Maryland Nursing Home Lawyer Blog

Pressure Mounts to Reduce Use of Antipsychotics in Dementia Patients

September 27, 2011 | Lebowitz & Mzhen

Antipsychotic medications are typically used to treat patients with schizophrenia or bipolar disorder, helping reduce and control delusional thinking and hallucinations. In nursing homes around the United States, staff also use antipsychotics for patients suffering from dementia as a way of controlling paranoia and aggression. These medications can be useful for the small percentage of dementia patients who actually demonstrate psychotic behavior and constitute a risk to other nursing home residents and themselves. For most dementia patients, antipsychotics may only further isolate them and make them even less communicative. This is of particular concern to families and loved ones of dementia patients, who wish to ensure that they are receiving the best possible care.

An FDA warning from 2005 gives notice to doctors of an increased risk of death from pneumonia or heart attacks among dementia patients prescribed atypical antipsychotics. This class of drug includes Abilify, Geodon, Invega, Risperdal, Seroquel, and Zyprexa. The agency added the older class of drugs known as typical antipsychotics to that warning in 2008. Typical antipsychotics include drugs like Thorazine and Haldol. Despite the warnings, off-label use of antipsychotic medications in dementia patients continues.

The Associated Press reports that nursing homes are beginning to take notice of the risks inherent in using antipsychotics for dementia and are gradually decreasing their rate of use. One nursing home in Florida has seen a reduction in the rate from twenty-five percent of all patients to a current rate of fourteen percent. A Brooklyn, New York nursing home went from thirty to fifteen percent without much trouble. Most patients taken off the antipsychotic regimen reportedly displayed significant improvements in both mood and behavior.

Among nursing home staff, the concern is that, without the antipsychotic medications, they will be unable to control aggressive or violent dementia patients. Some patients may truly need such medication, especially since there are no FDA-approved drugs specifically treating behavioral aspects of dementia. Patient advocates cited by the Associated Press argue that the use of such medications has more to do with keeping patients sedated for staff convenience. In situations where use of antipsychotics may be endangering a patient’s life, all other concerns should be secondary to protecting the patient.

“Granny Cam” Technology May Be Effective at Deterring Nursing Home Abuse

September 20, 2011 | Lebowitz & Mzhen

The use of surveillance cameras to monitor treatment of elderly patients by nursing home staff, sometimes known as “granny cams,” is becoming more and more common in Maryland and around the country. While granny cams raise some concerns about the privacy rights of the patients, they have proven to be effective at exposing abuse that might have otherwise gone undiscovered, and state legislatures and agencies are taking notice.

This Maryland Nursing Home Lawyer Blog has previously reported on incidents when granny cams provided evidence of abuse, including a New Jersey case in which the family of a nursing home patient have sued for wrongful death after finding footage of an employee removing the patient’s oxygen mask and hitting her, which they claim led to her death. An Ohio man captured evidence of nursing home staff slapping his Alzheimer’s-stricken mother, shoving her into bed and into her wheelchair, and slamming her against walls. Three nursing home workers in Pennsylvania were arrested when hidden camera footage showed them mocking a patient while forcing her to stand topless.

The nursing home industry has vigorously fought legislative efforts to compel nursing homes to allow placement of cameras in patients’ rooms. Privacy advocates, as well as doctors, have also opposed such legislation at times, arguing that placement of cameras could be used to violate patients’ privacy, considering that nursing home patients requiring assistance in performing daily routines may often appear undressed on camera. Nursing homes further argue that the use of cameras may erode the trust between patients and staff and act as an invitation to lawsuits without good cause. Nursing home reform advocates, however, increasingly favor legal requirements that nursing homes allow cameras.

Some states have passed legislation preventing nursing homes from blocking the use of cameras, although Maryland is not yet one of them. Former Maryland Delegate Sue Hecht introduced such legislation several times beginning in 2001, after she witnessed her mother, Vera, suffering abuse at the hands of nursing home staff. Several bills titled “Vera’s Law” did not make it out of their committees, but a bill passed in 2003, also titled “Vera’s Law,” that required the Maryland Department of Health and Mental Hygiene to develop guidelines that do opt to allow use of electronic monitoring devices with the consent of the patient or the patient’s guardian. The Department issued its guidelines on December 1, 2003, and those guidelines remain in effect today.

Flu Vaccination of Nursing Home Staff Linked to Decline in Patient Flu Outbreaks

September 14, 2011 | Lebowitz & Mzhen

A study has identified a link between increasing rates of influenza vaccination among nursing home staff and decreasing rate of flu infection among patients. The study, which looked at 75 New Mexico nursing homes, found an 87% decrease in the likelihood of a flu outbreak in facilities where 51% to 75% of direct care workers received vaccinations. This supports earlier findings from the Centers for Disease Control and Prevention, which has encouraged healthcare workers to get vaccinated against the flu.

Interestingly, the study also found that high rates of vaccinations among nursing home patients led to higher odds of a flu outbreak in that home. Researchers suggest that this is due to lower rates of vaccination among staff in nursing homes with high rates of patient vaccinations. This finding would further support the conclusion that high rates of staff vaccination keeps outbreak rates low.

The Centers for Disease Control and Prevention (the “CDC”) currently recommends that healthcare workers obtain annual vaccinations against the flu. Their research found that only 13% of healthcare workers reported a requirement of vaccination from their employers. At the same time, a substantial majority of healthcare workers reported vaccinations being available at work, often at no charge.

Outbreaks of disease in the nursing home environment are a persistent concern. Officials at a nursing home in Turtle Creek, Pennsylvania are currently fighting an outbreak of Legionnaire’s disease that has sickened eight people so far. A 2009 study in Ontario, Canada found that, of the 83 disease outbreaks reviewed, 91% of them occurred in long-term care facilities. A 2003 study published in the journal Clinical Infectious Diseases found that one-third of the reports of infectious diseases from nursing homes involved sudden disease outbreaks. The study examined reports of respiratory infections, including influenza, tuberculosis, and pneumonia; gastrointestinal illnesses such as E. coli, salmonella and viral agents; skin infections; and antibiotic-resistant bacteria. The study concluded that the environment of nursing homes allows easy transmission of disease outbreaks, largely due to close living conditions, lack of proper diagnostic equipment, and the already-diminished health condition of many nursing home residents. Recommendations included greater management plans and surveillance of symptoms in patients to try to recognize diseases before they reach outbreak status.

Vaccinating nursing home staff against known contagions is an important step in this process. Nursing homes must also commit to maintaining a clean environment for its residents. Many infectious diseases can reach outbreak status in a nursing home simply due to a lapse in cleaning. Respiratory illnesses such as influenza are commonly transmitted directly from one person to another, but germs can also persist on various surfaces. An elderly individual, practically one with an already-suppressed immune system, who comes into contact with a contaminated surface risks infection.

Maryland Nursing Director Faces Prescription Fraud Charges

September 8, 2011 | Lebowitz & Mzhen

A nursing director at a Maryland nursing home faces charges of forging signatures on prescription slips and attempting to obtain oxycodone at an area pharmacy. On August 24, 2011, Maryland State Police arrested Pamela Brittingham Quillen, nursing director of Manokin Manor Nursing & Rehabilitation Center in Princess Anne, and charged her with prescription forgery. She was released that day on a $5,000 bond.

Quillen is accused of forging the signatures of two individuals: Vincent Lewis, a physician’s assistant at Manokin Manor, and Dr. Vel Natesan, an internist in nearby Salisbury, Maryland. She then allegedly took the forged prescription to Karemore Pharmacy in Princess Anne. A pharmacist contacted Dr. Natesan’s office to verify the prescription. Dr. Natesan received a faxed copy of the prescription, confirmed with Lewis that it was a forgery, and contacted state police. Video surveillance footage also places Quillen at the pharmacy at the time the prescription was presented. Quillen now faces a trial date on October 14.

Coverage of this story offers no indication of any history of drug use or abuse by Quillen, nor does it address her employment at a nursing home. She is charged with five separate offenses:

obtaining a prescription by fraud under Maryland Criminal Code section 5-701(d)(4)(i);
obtaining a prescription by counterfeit or alteration under Maryland Criminal Code section 5-701(d)(4)(ii);
obtaining a prescription by concealment under Maryland Criminal Code section 5-701(d)(4)(iii);
personal identity information theft under Maryland Criminal Code section 8-301(c)(2)(i); and
theft of less than $100.00 under Maryland Criminal Code section 7-104.

Each of these offenses is a misdemeanor under Maryland law, carrying maximum jail terms from 90 days up to 2 years and fines up to $5,000.00. She will get her day in court, but her case demonstrates the importance of professionalism and care in nursing homes, particularly in positions of leadership.

To operate a Maryland nursing home, one must be licensed as a nursing home administrator by the Board of Examiners of Nursing Home Administrators. Nursing home administrators must adhere to a high standard of care in carrying out their professional duties. A nursing home can be a large and complex organization, requiring management of doctors, nurses, medical technicians, and other employees, not to mention the care of sick and elderly patients with a vast range of needs.

Former Schoolteacher Sues Nursing Home For Elder Abuse

August 30, 2011 | Lebowitz & Mzhen

Recently, our Baltimore nursing home abuse blog discussed the financial abuse of elders–a hugely under reported problem affecting around 3.5 million seniors around the country every year.

In recent nursing home abuse lawsuit news, a 68-year-old retired preschool teacher has sued a Seal Beach nursing home for elder abuse, alleging that as a resident, she was chemically restrained with drugs against her will, while the nursing home staff tried to take control of her retirement income.

According to the lawsuit, Marsha Davis lived in her own home until November of 2010, and suffered from many health issues, including diabetes. After collapsing at her home In the fall of 2011, Davis was reportedly hospitalized and then transferred to the Country Villa nursing home, for a three-month stay.

Davis alleges that while residing at the home, she was medicated with psychotropic drugs for chemical restraint against her will—allegations that were reportedly found to be true by state investigators in February. The lawsuit claims that after she was medicated to the point of being entirely disorientated, the nursing home stated that she was suffering from “cognitive impairment” and tried to collect her Social Security payments.

Although Davis has no immediate family members to act as an advocate on her behalf, a friend of hers reportedly intervened, and the medication was stopped. Davis was later transferred to another home where she remains today.

Nursing Home to Appeal $91.5 Million Negligence and Wrongful Death Settlement

August 26, 2011 | Lebowitz & Mzhen

As our Baltimore, Maryland accident lawyer blog recently reported, the family of an elderly nursing home resident whose wrongful death lead to a nursing home abuse and negligence lawsuit, was awarded $91.5 million earlier this month, after a Charleston, West Virginia jury found Heartland of Charleston nursing home and its corporate owners guilty of negligence—a verdict that the nursing home owners are likely to appeal.

According to the lawsuit, in September of 2009, Tom Douglas placed his mother Dorothy, who suffered from dementia, Parkinson’s and Alzheimer’s disease among other conditions, in Heartland of Charleston nursing home temporarily—until there was room for her in a nearby facility that specialized in Alzheimer’s disease healthcare and treatment.

Before placing Douglas in the home, her son claimed that his mother had lived with he and his family, experiencing improved health conditions that included walking, speaking and even recognizing her own family members.

Three weeks after Tom Douglas placed his 87-year old mother into the nursing home he reportedly found out that she was confined to a wheelchair, and suffered from malnutrition, and dehydration. By the time she was transferred to Heritage Center, the nursing home specializing in Alzheimer’s Disease healthcare, Douglas was reportedly unresponsive, had lost fifteen pounds and suffered such severe dehydration that she died the following day after her nursing home transfer.

Another Nursing Home Negligence Lawsuit for Madison County Home

August 25, 2011 | Lebowitz & Mzhen

A fourth nursing home abuse and negligence lawsuit has been filed this week against the owners of a Kentucky nursing home complex, after a resident allegedly suffered from inadequate care when her healthcare rights and safety were reportedly threatened.

According to a news development from the Richmond Register that our Maryland nursing home attorneys have been watching, Viola Fields was a resident of Kenwood Health and Rehabilitation Center from the end of October until the beginning of December in 2010. James Rutherford, Fields’ guardian, claimed that Fields, who is incapacitated and not of a sound mind, did not receive the minimum standard of healthcare that should have been available to her as a vulnerable nursing home resident. Rutherford claims that the home violated her nursing home rights as a long-term care resident.

The lawsuit accuses Kenwood of nursing home negligence for failing to provide Fields with timely and accurate nursing home healthcare and medication assessments, proper resident supervision, necessary medical intervention, and from failing to prevent accidental injury. Kenwood is also being accused of medical and corporate negligence.

Rutherford claims that the nursing home’s wrongful conduct caused the rapid deterioration of Fields’ health and physical condition, and led to the direct development untreated pressure ulcers, wound infections, sepsis, pneumonia, urinary tract infections and weight loss. The lawsuit accuses the home of acting with fraud, malice, gross negligence and reckless disregard for the health and safety of Fields and her rights as a nursing home resident. Rutherford claims that because of these injuries, Fields experienced physical impairment, and suffered embarrassment, along with incurring significant medical expenses.

Hospice Nurse Charged for Elder Abuse and Narcotic Theft

August 24, 2011 | Lebowitz & Mzhen

In a recent Baltimore nursing home lawyer blog, our attorneys discussed a nursing home abuse incident involving a former nursing aide, where the worker reportedly removed the Fentanyl pain medication patch from an elderly resident in order to take the pain medication for her own personal recreational drug use.

According to the Atlanta Journal-Constitution, a local hospice nurse has been charged in a similar elder abuse incident, after being caught on a surveillance video taking narcotic pain medication from an elderly person in the patient’s home.

A family member of the elderly patient reportedly contacted the police about the possibility of elder abuse and narcotic theft, after noticing that the pain killers that were prescribed to the patient were taken. The nurse, Amy M. Armstrong, was reportedly arrested after agents working for the Cherokee narcotics squad observed her taking the pills. After Armstrong was arrested, she was allegedly found to have other pills in her possession including anti-depressants and pain killers.

Armstrong was charged with two counts of elder abuse, two counts of felony theft for taking the medication, and two counts of possession of controlled substances.

The National Center on Elder Abuse states that elder abuse is the knowledge of or intentional act of negligence by a healthcare provider or any other person who causes harm or risk of great harm to a vulnerable senior in a physical, emotional, or sexual way, including exploitation and abandonment.

Feds Help Families Choose the Right Nursing Home With Improved Website

August 19, 2011 | Lebowitz & Mzhen

In an effort to help seniors and families better evaluate and choose the right nursing home, the federal government has recently improved the Nursing Home Compare website, according to a recent article in Forbes.

As our Maryland nursing home injury blog has previously discussed, the Nursing Home Compare website is a web service listing around 16,000 Medicaid and Medicare-certified nursing homes around the county on a Five-Star Quality rating system—that compares and contrasts the quality standards on both short-term and long-term care.

The newly improved Nursing Home Compare website will reportedly feature 21 new criteria that help to measure the quality of care each resident will receive at different nursing homes and facilities around the country. The government will now include valuable experience from nursing home patients in both short-term and long-term care facilities, making it available on the website. It will make any complaints about a nursing home available, such as nursing home negligence or abuse, providing the necessary information.

The Nursing Home Compare’s new criteria will replace a set of 17 criteria and will focus on the specific and crucial issues affecting nursing home residents today, like pressure sores, infections, nursing home falls, pain, and general health and well being. The new criteria will also discuss the different percentages of nursing home residents who have experienced physical restraint, claim to have experienced pain that is severe to moderate, and who have been given vaccine for pneumonia.

Nursing Home Aides Found Guilty of Elder Abuse by Engaging in Prank with Dementia Residents

August 18, 2011 | Lebowitz & Mzhen

In recent nursing home abuse news that our Baltimore, Maryland attorneys have been following, two former nursing aides in a Northern California nursing home were sentenced to a twenty day county jail sentence for allegedly organizing a prank for other workers by rubbing eight dementia nursing home patients with ointment to make them slippery to care for.

According to the Ukiah Daily Journal, Jennifer Louise Burton and Monica Rose Smith were found guilty of masterminding the nursing home abuse incident at Valley View Skilled Nursing facility in 2009, receiving a twenty day county jail sentence and two years probation for misdemeanor charges of elder abuse. Douglas Parker, Deputy District Attorney claimed that the elder abuse convictions and the fact that their nursing assistant licenses have been revoked by the state will ensure that the producers of this prank will on longer have the opportunity to work in a position of trust at a skilled nursing facility in the future.

The nursing home abuse incident reportedly occurred in November of 2009, and was investigated by then-Attorney General Jerry Brown, after he received an alert about the abuse by another nursing home operator. The company reportedly instantly fired six employees—Burton and Smith, along with three other defendants, all five of which have had their nursing home licenses revoked. Jared Buckley, the third nursing home defendant was also charged with a misdemeanor for elder abuse, and two other nursing assistants were found guilty of failing to report the elder abuse. The sixth nursing assistant had the charges against her dismissed.

The dementia patients were reportedly not physically injured or harmed in the prank, but they were unable to object to their mistreatment or stop it because of their mental and medical conditions and limitations.