As the average lifespan in America continues to increase, more and more families will need to rely on Maryland nursing homes to provide care for their aging loved ones. Indeed, nursing homes offer a necessary service; however, reports have recently come to light that nursing home abuse and neglect are rampant. Perhaps more alarming are the results of a recent government study indicating that of all the cases of nursing home abuse requiring hospitalization, 28% went unreported until the resident arrived at the hospital.

Instances of nursing home abuse and neglect are underreported for several reasons. One reason is that many residents are embarrassed to report what happened to them, or fear that they will be seen as troublesome by family members. Another reason is that the residents who are victims of abuse or neglect are often not in a condition to articulate what they are experiencing, and in some cases, residents have no one to report the abuse or neglect to.

According to a recent industry news source, the Centers for Medicare & Medicaid Services proposed a new regulation that would impose significant monetary fines upon employees of skilled nursing facilities who fail to report abuse, neglect, or other crimes within a certain period. Not only would the new regulation require an employee to report abuse or neglect that was witnessed, but it would also require an employee to report a “reasonable suspicion” that abuse or neglect was occurring. The idea behind the newly proposed regulation would be to encourage employees in these facilities to speak up on behalf of the residents who are the victims of abuse or neglect.

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This past month, the state of Maryland announced a settlement due to the involuntary discharge of nursing home residents in violation of Maryland’s Patient’s Bill of Rights.

Medicare Recipients’ Rights and Involuntary Patient Transfer and Discharge

Maryland’s Patient’s Bill of Rights protects the rights of individuals in nursing homes. Under the Bill of Rights, Medicare recipients are entitled to certain rights, including having access to doctors, specialists and hospitals, being treated with respect and free from discrimination, receiving health care services in a language the patient can understand, and appealing certain decisions about health care payment, coverage of services, and prescription drug coverage.

The Bill of Rights explicitly provides certain safeguards to nursing home residents who are involuntarily discharged. Discharged patients are at high risk for mortality, and discharge is meant to be an option of last resort for nursing homes. HG § 19-345.2 provides specific procedures for providers to follow before discharging or transferring a resident. Those procedures include having a post-discharge care plan, medical assessments, and written documents from the resident’s attending physician. Providers also are required to provide residents with at least a 3-day supply of medications.

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Recently, a state appellate court issued an opinion in a wrongful death case discussing the validity of an arbitration contract signed by the plaintiff on behalf of her elderly father. Ultimately, the court concluded that because the plaintiff’s father lacked the mental capacity to sign the contract at the time it was executed, the plaintiff could not be bound by the arbitration agreement. The case is significant because it presents the important and developing issue arbitration clause enforceability, which frequently arises in Maryland nursing home neglect and abuse lawsuits.

The Facts of the Case

The plaintiff was the daughter of a man who died from injuries allegedly sustained while in the care of the defendant rehabilitation facility. According to the court’s opinion, the plaintiff’s father suffered from a history of mental health issues, including dementia. One day, the plaintiff’s father fell and was admitted to the hospital. After about ten days in the hospital, the man was discharged from the hospital and sent to the defendant rehabilitation facility.

Before being moved to the rehab facility, the plaintiff executed several documents in preparation for her father’s transfer. Included in these documents was an agreement to arbitrate any claims arising from the facility’s care of the plaintiff’s father. About two months later, the plaintiff’s father was found unresponsive at the rehab facility. He was transferred back to the hospital, where he then passed away.

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Legal claims against a Maryland nursing home generally fall into three categories: abuse, neglect, or medical malpractice. Medical malpractice claims arise in the nursing home setting when healthcare professionals in nursing homes provide medical care for the residents. In these cases, plaintiffs have to make sure to comply with the additional requirements for medical malpractice claims.

In a recent case against a nursing home, a resident’s daughter brought a negligence claim against the nursing home and several nurses after the resident fell and died as a result of her injuries. Shortly after the resident’s death, the daughter’s lawyer mailed the nursing home a letter stating that the nursing home and “its employees” were negligent and that their negligence caused the resident’s death. The plaintiff later filed a lawsuit against the nursing home and against several nurses at the nursing home. The nurses filed a motion to dismiss, arguing that the daughter did not comply with the state’s pre-suit requirements.

The issue before that state’s supreme court was whether the letter sent to the nursing home was sufficient pre-suit notice to the nurses named in the lawsuit. Under that state’s laws, a plaintiff must provide at least sixty days’ notice to the defendant before bringing a claim, notifying the defendant of the legal basis of the claim, the type of damages being sought, and the nature of the injuries suffered.

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Nursing home residents in Maryland and across the country can be at great risk when left unattended, particularly if they have diminished mental capacity. In a recent case before a federal appeals court, a patient who had Alzheimer’s disease allegedly wandered from her room while unattended and died after she drank detergent she found in a kitchen cabinet.

The patient’s estate filed a wrongful death lawsuit against the nursing home, claiming the nursing home understaffed the home and failed to sufficiently secure the kitchen cabinet. The case went to trial and a jury found that the nursing home was liable for the patient’s death, awarding the patient’s estate $5.08 million. The nursing home agreed not to appeal but settled with the patient’s estate for $3.65 million, and the court set aside the judgment.

The nursing home later sued a contractor for contractual indemnification and breach of contract. The contractor provided kitchen and dining services at the nursing home, and the home alleged the contractor was liable for the patient’s death. The contractor claimed that the claims were barred by issue preclusion because the jury had already decided the nursing home was negligent.

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Because nursing homes generally offer medical care to residents, Maryland medical malpractice claims may arise in the nursing home setting. In a recent medical malpractice case, a family brought a medical malpractice claim after their elderly mother fell. The eighty-nine-year-old patient fell after she got out of her hospital bed, suffering a serious head injury. She had surgery but never fully recovered from the head injury. After her death a few years later, her daughters filed a medical negligence claim against the hospital. The case went to trial, and the court found in favor of the hospital, but the daughters appealed.

On appeal, the plaintiffs argued that the trial court was wrong in finding that the hospital’s failures to comply with the standard of care did not cause the patient’s injuries. At trial, the plaintiffs’ expert, a doctor at Johns Hopkins Health System, testified that the hospital breached the standard of care concerning fall-risk assessments by failing to use a bed alarm and by failing to make hourly comfort rounds. In contrast, the hospital’s expert testified that the hospital met the standard of care and that such measures would not have prevented the patient’s fall.

The appeals court agreed with the hospital, finding that the plaintiffs failed to prove the element of causation. The court explained that the plaintiffs failed to show that the lack of a bed alarm proximately caused the patient’s fall. The plaintiffs were required to show that there was a causal connection between the patient’s injuries and the hospital’s actions. The two experts presented conflicting testimony regarding the effectiveness of bed alarms, and the court noted that the plaintiffs’ expert testified that she did not know whether a bed alarm would have made any difference in this case. Therefore, the court found that the evidence was “too tenuous” to support a finding that the use of a bed alarm or of increased comfort round would have prevented the fall.

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As the average age of the United States population continues to increase, more families have to rely on the services of nursing homes to care for family members. Unfortunately, many nursing home facilities are not properly equipped to take care of aging individuals with serious limitations and as a result many residents suffer from abuse and neglect. A new study confirms that many families have good reason to worry, as chronic understaffing is a widespread issue among nursing homes. If you believe your loved one has been harmed by nursing home negligence, contact a skilled Maryland nursing home abuse attorney to discuss your options.

In a recent study by Kaiser Health News and the New York Times, 1,400 nursing facilities across the United States are understaffed. This means that they have do not have an adequate number of registered nurses, as required by the Centers for Medicare and Medicaid Services. The records showed lower staffing levels than the nursing homes had been reporting.

The researchers looked at the payroll records of nursing homes and found that many did not report having a registered nursing on duty for at least 8 hours on many days, which is required under Medicare. In addition, the records of nursing assistants, who provide complemental services to the work of registered nurses, showed their time working was inconsistent. Medicare has only collected and published payroll data on staffing at nursing homes in recent years, as opposed to relying on the homes’ own reports as it had done previously.

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These days, many Maryland nursing home admission agreements often include arbitration contracts or clauses, which require certain claims against the nursing facility to be resolved through arbitration. However, under some circumstances, such agreements may not be enforceable. In one recent case, a plaintiff claimed that the arbitration agreement was not enforceable because the agreement was unconscionable.

In that case, a nursing home resident died in the facility and her husband filed a wrongful death claim against the nursing facility. The husband alleged that the nursing home’s staff negligently allowed his wife to fall multiple times, which ultimately led to her death. The facility filed a motion to compel arbitration based on an arbitration agreement that was signed between the resident and the facility. The husband claimed that the arbitration agreement was unconscionable and could not be enforced.

In that case, there was a signed arbitration agreement, which was separate from the admission agreement. The heading on the cover page read, “EXPLANATION OF BINDING ARBITRATION AGREEMENT,” and stated, “PLEASE READ CAREFULLY.” The cover page of the arbitration agreement stated that the agreement was “voluntary and not a condition for admission” and that the resident could consult with an attorney before signing the agreement. The agreement also stated that the resident could withdraw her consent within thirty days of signing. The resident could do this by writing “CANCELLED” on the agreement and mailing it to the facility. The resident and her husband signed the arbitration agreement and did not withdraw consent within 30 days.

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Proving damages is an essential part of any Maryland nursing home claim. In a recent case before a federal appeals court, the court upheld a punitive damages award of over $4 million in a case where the compensatory damages award totaled just $650,000.

The Facts of the Case

In that case, the plaintiffs brought three wrongful death claims against a nursing home after three residents died at the home. The nursing home had a special “vent unit” for ventilator-dependent patients. The plaintiffs claimed that the three residents, who were ventilator-dependent patients, died because of the nursing home’s inadequate staffing and inadequate supplies.

One resident received an anoxic brain injury during the night and was found with his ventilator and all his alarms turned off. Another patient was found dead with her breathing apparatus pulled from her neck and without an alarm or oxygen monitor. Both deaths were found to be caused by understaffing. The third resident died because staff was not able to replace her tracheostomy tube in a timely manner due to a lack of supplies. The case went to trial and the jury awarded the plaintiffs $650,000 total in compensatory damages, and also awarded each plaintiff $1,523,939.16 in punitive damages.

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For family members who diligently researched the available options and carefully helped place a loved one in a Maryland nursing home, it is incredibly upsetting to hear a loved one disclose that they are being neglected or abused by nursing home staff members. However, this is exactly what many family members experience when their loved ones report back to them about their life in the nursing home.

It is estimated that approximately 500,000 elderly nursing home residents are the victim of abuse and serious neglect each year. However, it is also understood that this figure likely is much lower than it should be due to rampant underreporting by residents. In addition, when residents decide to reach out to nursing home management to disclose abuse, the allegations are too often swept under the rug. In many cases, it is only when family members get involved that allegations of abuse get taken seriously.

Once a nursing home resident discloses abuse, a Maryland nursing home abuse lawsuit can be filed against the responsible parties. If successful, the resident will be able to obtain compensation for their injuries. Importantly, this includes compensation for emotional injuries, as well as physical injuries.

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