New York Nursing Home Abuse Lawyer Blog

The Hamptons Center for Rehabilitation and Nursing, located on the east end of Long Island, failed to meet minimum standards in a Department of Health deficiency survey dated August 23, 2011. The survey noted issues regarding several areas of care, including proficiency of nurse aides and avoiding significant medication errors.

In large part, the quality of a facility's nursing staff correlates with the quality of care that a resident receives. Nurses and nurse's aides interact with and care for residents constantly. For this reason, section 483.75(f) of the CFR states that nurse aides must demonstrate competency in skills necessary to care for the residents' needs. The DOH found that this level of care was not present in its review of The Hamptons Center. In one instance, a knee separator that had been ordered by a physician was not in place for a resident lying in bed. Separators such as this serve several important functions, among them a higher comfort level for the resident and the prevention of pressure ulcers. Failure to implement the knee separator, contrary to the physician's orders, posed a potential for more than minimal harm according to the DOH.

Elderly nursing home residents rely on their caregivers for the administration of necessary medications. As such, the CFR provides that it is the duty of the facility to ensure that residents remain free of any significant medication errors. The DOH report documents a resident who went three days without receiving a physician-ordered prescription because it had not been received from the pharmacy. For this particular resident, whose diagnoses included atrial fibrillation (irregular heart beat) and hypertension (high blood pressure), this failure to medicate could have had severe consequences. Heart conditions are serious matters for a patient of any age. In an elderly nursing home resident, this failure to medicate exacerbates the risk of harm to the resident.

To read the full report of deficiencies for Hamptons Center for Rehabilitation and Nursing, see the DOH website.

A July 27, 2011 DOH Deficiency Survey cited Long Island nursing home Berkshire Nursing and Rehabilitation Center for several shortcomings. Among these deficiencies, the DOH noted a failure to ensure that a resident's drug regimen was free from unnecessary drugs, a violation of Title 42 section 483.25(l) of the CFR.

In this specific case, the DOH discovered that a resident had been prescribed several psychoactive medications. As this resident had been diagnosed with dementia and depression, these prescriptions alone are not abnormal. Prior to prescribing the medications, however, the facility did not properly assess the resident and failed to weigh the potential benefits of alternative treatment. According to the Code, the facility must ensure that residents who have not used antipsychotic drugs in the past are not given them, unless such drugs are necessary to treat a specific condition as documented in the patient's record. Additionally, according to the surveyors, the facility failed to monitor the effectiveness of the medications once they were prescribed.

Other deficiencies documented in this report, such as failure to develop and implement proper care plans and failure to create an activity program meeting individual needs, are in the full DOH report here.

Hilaire Rehab & Nursing, a Suffolk County-based nursing home, failed to meet minimum standards of care in several areas, according to a DOH survey dated June 14, 2011. The DOH gave the facility a one star (out of five possible stars) due to the prevalence of residents with bedsores (pressure ulcers, decubitus ulcers). 21% of residents found to be at "high risk" for developing bedsores had in fact developed a bedsore (the national average in the category is 12%). Among the deficiencies noted was the failure to ensure that the facility remained free of accident hazards and failure to ensure that services are provided by qualified persons in accordance with the care plan.

Title 42 section 483.25(h) of the CFR dictates that a resident must be supervised and provided with assistance devices to prevent accidents. The DOH report details a resident with a history of wandering and barricading herself in her room. Despite this history of barricading, no intervention was in place to prevent the behavior other than 15 minute room checks. As a result, the resident successfully barricaded herself in her room on no fewer than two occasions. The resident, who had a history of dementia and psychotic disorder, also had a roommate. Because of the barricade, the room was not immediately accessible. This could have led to a serious situation/injury had the resident attempted to cause harm either to herself or her roommate. This behavior should have been noted and accounted for in the comprehensive care plan, however it was not, leading to the deficiency rating.

The second deficiency noted above is in violation of section 483.20(k)(3)(ii) of the Code. In this instance, a physician ordered an antibiotic to treat a resident's urinary tract infection, however the medicine was not administered until three days later. The pharmacist stated that the medication was delivered to the home the day following the order. The Director of Nursing conceded that it should not have taken three days to begin administration of the prescription, but little other explanation was given for the delay. Many elderly residents at nursing homes often have numerous prescriptions to take on a daily basis. The staff must ensure that these medications are administered properly. The delay in providing this resident with his or her UTI prescription led to additional pain and discomfort for the resident, and could have resulted in sepsis.

A complete list of Hilaire's deficiencies can be found here on the New York DOH website.

Bellhaven Center for Rehabilitation and Nursing Care in Brookhaven, New York was found deficient by the DOH in a number of areas, according to a survey of August 8, 2011. The areas receiving less than adequate marks were clinical record keeping, accident reporting, proficiency of nurses aides, and avoidance of unnecessary catheterization.

As is often the case in these DOH deficiency reports, the study references Title 42 of the CFR. Section 483.75(l)(1) states that the facility must maintain complete clinical records for each patient, in accordance with accepted professional standards and practices. The study details two incidents at Bellhaven in which physicians ordered medication for residents, however there was no documentation that the medications were actually administered to the patients. Proper record taking is essential to the safety and well-being of nursing home residents. Quite often, a resident is unable to communicate accurately with a member of the staff. Failing to document what type of medication is administered to a patient, as well as when and where such medication was administered can lead not only to sloppy records, but sickness or death for the patient.

Section 483.10(b)(11) of the Code makes clear that: "[A] facility must immediately inform the resident; consult with the resident's physician; and if known, notify the resident's legal representative or an interested family member when there is an accident involving the resident which results in injury and has the potential for requiring physician intervention." In the incident cited by the report, a resident was scheduled for a dermatology appointment. Not only was the resident's family not informed of this appointment, the resident herself was never picked up to attend the appointment. The patient was not told why the appointment was missed.

In most, if not all cases, an individual is placed in a nursing home because he or she no longer has the full ability to care for him or herself. In such cases, it is a necessity to maintain open and clear lines of communication both internally within the facility and externally to family members or legal guardians. Failure to do so is unacceptable, and can lead to dire consequences for the most vulnerable member of the equation: the patient.

The entire DOH report can be found here.

At Terence Cardinal Cooke, a nursing home in New York, NY, Coral Quintyne, a Licensed Practical Nurse, was recently arrested and prosecuted for giving methadone to the wrong resident. As a result of the medication error, the elderly resident required hospitalization. What is more disturbing and likely the reason for the arrest is that the nurse failed to report her error and falsified documents in an attempt to cover it up. On 2/4/2011, she was sentenced to six months incarceration.

The reality is that mistakes happen. In fact, I recently gave my 2 year old son five times the amount of prescribed dose of an antibiotic (luckily with no adverse effects). In nursing home and hospital settings, medication errors can occur in an instant without indifference to residents. However, the appropriate response is to advise a physician and immediately obtain necessary care. The falsification of records and attempted cover-up is inexcusable. As it always seems, in this instance the cover-up was worse than the crime.

Long-Term-Care Community Coalition, Enforcement Actions 12/16/10-3/15/11.

Uihelm Nursing Home in Lake Placid, New York was recently fined over $75,000 by the Centers for Medicare & Medicaid Services following a New York State Department of Health survey. The surveyors found nine violations that constituted immediate jeopardy to residents' health and safety, one violation that caused actual harm to residents and three that had the potential for more than minimal harm.

The vast majority of the violations stemmed from the death of an 81-year-old male resident due to a medication error. The man was reportedly admitted to the nursing home facility from a nearby hospital in Saranac Lake. Upon discharge from the hospital, 0.125 milligrams of Xanax, an anti-anxiety drug, every two hours was mistakenly transcribed as 1.25 mg every two hours by an Uihelm staff member.

The resident was given two 1.25 mg doses of Xanax and fell into a coma. Five hours then passed before the situation was reported to a physician.

Website Resource:

Uihlein draws major fine, Adirondack Daily Enterprise, Jessica Collier, June 17, 2009.

In a March 9, 2009 survey conducted at Rivington House - The Nicholas A. Rango Health Care Facility , a Manhattan (NYC) nursing facility, surveyors found that the NYC facility failed to develop and implement policy and procedures to track and monitor laboratory orders and results. The 52 year-old resident that was the subject of the investigation was admitted to the facility with a medical history of Coronary Artery Disease, status post a bypass graft, and Hypercholesteremia.

The resident had been prescribed Coumadin for DVT prophylaxis after the bypass graft surgery. However, PT/INR (Prothrombin Time/ International Normalized Ratio) tests were not performed for two consecutive weeks as ordered. Once recognized, the resident was admitted to the hospital with critical lab values, and then subsequently expired at the hospital due to a cerebral hemorrhage.

The surveyors found that the NYC facility had no system in place to ensure that all physician laboratory orders, specifically standing orders, are completed. They also found that Rivington House failed to implement a system to ensure that the labs were actually drawn and the results subsequently obtained. As a result of the surveyors' findings and the facility's neglect, Rivington House was fined $45,750 in federal sanctions.

According to a 2008 poll conducted by the American Nurses Association, 73% of nurses polled do not believe the staffing on their unit or shift is sufficient. Over 10,000 nurses nationwide were surveyed. The survey also found the following:

• 59.8% of the nurses polled knew of someone who left direct care nursing due to concerns about safe staffing;
• Of the 51.9% of nurses polled who are considering leaving their current position, 46% cite inadequate staffing as the reason;
• 51.7% of the nurses polled opined that the quality of nursing care on their unit has declined in the last year; and
• 48.2% of the nurses polled would not feel confident having someone close to them receiving care in the facility where they work.

ANA President Rebecca M. Patton, MSN, RN, explained in a recent press release, "Safe nurse staffing has been linked to more positive patient outcomes, decreased length of
hospital stay, and decreased number of medical errors and patient falls. It has also been shown to improve nurse satisfaction and decrease burnout, both significant factors contributing to nurses leaving the profession."

The New York Elder Abuse Attorneys at Gallivan & Gallivan have successfully represented many victims of abuse and neglect whose main complaint about their nursing home or hospital was understaffing. We have seen first-hand, that short-staffing can result in falls/fractures, bedsores (pressure sores, pressure ulcers, decubitus ulcers), malnutrition and dehydration, and or abuse.

If you or a loved one is being neglected due to a facility's decision not to hire an appropriate number of nurses and/or nurse's aides, please contact us for a free consultation.

A nursing home administrator at Kern Valley Hospital, Pamela Ott, has been charged with eight felony counts of elder abuse for allegedly authorizing the administration of high doses of psychotropic medications to residents in inappropriate circumstances. The court documents indicate that the medications were administered in order to keep the dementia and Alzheimer's patients sedated for the convenience of the nursing home staff.

Attorney General, Edmond G. Brown, Jr. explained, "As hospital administrator, Pamela Ott, was ultimately responsible for safeguarding the welfare of her patients. Instead, Ott abdicated her responsibility and allowed the staff of the Kern Valley Hospital to forcibly sedate patients who questioned their care."

These allegations follow charges previously filed by the California Attorney General against the former director of nursing, former pharmacist and former medical director at the same facility. The pharmacist allegedly filled the prescriptions for the psychotropic medications without orders from physicians. The administration of these medications reportedly resulted in the deaths of three residents, as well as other medical problems for additional residents.

Website Resources:

Criminal Charges Filed Against Former Nursing Home Admin., Bakersfield News, September 8, 2009.

La Jolla Nursing and Rehabilitation Center was cited by the California Department of Health Services in January 2009 for failing to follow a physician's orders regarding the administration of the medication, Coumadin.  According to a Department of Health Services report, the nursing home failed to conduct daily blood tests to monitor the resident's response to the medication, which is taken in order to prevent blood clots.
 
The state's review of the resident's records found that 10 milligrams of Coumadin was administered for 23 days from the time the patient was readmitted to the nursing home until January 16, 2009. The state found no lab reports to indicate that blood testing was done over that period of time. Though the nursing staff's patient care plan noted an "increased potential for bleeding secondary to the use of anti-coagulant," there was no evidence the tests were performed.
 
On January 16, 2009, the resident was transferred to a hospital emergency room and treated for massive bleeding in the brain. Physicians concluded that the patient died do to intraventricular hemorrhage and excessive anticoagulation levels.

Website Resources:

La Jolla nursing home is cited after death of patient
La Jolla Light, March 21, 2006