From the New York Times:

A study from the Archives of Internal Medicine found that elderly people who take narcotic-based drugs for pain face an elevate risk of bone fractures, heart attacks and death than those who take a non-narcotic pain reliever. In what is considered the first large-scale effort to examine the safety risks associated with narcotic pain relievers, researchers concluded that narcotics were more dangerous than non-narcotics, contrary to popular belief.

“Doctors should not assume that opioids are a safer alternative,” said Daniel H. Solomon, the study’s researcher, said in a telephone interview on Monday. “They seem to carry profound risks to cardiovascular system as well as increased risk fractures and appear to be associated with increased risk of death.”

Homicide detectives in San Diego were investigating the death of an elderly woman from the Palm City area. According to reports, the woman was being cared for by a professional “caretaker.” When a relative of the 83-year-old victim called police to check on the victim, police went to the woman’s home and found her dead in the bathroom.

According to police, there were no signs of trauma but that elder abuse was suspected. Police arrested caretaker Maria Moore on suspicion of elder abuse and booked her into county jail. A cause of death has not been determined.

News accounts do not state where Moore was employed by a home health agency or whether or she was working on her own. If is determined that the victim’s death was due to neglect, Moore and the agency she works with (if there is one) may face civil liability under California’s Elder Abuse and Dependent Adult Civil Protection Act.

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Peer-on-peer abuse in the nursing home setting is a problem that gets very little attention, but occurs with more and more frequency. A horrific example of this occurred two weeks ago at Chino Valley Health Care Center in Pomona. On November 23rd, John Lazzaro, a 91-year-old resident of the rehabilitation hospital, was killed after being attacked by fellow resident Matthew Harvey, who was only 47.

The details of the attack are kind of sketchy, but according to news accounts Lazarro was found in his room with severe wounds to his arm and face. So severe were the wounds to his arm it required amputation. It is very likely that Mr. Lazzaro couldn’t survive the surgery and died shortly thereafter.

The nursing home industry (and nursing home lawyers) was stunned earlier this year when a Humboldt County jury returned a class action verdict against the nursing home chain of $677 million dollars. The plaintiffs alleged, and the jury believed, that Skilled Healthcare, the owner of many nursing homes in several states, routinely understaffed its California nursing facilities, compromising patient care in an effort to maximize profits.

The case was a battle. ”Everything was fought tooth and nail,” Timothy Needham, lead trial lawyer for the team of plaintiff lawyers told the Times-Standard. The trial lasted six months. But the verdict was so big it created practical problems for the victors, and potentially fatal concerns for Skilled Healthcare, a publically traded company. Because of the size of the verdict, Skilled Healthcare could not afford to pay such a huge judgment and could not appeal the result (appeals require the posting of a bond, which is a percentage of the verdict), and the plaintiffs really didn’t want to take over the company. So, smartly, everyone agreed on a settlement.

It was announced yesterday that the verdict of $677 million was settled for $62.8 million.

The giant nursing home neglect verdicts continue to come in around the country. Last week, a jury in Kentucky awarded the family of a neglected nursing home resident $42.75 million after the resident became lethally dehydrated and malnourished, and arrived at the hospital covered in bed sores. The resident died as a result.

According to news accounts, 92-year-old Joseph Offut had been a resident of Harborside nursing home for only nine days prior to his death. The World War II veteran had been very active up until the age of 90, when he suffered a stroke and was cared for by his wife of 58 years. Like many, after some difficult conversations the family ultimately decided that Mr. Offut needed professional care and placed him in a nursing home.

After his death, Offutt’s family filed a lawsuit for wrongful death against the nursing home’s parent company, Sunbridge Healthcare Corp. The lawsuit alleged that caregivers at the nursing home neglect Offut, causing him to suffer severe dehydration, malnutrition, decubitus ulcers, and ultimately death.

The unspoken problem with California nursing homes is staffing. Not enough of it, and poor training for those who do it. Who knows what caused this major screw up, but you can be sure it’s related to staffing. A 94-year-old resident of Silverwood Senior Living Facility, a skilled nursing facility, went missing last month. Staff searched everywhere for the dementia patient, but couldn’t find her.

Thankfully, someone thought to check the walk-in freezer in the nursing home kitchen. There they found the resident locked inside the freezer where the temperature was set at five degrees. Thankfully she was unharmed. Still no one knows just how she got in the freezer, and the home, who has a history of regulatory violations, self-reported the incident as required by law.

Mark Mostow, a VP for the nursing home, released this obligatory statement about the resident: “We immediately conducted an investigation, and took appropriate corrective action against two employees. It’s an unfortunate incident, and we’re very sorry that it happened, and we’ll do everything in our power to ensure this does not happen again.”

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It is being reported by California Watch that the U.S. Department of Justice is investigation what is being described as lax care at several California nursing homes, and even threatening criminal and civil actions against those homes. Specifically, the investigators will be examining the use of psychotropic drugs in these facilities and those injured by the misuse of such drugs. Also being investigated are the nursing homes that prematurely discharge patients whose condition requires them to stay.

The investigation was triggered in part by the federal health reform law that includes the Elder Justice Act. That act allows for the coordination between the U.S. attorney general’s office and local and state law enforcement to crack down on elder abuse and neglect. The Northern California office of the Justice Department retained the services of a consultant, who interviewed local ombudsmen’s offices about nursing home complaints. Out of those interviews, several facilities were identified.

U.S. Attorney Melinda Haag told California Watch that her office hired the consultant approximately two months ago, shortly after a California Watch article about the decline in the prosecution of elder abuse cases. “My office is in the process of evaluating the complaints our consultant gathered and will prosecute, to the fullest extent of the law, those individuals who are in violation of federal statutes,” Haag said in a written statement.

The California Department of Public Health issued its most severe citation to a California nursing home following the death of a 97-year-old resident. According to reports, the Gramercy Court nursing home patient fell out of her bed and onto the floor while a nursing assistant had her back to the patient. The resident suffered a spinal injury and died a short time later.

State investigators said the fall could have been prevented if the bed rail, which was ordered, had been in place. As a result, a AA citation was issued against the facility, and a $90,000 fine assessed. The maximum fine allowable under California law is $100,000.

To read the entire AA citation, CLICK HERE (.pdf).

At Walton Law Firm, we have handled numerous cases involving decubitus ulcers or bed sores, many of them resulting in the death of the patient. But the cases we handle are civil cases; a prosecution of the nursing home or other caregiver to seek money damages. We have never seen any caregiver prosecuted criminally for such neglect.

090903_jean_rudolph.jpgIn Washington State, however, the owner of an assisted living facility and an employee were charged with crimes for the neglect of Jean Rudolph, who died under their care. When Rudolph died in 2008 at the age of 87, she weighed only 68 pounds. The cause of death was related to infections that were caused by bed sores so severe that they exposed her bones, including a hip sore so severe that her hip bone jutted out of her body.

Her son, who visited her twice a week, never knew of the sores. His mother suffered from end-stage dementia and couldn’t speak or express her needs, and each time the son visited she was always under covers.

A 72-year-old woman suffered burns on her hands and feet while under the care of an Escondido woman and her son at their home-based elder care facility. Mila Labayen, 74, and her son, Steve Perez Lopez, 50, face criminal charges for elder abuse arising from their failure to seek immediate medical attention for the injuries of the resident who suffers from dementia. In addition, Mr. Lopez is charged with draining $45,000 from the bank account of another elderly resident, who suffers from schizophrenia. Mr. Lopez allegedly took the money while out on bail for charges relating to the elder abuse claim. Alert bank employees alerted authorities to the suspicious withdrawal of money.

It is unclear what caused the 72-year-old woman’s burns, but by the time her daughter learned of her injuries and brought her to the hospital, her skin was already sloughing off, and she remained in the hospital’s burn unit for nine days.

The elder care home, Liberty Care Homes III, located on the 1100 block of Via Rancho Parkway, was owned and operated by Ms. Labayan and was licensed to provide residential care for up to six elderly people. The license was first issued in 1993. Liberty Care Homes III is now closed.

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