New York Nursing Home Abuse Lawyer Blog

According to the NY Daily News, Juliet Clifford, Director of Nursing Services at the Queens nursing home Bishop Charles Waldo Maclean Episcopal Nursing Home, has been arrested.The trouble began for Clifford when a seventy-four year old dementia patient eloped from the facility approximately two weeks ago. Authorities claim that Clifford failed to call 911 when she learned of the elopement, and afterward falsifying records. In addition to the charge for the records alteration, Clifford is charged with endangering the welfare of an incompetent person. The resident has not been found, nor has he returned to the facility.

This blog has written about Maclean in the past for Department of Health violations ranging from pressure sore treatment to nutritional violations. Those violations did not rise to the level of criminal offenses, however. Had Clifford reported the incident to the proper authorities, most likely criminal charges would not have been filed. More importantly, perhaps the elderly dementia patient may have been found and returned to safety.

Maintaining effective levels of staff and security personnel is essential for nursing homes, particularly nursing homes with dementia wards. Often, elderly individuals suffering from dementia or Alzheimer's Disease will lose track of time and surroundings and attempt to wander from the facility. Staff trained with procedures for preventing elopement can often avert this problem before it occurs. If a resident is able to exit the nursing home, the staff should immediately notify family and the authorities who will be better able to locate the resident once outside the facility.

The original Daily News article can be accessed here.

In an April, 2011 deficiency report, the Department of Health cited Hopkins Center for Rehabilitation and Healthcare, a Brooklyn nursing home, for the failure to maintain an environment as free of accident hazards as possible. Specifically, Hopkins failed to ensure that residents at risk for elopement were properly monitored. This failure led to the wandering and elopement from the facility of an 85 year old resident.

The breach of duty effected one out of a sample of seven residents in the DOH survey. The Department noted, however, that it had the possibility to affect a total of twenty-one residents of the Brooklyn nursing home. The resident who eloped suffered from dementia, among other physical ailments. In her Minimum Data Set (MDS) Assessment, the facility noted that the resident's mental status was "severely impaired." Due to this impairment, the nursing home deemed that she was an elopement risk, and ordered this risk factor to be incorporated into her care plan. In fact, the resident's dementia extended to the point that, during a subsequent interview with the Department of Health, she stated that she still worked every day and returned to her home in the Bronx afterward. Despite the recognition that the care plan precaution be taken, the patient managed to leave the facility unaccompanied one afternoon. Several hours later, she was located at her former home wearing only pajamas (the incident occurred in late March). Ultimately, the resident was unharmed, but the failure of the facility to properly monitor her actions and well-being placed her in immediate jeopardy.

Per federal regulation, a facility must ensure that a resident receives adequate supervision to prevent accidents of any type, including wandering/elopement described above. Exacerbating the nursing home's failure is the fact that the staff recognized this particular resident's potential propensity for wandering off, yet somehow she managed to exit the home without staff supervision. The DOH report also notes that security personnel in charge of guarding exits were not properly trained to prevent such an elopement from occurring. Properly training these guards may have prevented this dangerous condition after the resident went unnoticed by the CNA's on staff at the nursing home.

One need not be a doctor or lawyer to understand the risks associated with an elderly person suffering from dementia being allowed to wander from a care facility unsupervised, including falls, fractures, car accidents, etc. Fortunately in this case the resident was returned unharmed to the facility. This incident underscores the importance of developing, implementing, and maintaining proper and individualized care plans for each resident of a nursing home. Additionally, staff members of every sort must be trained to know the protocol for dealing with an elopement risk. Perhaps this incident will cause Hopkins to update its policies and procedures in the future to prevent another incident like this from taking place.

The Department of Health report, including several other violations found while investigating Hopkins, can be found on the DOH website here.

Bay Park Center for Nursing and Rehabilitation was recently fined $18,000 by the Department of Health. The fine stems from a certification survey in February of 2011, in which the facility was graded deficient in 23 various areas. Among these areas were failure to keep the facility free of accident hazards and failure to keep residents free from abuse.

A facility must ensure that it is as free of accident hazards as possible, and it must monitor residents and provide assistance devices to prevent accidents. In one instance documented in the DOH report, a resident who was known to be an elopement risk was able to elope from the facility. He returned the next day with his family. Despite knowing that he was at risk to leave the home if able, the facility did not implement wander guards for the resident, at his request. The resident was on 30-minute visual check rounds. During part of the period that he was missing, CNA's had signed that they had seen him, thus falsifying records after the elopement.

A resident has the right to be free from abuse, including verbal, sexual, physical, and mental. The report illustrates a scenario in which a male resident entered a female's room on several occasions and exposed himself to her. The victim described being scared for weeks following the incidents. Although the exposer did not make physical contact with the female resident, the RN Risk Manager at the facility did state that she understood that abuse could be verbal or mental in addition to physical.

As mentioned, there are twenty-three violations described in the DOH report. It is unclear for which particular deficiencies the fines were levied. A full copy of the Health Department's report can be read here.

If you or a loved one has been a victim of abuse in a nursing home, contact the attorneys at Gallivan & Gallivan to protect your rights.

In April of this year, the Medicaid Fraud Control Unit (MFCU) prosecuted Vicky Williams, a CNA who had been employed at Beth Abraham Health Services Facility, for falsifying records of a resident at the home. The resident in question was at risk for wandering and elopement, and in fact did elope from the facility early one morning just before 2:00 a.m. Nurse Williams, despite the fact that the resident was not even on the premises, documented hourly checks as routine for the hours of 3:00 a.m. to 7:00 a.m.

The mission of Medicaid Fraud Control Unit is to identify and prosecute providers who attempt to defraud Medicaid. The MFCU tries to prevent a facility or provider from billing Medicaid recipients for services not rendered, as well as to prevent falsification of records, among other aspects of the Unit. Ultimately the MFCU exists as much to protect Medicaid recipients as it does to prosecute the fraudulent providers. The case of Nurse Williams illustrates just such a scenario, as she falsified the resident's records while claiming to have provided services not rendered.

Additional recent actions by the MFCU, as well as other actions against New York nursing homes, can be found in the Long Term Care Community Coalition Quarterly Enforcement Newsletter.

The death of an elderly St. Louis nursing home resident has prompted a lawsuit against the facility. Aubrey Giles, who suffered from dementia, went missing from the Midwest Rehab and Respiratory Center in January, and his body was found in the woods two days later in a wooded, frozen ravine nearby. He reportedly died of hypothermia.

The four-count lawsuit filed in St. Clair County Circuit Court alleges that the home was aware that Giles had a pattern of trying to leave the facility (sometimes referred to as "elopement"), yet failed to monitor him and failed to have appropriate interventions in place to prevent him from exiting the premises. The family further alleges the nursing home violated various state regulations, failed to provide adequately supervise its staff, and failed to notify authorities in a timely fashion.

Daughters sue Belleville nursing home over death of man who walked away, Nicholas J.C. Pistor, Post-Dispatch, February 22, 2012.

Northern Riverview Health Care Center, Inc. in Rockland County, NY was fined $24,000 as a result of a Department of Health Certification Survey dated April 8, 2010. The survey noted no less than 14 deficiencies that contributed to the substantial fine.

Among the shortcomings noted by the surveyors were failures with respect to comprehensive care plans (a repeat deficiency for Northern Riverview), the failure to keep the facility free of accidents hazards, and failure to take proper measures to treat and prevent/heal pressure sores.

A facility must develop, review, and revise a comprehensive care plan for each resident. With respect to two patients, Northern Riverview failed to do this according to the DOH. In one case, the patient did not have a care plan in place for dehydration treatment, despite the fact that the patient was being monitored for dehdration. In the second instance, a patient had no care plan for limited functionality in her left hand, although it was observed that the resident was unable to unclench that hand.

A facility must also ensure that the resident environment remains as free from accident hazards as possible. On March 22 of last year, a resident eloped from Northern Riverview. The resident had been diagnosed previously with both Alzheimer's Disease and Depressive Disorder. Needless to say, the potential dangers of an elderly resident leaving a facility unattended are amplified when additional diagnoses such as Alzheimer's and depression are added to the situation. Fortunately, in this instance the resident was returned to Northern Riverview unharmed. However, without diligent checks on residents with the potential to wander, occurrences such as this could lead to much more serious consequences in the future.

As this blog has discussed frequently, a facility is required to ensure that a resident who enters a facility without pressure sores does not develop them unless the sores are clinically unavoidable, and a resident with pressure sores receives the necessary treatment to promote healing, prevent infection, and prevent new sores from developing. In the DOH report, it is noted that a resident, although noted to be at moderate risk for the development of pressure sores, still developed several pressure ulcers between Stages II and IV. Although the patient's care plan called for turning and positioning every two hours, it is not noted in the nursing notes that this was performed consistently. Additionally, the survey details departure from protocal while cleaning and dressing the wounds, such as a failures by LPN's to wash hands during the process and placing an undressed wound directly on bed linens. In limited instances, skin breakdown in an elderly person is an unavoidable side effect of underlying disease processes. Failing to take all necessary steps to avoid this breakdown is certainly avoidable, however, as is failing to properly clean and dress wounds.

Documentation of Northern Riverview's fine can be found here. The full DOH survey results are linked below.

Website Resource: Northern Riverview Health Care Center, Inc.

Three nurse's aides at Beth Abraham Health Services in the Bronx were arrested after failing to notice the elopement of a 64 year old schizophrenic patient in a wheelchair, and then attempting to cover-up the incident. Although police found the man approximately six hours later at a friend's home, the aides at Beth Abraham allegedly documented that they had checked on him and given him his medication during the period that he was missing.

Title 10 Section 415.12(h) of the New York Code of Rules and Regulations states that "[T]he facility shall ensure that: (1) the resident environment remains as free of accident hazards as is possible; and (2) each resident receives adequate supervision and assistive devices to prevent accidents." Clearly, allowing a schizophrenic patient to elope from the facility violates the regulation above. It was the duty of the nurse and her aides to report the missing patient as soon as they were aware of his elopement. That said, what makes the incident much worse is the attempt to cover-up the mistake by falsifying documentation.

Maintaining a safe environment for nursing home residents is a duty and should be a priority for the administration and staff at long-term-care facilities. This is not always the case, however. Diligence must be maintained to be certain that nursing home residents, particularly residents with special mental needs, are cared for in the manner mandated by both state and federal law. Thankfully, in this instance, the NYS Attorney General's Office investigated and plans to hold those responsible accountable.

Website Resource:
Three nursing home aides lied about missing schizophrenic patient in wheelchair: AG, New York Daily News, Kathleen Lucadamo, February 24, 2011

In its June 14, 2010 inspection report, the Department of Health cited Marcus Garvey Nursing Home in Brooklyn for violation of regulations applicable to New York nursing homes. The violation details substandard quality of care with respect to wandering and elopement of patients within the facility.

Title 10 Section 415.12(h)(2) of the Code states: "The facility shall ensure that each resident receives adequate supervision and assistive devices to prevent accidents." The deficiency report details a resident, referred to as Resident #1, with documented and frequent elopement attempts. Although the facility labeled Resident #1 as an elopement risk, his picture was not in the elopement risk photo book at the security desk, nor was he on the elopement risk list. Resident #1 successfully eloped on 5/29/2010. Resident #1 was missing for appriximately seven and a half hours before his family informed the facility that they had located him in the Bronx.

Among its residents, Marcus Garvey Nursing Home had identified nineteen residents as potential elopement risks. Despite this number, the Director of Nursing was unaware of the facility's use of wander guards to prevent elopement, stating that she "did not really read the policy." The facility Administrator was unaware of the Residents at Risk for Elopement book, stating that photos of such residents are posted by the security desk. At the time of inspection, two pictures were posted on the security desk wall.

Wandering and elopement pose a serious threat to elderly nursing home residents. Unmonitored wandering can lead to falls and fractures, among other consequences. Merely identifying residents who pose such a threat to themselves is not enough. Facilities must ensure that these residents are not allowed to wander and create additional risk for themselves. An individualized comprehensive care plan is a necessary first step. Following through on these care plans is equally, if not more, important.

Website Resource: New York State Department of Health

A Department of Health (DOH) study regarding the 2008 elopement of a 59 year old woman at Fieldston Lodge Care Center in Riverdale, NY found the facility's measures to prevent such wanderings lacking. The patient, identified in the report as "Resident # 1," entered the facility in November, 2007 with diagnoses ranging from Hypertension to paranoid Schizophrenia. Upon admission, the facility recognized that Resident # 1 was an elopement risk, both through its elopement risk assessment tool and the Comprehensive Care Plan. She was fitted with a wanderguard, among other standard interventions for elopement

Fieldston documented that Resident # 1 grew increasingly anxious about leaving the facility and returning home. Her score on the elopement assessment tool increased as well. Despite these warning signs, Fieldston implemented no additional interventions or monitoring. On August 16, 2008, Resident # 1 left the facility of her own volition. Not until August 19 did three staff members finally find the resident in her apartment building. Luckily, she was not seriously injured.

The Code of Federal Regulations and the NY Public Health Laws have very specific requirements to ensure the safety of residents and the prevention of neglect on the part of the facility. The Department of Health cited two relevant sections in its write-up of Fieldston. Title 42 Section 483.13(c) of the Code of Federal Regulations states that "[t]he facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property." Additionally, Title 42 Section 483.25(h) sets forth that: : "The facility must ensure that (1) The resident environment remains as free of accident hazards as possible; and (2) Each resident receives adequate supervision and assistance devices to prevent accidents." The DOH cited each of these sections in its deficiency report for Fieldston. In a situation fraught with risk as in the case of Resident # 1, the Department of Health demands that a certain standard of care be maintained by the facility with respect to the patient. In this case, the department obviously felt that this standard was not met.

Website Resource: Department of Health

Elant at Brandywine, a Westchester County nursing home in Briarcliff, New York was recently fined $38,150 by the U.S. Federal Government based on findings of substandard care made by surveyors during a September 2, 2009 investigation. According to the inspection report, surveyors cited the facility for failing have systems in place to adequately monitor and prevent residents with cognitive impairment and/or unsafe wandering or elopement behaviors from exiting the facility undetected.

The surveyors uncovered that a cognitively impaired resident who had eloped from the facility 2 days prior, eloped again during the night, and was found approximately 3 ½ hours later more than 3 miles from the facility by a staff member on her way to work. The staff had not placed a Wanderguard, a monitoring device, on the resident as would have been appropriate given her medical history. Elant at Brandywine received an immediate jeopardy citation, the most serious classification, as a result of this incident.

Elopement occurs when a nursing home resident, usually a resident with Alzheimer's or dementia, is allowed to exit the facility without supervision. Elopement of cognitively impaired nursing home residents can result in falls, fractures, brain injuries, hypothermia or heat stroke.

Website Resources:

New York State Dept. of Health, Elant at Brandywine, September 2, 2009 Survey.
Long-Term-Care Community Coalition, 9/09-12/09 NY Enforcement Action Report.