New York Nursing Home Abuse Lawyer Blog

Momentum at South Bay, the East Islip based nursing home, was cited in a New York Department of Health deficiency report dated June 20, 2011. The report details numerous citations and violations of policy by the Suffolk County nursing home. The facility was cited for 27 standard health deficiencies. The New York State average number of standard health deficiencies was 17.

Listed first in the report is a violation of 42 CFR 483.20(g)-(j). These sections mandate an accurate assessment of the resident's status, as well as coordination between nurses and health professionals, and certification of the assessments when complete.The report states that according to the facility's Minimum Data Set, "Resident 13" was on a physician-prescribed weight loss program. Documentation of the physician orders contradicted this MDS, however, as there were no physicians orders for weight loss. Ordering a manageable diet in elderly and infirm residents in a nursing home is the responsibility of a physician and/oror dietician. Because these residents must maintain very specific nutritional requirements, a nurse or nurse's aide cannot take it upon him or herself to adjust the diet of a resident. Unfortunately, it appears from the report that this is what occurred at Momentum at South Bay.

A second deficiency noted in the report is a failure to establish an infection control program. This was noted during an unsanitary cleansing of a sacral pressure ulcer. A nurse did not employ adequate sanitation measures while cleansing the ulcer. According to federal regulation, a facility must maintain a program designed to prevent the development and transmission of disease and infection. When dealing with pressure ulcers, this is even more essential than normal. Because they are open wounds, pressure ulcers have a predisposition to infection. Failure to perform any and all necessary sanitation precautions prior to cleansing the wound or changing dressings may lead to an increased risk of infection, or the exacerbation of an infection already present. This in turn may lead to further infection, sepsis, and death.

The above are only two of the deficiencies noted by the DOH in its report. Click here to access its findings in their entirety.

Northern Metropolitan Nursing Home in Monsey, New York was recently cited by the New York State Department of Health for incidents involving residents that developed pressure sores (decubitus ulcers, bedsores) in late 2009. According to the statement of deficiency, inspectors discovered that three out of twenty-one residents surveyed developed pressure sores at the facility. Although the residents were "at risk" for pressure sores, care plans and preventative measures were either not in place, or deficient, in ensuring that the sores did not develop.

One of the residents surveyed was readmitted to Northern Metropolitan on September 2, 2009 with a Stage II pressure ulcer on the sacrum and by December 7, 2009 two more ulcers on the hip and scapula (upper back) had developed. Another resident was readmitted on March 2, 2009 and by August 3, 2009 had developed a Stage IV (the most severe) pressure ulcer on the right Ischium (hip area). In the third case, although a patient was admitted on October 15th, 2009 with noticeably red heels, an individualized care plan was not implemented until November 4th. The resident subsequently developed a Stage II pressure Ulcer. Two of the three patients also experienced significant weight loss.

The actions of Northern Metropolitan are in direct violation of New York Codes, Rule and Regulations, specifically 10 NYCRR 415.12(c). A facility must ensure that all reasonable measures are taken to prevent pressure sores. In the event that a sore is present upon admission or develops despite appropriate measures, a facility must take all reasonable steps to treat existing sores and prevent new ones from developing. Despite the risk factors of these patients, Northern Metropolitan failed to adhere to the standard of care designated by law. This is no doubt a frustrating scenario for both the residents and their families, as with the proper interventions, these sores were, in all likelihood, avoidable.

The facility was also cited for failing to provide services in accordance within accepted parameters of nursing practice.

Website Resource: New York State Department of Health

A Kentucky jury has awarded $42.75 million to the family of an elderly man who was allegedly neglected in a Madisonville nursing home. The decedent, Joseph Clint Offutt, 92, was reportedly only a resident at the facility, Harborside of Madisonville, for nine days before he died. Wilkes & McHugh represented the family.

The trial lasted three weeks. The family alleged that nursing home staff members neglected Offutt, causing him to suffer severe dehydration, malnutrition, bedsores (pressure sores, decubitus ulcers), infections and, ultimately, death. Adult Protective Services officials of the Cabinet for Health and Family Services reportedly substantiated the allegations of neglect of Offutt. In particular the Cabinet found cited the nursing home for failing to prevent bedsores that developed during the decedent's admission.

Offutt served in World War II and was still planting crops at age 88. A stroke weakened him in 2007, and his wife of 58 years, Pearline, cared for him at home for eight months before the family realized he needed professional care. The jury awarded $1 million for Offutt's pain and suffering, $1.75 million for his wife's loss and $40 million for punitive damages, according to court documents.

Website Resource:

Family awarded $42.75 million in nursing home case, Lexington-Herald-Leader, Valarie Honeycutt Spears, November 19, 2010.

As we have previously explained on the New York Nursing Home Abuse Lawyer Blog, Medicare rates all New York nursing homes based on three criteria:

1) Findings during health inspections;
2) Nursing home staffing; and
3) Quality measures.

The following nursing homes in Bronx, NY received the lowest rating from Medicare (one out of five stars - much below average):

Beth Abraham Health Services
Bronx Center For Rehabilitation & Health
East Haven and Nursing & Rehabilitation Center
Gold Crest Care Center
Jewish Home & Hospital For the Aged
Morris Park Nursing & Rehabilitation Center
Pelham Parkway Nursing Center
Throgs Neck Extended Care Facility

The homes received such low grades for a variety of reasons including failing to provide proper care to resident "at risk" for developing bedsores (pressure sores, decubiti); failing to prevent falls and fractures, failing to properly assess residents, failing to properly implement appropriate plans of care, failing to properly monitor resident lab values, failing to properly prevent elopement, failing to provide appropriate nutrition or hydration, and failing to prevent physical and sexual abuse.

A recent study conducted by the Journal of the American Medical Directors Association (JAMDA) indicates that surveyors routinely failed to detect quality care issues with respect to the assistance provided by nursing home staff members at mealtime. As we have discussed many times on this blog, malnutrition and dehydration are two of the most common and most important issues facing nursing home residents.

According to the JAMDA website, "Guidelines written for government surveyors who assess nursing home (NH) compliance with federal standards contain instructions to observe the quality of mealtime assistance. However, these instructions are vague and no protocol is provided for surveyors to record observational data. This study compared government survey staff observations of mealtime assistance quality to observations by research staff using a standardized protocol that met basic standards for accurate behavioral measurement."

The study found that nutritional care (or lack thereof) is a significant problem in long-term care facilities, and noted that it is underdetected in the survey process. The researchers that conducted the study call for surveyor training on this issue that fosters more accurate and consistent observation of feeding assistance issues and a "standardized protocol to organize and guide" surveyor observations.

Lacy Reid, a 45 year-old assisted living employee residing in Nassau County, has been charged with Felony Reckless Endangerment for failing to come to the aid of his ailing mother. His mother allegedly fell in her kitchen on Tuesday night and remained on the floor until Thursday. Mr. Reid, who lives with his mother, stepped over her on his way to work Wednesday and Thursday.

When the authorities were finally called, officers found Mary Reid face down in the foyer by the front door. She was dehydrated and malnourished, and she suffered a heart attack while being transported to the Emergency Room.

Website Resources:

Cops: Freeport man left ill mother on floor for 2 days, Newsday, Zachary R. Dowdy, August 14, 2009.

Dehydration, or inadequate hydration, is a serious problem facing nursing home residents. Dehydration means that an individual is losing more fluid than his or her body is taking in. Although it would seem that keeping a resident hydrated in a nursing home setting would be simple enough, it is one of the most common diagnoses when nursing home residents are discharged from a nursing home to a hospital.

Dehydration can occur if residents are on certain types of medication and/or if a resident has diarrhea. In addition, some nursing home residents become refuse to eat or drink. However, in these situations, it is incumbent upon the nursing home staff to be more vigilant in monitoring the resident's hydration. Unfortunately, dehydration is often the result of nursing home neglect and/or understaffing. Dehydration can lead to:

1) Infection;
2) Confusion;
3) Weakness;
4) Bedsores;
5) Pneumonia; and
6) Death.

Signs of dehydration include dry mouth, grey or ashen skin, confusion, dark or amber urine, low urine output, fever, delirium, and infection. We cannot stress enough how important it is for families of nursing home residents to be a constant presence where a loved one is a resident. By doing so, the family members can observe and react appropriately if signs or symptoms of neglect or abuse arise.

At Gallivan & Gallivan, we represent individuals who have suffered from dehydration or malnutrition as a result of nursing home neglect or abuse. If you or a loved one has been the victim of elder abuse or neglect, please contact us to discuss the matter further.

Website Resources:

Dehydration, Mayo Clinic, Mayo Clinic Staff.

Malnutrition & Dehydration in Nursing Homes, Nursing Home Abuse Resource Center.

Two Orange County nursing homes have been fined for care (or lack therof) that resulted in the wrongful death of two residents. At Alamitos West, an 82 year-old resident died from dehydration after the nursing home failed to provide sufficient fluids. Investigators found that intake and output records were blank and/or illegible over the course of the resident's admission.

Staff at Huntington Valley Nursing Home failed to resuscitate a resident because they mistakenly believed that a Do Not Resuscitate order was on file. In fact, the resident's chart indicated that the family specifically requested that CPR be administered if necessary. By the time paramedics arrived, the resident had passed away.

As a result of these incidents, Alamitos West was fined $100,000 and Huntington Valley was fined $80,000.

Website Resources:

2 Orange County nursing homes fined for patient deaths, Los Angeles Times, Rong-Gong Lin II, June 11, 2009

According to the New York Times article below, in a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence. This relatively new research suggests that the battle against bedsores requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

This should not be a surprise to anyone familiar with the nursing home environment. It is vitally important for residents at risk for pressure ulcers to receive appropriate care and attention from all employees listed above. A lapse in one area for even a short period of time can lead to the development and progression of an otherwise preventable pressure ulcer.

Website Resources:

Fighting Bedsores With a Team Approach, Amanda Schaffer, New York Times, February 19, 2008.

The article below gives an insightful overview of some of most common causes of serious injury and/or death in the nursing home setting that are completely preventable:

1) Malnutrition;
2) Dehydration; and
3) Infected Pressure Sores.

The article cites data from the U.S. Centers for Disease Control and Prevention that was analyzed by the Detroit Free Press. The data indicates that nearly 14,000 deaths in nursing home patients between 1999 and 2002 were caused by malnutrition, dehydration, and/or infected pressure sores. The author of the article, Andrea Billups, also recounts some specific instances of neglect and abuse in facilities nationwide. Understaffing at nursing homes is named as one of the causes of such neglect. Although it was published in 2006, its findings are certainly still relevant and worth reading.

Website Resources:

Deadly Neglect: The shocking truth about what's going on in America's nursing homes, Andrea Billups, Reader's Digest, December 2006.