September 30, 2008
By ROBERT PEAR, The New York Times
WASHINGTON — More than 90 percent of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes, federal investigators say in a report issued on Monday.
About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.
Problems included infected bedsores, medication mix-ups, poor nutrition and abuse and neglect of patients.
Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.
About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.
The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.
“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”
On Monday, Mr. Levinson issued a compliance guide that says some nursing homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.”
Researchers have found that people receive better care at homes with a higher ratio of nursing staff to patients.
The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”
Bruce A. Yarwood, president of the American Health Care Association, a trade group, said: “We know we have to do a better job. We have been doing a better job, in treating pressure sores, managing pain and reducing the use of physical restraints.”
Mr. Yarwood complained that the inspection system was broken. “It does not reliably measure quality,” he said. “It does not create any positive incentives.”
More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are typically inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.
Deficiency rates varied widely among states. The proportion of nursing homes cited for deficiencies ranged from 76 percent in Rhode Island to 100 percent in Alaska, Idaho, Wyoming and the District of Columbia.
The average number of deficiencies also varied, from 2.5 deficiencies per nursing home in Rhode Island to 13.3 per home in Delaware.
Mr. Yarwood, the president of the nursing home association, said: “Inspectors are subjective and inconsistent. They interpret federal standards in different ways.”
In December, the Bush administration plans to begin using a five-star system to describe the overall quality of care at individual nursing homes. The best homes will get five stars, and the worst will get one. The rankings will be published on a federal Web site.
Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill and need more services. Mr. Levinson said some nursing homes had improperly classified patients, or overstated the severity of their illnesses, so the homes could claim larger Medicare payments.
Federal officials have publicly identified 163 nursing homes that will receive extra scrutiny because of their “chronic failure to comply with
BY NATE TAYLOR
NateTaylor @coloradoan.com
Judy Johnson describes her parents as having been “madly in love” for nearly 70 years before her mother died due to complications from surgery after breaking her ankle at Spring Creek Healthcare Center.
While Johnson says her 87-year-old mother Doris Wolfe’s November 2007 death was the hardest thing she’s had to live through, a close second was the lawsuit her family endured suing Spring Creek Healthcare Center, 1000 E. Stuart St., for Wolfe’s death.
But after a Larimer County jury returned a $375,000 verdict this week against Spring Creek, Johnson says there is a huge sense of victory.
“We’re just a little tiny family of four against this huge corporation of nursing homes,” Johnson said, referring to Spring Creek Healthcare Center’s parent company, Sava Senior Care. “You would never, ever, ever go through (a lawsuit) for any reason other than somebody had been harmed and you felt like you had to fight that fight. It was brutal.”
Sava Senior Care owns approximately 185 nursing homes across the country, including Spring Creek and Fort Collins Health Care Center.
And while Johnson and her family are celebrating the jury’s decision, a spokeswoman for Spring Creek Healthcare Center said Sava Senior Care intends to explore its appeal options.
“We disagree with the outcome of this particular judicial matter and do not believe the evidence presented in this case justified this result,” said Melody Chatelle in a statement on behalf of Spring Creek. “Our center representatives will continue to explore all appeal options as they move forward with this matter.”
Johnson said her mother stayed at Spring Creek for 17 days to rehabilitate following back surgery at Poudre Valley Hospital. Wolfe broke her ankle the day she was supposed to be sent home.
According to an investigation by the Colorado Department of Public Health and Environment, Wolfe may have turned on her call light to request help to go to the bathroom. When Wolfe thought an “extended amount of time passed” and no one answered her request, she opted to try to walk toward her walker on her own and fell and broke her ankle.
When asked if Spring Creek Healthcare Center disagreed with the jury’s decision because the health department investigation could not determine whether Wolfe pushed the call button, Chatelle said Spring Creek would not comment further on the lawsuit.
Jay Reinan, a Denver lawyer who represented the Wolfe family, said Doris Wolfe did push the button.
“As a result of staffing deficiencies, Mrs. Wolfe was left to decide between soiling herself or attempting to go to the bathroom on her own, and that eventually led to her death,” Reinan said. “With a lot of older folks, dignity is important, and that’s what happened to Mrs. Wolfe.”
The health department investigation also indicated that Spring Creek X-rayed Wolfe’s ankle and found no fracture, but a family physician looked at the X-ray results and determined it was fractured in two places.
Johnson said she hopes the jury’s decision will lead to changes at the nursing home.
“As scary and intimidating as it was, that’s why we did this - for change,” Johnson said.
According to the health department Web site, another resident at Spring Creek Health Center was denied help going to the bathroom in February.
“The resident put on her call light and when staff responded, asked for assistance with toileting,” the report reads. “The staff member told her s/he didn’t have time to assist her and she would have to wet the bed. Another staff member assisted the resident.”
The employee who declined to help the woman was later fired, according to the report.
“Our policies and procedures are, and were at the time, appropriate for meeting the individual needs of the residents we are privileged to serve,” Spring Creek Healthcare Center said through Chatelle.
Pennsylvania and New Jersey have laws requiring medical providers to report errors. Experts say that compliance with these error reporting statutes is spotty, at best.
By: Josh Goldstein - Philadelphia Inquirer Staff Writer
Two patients at Fox Chase Cancer Center in Philadelphia required additional surgery last summer after objects were accidentally left inside their bodies, state health investigators found.
Three patients at Mercy Fitzgerald Hospital in Darby had to be sent back to the OR last year to stop excessive postoperative bleeding.
At Abington Memorial Hospital, an elderly woman recovering from surgery for a broken hip in 2005 was left on a bedpan for at least 41/2 hours. She developed two open bedsores as a result.
None of the hospitals reported the problems, a violation of state law, according to the Pennsylvania Department of Health.
For several years now, hospitals in Pennsylvania and New Jersey have been required to report medical mistakes and serious complications to state agencies charged with reducing medical errors. But some hospitals aren’t fully complying, undermining efforts to improve patient safety, experts say.
In New Jersey, five of the state’s 80 hospitals failed to report a single preventable mistake last year, officials said. In Pennsylvania, some facilities didn’t report any serious events or even the near misses that might have harmed patients.
“I don’t know how many is enough, but zero is a bad number,” said James Bagian, head of the Department of Veterans Affairs’ National Center for Patient Safety.
“Anybody that is supposed to report close calls and has zero reports is clueless,” he said. “Management is asleep at the switch and just waiting until they kill someone.”
There currently is no way for consumers to know how local hospitals are doing. Agencies in both states declined requests by The Inquirer to release the number of reports from individual hospitals. So the public can only learn that a hospital isn’t reporting mistakes in those rare instances when the health department cites it for failing to comply with the law.
Twenty-six states require hospitals to report mistakes, and by next year Massachusetts, California and Minnesota will make the reports public.
Hospital associations in both Pennsylvania and New Jersey say members are training more staff and working to improve treatment in everything from medication safety to fall prevention.
“We are only a few years into this process,” said Aline Holmes of the New Jersey Hospital Association, and “we have seen a steady increase in reporting.”
Pennsylvania’s mandatory-reporting law, passed in 2002, established the Patient Safety Authority and requires hospitals to report events that result in death or an “unanticipated” harm. Hospitals are also required to report near misses.
New Jersey’s 2004 law makes hospitals report serious incidents, based on “never events,” a list of 28 problems that should never happen. They include surgery on the wrong patient, an infant discharged to the incorrect person, serious injury from incompatible blood transfusions, and death or serious injury due to a medication error.
Since reporting began in February 2005, the health department has received 1,600 reports - about 20 per hospital for the 31/2-year period - and an analysis of each case.
“There is still some underreporting, and we are working directly with the hospitals to understand why,” said Eliot Fishman, policy director of the New Jersey Department of Health and Senior Services.
Fishman said that the state had not cited any hospitals for failing to report but that it was helping them improve their internal safety systems.
Consumer advocates want more transparency so patients can make better health-care decisions.
“All the experts we have talked to have told us that there is not enough reporting going on to reflect the real number of major adverse events occurring in New Jersey hospitals,” said Doug Johnston, chief lobbyist for AARP of New Jersey.
The senior citizens’ group and Consumers Union are asking the agency to release hospitals’ reports to the public, as it will do with hospital-acquired infection rates.
The New Jersey Hospital Association, which supports reporting, opposes public release of that information.
“It may present an unfair picture of what is actually going on . . . when we have some hospitals that are not reporting and other hospitals that are reporting,” said the hospital association’s Holmes.
In Pennsylvania, the authority’s 2007 annual report noted reporting disparities. For example, while one large academic medical center reported one serious event for every 200 days of patient care, a similar hospital reported one every 12,500 patient days.
A few hospitals, the authority noted, submitted no reports at all.
How many should be reported? James Conway, a quality expert at the Institute for Healthcare Improvement in Cambridge, Mass., said on average a review of 100 patient medical charts reveals 40 instances of harm.
“The best we have found anywhere is 20 instances of harm and the worst is over 100,” Conway said. “Are all of those serious, reportable events? No, but it shows that even in the best hospitals, there is suffering and harm at a minimum, if not tragedy.”
In the five years since the Pennsylvania law went into effect, the health department has cited four hospitals in Southeastern Pennsylvania for failing to report serious events.
None was fined.
Both states could impose a $1,000-a-day penalty for each failure to report.
The foreign objects left in the patients at Fox Chase and the severe-bedsore case at Abington are considered “never events.”
Delinda Pendleton, Fox Chase’s director of quality management, said in a statement that the patients were informed of the mistakes in face-to-face conversations. She said Fox Chase recognizes that reporting such errors provides opportunities “to learn and improve the already high quality of our patient care.”
Yashima White, a spokeswoman for Mercy Fitzgerald, said in a statement that the hospital staff didn’t realize that postoperative complications rose to the level of requiring a report. All three patients bled excessively after their release from the hospital, she said, and had to have additional surgery. The hospital has now adopted the health department’s approach to ensure such problems are reported.
Besides Fox Chase, Mercy Fitzgerald and Abington, Brandywine Hospital in Chester County was cited for failing to file any serious-event reports from October 2006 through March 13, 2007.
Brandywine’s chief executive, Mark A. Betz, said the hospital’s failure to report happened when it was between risk-management directors. Steps have been taken to correct the lapse.
John J. Kelly, Abington’s chief medical officer, said the hospital acted quickly in the case of the patient left on the bedpan. It implemented training sessions for nearly 1,000 nurses and spent $2.6 million to install 250 beds designed to reduce pressure ulcers.
That’s how the system is supposed to work, and why reporting mistakes and trying to fix them are critical to improving patient care.
“We apologized to the patient and her family and have taken measures to prevent something like this from happening again,” Kelly said. “We made a mistake. It was entirely avoidable.”
But he also noted that the state, prompted by a complaint from the patient’s family, began looking into the matter so quickly that the hospital hadn’t had time to determine whether or not the incident had to be reported.
Still, the numbers suggest underreporting is more than just a passing problem.
Calvin Johnson, the Pennsylvania secretary of health, said only people with their “head in the sand” would fail to see the problem of uneven reporting by hospitals. But he noted that with about 200 hospitals and millions of patient visits each year, it is impossible for the state to check every chart.
“It requires that something trigger the system,” he said, such as a patient complaint.
Plaintiff lawyers said there were many cases to examine because of a large loophole in reporting requirements.
Hospitals don’t report serious events if patients have been warned of the possibility of them in consent forms, said Clifford Rieders, a trial lawyer and member of the Patient Safety Authority’s board.
He said he thought one reason many hospitals don’t want to report serious events is that the law also requires that patients be informed in writing within a week of such problems. So, if a hospital doesn’t report a problem, it doesn’t have to send the patient that letter.
Rieders says the agency has allowed hospitals to determine for themselves what constitutes a serious event and the agency has failed to come up with a solid definition in six years.
Fixing this “is not a priority,” he added.
Others on the authority’s 10-member board said the agency was working on more concrete definitions.
“We are trying to come up with a tighter interpretation,” said Ana Pujols-McKee, chair of the authority’s board and chief medical officer at Presbyterian Medical Center in Philadelphia.
McKee said the disparity in reporting just became apparent after three full years of results.
In 2007, the authority said hospitals and other health facilities reported 7,277 serious events and 204,706 near misses. Hospitals accounted for 99 percent of the reports.
While it’s important to study each of those reports, it is at least as crucial to identify hospitals that are not participating at all, said Conway, of the health-care improvement institute.
“We cannot improve care unless we understand the problems,” Conway said. “There can’t be safety without transparency.”
Sept. 11, 2008 - The Public Citizen
Nursing Home Industry Launches Campaign of Deception
to Derail Protections for Elderly Residents
More Than 100 Public Interest Organizations Support the Legislation;
Industry Coalition Opposes It Under Pretense of Consumer Protection
WASHINGTON, D.C. – On the eve of a key U.S. Senate committee vote on legislation to help protect residents of nursing homes and assisted living facilities from abuse and neglect, the nursing home industry has launched a campaign of deception about the legislation.
Today, the Senate Judiciary Committee is expected to mark up S. 2838, the Fairness in Nursing Home Arbitration Act, sponsored by Sens. Mel Martinez (R-Fla.) and Herbert Kohl (D-Wis.). The bill would make pre-dispute binding mandatory arbitration provisions unenforceable in nursing home contracts. The House Judiciary Committee approved the measure in July.
Buried in the fine print of admissions contracts, these arbitration clauses strip elderly residents and their families of the right to take nursing homes to court in cases of abuse or neglect – a critical tool in prompting nursing homes to take better care of residents. Instead, any disputes must be brought in a private, expensive, secretive forum chosen by the nursing home, giving the arbitration firm an incentive to favor the nursing home company that brings it business. A 2007 Public Citizen study of 34,000 credit card arbitration cases showed that businesses won 94.7 percent of cases against consumers.
Most people are unaware of arbitration provisions in the fine print of nursing-home admissions documents and do not understand them. The clauses also are typically non-negotiable. For these reasons, businesses can use arbitration “agreements” to immunize themselves from accountability in court for their wrongdoing.
On Wednesday, a group led by the U.S. Chamber of Commerce wrote a letter opposing the legislation to Sen. Patrick Leahy (D-Vt.), Judiciary Committee chairman, and Sen. Arlen Specter (R-Pa.), ranking member of the committee. The letter is remarkable in the extent of its deception.
The authors claim to be a “diverse coalition of senior, caregiver, taxpayer, and business advocacy organizations” and claim they wish to protect consumers. But nearly all those listed as signers are business and professional associations whose goals are to maximize profits and limit corporate accountability for wrongdoing. The groups also misrepresent what the legislation would do. They erroneously claim that the Fairness in Nursing Home Arbitration Act would “eliminate or significantly limit the use of arbitration.” In fact, the bill would actually allow consumers to choose whether to go to arbitration or court to resolve disputes, meaning that businesses couldn’t force people into unfair arbitrations.
A truly broad coalition of groups that advocate on behalf of consumers, senior citizens and employees also sent a letter to the Senate Judiciary Committee on Wednesday, urging support for the bill. More than 100 organizations from 30 states, including Public Citizen, signed on to the letter to support protecting the rights of nursing home residents and their families.
“It’s appalling that the nursing home industry is fighting against senior citizens under the banner of consumer protection,” said David Arkush, director of Public Citizen’s Congress Watch division. “But the level of dishonesty reflects the disgrace in their position. It wouldn’t work if they told the truth and said, ‘We corporate lobbyists oppose this bill because our multimillion-dollar corporate clients want immunity when they abuse or neglect some of America’s most vulnerable citizens.’ If arbitration is good for consumers, then they will choose it. There is no justification for forcing it on people.”
Commonly reported nursing home injuries include pressure sores that lead to infection and amputation of limbs, suffocation on bedrails and other restraining device, physical and sexual assault, renal failure from dehydration, malnutrition, and death from fires in buildings lacking sprinkler systems. According to a 2007 report by the Government Accountability Office, almost half of states cited more than 20 percent of their nursing homes for serious deficiencies in 2006; six states cited 30 percent or more for dangerous conditions or harming residents.
Hospital Stays are the 8th Leading Cause of Death in the United States
By: Russell Blaylock, MD
Odds are high that at some point in your life, you’ll need to go to the hospital.You could be struck down by an illness or an injury — or perhaps just require some complicated elective surgery.
Whatever the case may be, a hospital visit should not be taken lightly.
Beyond the potentially life-threatening reasons you might enter the hospital, many new perils and pitfalls await you once you’re admitted.Here are just a few facts that hospitals don’t want you to know:
FACT: Hospital complications and errors comprise the 8th leading cause of death in the U.S. (exceeding even motor vehicle accidents, breast cancer and AIDS).
FACT: Hospital-acquired infections account for 100,000 American deaths each year.
FACT: Medical complications kill 30,000 more people a year (and cost us over $9.3 billion).
FACT: Medication errors lead to 7,000 deaths annually.