April 10, 2008

DENVER — One state lawmaker believes more and more nursing homes are taking advantage of elderly patients and their families by including binding arbitration clauses in their contracts, and she is sponsoring legislation to prohibit the clauses.

“Binding arbitration means you don’t get your day in court,” said Rep. Cheri Jahn, D-Wheat Ridge.

The arbitration clauses mean that no matter how egregious the treatment, the patient can’t file suit in public court to settle a dispute, Jahn said. The patient can only negotiate behind private doors with an arbitrator chosen by the nursing home, she said.

“More and more they’re placing them in these contracts, and people literally don’t know what they’re signing. That is wrong,” Jahn said.

Mike Trenkle, of Elizabeth, experienced the issue firsthand after admitting his grandmother into a Colorado nursing home.”You just sign whatever you do because you care for your loved one,” said Trenkle.

He said after a negligent physical therapist caused his grandmother to break her leg, he pulled her out of the home and tried to sue, but he had signed a binding arbitration agreement. The arbitration procedures dragged on for more than two years, until she died in January.”When you’ve got these arbitration agreements there’s nothing to make these people toe the line,” he said.

Jahn said she is drafting a late bill to ban binding arbitration agreements in long-term care contracts. The Colorado Health Care Association, a trade organization representing the state’s nursing homes, is opposed to the bill. In a statement, the groups general counsel, Fred Miles, wrote:

“The process is not mandatory and may not be a condition of admission to any facility; in fact, the agreement may be rescinded by the patient or responsible party within 90 days of signing if they so choose. It is condescending to suggest or imply that these citizens should be denied this right because they don’t know what they are doing — we venture to say that the real motive behind this bill relates to the monetary desire of trial lawyers to further litigation and to ‘control’ their clients. The increased cost associated with litigation will be borne by you and I as citizens (in the form of increasing the cost of long-term care to private payers) and the taxpayers (as such cost increases will be passed on to governmentally funded health care programs such as Medicare and Medicaid).

By ALLISON HOFFMAN

April 8, 2008

Marine captain who is on his third tour in Iraq was awarded $3.5 million in punitive damages Tuesday from a servicemembers’ insurance company for water damage to his house.

Capt. John Colombero already won $50,000 in damages for emotional distress last week after his lawyers argued that he spent time between deployments arguing with his insurance company, USAA. The insurer had denied a 2004 claim for $84,744 in damage to his house in Oceanside, south of the Marine Corps’ Camp Pendleton.

Colombero’s father said financial uncertainty and paperwork associated with the insurance claim and lawsuit took their toll on his son.

“The Marines don’t give you much flexibility, so he had to take care of the documents and then worry about his deployment too,” John Colombero, Sr., said in an interview. “He’d get up at 4:30 in the morning and come home at 10:30 at night and then have to deal with this.”

USAA spokesman Roger Wildermuth defended the company’s work and said the insurer plans to appeal the damages.

Jurors indicated on court forms that the punitive award was intended to punish USAA for malice, oppression and fraudulent conduct, said Ricardo Echeverria, Colombero’s lawyer.

An insurance litigation analyst said the damages would likely be reduced.

“I say ‘wow’ because it’s really an amazing jump to get from the initial award to those punitive damages,” said David Rossmiller, managing editor of the Insurance Coverage Law Blog. “It absolutely plays into people’s minds, that he’s a Marine. Would they have given the same award to somebody else? Maybe not.”

USAA, a private company based in San Antonio, provides insurance and financial services to 5.6 million servicemembers and their families.

Colombero, 34, originally of San Jose, bought his three-bedroom house for $352,000 in 2002 and rented out the spare bedrooms to make his payments. In 2004, after he returned from a tour in Baghdad, Colombero decided to build an addition. A pipe burst during construction, damaging the foundation.

Colombero, who testified before he deployed again March 20, heard about the verdict when he made on a phone call to his fiancee, Kimberly Collins, from Iraq.

“We were in there with the jurors, so I put him on speakerphone and he thanked them for their service,” Collins said. “Then I took him off speakerphone and told him they just gave him $3.5 million, and he just said, ‘Oh my God.’”

Vittorio Hernandez - AHN News Writer

Sacramento, CA (AHN) - A study released Tuesday reported growing profitability of the nursing home industry, but declining health care quality.

Researchers from the University of California San Francisco found out that two years after the state passed legislation increasing reimbursements from Medi-Cal, average nursing home income from the state’s healthcare program went up to $152 from $124 daily.

The same study discovered 16 percent of nursing homes in the state failed to measure up to California’s minimum staffing benchmarks. A minimal rise in average salary for nursing assistants by less than one dollar was not sufficient to cover inflation rate increases. Even higher-paid nurses had a fast turnover rate, with 7 in 10 resigning from their jobs in 2006.

But average spending on direct patient care went down by 3.6 percent, while complaints of patient mistreatment proven went up by 36 percent.

Charlene Harrington, the lead author of the study, wrote as her comment, quoted by the Los Angeles Times, “They got so much money, they should have been able to do something.”

Betsy Hite, spokeswoman for the California Association of Health Facilities, said it was too early to judge the nursing homes. She admitted the legislation turned around the association members’ finances, but would prefer true accounting of funds received from the Medi-Cal to be done closer to 2009.

Meanwhile, United Way, a charitable organization which funds nursing homes, soup kitchens and other social service providers, reported difficulty in raising funds. Carol McCormack, president of United Way Mesa, attributed the decline in donations to the slump in the housing industry since architects, engineers, real estate agents and construction workers form the bulk of the group’s major donors. The shortfall in fund raising this year was $350,000, McCormack told the San Francisco Examiner.

April 2, 2008

WellPoint won’t pay for botched surgeries

By Tom Spalding, Indianapolis Star
WellPoint has come up with a new way to protect patients from having a routine surgery go awry.

It won’t pay for them.

The Indianapolis-based health insurer today said it has informed hospitals that service WellPoint’s 35 million members that it won’t pay the hospitals for medical errors in 11 scenarios, including surgery on the wrong body part or for an object or medical instrument left in the body during surgery.

Other boo-boos that won’t be tolerated: catheter-associated infections and hospital-acquired injuries such as fractures, dislocations, crushing injuries and burns.

WellPoint says its stance should save money, since medical professionals will have to be extra careful. Avoidable errors will now carry a price tag.

“Our primary focus is to help ensure that physicians and hospitals are using appropriate processes, technologies and strategies to address ‘never events’ and ultimately to enhance the quality of care delivered to hospitalized patients,” said Sam Nussbaum, WellPoint executive vice president of clinical health policy and chief medical officer.

In a news release, the president of the National Patient Safety Foundation praised WellPoint’s initiative, which is in its first stage. Diane Pinakiewicz called the move “commendable” and a proactive way of ensuring patient safety.

One client is already praising WellPoint for its stance.

“It is critical that the entire health care system be looking for ways to improve safety and reduce harmful medical mistakes,” said Bruce E. Bradley, a General Motors health care director says. GM thanked WellPoint for “implementing policies to help eliminate these costly adverse events.”