THE WALL STREET JOURNAL TAKES A LOOK AT CARILION

I live in Roanoke, Virginia, a community of about 200,000 people. We have two hospitals but one, the Carilion Health System, is proverbial 800 pound gorilla.

You see, Carilion is a non-profit hospital....meaning that they save about $50 million a year in tax exemptions! Originally, non-profit hospitals were set up to serve the poor and Carilion states that it provided an average of $36 million in charity care for each of the last two years. Wonder where the other $28 million in tax savings over the last two years has gone?

While Carilion says it is a "non-profit" hospitial...it is anything but! How about a profit of $107 million in 2007? How about profits of between $60 and $80 million for each year between 2004 and 2006? I am not an economist but Carilion sounds pretty profitable to me!

But what really bothers me about Carilion is what this monolithic empire has done to the cost of medical care in Southwest Virginia. The Wall Street Journal published an article on August 28 which is excellent. Hey Roanokers and those living in Southwest Virginia, you pay some of the highest cost of health care of anyone living in Virginia...and you may just have your local non-profit hospital to thank for it!

The Wall Street Journal article is a must read!

MS DRUG MAY CAUSE BRAIN DISORDER

I watch the FDA closely, but have a vested interest in drugs approved for the treatment of Multiple Sclerosis. Apparently, Michelle Obama and I have something in common - a parent with MS. So I was interested in today's Wall Street Journal which reports Biogen will be working with the FDA to change labeling for a new MS drug, called Tysabri.

According to the manufacturer's website on Tysabri, the rare brain disorder may cause death or disability. The drug may also cause liver damage, urinary tract infections, lung disease etc.

Bottom line - there are always side effects to every drug.... And in my personal experience, no MS drug is a clear solution... so please, when recommended by a doctor, investigate before you sign up for a new drug!

VA NURSING HOME LAWSUIT

A federal Law suit was filed against a Virginia Nursing Home, New Market Nursing Care,
alleging the nursing home was negligent in their care of Kenneth E Huffman.

Plaintiff alleges that "the Defendant's agents and employees deviated from the standard of care by failing to prevent avoidable skin breakdown, by failing to prevent the development of avoidable pressure sores."

The sores weren't treated properly, and a catheter wasn't placed or cared for properly either, according to the suit. Nor were changes in Huffman's conditions reported to a physician, or his records properly maintained, it says.
As a result, according to the lawsuit, Huffman suffered a sacral wound, an abscess, a urinary tract infection and renal damage.
According to a statement from Deanne Craft, executive director of the Life Care Center, the facility hadn't yet been served with the lawsuit.
"The staff of Life Care Center of New Market gives our residents professional care in a spirit of love and compassion, and we remain alert to that goal and pursue it each day," the statement says. "We strive to make this nursing center one that is known for its quality health care services, and we regret that an individual has chosen to call the commitment of both this center and our professional caregivers into question."

WOW - I like that the Director made a comment to the press.... but does she really believe the plaintiff is calling the commitment of the caregivers into question? Or could the plaintiff simply be stating, commitment or not, my loved one wasn't cared for?

I know - a lawyer getting upset at a war on words, or semantics - but sometimes, I do appreciate straight talking, and her comment is surely missing the point!

NORTH CAROLINA PATIENT DIES AFTER SITTING IN CHAIR FOR 22 HOURS

This story should result in criminal charges of neglect. According to a report from CNN, a mental patient died after workers at a North Carolina hospital left him in a chair for 22 hours without feeding him or helping him use the bathroom, said federal officials who have threatened to cut off the facility's funding. Cutting off funding is insufficient punishment!

A report released lasts week found that 50-year-old Steven Sabock died in April after he choked on medication and was left sitting in a chair for close to a day at Cherry Hospital, a facility about 50 miles southeast of Raleigh. Surveillance video showed hospital staff watching television and playing cards a few feet away.

The report also found that Sabock, formerly of Roanoke Rapids, North Carolina ate nothing the day he died and had little food in the three days preceding his death.

How and why does this happen in America?

CLASS ACTION LAWSUIT AGAINST CALIFORNIA NURSING HOME SETTLES

Sun-Mar Heath Care Inc, the operator of 18 skilled nursing homes across Southern California, will pay $2 million to former residents in a settlement stemming from a class-action lawsuit that alleged substandard care of elderly patients. About 4,000 people are part of the class, which covers people who lived in Sun-Mar facilities between January 2005 and January 2008. The attorney representing the plaintiffs estimated that only a fifth or so of those people are still alive.

Virginia law doesn't provide for class action lawsuits. I think the lack of the ability to file class actions does a disservice to Virginia residents, and the California settlement is a prime example of why. Clearly, Sun-Mar was aware of the substandard care it was providing to its residents....you don't just pay $2 million to get rid of a "frivolous lawsuit."

The problem is no lawyer or family would undertake the prosecution of a nursing home abuse case if the recovery was $500. That is correct...these residents and their families each recovered only $500. So, with the availability of a class action, these residents and their families were able to hold a corporate owner responsible without going broke doing it.

I invite your comments about whether you agree about class action lawsuits.

FALSE ADS FOR AIRBORNE?

Airborne Coughs Up Millions to Settle Suit
Check out this article in the Washington Post:
http://www.washingtonpost.com/wp-dyn/content/article/2008/08/14/AR2008081403142.html

By Annys ShinWashington Post Staff Writer Friday, August 15, 2008; Page D01

Over the past decade, millions of consumers, including Oprah, have come to swear by Airborne -- fizzy orange tablets containing vitamins, herbs and minerals that its makers for years said keeps cold germs at bay.
Gena Crowe of Fairfax says she doesn't get on a plane without it. "If I feel like a sore throat is coming on," she said, "it seems to take it away."
Airborne, however, when used as directed does not prevent class-action lawsuits, charges of deceptive advertising -- or, according to the government, the common cold.
"There is no credible evidence that Airborne products . . . will reduce the severity or duration of colds, or provide any tangible benefit for people who are exposed to germs in crowded places," said Lydia Parnes, director of the Federal Trade Commission's Bureau of Consumer Protection, which filed a complaint against Airborne's makers.
The remedy prescribed by the FTC is for Airborne to pay consumers back for as many as six purchases, a nationwide total of as much as $30 million.
Under a settlement announced yesterday, the privately held Airborne Health, based in Bonita Springs, Fla., will add $6.5 million to funds it has already agreed to pay to settle a related class-action lawsuit. That suit, which alleged that Airborne falsely claimed its products could cure or prevent colds, was settled earlier this year for $23.5 million. Consumers who bought Airborne products between 2001 and 2008 have until Sept. 15 to apply for a refund for as many as six purchases, the FTC said. Claims will be paid by Oct. 15, 2008, the company said in a statement.
Airborne said it had already begun to change its packaging and marketing language. "It's important to note that this is a settlement over older advertising and labeling, and has nothing to do with public safety," said Airborne chief executive Elise Donahue. "We've offered a money-back guarantee for our products since 1997, and we have millions of satisfied customers. A class-action lawsuit sparked this matter. We're just one of many major consumer brands across America that are under assault by class-action lawyers."


I think it is very interesting. Major drugs and products every day are given federal protection from suits when they cause problems, or do not deliver as expected....

But a medication that only attempts to cure the cold - has to pay millions?

I would prefer to see some consistency with the way drug makers are treated. I guess Airborne's federal lobby is not as strong as others.

NURSING HOME SYSTEM IN AMERICA IS BROKEN!

I don't think this is breaking news to most of the readers of Legal Medicine, but it does offer confirmation of what we discuss and write about every week.

The American Association of Homes and Services for the Aging (AAHSA) has concluded the nursing home certification process is broken and cannot be fixed. The AAHSA is not-for-profit organizations dedicated to providing the services that people need, when they need them, in the place they call home.

The organization is calling for an independent commission, such as the Institute of Medicine, re-examine the survey and certification process for nursing homes to "create a common vision for how our nation should care for its frailest citizens and to recommend a new oversight model for ensuring that this vision becomes reality in every nursing home today."

Read the AAHSA report condemning the current process of certifying nursing homes.

The elderly in America deserve better!

NEW RESOURCE FOR VIRGINIANS

A great new website and resource for Virginia debuted this week. VIRGINIA EASY ACCESS - a partnership between 2-1-1 Virginia (public service information source), Senior Navigator (Senior resource) and the Commonwealth.

It has great information - is organized clearly and simply - and appears to be a wonderful resource.

I would direct anyone to the page explaining Legal Rights - and while it is not complete in listing what legal rights nursing home residents have (which are defined by state and federal law) - it is a good start: http://www.easyaccess.virginia.gov/legalrights.shtml

So thank you VIRGINIA EASY ACCESS - for creating an easy to use resource. We look forward to watching as you update your content.

HOSPITALS SHOULD NOT BILL PATIENTS FOR "NEVER EVENTS"

By now most Americans have read that Medicare has decided it will not pay hospital bills for "Never Events," which are defined as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and indicate a real problem in the safety and credibility of a health care facility. Never Events include operating on the wrong patient, wrong site surgeries, or giving a patient incompatible blood.

Now, according to a recent article on MSNBC.com, hospitals in nearly half the states in the nation say they won’t bill patients for Never Events. Unfortunately, Virginia is not one of those states!

But why do we have to wait on the Virginia General Assembly to pass legislation? Why don't our hospitals just agree to implement what is a fair and reasonable policy?

What is the policy at Carilion Roanoke Memorial Hospital, Lewis-Gale Hospital, Memorial Hospital of Martinsville and Henry County, Danville Regional Medical Center, Stonewall Jackson Hospital, Carilion New River Valley Hospital, Montgomery Regional Hospital, Wellmont Bristol Regional Hospital, Carilion Giles Memorial Hospital, Alleghany Regional Hospital, Carilion Franklin Memorial Hospital, and Tazewell Community Hospital?

Come on hospitals....I would like to read your responses.

TEXAS NURSING HOMES WANT MORE MONEY

I ran across an Associated Press article about nursing home owners wanting higher Medicaid reimbursement rates from the state of Texas. I have no problem with their request. However, any increase in reimbursement rates should be tied to better nursing home care....including higher salaries for nurse assistants and all staff. Increase payments should also be accompanied by minimum staffing levels.

Having a sufficiently trained staff, in sufficient numbers to provide needed daily care, should be the number one goal of every nursing home in America!

VIRGINIA LAW REQUIRES PHYSICIANS TO REPORT ELDER ABUSE

Did you know that Virginia law requires doctors to report evidence of elderly abuse? The statute (Va. Code § 63.2-1606) requires doctors to immediately report suspected abuse, neglect, or exploitation of adults to the local department or the adult protective services. Why? Because physicians, often emergency room physicians, are uniquely situated to observe and detect elder abuse before it becomes deadly.

Are doctors complying with the reporting law? Apparently not. According to the Rhode Island News, physicians report just 2 percent of the elder abuse and neglect cases recorded each year by state protective service agencies, according to medical and legal experts and recent articles published in medical journals. One study, published in 2005 in a journal focusing on geriatric medicine, says that the actual figure may be even lower.

Every year, an estimated 2.1 million older Americans are victims of physical, psychological or other forms of abuse, according to the American Psychological Association. Congress says the number could be closer to 5 million. Most of the abused or neglected elderly live in the community — not in nursing homes or assisted-living facilities –– and 90 percent of the time, the perpetrator is a family member, most often an adult child or spouse, according to the National Center on Elder Abuse.

Come on doctors....lets stop elder abuse now by reporting what you see and know!

CAN THEY DO THAT?

We frequently get calls from worried families - "Can they make my Mom leave the nursing home for not paying?" My response is always, "YES - under Virginia law, they can do that."

According to a recent article by the WallStreet Journal, nursing homes are bending the rules when evicting residents.

To Be Old, Frail And Evicted: Patients at Risk
As Nursing Homes Shift Focus To Short-Term Rehab Care, Families Must Look Elsewhere
By THEO FRANCIS August 7, 2008; Page D1

"Since Jasmine Nguyen collapsed nine years ago, apparently from a seizure, the 32-year-old has lived in a nursing home in Lodi, Calif., dependent on a ventilator to breathe and the facility's staff for her daily needs.
But since early this year, the nursing home has been seeking to evict Ms. Nguyen and a dozen other residents in similar situations, potentially replacing them with shorter-term residents likely to bring more revenue.
Across the country, nursing homes are forcing out frail and ill residents. While federal law permits nursing-home evictions in some circumstances, state officials and patient advocates say facilities often go too far, seeking to evict those who are merely inconvenient or too costly. Residents with dementia or demanding families are among the most vulnerable, particularly if -- like Ms. Nguyen and the other Lodi residents -- they depend on Medicaid to pay their bills, the officials and advocates say."

"Federal and state law gives nursing-home residents strong protections against eviction -- at least on paper. But these protections don't apply to residents in assisted-living facilities. And residents dependent on Medicaid are particularly vulnerable to eviction, state officials and resident-advocates say."

Read the article... it is sad but true. When making money is the goal, those in need are often not cared for.

Sexual Assault by Hospice Care Provider

I am saddened to say it happened again.

An 84 year old man was molested by a hospice care giver in March of 2007 - his wife walked in on the male hospice care giver, attempting to perform oral sex on her husband.

Settlement was reached.

We see these case far to often - and most go unreported because no eye-witnesses exist. Please be careful and watchful!

ER WAIT TIMES ---- Is an hour too long?

According to federal statistics, in the last ten years, the average wait time in an ER has gone from 38 minutes, to over an hour.

Why? It seems like a simple supply and demand issue. More people rely on emergency health care for their primary health care, and there are fewer emergency rooms to serve this increased need.

Other statistics - Most patients that went to the ER had private insurance, but at least 17% had no insurance. About 50% of those admitted to the hospital, were seen in the ER first - which means people are waiting to seek care.

Is this change all about the bottom line? People can't afford, or can't get appointments quickly with their primary care docs, so they use the ER? Is it an insurance issue?

What ever it is - it is scary!

Green Nursing home?

Many weeks ago we blogged about a wonderful alternative to nursing homes - a place where dignity is respected in small group living environments. Here is a great plug

Frith Law Firm Seminar - Q&A session - in case you missed it!

WANT TO GET INVOLVED WITH FUTURE OF LONG TERM CARE?

HOSPITALISTS: WHAT ARE THEY?

Hardy a week goes by that I don't read an announcement in the Roanoke Times about a new "hospitalist" hired by Carilion Roanoke Memorial Hospital. Do you know what a hospitalist is? Most people do not!

The old system was easy to understand. Hospitals granted privileges to physicians to admit and treat their patients, and the physicians returned the favor by assuming unpaid responsibilities like taking call, providing care to uninsured or emergency patients, and serving on administrative committees. Making money has changed the old system.

Today, we have hospitalists or physicians who work only at the hospital. Their professional life is with the hospital as an institution. Hospitalists can be ER doctors, critical care physicians, anesthesiologists and radiologists. The hospital is the location of their work and provides the tools to do their job.

My concern is whether the hospitalists first loyalty is to the hospital or to the patient who is randomly assigned to their care. You see...the patients do not get to chose their hospitalists the hospital does.

I know this set up makes more money for the hospital but is it a good system for the provision of health care?