Nursing Home Abuse

Nurse Convicted of Involuntary Manslaughter for Drugging Patient, Causing Patient’s Death

June 7, 2012 | Lebowitz & Mzhen

A nurse in Durham, North Carolina pleaded guilty to charges of involuntary manslaughter and patient abuse when a nursing home resident under her care died. Prosecutors accused her of drugging patients under her care in order to “keep them quiet.”

Angela Almore worked as a nurse at Britthaven of Chapel Hill, a nursing home located in Chapel Hill, North Carolina. She was reportedly working the 3 p.m. to 11 p.m. shift in the home’s Alzheimer’s unit on February 13, 2010. Seven residents were taken to a nearby hospital in the early morning of February 14 for respiratory issues. All seven of them tested positive for opiates, although it reportedly took doctors several hours to determine what was wrong with the patients. One of the residents, 84 year-old Rachel Holliday, died at the hospital. The cause of death was determined to be pneumonia due to morphine toxicity. The other six residents received treatment for various respiratory ailments and eventually returned to the nursing home.

Fourteen of the approximately twenty-five residents in the Alzheimer’s unit tested positive for morphine. Only one of the residents had a prescription for the powerful opiate. During the subsequent investigation of Holliday’s death and the positive toxicology tests, several employees stated that they had seen Almore giving an orange fluid to patients that did not look like the patients’ regular medication. According to the assistant district attorney who prosecuted the case, employees said that Almore told them she did not want to deal with patients during that shift, and that she had given them something to “relax.” Almore also allegedly stated that “she knocked all their asses out.” One employee who worked in the Alzheimer’s unit told the judge presiding over the case that none of the drugged patients ever caused trouble for the staff.

Nursing Home Staffer Charged with Elder Abuse for Allegedly Stealing Medicine

May 15, 2012 | Lebowitz & Mzhen

Prosecutors in Great Falls, Montana have charged former nursing home employee Jennifer Allgrunn with drug possession and elder abuse. The theft of medications allegedly went on for several months, during which time residents might not have had enough medications for their needs. Although the underlying alleged offense is essentially theft and a drug offense, the fact that it directly harmed the nursing home’s elderly residents led to a criminal charge for elder abuse.

Police arrested Allgrunn on Friday, May 4, 2012, after staff at Goldstone Assisted Living Home complained about ongoing and routine drug thefts. Allgrunn had worked at Goldstone since December 2011. Police found nine prescription pills on Allgrunn’s person, including the painkiller hydrocodone, as well as additional medication packaging. Goldstone administered all of the medications in Allgrunn’s possession. She reportedly admitted to police that she had been regularly stealing drugs from the nursing home since December.

Prosecutors charged Allgrunn with elder abuse and criminal possession of dangerous drugs. Court documents filed by prosecutors allege that her thefts harmed the elderly residents of the nursing home by depriving them of medication, and therefore sufficient medical care.

Owner of Nursing Home Charged with Neglect for Second Time in Eight Years

April 20, 2012 | Lebowitz & Mzhen

Police in North Charleston, South Carolina arrested a nursing home owner on Thursday, April 12, 2012 after an inspection of the facility reportedly found extensive evidence of neglect. Andrea Magwood, age 68, is accused of neglecting vulnerable adults under her care. She went free on April 16 on a $250,000 bond. Her nursing home is currently closed, and authorities have transferred the thirteen residents to other facilities. Magwood faced a similar investigation and charges in 2004 relating to alleged abuse at the same facility.

The Governor’s Office of Ombudsman, the office charged with investigating reports of abuse or neglect in nursing homes, contacted North Charleston police on April 5 with concerns about the health of one of the residents. A 79 year-old resident of Magwood’s nursing home, Fair Havens Manor, had reportedly been admitted to the hospital. Doctors diagnosed him with severe dehydration and malnutrition, and they reportedly found a subdural hematoma on his head that possibly required surgery. Inspectors arrived at the home later on April 5. They reported finding mold clinging to the walls and cockroaches “crawling all over.” Residents allegedly received rotten food, and medications lacked labels or records that would indicate to which resident they belonged.

By April 12, North Charleston authorities had condemned the home’s two buildings and arrested Magwood. EMS personnel assisted police in removing the residents from the facility and taking them to a nearby hospital for medical assessment. From there, the residents would either receive medical care or be transferred to another facility.

Prosecutors charged Magwood with neglect of a vulnerable adult, a felony offense in South Carolina with a maximum penalty of five years in prison. State statutes also allow the attorney general’s office to being a civil action for a penalty of up to $30,000 for a nursing home owner who allegedly fails to protect residents from neglect. A judge set Magwood’s bond at $250,000 on April 13, and she reportedly left jail on Monday, April 16.

Magwood faced similar charges in 2004 when another resident reportedly suffered malnutrition and dehydration. Police raided the home, then known as Genesis Nursing Home, In June 2004 after a bank teller reported several large withdrawals by one of the residents while accompanied by Magwood. The teller also reported that the resident showed signs of physical abuse.

Proposed Maryland Legislation Would Increase Criminal Penalties for Elder Abuse

March 16, 2012 | Lebowitz & Mzhen

A bill that would increase criminal penalties for people who engage in elder abuse has met with unfavorable reports in the judiciary committees of both houses of the Maryland Legislature. The bill, known as the John H. Taylor Act, has been introduced in the Legislature several times, and its supporters are not likely to give up. The bill’s namesake, was ninety years old when he suffered several severe beatings by an in-home caregiver in 2007. He was recovering from multiple strokes at the time. One of the beatings was caught on tape, and his daughter, Jacqueline Taylor, learned that he had suffered three more beatings from his caretaker that month. She showed the video to the House Judiciary Committee at a hearing in January and testified in support of the bill.

According to a website set up by Jacqueline Taylor, the caretaker, Anastacia Oluoch, was arrested in 2007 and charged with four counts each of abuse or neglect of a vulnerable adult, second degree assault, and reckless endangerment. All of the charged offenses are felonies. She was released on bail and fled the country before her trial date. She was reportedly arrested in Kenya in 2011 and could be extradited to the United States. John H. Taylor passed away in 2009.

Under current Maryland law, abuse or neglect of a vulnerable adult applies to a person with a “contractual undertaking to provide care” to an adult lacking “the physical or mental capacity” to provide self-care. “Abuse” includes intentionally inflicting pain or injury and sexual abuse. “Neglect” includes the withholding of food, medical care, and other necessary services. Abuse or neglect that involves sexual abuse or results in death or serious physical injury is a first-degree offense, carrying a maximum penalty of ten years’ imprisonment and a $10,000 fine. All other abuse or neglect is a second-degree offense, with a punishment of up to five year’s imprisonment and a fine of $5,000.

The proposed legislation would modify the statutes defining both first- and second degree abuse or neglect of a vulnerable adult. It would prohibit a District Court commissioner from releasing a defendant charged with either offense prior to trial. A judge, subject to certain requirements and conditions, could still authorize a defendant’s release, with provisions specifically preventing a defendant from leaving the country. The bill also doubles the maximum penalties for first- and second-degree offenses. Critics of the bill worry that it may infringe on a defendant’s due process rights and limit judges’ discretion.

Nursing Home Addresses Safety Concerns, Deals with Allegations of Sexual Abuse

February 21, 2012 | Lebowitz & Mzhen

A Rhode Island nursing home faced an ultimatum from the government in January: fix various problems by February 1 or lose its status as a Medicare and Medicaid provider. The Centers for Medicare & Medicaid Services (CMS), the federal agency tasked with managing both programs, sent a letter to Hebert Nursing Home in Smithfield, Rhode Island on January 19 outlining infractions of seven regulations that the nursing home needed to address. The regulations in questions dealt with issues of mistreatment or neglect of residents, residents’ dignity and respect, residents’ well-being, administration of the facility, and the medical director’s responsibilities. A CMS spokesperson called the alleged infractions “serious” and said they posed “immediate jeopardy” for residents, but could not disclose many specific details of the allegations.

CMS has legal authority to monitor nursing homes that are part of the Medicare and Medicaid systems, and it has the responsibility of maintaining standards of quality in all of the nursing homes it monitors. As part of its corrective actions, CMS began fining Hebert $5,500 a day beginning December 22, 2011. It also stated that it would begin denying payments under both its programs for new patients after January 23. It gave Hebert’s administrators until February 1 to address CMS’s concerns, after which it would terminate Hebert’s involvement with Medicare and Medicaid. This would effectively destroy Hebert’s business since so many nursing home residents rely on one or both of these programs to pay for their care.

By the beginning of February, CMS had withdrawn its complaint after receiving a satisfactory response from Hebert, indicating that it was addressing CMS’s concerns. At about the same time, however, allegations publicly surfaced that several staff members had voiced concerns about the sexual abuse of a resident. Two certified nursing assistants and a psychiatric nurse reportedly gave statements to police on November 30 and December 1, 2011, describing incidents of sexual abuse they had witnessed at the nursing home.

The three employees stated that they saw two women sexually abusing their 89 year-old mother, a resident at the facility, on several occasions while visiting her. In their statements to police, they reported seeing the women touching their mother in her genital area and other acts of abuse. The two women reportedly told the workers that they needed to check their mother’s incontinence, but the psychiatric nurse claims that there would be no reason for them to do so manually.

Maryland Nursing Home Staffer Pleads Guilty to Abuse of a Resident

February 14, 2012 | Lebowitz & Mzhen

A former staffer at a Timonium, Maryland nursing home pleaded guilty late last month to abuse of a vulnerable adult in the second degree. This Maryland Nursing Home Lawyer Blog previously reported on the case of Shirleen Diane Sheppard when prosecutors first indicted her last year. Sheppard worked as a geriatric nursing assistant at Stella Maris. According to the Maryland Attorney General’s Office, Sheppard was attending an 82 year-old female resident on October 17, 2010. She became angry and slapped the patient’s face. She also reportedly refused to put ointment on the patient’s rash and kept the assistance call button away from the patient.

Another staffer witnessed the incident, cared for the patient, and then reported the matter to the nursing home’s administration. Sheppard admitted to the assault, and the nursing home fired her. The patient reportedly did not suffer any lasting injury.

Sheppard was indicted in the Circuit Court of Baltimore County on four counts: one count of second-degree abuse of a vulnerable adult, two counts of second-degree neglect of a vulnerable adult, and one count of second-degree assault. All of these charges are misdemeanors under Maryland law. Second-degree assault carries a potential penalty of ten years imprisonment and a fine of up to $2,500. The abuse and neglect of a vulnerable adult charges each carry potential prison terms of five years and fines of $5,000. Maryland’s criminal laws define “abuse or neglect of a vulnerable adult” as the deliberate infliction of pain or injury, “cruel or inhumane treatment,” sexual abuse, and failure to provide “necessary assistance and resources” like food and shelter. The second-degree abuse or neglect statute applies to a caregiver, parent, household or family member, or other person with “permanent or temporary care or responsibility for the supervision” of an adult deemed “vulnerable.” “Vulnerable” is defined as “lack[ing] the physical or mental capacity to provide for [one’s own] daily needs.”
Sheppard formally entered a guilty plea to one count of second-degree abuse of a vulnerable adult at a hearing on January 18, 2012. The judge accepted her plea and imposed a three-year suspended prison sentence. She will be on probation for three years and must complete 150 hours of community service within the next year. The judge also barred her from working as a geriatric nursing assistant during her probation term.

Maryland Podiatrist Sentenced to Four Years in Prison for Scheme Involving Nursing Home Patients

February 7, 2012 | Lebowitz & Mzhen

A Maryland podiatrist, Larry Bernhard, was sentenced by a U.S. District Judge in Baltimore to fifty-four months in prison, plus three years’ supervised release, for a series of fraudulent bills to Medicare totaling more than $1.1 million. He pleaded guilty to charges that included health care fraud and identity theft. His scheme involved misrepresentation of podiatric services in billing statements to Medicare, and theft of nursing home patients’ names and identities in order to bill for services never actually rendered.

Bernhard operated a podiatry practice, Chesapeake Wound Care Center, out of his home in Gambrills, Maryland. He has been licensed as a podiatrist by the state of Maryland since 1981. He first came to the attention of law enforcement over allegations that, between April 2002 and October 2004, he submitted a series of fraudulent claims to Medicare. In about eighty separate claims, he claimed reimbursement for podiatric services rendered at “skilled nursing facilities” that were actually performed at hospitals. He did this allegedly in order to claim a higher rate. He and the government entered into a settlement agreement in October 2007 regarding these allegations. As part of that agreement, Bernhard agreed to a three-year period of exclusion from all federal health care programs, including Medicare and Medicaid.

According to Bernhard’s recent plea agreement, he began a new fraudulent billing scheme soon after signing the settlement agreement. Beginning in October 2007, and continuing until July 2010, he submitted fraudulent bills to Medicare Advantage plans and received upwards of $1.1 million. Prosecutors estimated that at least $1 million of the total amount was compensation for podiatry services that he never actually performed. In order to enact this scheme, Bernhard admitted, he used the personal identifying information of about two hundred nursing home patients for services that were never rendered.

Bernhard’s actions clearly violated his 2007 settlement agreement with the government. He pleaded guilty to aggravated identity theft and health care fraud. In addition to the four-and-one-half year prison sentence, he must pay restitution of $1,122,992.08.

This case illustrates some troubling vulnerabilities in the nursing home population. He used the names and other identifying information of nursing home patients as the basis for his false billing statements. The press release from the FBI describing Bernhard’s sentence does not go into detail about how the scheme affected the nursing home patients. Presumably they were simply names that Bernhard appropriated, but it could be possible, in a similar scheme, for someone to actually withhold needed treatment yet bill Medicare for the services. It is also possible that a doctor or other medical professional could order unnecessary treatments in order to pad a bill.

Former Nursing Home Staffer Sentenced in Sex Abuse Case

January 18, 2012 | Lebowitz & Mzhen

A former staffer at a nursing home in Barboursville, West Virginia was sentenced to one to three years in jail, including time served, after pleading guilty to the offense of attempting to commit a felony. Darren Canada, a 41 year-old Huntington resident, could be released within a few months because of time already served during the case. His jail sentence could be even shorter with credit for good behavior. The original indictment, issued in September 2010, charged Canada with second-degree sexual abuse and abuse or neglect of an incapacitated adult. He entered a guilty plea to the lesser offense in late 2011.

Canada worked at the Chateau Grove Senior Living Facility. In January 2010, another employee reportedly caught Canada attempting to sexually assault an 81 year-old female resident. According to the criminal complaint, Canada fled the facility by jumping out a window. Authorities say that he later confessed to the crime. His victim has since died.

The jail sentence imposed by the judge is the maximum allowed by West Virginia state law. The previous felony charges could have carried much more serious penalties. The prosecutor said that the sentence was “in the best interest of justice” based on the available evidence. The nursing home reportedly cooperated fully with law enforcement during the investigation of the case, earning the praise of the county sheriff. A relative of the victim spoke to the media about the sentence on her behalf.

Cases such as this present certain difficulties for law enforcement. Victims often cannot speak out for themselves due to physical frailty or mental difficulties. They may not remember important details or may not be able to communicate effectively. They may suffer further incapacitation or even die before a case can be adjudicated, making convictions much harder to obtain. Unfortunately this gives quite an advantage to perpetrators. The nursing home appears to have acted admirably in this case in cooperating with authorities.

Proposed Bill Would Require Notification of Nursing Home Residents on Sex Offender Registry

January 9, 2012 | Lebowitz & Mzhen

Governor Terry Branstad of Iowa has asked the Iowa Legislature to pass a bill requiring nursing homes to notify residents when a registered sex offender moves into the facility. Courts often order individuals into nursing home care after a plea or conviction, and some of those individuals must also go on the sex offender registry under the same order. Iowa officials estimate that fifty to fifty-five registered sex offenders currently reside in nursing homes in the state. Discussion of nursing home abuse and neglect often focuses on the action, or inaction, of nursing home staff, but residents may also face the risk of abuse from fellow residents.

The governor’s proposal arose from an incident last year at a nursing home in Pomeroy. An 83 year-old male convicted sex offender suffering from dementia who suffered from dementia assaulted a 95 year-old female resident. After the man was released from a facility designated for sex offenders, a judge had ordered him to be placed in the nursing home.

Shortly after the incident in Pomeroy, the governor convened a group to review laws relating to sex offenders in long-term care facilities. The proposed legislation is based on their recommendations. The governor announced the bill during his weekly radio address on January 9. In addition to notification of other residents or their representatives, nursing homes would have to create a written safety plan for use when a sex offender resides in the facility. He suggested that facilities might choose to designate an area to focus on sex offender residents, comparing the idea to wings designated for Alzheimer’s patients and other conditions.

The bill creates a delicate question about how to balance the right of nursing home residents to a safe living environment with the right of convicted sex offenders to also get an appropriate level of care. Nursing home residents are among the most vulnerable of people, and the notion that they might face abuse by a fellow resident with a possible history of abuse seems to shock the conscience. Once convicted sex offenders have served their punishments, however, they ostensibly have the same rights to nursing care as anyone else. Governor Branstad acknowledged the need to balance the interests of resident and public safety with the right to receive care, particularly when a person has been committed to care via a court order.

Most Elder Deaths in Nursing Homes are Never Investigated

January 2, 2012 | Lebowitz & Mzhen

Deaths occurring among elderly nursing home residents often escape scrutiny. Doctors may classify possibly suspicious deaths as the result of “natural” causes, and as a result cases of abuse and neglect are not investigated. Reporters for ProPublica, in cooperation with PBS’ “Frontline” and other news organizations, conducted a review of coroner and medical examiner records from around the country to examine how often suspicious deaths in nursing homes get swept under the rug. While an accurate total is probably impossible to determine, they identified over three dozen cases in which authorities missed “alleged neglect, abuse, or even murder of seniors.” The resulting article names three systemic problems in elder care that contributes to the problem of under-reporting suspicious deaths: incorrect identification of causes of death, completion of death certificates by doctors who did not examine the body, and infrequent autopsies of elderly decedents.

The authors of the study describe the case of Joseph Shepter, a resident of a California nursing home who passed away in 2007. The chief medical officer stated that his death resulted from heart disease, and the coroner never investigated. Around the time of his death, a staffer at the nursing home reported to state officials that the home was using antipsychotic drugs to “chemically restrain” dementia patients. This led to a fine against the home and an investigation by the state attorney general, including a look at the circumstances of Shepter’s death.

The investigation found widespread abuse and neglect, particularly with regard to Shepter. He had apparently lost nearly twenty percent of his body weight in the three months prior to his death. His cause of death was revised from heart failure to a combination of conditions related to neglect, such as dehydration, sepsis, and pneumonia, all made worse by the use of antipsychotic medications. Two years after Shepter’s death, prosecutors brought criminal charges for homicide against the chief medical officer and two others. His case helps illustrate the three systemic problems identified in the report.

1. Incorrect Causes of Death. States tend to rely on treating physicians to determine whether or not a death is “suspicious” or “natural.” If a treating physicians certifies a death as resulting from natural causes, coroners will not conduct an investigation. The law does not generally consider the possibility that a doctor would incorrectly identify, or even deliberately misstate, the cause of death.

2. Death Certificates, Sight Unseen. Many states allow doctors to complete a death certificate without examining the decedent’s body. Obvious physical signs of abuse or neglect may go entirely unnoticed.

3. Autopsy Ageism. The study found that autopsies are performed on elderly people in ever-decreasing numbers. In one sense, this is rational. The death of an elderly person, while tragic, is neither uncommon nor entirely unexpected, as opposed to the death of a younger person. As a result, elder deaths are often attributed to existing health conditions without much review, leading to physical evidence being overlooked.