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A Platte County, Missouri, jury this week ordered the owner-operator of two nursing facilities to pay more than $3 million to the estate of a former patient who died in 2004. The verdict stems from a lawsuit alleging that nursing staff at two nursing homes managed by Health Care Management failed to properly care for John Novogradac. The suit alleged that during his stay at Barry Manor and White Oak Manor between 2001 and 2003, Novogradac developed severely infected bedsores resulting in bilateral above-knee amputations. The jury found that the nursing homes failed to provide adequate staffing, didn't attend to Novogradac's bedsores, and did not turn or reposition him to prevent the the sores from developing. The jury also found that the staff did not properly treat Novogradac's wounds, did not monitor his condition, and did not alert a physician when his condition worsened. According to the attorney for the Novogradac estate, the jury felt that the operator was not appropriately staffing his facility and felt strongly that the operator should provide enough staff to meet the needs of the patients. The jury awarded the estate $500,000 in compensatory damages and more than $2.5 million in punitive damages.
Healthcare Bills Vetoed by California Governor
Governor Arnold Schwarzenegger recently vetoed two bills pertaining to the Health Care industry.
Assembly Bill (AB) 399, would have required the state to complete an investigation of an allegation against a nursing home in California within 40 days from the time the complaint was made. Certain extensions would have been granted for good cause based on inaccessibility of evidence. This bill was widely supported by elder advocacy groups. The bill passed in both houses with only one vote opposed. Proponents argued that 30% of the state's complaint investigations were not completed within 60 days. The Governor's stated reason for the veto was that while he supports increased staffing for enforcement of nursing home regulations, he believes that the Department of Health Services has already made improvements in the process of initiating and completing complaint investigations. Additional investigation requirements, he believes, are premature at this time.
He also vetoed Senate Bill (SB) 171 on its fourth appearance on his desk. The bill would have required general acute care hospitals to establish a patient protection and health care worker back injury prevention plan that included identifying patients needing lift teams, and assistive devices. The bill required that appropriate lift teams be available at all times. The Governor had already vetoed three previous incarnations of the bill sponsored by the California Nurses Association (CNA). Proponents argued that according to the U.S. Bureau of Labor Statistics, 72,780 health care workers suffered work-related back or neck injuries in 2005, outpacing by 36,880, those suffered by construction workers. The Department of Health Services (DHS) indicated there are over 430 general acute care hospitals in California. Of this total, over 350 are private and 80 are public, of which five are operated by the University of California. Kaiser Permanente and the Association of Healthcare Districts supported the legislation, while the California Hospital Association opposed it.
The governor vetoed Senate Bill 171 on the grounds that it imposed a "one-size fits all" mandate on hospitals to establish a "zero lift" patient handling policy. Additionally, the mandate failed to give hospitals the flexibility needed to reduce work place injuries while efficiently addressing individual hospital needs and resources.
Medicare Audits Show Problems With Part D Providers
Medicare Part D drug plan providers are not complying with plan requirements, according to recent audits. According to a New York Times article published October 7, 2007, recent audits of private Medicare "Part D" drug plan benefit providers have shown compliance problems including improper termination of coverage for H.I.V. / A.I.D.S. plan beneficiaries, complaint backlogs, and failing to answer telephone calls from consumers, doctors and drugstores. Medicare officials said that compliance problems occurred most often in the areas of marketing, and the handling of appeals and grievances related to the quality of care. In a review of 91 audit reports, the New York Times reported that Medicare officials have required insurance companies of all sizes to adopt "corrective action plans." Since March, Medicare has imposed fines of more than $770,000 on 11 companies for marketing violations and failure to provide timely notice to beneficiaries about changes in costs and benefits. The companies include three of the largest participants in the Medicare market, UnitedHealth, Humana and WellPoint.
Federal auditors found similar violations with insurance companies selling Medicare Advantage plans, providing a full range of benefits including coverage of doctor's visits and hospital care. Enrollment in Medicare Advantage plans has grown rapidly, to more than 8 million, from 4.7 million in 2003.
Many of the marketing abuses occurred in sales of the fastest-growing type of Medicare Advantage product, known as private fee-for-service plans. In June, the government announced that seven of the leading companies in this market, including UnitedHealth, Humana and Coventry, had agreed to suspend marketing of these plans. Medicare recently allowed them to resume marketing after they took steps to monitor their sales agents more closely.
The full article may be found at www.nytimes.com/2007/10/07/us/07medicare.html.
CMS Website For Medicare Advantage and Prescription Drug Plan Organizations
The Centers for Medicare & Medicaid Services (CMS) now posts audit and enforcement information pertaining to Medicare Advantage (MA) and Prescription Drug Plan (PDP) organizations. CMS is charged with overseeing the operations of MA and PDP organizations that have contracted with CMS to provide Medicare services and prescription drugs to Medicare beneficiaries. As part of its oversight, CMS conducts periodic performance audits, and requires corrective action plans in response to deficiencies. Data including the types of conduct CMS has been auditing, the basis for enforcement actions, corrective action plans and imposed penalties may now be found at:
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/CAP/
Alliance President Contests Census Data on Elders
Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, recently criticized Census Bureau data suggesting a decrease in the percentage of elderly citizens living in American nursing homes today. (Rosenbloom, USA Today, October 5, 2007) According to the data, 7.4% of residents, 75 years of age and older, lived in nursing homes in 2006, compared with 8.1% in 2000 and 10.2% in 1990. However, based on Alliance data, Rosenbloom argues, nursing homes care for more people today than in the past, since "ever-increasing numbers receive short-term rehabilitation and return home." According to Rosenbloom, the good news is that nursing home patients are receiving better care and returning home more than ever.
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