ boot" had been ordered to further off-load pressure, however it did not appear to have been implemented. The DOH made efforts to interview the CNA who had provided care for the resident following her return to the facility after surgery, but the charge nurse LPN could not identify the CNA. In an interview that the DOH was able to conduct, the LPN Rehab and Wound Care nurse told investigators that the nursing home did not even stock the EZ boots that had been recommended by the Wound Care Specialist.

Noted above, upon admission to the facility, the resident was already a risk for the development of pressure ulcers. Her fall and subsequent immobility added to the risk already present due to her underlying hypertension and diabetes. While this added risk factor does make the prevention of pressure ulcer development more difficult, the nursing home is still charged by state and federal regulations to ensure that an individual exhibiting no pressure ulcers does not develop them unless such development is unavoidable. It is impossible to say with any certainty whether the ordered interventions in this case would have worked to prevent such a wound, had they actually been timely implemented.

The full report on Dumont contains details of other deficiencies recorded by the Department of Health during its visit to the nursing home. These deficiencies, including improper labeling of drugs and biologicals and failure to provide services by qualified persons in accordance with a resident's careplan, can be found here.

February 9, 2015

Long Island Nursing Home Fined After Resident Chokes to Death

Woodhaven Nursing Home, located in Suffolk County, was fined $21,937.50 by the Department of Health after an unsupervised resident choked on a sandwich in December, 2013. The resident was allowed to eat unsupervised despite being a known choking risk due to underlying conditions including dysphagia and impaired cognition. The nursing home had also implemented an aspiration precaution careplan for the resident. He died as a result of the choking incident.

Because Woodhaven had placed aspiration precautions in the resident's careplan, staff was not supposed to give him any food that could lead to choking. Rather, his diet was to consist of pureed solids and/or honey thickened liquids. Additionally, staff was to assist the resident while eating until each meal was finished. Numerous notes in the resident's chart throughout and leading up to the incident document his dietary restrictions. On December 11, 2013, the 24-hour note states that he had expired during the night shift. This particular note contains no other information on the resident.

Details of the patient's death are not recorded until a Nursing Note dated the following day. According to the note, the patient choked while eating a sandwich. Despite resuscitation efforts (Heimlich and suctioning), the staff was unable to revive the man. A separate Nursing Note suggests that although staff were present at the time of the incident, they were not assisting the resident with eating. Staff did advise the resident to eat more slowly, however he did eventually choke on the sandwich and subsequently passed away.

As it often does in cases such as this, the DOH conducted numerous interviews with staff at Woodhaven. One such interview of particular interest was conducted with the Medical Director of the nursing home. He told the Department of Health that he was not aware of a system in place for aspiration precautions. He also told the DOH that he could not recall ever reviewing a policy on aspiration precautions. The Director of Nursing, in her interview with DOH investigators, stated that she did not believe that neglect had occurred "because staff did not intentionally force food down his mouth."

As has been documented many times before on this blog, it is the duty of a nursing home to ensure that the resident environment remains as free of accident hazards as possible. The nursing home must provide adequate supervision to residents to ensure that accidents do not occur. "Accidents" can include choking incidents, such as the one described above, falls, fractures, and any number of other incidents that may occur at a nursing home. Unfortunately for the man and his family who put their trust in Woodhaven to care for him, this incident ended in tragedy.

The entire Department of Health survey can be accessed here.

February 9, 2015

Department of Health Fines Monroe Nursing Home Almost $78,000 for Medication Error

Following a December, 2013 certification survey during which the Department of Health found a significant medication error, Hill Haven, an upstate New York nursing home, has been fined $77,935.00. The fine comes in the form of a Federal Civil Money Penalty, used by state and federal governments when a nursing home does not adhere to minimum standards of care.

pills9.jpgThe Department of Health conducted the survey leading to the fine on December 6, 2013. The reason for the steep amount of the monetary penalty could be that one violation documented, failure to ensure that residents are free from significant medication errors, was a repeat offense from a survey taken about a year earlier. The 2013 survey details the failure of the nursing home to provide a steroid used to control inflammatory diseases to a resident suffering from an inflammatory skin disorder.

Per physician's orders, the resident in question was to receive the drug, Prednisone, on a daily basis while at the same time decreasing the dosage from the start of admission. After failing to administer the drug for a two day period roughly two weeks after admission, the resident required hospitalization. After the week long hospital stay, the resident was readmitted to Hill Haven. Again, the order stated that the patient was to receive the Prednisone, tapering the prescription level on a weekly basis. Despite both the order and the previous hospitalization due to failure to administer his medication, the nursing home again failed to provide the Prednisone to the patient. He was sent back to the hospital only seventeen days after his readmission to the nursing home.

Interviews conducted of the Registered Nurse Manager, attending physician, and Medical Director revealed that all were aware of serious side effects of abruptly stopping Prednisone usage. Additionally, and somewhat obviously, the facility's policy stated that all medications were to be administered in accordance with physician orders.

Both state and federal regulations dictate that a nursing home must ensure that residents are free of any significant medication errors. Perhaps the simplest way to do this is to have a physician examine incoming residents, develop an individual medication plan, and communicate this plan via physician's order to all other caregivers. When these orders are not followed by the nursing staff, residents can face serious consequences, including hospitalization and death. The Department of Health did not include in its survey the current state of the resident's health.

The full report from the DOH can be found here on its website.

January 30, 2015

Bronx Supreme Court Denies Defendant's Motion for Summary Judgment as to Negligence and Public Health Law Violations

A Decision and Order issued by the Hon. Stanley Green in Bronx County Supreme Court in March, 2014 denied defendants' summary judgment motion as to negligence and violations of NY Public Health Law in a Bronx nursing home negligence action. Judge Green did grant summary judgment for the defendants as to an assault and battery cause of action.

The facts surrounding the complaint involved a nursing home fall and the subsequent development of pressure ulcers. Plaintiff had been admitted to the defendant nursing home as a resident with a high risk for both pressure ulcers and falls. One particular morning several months into the resident's stay, a CNA entered her room on her care rounds. After raising the bed and removing a nearby floor mat, the CNA left to prepare a wash cloth in the bathroom. Upon re-entering the resident's room, the CNA found her on the floor with several cuts to the face. In addition to the fall, the resident developed several pressure sores during her stay at the defendant facility.

The nursing home moved for summary judgment on grounds that the fall was unavoidable, and that it had exercised all reasonable care with respect to the resident's treatment. In addition, the defendant moved for dismissal of the Public Health Law cause of action as duplicative of the negligence cause of action.

Judge Green's Decision addresses and dismisses a cross claim by a co-defendant (the nurse staffing company) as to indemnification by the nursing home. Although an interesting contractual case study, the merits of this motion fall outside the realm of this blog. More relevant to our purposes is the short, yet important, discussion that Judge Green provides as to the defendant's claim that plaintiff's Public Health Law cause of action was duplicative.

In denying this aspect of the motion, Judge Green cites Zeides v. Hebrew Home for the Aged, 300 A.D.2d 178, 753 N.Y.S.2d, 450, a case well known by nursing home attorneys. Zeides notes that a cause of action under the Public Health Law is not duplicative of negligence. Per Judge Green's opinion, "remedies under the Public Health Law are in addition to and cumulative with any other remedies available at law or in equity and a plaintiff need not choose between traditional tort causes of action and a PHL 2801-d cause of action, but may pursue both." (citations removed).

With Zeides as precedent, Judge Green denied the defendant's motion to dismiss the PHL cause of action. Having survived summary judgment, the plaintiff may now move forward with pursuing her case.

Placide v. United Odd Fellow and Rebekah Home, Inc. et. al., NY Slip Op 31082(U)

January 29, 2015

First Department Upholds Summary Judgment for Defendant in Bronx Nursing Home Action

A March, 2014 Decision and Order by the Supreme Court Appellate Division, First Department, upheld a lower court's finding of summary judgment for a defendant nursing home. The underlying complaint, negligence against the Bronx nursing home for failure to properly treat and heal a pressure ulcer, leading to amputation, was therefore dismissed.

wheelchair room.jpgPlaintiff-appellant had been discharged to the defendant nursing home with two existing Stage IV pressure ulcers on his left leg. A prior diagnosis at a Florida hospital stated that the decedent was a candidate for potential amputation due to the deterioration of the ulcer. In fact, the hospital advised that the patient undergo the procedure because the prognosis for recovery was so slight. Ultimately the resident did have his left leg amputated below the knee. The plaintiff sued, claiming that the nursing home's negligence in allowing a previously healed pressure ulcer to reopen was the cause of the eventual amputation.

The First Department disagreed with the plaintiff-appellant. In doing so, the Court relied upon conflicting accounts as to the origin of the injury. Additionally, the defendant-respondent's expert opined that the amputation was inevitable, due to the preexisting condition. He also claimed that the nursing home had adhered to appropriate medical standards in treating the patient. The appellant's expert asserted a merely conclusory opinion that the amputation was avoidable because "no other extremity required amputation."

Clearly the defense expert affirmed that the nursing home did not depart from an accepted standard of care. After the defendant made this prima facie showing, it became incumbent upon the plaintiff's expert to raise a triable issue of fact to overcome summary judgment. Because the Court felt that the plaintiff's expert affirmation was conclusory, the plaintiff was unable to meet his burden and overturn the lower court's finding.

Iciano v. Franklin Nursing Home, 2014 Slip Op 3009

January 28, 2015

Court Rules 18 Month Delay in Appointing Administrator Did Not Prejudice Defendants

In March, 2013, the Supreme Court, Nassau County decided that a delay of roughly one and a half years in appointing an Administrator did not prejudice the defendants to the extent that they could not defend a nursing home negligence/malpractice action. Abdul Hasan, the named plaintiff in the complaint, died approximately two months after plaintiffs filed their pleadings. Because of Hassan's death, it was necessary to substitute a plaintiff to continue the action. As Hassan died intestate (without a will), this substituted plaintiff would necessarily be the Administrator if his estate. Due to complications with the petition, or application, for Letters of Administration, plaintiffs were unable to have a representative appointed until about eighteen months after Hasan's death.

The co-defendants, a Nassau County nursing home and a Nassau County hospital, argued that this delay severely prejudiced their ability to defend the action. They claimed that plaintiffs had been uncooperative; that the decedent had not been deposed; that discovery had been delayed; and that witness memories had faded to the extent that they would be unable to recall the circumstances underlying the complaint. In response, plaintiffs argued that they were unable to adequately complete discovery without the benefit of a representative of the estate; that they could, at the time of the decision, complete such discovery; and that the defendants had failed to meet their burden of showing prejudice. In its Decision for the plaintiffs, the Court noted that plaintiffs could not have acted without a legal representative of the estate, and that defendants merely showed delay, not prejudice. The Court ordered a preliminary conference to move forward and facilitate the discovery process.

Often in nursing home negligence actions, the individual who suffered the injuries is deceased. In these situations, a personal representative of the decedent's estate must be appointed for the action to continue. The case described in this post involves an Administrator, the name for a personal representative appointed when the decedent did not have a will (as opposed to an Executor, who would be named within the decedent's last will and testament).

A petition for Letters of Administration is filed with the Surrogate's Court of the decedent's county of residence. When examining the petition, the Surrogate requires at least two documents. The first is an original, certified death certificate. The second is a paid funeral bill. Per the facts of the Decision, the plaintiffs above had difficulty obtaining each of these documents. This contributed to the delay in the issuance of Letters.

Often, in addition to the death certificate and funeral bill, the Surrogate will require other documentation before processing a petition. If you have questions about being appointed as the personal representative of a loved one's estate, contact the trusts and estates attorneys at Gallivan & Gallivan today.

Hasan v. Sunharbor Manor et. al., 2013 NY Slip Op 32815(U)

January 28, 2015

Plaintiff Awarded Judgment in Legal Malpractice Action After Attorney Fails to Timely Commence Pressure Ulcer Suit

A March, 2013 judgment in Suffolk County Supreme Court awarded a plaintiff roughly $463,000.00 in a legal malpractice action. The case was brought when the plaintiff's attorney failed to timely commence an action for negligence, medical malpractice, and violations of NY Public Health Law section 2801-d against a defendant nursing home.

ambulance1.jpgThe underlying cause of action involved the development and progression of a sacral pressure ulcer at the defendant facility. Plaintiff, as Administratrix of the Estate of the decedent, retained an attorney to investigate and pursue an action for pain and suffering stemming from the deterioration of the pressure ulcers at the Nassau County nursing home. Plaintiff's attorney missed the statute of limitations, failing to commence the action in a timely manner. This failure led the plaintiff to pursue a cause of action for legal malpractice against her attorney.

A cause of action for legal malpractice consists of two elements. First, the plaintiff must allege that the attorney failed to exercise ordinary, reasonable skill and knowledge commonly possessed by a member of the legal profession. Second, the plaintiff must allege that the breach of this duty proximately caused actual and ascertainable damages. In other words, the plaintiff must show that he or she would have prevailed in the underlying action but for the attorney's negligence.

In this action, the Court found that the plaintiff would have prevailed against the facility on her Public Health Law claim. As this blog has discussed previously, a resident entering a facility must receive proper treatment to promote healing of pressure sores, prevent infection, and prevent further sores from developing. Here, plaintiff's decedent entered the facility with a Stage I-II pressure ulcer that deteriorated to a Stage IV. She ultimately died of sepsis, presumably from an infection stemming from the pressure ulcer. The Court found that the nursing home's violation of Public Health Law, as well as state and federal regulations, would have led to plaintiff prevailing in the underlying action. Thus, because her attorney failed to timely file the action, plaintiff suffered damages recoverable under the theory of legal malpractice.

In determining damages, the Court must award an amount that does not materially deviate from what would be considered reasonable compensation under the circumstances given the plaintiff's injuries. Through an examination of jury verdicts of cases featuring similar injuries to those suffered by plaintiff's decedent, the Court arrived at the final judgment of approximately $463,000.00.

A key takeaway from this judgment is the importance of statutes of limitations. Neither lack of knowledge nor mistake is a defense for missing a statute. Accordingly, if you feel that a loved one has suffered an injury due to the negligence or mistreatment of a hospital or long term care facility, contact the experienced nursing home attorneys at Gallivan and Gallivan today to preserve your rights.

January 13, 2015

Second Department Finds Potentially Inflammatory Language Relevant to Matter in Brooklyn Nursing Home Action

A case recently decided by the Supreme Court Appellate Division, Second Department, shines some light on the extent that a nursing home defendant will go in order to have language excised from a lawsuit that is not to its liking. The Appellate Court denied them the opportunity to strike the language, but it is a case worth reviewing a bit more detail.

The case at issue is Irving v. Four Seasons Nursing & Rehabilitation Center, 2014 NY Slip Op 07330, a Kings County action containing some serious allegations against a Brooklyn nursing home and adult day care center. Specifically the complaint - filed in 2009 and currently ongoing - alleges claims of personal injury, violations of resident rights, intentional infliction of emotional distress, and medical malpractice.

The language that Four Seasons argued was inflammatory and prejudicial was contained in the bill of particulars. A bill of particulars, served during discovery after a demand is made by either side, adds detail to a complaint, which often contains the barest facts and legal theories underlying the action. In the bill of particulars, the party provides more specific information demanded by its adversary, and supplies more specific information regarding the facts and underlying theories (in a plaintiff's bill of particulars), or the facts and more specific theories of defense (in a defendant's bill of particulars). Here, the plaintiff's bill of particulars specifically alleged that Four Seasons had engaged in "recklessness/reckless, intentional and malicious conduct, gross negligence" and "blatantly illegal conduct/illegal conduct."

The motion by Four Seasons was not trying to get an actual cause of action - which could subject them to liability and damages - dismissed; it was only trying to have certain language struck. Inflammatory language in a complaint can be prejudicial, and that's why the law allows for motions like the one Four Seasons made. But the law also specifies that such language can only be struck when it has no significant relationship to the underlying complaint. An easy example would be accusing someone of tax fraud during a breach of contract lawsuit - one has nothing to do with the other, and such an accusation is inflammatory and potentially prejudicial.

The lower court sided with Four Seasons - the judge ordered the language to be removed. At the appellate level, however, the Court reversed, deciding that the language was related to very serious and grave allegations at the heart of the complaint.

December 23, 2014

Summary Judgment Motion for Queens Nursing Home Denied by Supreme Court

In February, the Supreme Court, Queens County denied the summary judgment motion of defendant Flushing Manor Care Center in an action claiming violations of the New York Public Health Law. The Court, in its opinion, noted that the differing expert affidavits of plaintiff and defendant precluded a finding of summary judgment.

wheelchair6.jpgThe plaintiff was admitted to the defendant nursing home following a fall at a Queens assisted living facility and a subsequent hospitalization. She had been experiencing brief fainting spells and losses of consciousness, known as syncope, and had pain in her hip upon her admission to the nursing home, but an x-ray taken at the hospital showed no fracture from the current fall.

Because of her syncope and the recent fall, the facility determined that the plaintiff was at a high risk for falls. Flushing Manor implemented a care plan with numerous interventions to prevent falling, including side rails for bed and a locked bed and wheelchair. Additional interventions were ordered when it was noted that the plaintiff was also incontinent and unsteady on her feet. Despite the interventions, one night the plaintiff fell while attempting to stand up from her wheelchair. The on-duty nurse testified that she heard the chair alarm, saw the plaintiff attempting to stand, and rushed to her aid, but was unable to completely stop the fall. The plaintiff was taken to the hospital, where a right hip fracture was diagnosed.

The nursing home moved for summary judgment, submitting with the motion an expert affirmation from a physician stating that it (the facility) did not depart from accepted standards of care. Plaintiff's opposing expert raised a triable issue of fact regarding the nursing home's deviation from accepted standards. The nursing expert claimed that the home was inadequately staffed at the time of the fall, and that the interventions implemented were insufficient to prevent falls. The Court agreed with the plaintiff that an issue of fact did exist to present to a jury. As such, because the issues before the Court were not merely of law, it would have been inappropriate to grant the nursing home's motion for summary judgment.

Buchanan v. Flushing Manor Nursing Home, Inc., 2014 NY Slip Op 30401

December 22, 2014

Brooklyn Nursing Home Cited for Numerous Deficiencies in March, 2014 Department of Health Report

Brooklyn nursing home Keser Nursing and Rehabilitation Center received deficient ratings in ten standard health inspection categories during a March, 2014 inspection conducted by the New York State Department of Health. Among the deficiencies reported by the DOH were failure to establish an infection control program, failure to inform of accidents and/or significant changes in resident status, and failure to ensure that a resident's nutritional status remains unchanged unless unavoidable.

A nursing home must establish and maintain an infection control program to minimize and help prevent the spread of infection. During its inspection of Keser, the DOH encountered several situations for which it cited the facility. First, a resident's nasal tubing was not properly secured behind his ears, but rather allowed to hang in such a way that it was touching the floor. Inspectors also noted several instances in which garbage pails and trash bins were left uncovered in common eating areas, subjecting eating residents to a potential spread of infection from the refuse.

scale4.jpgThe remaining two deficiencies referenced above involve a single resident, a sixty year old male with multiple underlying conditions including diabetes, hypertension, and epilepsy. Per the report, the resident also displayed "severely impaired cognitive skills for daily decision making." During routine weight checks, it was noted that the man had lost eighteen pounds, nearly eleven percent of his total body weight, in the several months prior to late October, 2013. The dietary note for this resident also documented conflicting information, at one time stating that the patient's appetite was "fair to good," yet at another stating that he was eating less than 75% of his meals. Despite this weight loss and the differing information in the notes, no new interventions were ordered for the resident. The physician's notes from the relevant time period list the resident's weight as steady at 170 pounds, again in conflict with the weight records. During an interview with the Department of Health regarding this patient, the current physician informed investigators that the doctor who had written the notes for August, September, and October 2013 was no longer employed by the nursing home.

The remaining deficiencies detailed by the Department of Health in this March inspection report include, among others, failure to provide services by qualified persons in accordance with each resident's care plan, failure to equip corridors with firmly secured handrails, and failure to promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his or her individuality. To read more, or to access the full report, visit the Department of Health website here.

December 22, 2014

Queens Nursing Home Fails to Provide Proper Treatment to Prevent/Heal Pressure Ulcers

In January of this year, Silvercrest, a Jamaica, Queens nursing home, was cited by the Department of Health for failure to prevent and/or heal pressure ulcers. The survey and the resulting deficiency report involved one resident, a 77 year-old female who was admitted to the nursing home with several diagnoses, among them a sacral pressure sore.

hospital bed3.jpgAt the time of the incident, the female resident had been admitted to Silvercrest for approximately two and a half years. She had a previously healed pressure ulcer to the same area, the sacrum, at which the subsequent wound developed. After the original sore healed, the facility put in place numerous interventions designed to prevent the development of additional wounds, including pressure relieving mattresses and a turning and positioning program. Despite these proper interventions being in place, a pressure ulcer recurred to the resident's lower back. An MD assessment noted that the wound was Stage III. After the examination, the physician ordered treatment for the pressure sore during every shift. Treatment was to include cleansing and dressing the ulcer, applying ointment, and securing the dressing.

For the next six shifts immediately following the physician's order, treatment was not provided to the resident. The Treatment Administration Record listed the reasons for the lack of treatment as "awaiting delivery" and "delivery pending." During a Department of Health interview with a Licensed Practical Nurse who was on shift for the missing treatments, the LPN stated that the Nurse Practitioner had entered the order incorrectly into the facility computer, causing a delay in the procurement of the medication. Because of poor record keeping, there is no documentation of what, if any, treatment was provided to the patient during the six shifts for which the medication was not available.

New York State nursing homes are governed by both state and federal regulations. These regulations dictate the type of care that nursing home residents must receive. Specific to pressure ulcers, the regulations state that a resident who enters a facility without pressure ulcers must not be allowed to develop pressure ulcers unless his or her clinical condition demonstrates that such development is unavoidable. Additionally, a resident having pressure sores must receive necessary treatment to promote healing, prevent infection, and prevent new sores from developing.

In this case, Silvercrest failed to provide the proper treatment to its resident. Physician's orders must be followed. Failing to treat a pressure ulcer for six shifts after a physician's orders is a violation of the resident's rights, and can have dire consequences. Ideally, this citation by the Department of Health will cause Silvercrest to be more diligent in its future treatment of its residents presenting signs and symptoms of pressure ulcers.

December 1, 2014

Utica Nursing Home Nurse's Aide Charged with Sexual Abuse of Elderly Resident

New York State Attorney General Eric T. Schneiderman recently announced that John Tamba, a 48 year old CNA from Utica, NY was indicted in October on nine counts of abusing a female patient. Tamba worked at the Focus Rehabilitation and Nursing Center at Utica, located at 1445 Kemble St, Utica, NY, and is being held at the Oneida County Jail without bail. Tamba was charged with three counts each of sexual abuse in the first degree, endangering the welfare of a vulnerable elderly person or an incompetent or physically disabled person in the second degree, and willful violation of health laws. If he is convicted on all nine counts he faces up to 21 years in prison.

It is alleged that Tamba engaged in forcible sexual contact with a physically disabled female patient while she was in his care at the nursing home. Tamba was charged by the Medicaid Fraud Unit, which is a part of the Attorney General's office that is charged with protecting the elderly and disabled from fraud and abuse perpetrated by nursing homes, as well as investigating and prosecuting Medicaid fraud. The Attorney General has repeatedly said how strongly he feels about protecting nursing and long term care patients as they are in a very vulnerable situation. He is quoted in the press release as saying that "those who are charged with protecting the health of the most vulnerable New Yorkers must do that - care for them and not hurt them," and that his office "will go after those who break the law and seek justice for those who cannot defend themselves."

The indictments against Tamba come from events which happened while Tamba was working at the Focus Rehabilitation and Nursing Center. The upstate New York nursing home offers a range of services to seniors including, independent living apartments, assisted living services, an adult day care program, short or long term rehabilitation, or specialized care for people with Alzheimer's or dementia. However, the facility also has an extensive record of complaints with the Department of Health. The Department of Health is in charge of regulating and inspecting nursing homes in New York. It publishes information about nursing homes including a range of quality measures, statistics on inspections and complaints and enforcement measures taken by the Department. While nothing in the Attorney General's press release indicates that Tamba's actions were caused by the nursing home, it is always important for patients and their families to research nursing and long term care centers before engaging their services.

In the reporting period of November 2010 through October 2014, Focus Rehabilitation and Nursing Center had 67 Standard Health Deficiencies which compares unfavorably to a state wide average of 23. A Standard Health Deficiency is a measure of the quality of care provided by the facility. Nursing homes are routinely inspected by the Department of Health. Trained inspectors, using established protocols, will interview a sample of residents and family members about their life within the nursing home The inspectors also interview caregivers and administrative staff. The home had 15 Life Safety Code Deficiencies, four more than the state average of 11. Life Safety Code Deficiencies are violations of the fire safety regulations set by the National Fire Protection Agency (NFPA). When such violations are discovered the facility must submit a plan of correction to the agency.

Patients and family members who would like more information than is contained on the Department of Health's website may email nhinfo@health.state.ny.us or write to New York State Department of Health, Division of Residential Services, 875 Central Ave.,Albany, NY 12206 and request a copy of the survey which will have more detail into the citations given to that facility. When writing please include the name of the nursing home, Permanent Facility Identifier, and survey date as they appear on the report.
Abuse of patients in long term care facilities and nursing homes is a serious problem and while not all problems can be avoided with due diligence, the Department of Health's reports are a good place to start in researching a facility.

November 24, 2014

Nurse Charged With Accidently Giving a Patient Morphine and Falsifying Medical Records to Cover Up Her Mistake

The New York State Attorney General has announced the unsealing of a felony indictment against Vicki Price charging her with a range of crimes in connection with the accidental overdose of a patient at the nursing home where Price was a nurse. When an indictment is sealed it is available to the public. Indictements may be sealed for various reasons, for example after the person named in the indictment is arrested by the police or is has been notified of the charges if they were not already known to them. Price, a licensed practical nurse, was employed at Bayview Nursing and Rehabilitation Center, at 1 Long Beach Road in Island Park, New York, when a forty six year old resident of the center fell ill from an overdose of morphine. It is alleged that Price administered the patient morphine instead of the prescribed muscle relaxant and then falsified the patient's medical records to cover up her mistake. Price did not confess to the mix up even when the patient was transferred to Long Beach Medical Center after losing consciousness.

The patient who suffers from spina bifida was treated with Narcan, a drug used to counter the effects of an opiate overdose. The patient spent five days at Long Beach Medical Center before being released. It is unclear if Price's failure to confess to the mistake led to the patient not being treated promptly or caused the patient to remain in the hospital longer than it would otherwise. Price has been charged with one count of endangering the welfare of a vulnerable elderly person, or an incompetent or physically disabled person, in the second degree, which is a class E felony; one count of endangering the welfare of an incompetent or physically disabled person, which is a class A misdemeanor; one count of wilful violation of the public health laws, which is an unclassified misdemeanor; and two counts of falsifying business records in the first degree, which is a class E felony. Medical personnel falsifying business records are particularly dangerous because it can lead to patients being given medically inappropriate treatment or having proper treatment delayed. In a case like this where the wrong medicine is given out proper treatment may be delayed while medical staff figure out what was given if no or a false entry is made into the patient's medical record.

Price faces a total of between one and one half years and four years in jail if she is convicted of all counts. She is no longer an employee at the Bayview Nursing and Rehabilitation Center. The case is being prosecuted by the Medicaid Fraud Control Unit, an arm of the Attorney General's Office tasked with combating large scale Medicaid fraud as well as cracking down on abuse in nursing homes and long term care facilities. The Attorney General has put his commitment to protecting the often venerable population of nursing and long term care homes in strong terms stating that "my office will pursue justice when our basic tenets of care are not met. There is one set of rules for all caregivers, and those rules must be enforced."

The Department of Health also offers detailed information on inspection and citations given to facilities. It is an excellent place to get information about a nursing or long term care home. The information can be found online at the Department of Health's website. The Bayview Nursing and Rehabilitation Center where Price worked is now called the South Point Plaza Nursing and Rehabilitation Center. It has a higher than average number of complaints. During the reporting period from November 2010 to October 2014 the Department of health received 76 complaints about the facility. This was higher than the average number of complaints received per one hundred beds by other facilities in New York State. The facility has also been fined three times since 2004 in amounts from 2000 to 10000 dollars.

November 24, 2014

Nurse Accused of Switching Oxycodone For Allergy Pills in Ulster Care Home

In September the Attorney General Eric T. Schneiderman announced that Amy DeAngelis-Martin a licensed practical nurse was arrested on charges including Endangering the Welfare of an Incompetent or Physically Disabled Person in the First Degree. DeAngelis-Martin was employed as a nurse at the Northeast Center for Special Care in the Town of Ulster, New York. She is accused of stealing oxycodone pills, an often abused painkiller, from one of her patients and replacing them with similar looking over the counter allergy pills. Replacing prescription painkillers with relatively harmless over the counter medication is a common way for medical staff to steal pills from patients.

The fifty two year old patient in question was paralyzed from the waist down due to trauma to the head and neck and was taking the medication for pain.
Nurses and other medical staff stealing or diverting prescription pain medication is a major problem in nursing homes as it can lead to patients not getting the care and pain management they need as well as potential drug interactions or complications arising from the patient taking undocumented medication. It also poses a problem in that medical staff who are abusing narcotics may not be capable of providing care to those in need. DeAngelis-Martin was charged with two felonies and two misdemeanors. She was charged with endangering the welfare of an incompetent or physically disabled person in the first degree which is a class E felony and one count of falsifying business records in the first degree which is also a class E felony as well as one count of criminal possession of a controlled substance in the seventh degree a class A misdemeanor and one count of petit larceny also a class A misdemeanor. If she is convicted the charges carry between one to four years in jail.

The Attorney General through his Medicaid Fraud Control Unit investigates abuse and neglect by nursing and other health care facilities. Schneiderman has said that "Staff at nursing facilities are entrusted to care for those who are unable to care for themselves, including administering appropriate medication," and that his "office will prosecute individuals that violate that trust and prey upon the vulnerable patients. The allegations in this case serve as a strong reminder of the dangerous and addictive qualities of opioid medications -- and why they must be closely monitored." Those looking into care for themselves or their loved ones should be aware of the potential for abuse and neglect and carefully research facilities.

The Northeast Center for Special Care, also known as the Northeast Center for Special Care, in Ulster County New York specializes in traumatic brain injuries and treating other patients with traumatic injuries. Information about the facilities record can be found on the website of the Department of Health, which is tasked with inspecting and taking complaints about nursing homes and care facilities, shows that the center had a slightly higher than average number of complaints. It received 59.4 complaints per 100 beds during the reporting period which lasted from October 2010 until September of 2014.

The average number of complaints per 100 beds in New York state was 35.7. Otherwise the home had only one quality of care citation given during an onsite inspection working out to well under the statewide average. The fact the care homes record is better than average in many ways only highlights how important it is for there to be oversight of nursing and care home personnel. While families and patients may do their due diligence in researching facilities this type of conduct, which DeAngelis-Martin is alleged to have been involved in, can happen even in facilities with good records. More information about the facility, and all other nursing and care homes in New York State, can be found on the Department of Health's website which lists a number of statistics on inspections and complaints as well as standard of care metrics.

November 21, 2014

Two Certified Nurse's Aides at the Terrace View Long Term Care Facility in Buffalo Charged with Abuse and Neglect

In September the NYS Attorney General's office announced that two certified nurse's aides at the Erie County Medical Center Skilled Nursing Facility in Buffalo, which has recently changed its name to the Terrace View Long Term Care Facility, have been charged with neglecting an elderly resident of the facility. Donna Laury and Nakeia Green were charged with a range of misdemeanor and felony counts in Buffalo County Court. The Attorney General Eric T. Schneiderman has said that because "nursing home residents are among our state's most vulnerable citizens, and the neglect that the victim in this case suffered is reprehensible... my office will not tolerate anyone being neglected by those responsible for their care, and we will use every tool in our arsenal, including hidden cameras, to ensure that those most in need of help are safely cared for and treated with respect and dignity." The Attorney General's office through the Medicaid Fraud Control Unit is tasked with looking into large scale Medicaid fraud including overbilling, kickbacks, substandard drugs and medical equipment. It also investigates and prosecutes abuse and neglect cases in nursing homes and other health care facilities.

The Terrace View Long Term Care Facility is a 390 bed facility that is part of the ECMC Health Campus on Grider Street in Buffalo. It totes itself as "designed to be patient-centered with a household or neighborhood design that focuses on the latest care delivery models", but the facilities record with the Department of Health points to more systemic problems within its system. The Department of Health, which keeps detailed records online about nursing home complains and conditions, has received 247 complaints about the Terrace View Long Term Care Facility in the reporting period lasting from October, 2010 until September of 2014. This is a rate of 125.3 complaints per occupied beds which compares to a statewide average of 35.7 complaints per 100 beds. In addition to the citations the facility has had 13 citations following onsite inspections during the reporting period, a number approximately three times the average in the state.

The facility has also been fined several times for quality of care complaints with fines ranging from two thousand to ten thousand dollars and its parent company Erie County Medical Center was involved in a large settlement for Medicaid overbilling. Further information about the facilities inspection record and complaint record may be found on the Department of Health's website where the department maintains information on all the nursing homes in New York State.

The employees were charged with falsifying business records in the first degree which is a class E felony, endangering the welfare of an incompetent or physically disabled person which is a class A misdemeanor, and willful violation of public health laws which is an unclassified misdemeanor. The most serious of these charges, falsifying business records in the first degree carries a penalty of up to four years in jail. It is alleged that the employees failed, in violation of the patient's personal care plan, to use two people while performing incontinence care and failing to use a mechanical lift to transfer the resident. It is also alleged that the employees falsified the patient's medical records in order to avoid detection.

The patient, who was not named in the Attorney General's press release and is referred to in court papers as M.H. to protect her privacy, is a 79 year old woman who suffers from Alzheimer's disease and dementia and is unable to walk. She is totally dependent on the care of the nursing home staff driving home the need for laws, regulation and oversight for these vulnerable members of the community who may not be able to advocate for themselves. Families and patients looking into nursing homes should be aware of the inspection and complaint record of the facility they are considering as neglect and abuse is a problem in many facilities in New York.