October 2009 Archives

Section 14-302 of the Family Law Article of the Maryland Annotated Code requires Maryland health practitioners, police officers or human service workers who have reason to believe that the a vulnerable adult has been subject to abuse, neglect, self-neglect, or financial exploitation to report such abuse immediately to the local department of social services.  This statute would include reporting of nursing home abuse/neglect.  Any other person (other than health practitioners, police officers or human service workers) who has reason to suspect elder abuse/neglect may also make a Complaint.  

To make a complaint, call the following telephone number - 1-800-917-7383.   

A State investigation is conducted in response to every complaint of neglect/abuse.  If abuse is substantiated, Maryland Adult Protective Services may intervene.

Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of nursing home neglect or abuse.

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Elderly nursing home patients are at risk for developing bedsores (also known as pressure sores or decubitus ulcers).  Decubitus ulcers are bed sores caused by unrelieved pressure on the skin from lying or sitting in the same position too long and are associated with pain.   

Once a bed sore becomes infected and progresses to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications.  These individuals may develop sepsis (blood infection) and/or osteomyelitis (infection of the bone) requiring surgical wound debridement, and ultimately resulting in death.     

Fortunately, decubitus ulcers are entirely avoidable as long as proper care and preventative measures are instituted and carried out by the nursing home staff.  Under new Medicare guidelines, hospitals are no longer even reimbursed for additional care resulting from bed sores as the government has determined that development of bed sores at a hospital is a so-called "never event." 

Under Maryland law, when a nursing home resident dies as a result of nursing home negligence, two causes of action arise: (1) a wrongful death claim; and (2) a survivorship claim. 

In our nursing home bedsore cases, we routinely serve Corporate Designee Deposition Notices upon the Defendants along with the Complaint and other discovery requests at the outset of the case.  In this regard, Maryland Rule 2-412(c) and (d) requires nursing homes to produce documents (including medical records and policies and procedures) and to designate individuals to testify as to matters set forth in the deposition notice.  The testimony given will bind the nursing home on the subjects described. 

Our Corporate Designee Deposition Notices are targeted to obtain records and information concerning important issues including: (1) ensuring that the proper corporate entities have been named as Defendants; (2) ensuring that the healthcare providers at issue are employees or agents of the Defendants; (3) ensuring that information contained in medical records or other documents is accurate; (4) potential defense motions to transfer venue; (5) the treatment provided to the plaintiff; (6) the nursing home's policies and procedures concerning a variety of areas including wound prevention and wound care; and (7) potential nursing home staffing shortages.  These Corporate Designee Depositions also force the nursing homes and their lawyers to focus on and evaluate the circumstances of the case at an early stage as they have to identify and produce witnesses for deposition, and may help to facilitate early mediation or settlement.
 
A sample Corporate Designee Deposition Notice in a wrongful death/survivorship lawsuit involving claims of negligence relating to nursing home bed sores/pressure sores/decubitus ulcers follows:

NOTICE TO TAKE DEPOSITION

Pursuant to Maryland Rule 2 412(c) and (d), you are requested to do the following:
(a) designate one or more officers, directors, managing agents, or other persons who will testify on your behalf regarding the following matters known or reasonably available to the organization, and
(b) produce for inspection and copying at the deposition all documents or tangible things within your possession, custody or control regarding the following matters:

1. The corporate structure of [INSERT NAMES OF DEFENDANTS], and their parent corporations, subsidiaries, and affiliated entities from 2005 to the present.
2. The nature and scope of all operations and business activities of [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
3. The corporate structure and scope of operations of all facilities owned, operated, managed, or supervised by [INSERT NAMES OF DEFENDANTS] from 2005 to the present.
4. The nature and scope of all advertising activities of [INSERT NAMES OF DEFENDANTS] within the City of Baltimore from 2005 to the present.
5. The nature and scope of all services, including but not limited to, nursing home, assisted living, in-patient and outpatient rehabilitation, hospice, and home health care services provided by [INSERT NAMES OF DEFENDANTS] and their parent corporations, subsidiaries, and affiliated entities, within the City of Baltimore from 2005 to the present.      
6. The care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION], including but not limited to efforts to turn and reposition the patient, and monitor, prevent and treat decubitus ulcers.
7. The skin care and wound care, prevention and treatment provided to [INSERT NAME OF PLAINTIFF] at [INSERT NAME OF NURSING HOME FACILITY] from [INSERT DATES].
8. All skin evaluation practices and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY].
9. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds.
10. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the prevention of decubitus ulcers/ pressure wounds via the use of specialty mattresses or beds.
11. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the care, treatment, and monitoring of decubitus ulcers/ pressure wounds.
12. All information and documents that discuss or pertain to any specialty mattresses or beds that were used in the care and treatment of [INSERT NAME OF PLAINTIFF]'s decubitus ulcers/ pressure wounds throughout her stay at [INSERT NAME OF NURSING HOME FACILITY].
14. All written manuals, guidelines, policies, or procedures in effect at [INSERT NAME OF NURSING HOME FACILITY] from 2005 through the present that discuss or in any way relate to the diagnosing, monitoring and/or treatment of pressure wounds and/or decubitus ulcers.
15. All information and documents that discuss or pertain to [INSERT NAME OF NURSING HOME FACILITY]'s  procedures, guidelines or policies in effect from 2005 through the present concerning the circumstances under which nurses and nursing assistants should consult with the patient's treating physician or other doctor regarding the patient's skin integrity or condition, including the development and progression of decubitus ulcers/ pressure wounds.
16. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to the circumstances under which nurses and nurse practitioners should consult with the resident's treating physician or other physician regarding the patient's status and/or ongoing care needs at [INSERT NAME OF NURSING HOME FACILITY].
17. The identity of all individuals who provided care to [INSERT NAME OF PLAINTIFF]'s during his stay at [INSERT NAME OF NURSING HOME FACILITY] during the time period of [INSERT DATES OF ADMISSION] including but not limited to efforts to monitor, prevent and treat decubitus ulcers.
18. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY] pertaining to incident reporting.
19. Information concerning and copies of all incident reports generated by Defendants and their agents or employees pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY].
20. All policies, practices, and procedures in effect during [INSERT NAME OF PLAINTIFF]'s stay at [INSERT NAME OF NURSING HOME FACILITY pertaining to or relating to documenting a resident's medical records.
21. Information concerning and copies of all inspection reports or evaluations pertaining to the care provided to [INSERT NAME OF PLAINTIFF] during his stay at [INSERT NAME OF NURSING HOME FACILITY] generated by any federal or state government agencies (including but not limited to Adult Protective Services) that regulated or monitored [INSERT NAME OF NURSING HOME FACILITY].
22. Information regarding staffing levels, staffing sheets and staffing shortages at [INSERT NAME OF NURSING HOME FACILITY] during the time period during which [INSERT NAME OF PLAINTIFF] resided at [INSERT NAME OF NURSING HOME FACILITY].

* * *

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

A recent Clinical Research Study entitled "The Safety of Warfarin Therapy in the Nursing Home Setting" published in the American Journal of Medicine, Volume 120, No. 6 (June 2007) examined the preventability of adverse warfarin (also known as Coumadin) events in the nursing home setting.  This study concluded that the use of warfarin (Coumadin) "in the nursing home setting presents substantial safety concerns for patients.  Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting.  Prevention strategies should target the prescribing and monitoring stages of warfarin management."   

Coumadin (generic name: warfarin) is an anticoagulant, or blood thinning medication, that is prescribed to many nursing home patients who are at risk for developing blood clots that could result in heart attacks or strokes.  It is a very powerful drug that is also still used as rat poison and requires careful monitoring in humans.  In our practice, we have seen the devastating results when nursing homes fail to take the proper steps to ensure that their residents receive proper administration and/or monitoring of their Coumadin therapy. 

Patients taking Coumadin require periodic blood samples to measure their clotting time, or INR (International Normalized Ratio), and may require periodic adjustments of their daily dosage of Coumadin in order to ensure that their blood remains within their predetermined therapeutic range.  The physician overseeing a patient's Coumadin therapy will set a target INR range usually between 2.0 to 3.0.  Patient's with mechanical heart valves may require target INR in the range of 2.5 to 3.5.    

If a patient takes too much Coumadin, they can suffer life-threatening complications due to excessive bleeding.  If a patient takes too little, their blood will clot and they can suffer a heart attack or stroke. 

The nursing home staff must ensure that the resident takes the appropriate dosage and receives regular INR testing.  The nursing home staff must also ensure that the doctor overseeing the care timely receives the testing results, and is immediately made aware of all significant changes in the patient's condition.  In the event that the physician cannot be reached, residents experiencing significant changes in condition should be transported to a hospital immediately.

The nursing home staff must also ensure that patients taking Coumadin are provided with the appropriate diet because some foods interact with the drug.  Many commonly used medications such as antibiotics also interact with Coumadin.  Additionally, the nursing home staff must institute and implement fall precautions because residents taking Coumadin may have increased bleeding risk.

Ultimately, Coumadin administration and/or monitoring errors may be avoidable so long as nursing homes develop and implement policies and protocols aimed at: (1) ensuring that the resident receives proper INR testing, and that the results are timely analyzed and acted upon; and (2) ensuring there is a clear flow of information provided to all health care providers (especially the prescribing doctor) who interact with the resident.

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of Coumadin administration and/or monitoring errors, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, nursing home falls, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

I just read a disturbing article in the October 1, 2009 online edition of the Chicago Tribune entitled "Nursing Homes a Risky Business - Dozens of Mentally Ill Felons Are Housed in Facilities Tied to 2 Executives."  This article discusses the practice of nursing homes admitting mentally ill criminals (often in order to receive Medicaid reimbursement) who go on to harm other residents.  The incidents cited in the article include allegations of physical assault and rape.

As if families forced to put their loved ones into nursing homes didn't already have enough to worry about, they must now consider the possibility that dangerous, mentally ill fellow nursing home residents may harm their loved one.

Ultimately, a nursing home may be responsible for injuries caused by fellow nursing home residents as the nursing home must institute appropriate protocols and policies that protect the safety and welfare of their residents.

Please feel free to contact the attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injuries inflicted by a fellow nursing home resident. 

Contact Our Firm
Your Name: Email Address: Phone Number:

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This page is an archive of entries from October 2009 listed from newest to oldest.

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