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Health Changes in Elders Residing in California Nursing Homes

October 31, 2014

By law, the staff members employed by California nursing homes are required to report health changes observed in the elders residing in their facilities. Unfortunately, all too often these changes are unreported. The change in condition of a resident may not be reported for a variety of reasons, including fear that the nursing home be may fined for understaffing, or neglecting California elders residing within the facility. In other cases, a resident who has experienced a rapid deterioration in condition, may indicate that isolation, neglect, or even abuse is occurring within a facility.

Failure to report changes in condition to an elder's doctor and family members is a violation of the law.
old woman.jpg Changes in an elder's condition which must be reported may include, but is not limited to:
• Cracked lips, or sores in and around the mouth
• Noticeably dry skin
• Eyes which appear sunken in
• Disorientation/Confusion
• Fever and/or thirst
• Rapid weight loss
• Bed sores
• Broken bones

Elders residing within California nursing homes are granted certain rights. If they are violated, resulting in a change of condition, a crime may have been committed. It is important that all staff working in nursing homes in California report these changes in the condition of elderly residents in order to prevent serious health problems, injury, or even death to residents.

If you notice changes in the condition of your loved one while residing in a nursing home in California, report your concerns immediately. In Southern California and San Diego, you may consider reporting your suspicions to:

• Your loved one's doctor.
• Long-Term Care Ombudsman Program. They provide a 24/7 Crisis Complaint Hotline at 800-231-4024.
• Adult Protective Services (APS). In San Diego County, you may contact: San Diego County Aging and Independent Services (858) 495-5660, or the Eldercare Locator help line at 1-800-677-1116.
• Your Department of Public Health Licensing Office.
• Local Law Enforcement, including the Police, Sheriff, and District Attorney's office. The San Diego County Sheriff's department can be reached at (858) 565-5200. The San Diego County District Attorney may be reached at 619-531-4040.

All elders in California nursing homes have the right to quality care and attention, regardless of their age or health. If those rights are denied, abuse must be reported. For tips on reporting suspected neglect and/or abuse in a California nursing home, the Justice Department has a helpful citizen's guide that can be found at the following website: http://ag.ca.gov/bmfea/pdfs/citizens_guide.pdf

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Inaccuracies & Falsifications of Medical Charts in Southern California Nursing Homes

May 1, 2014

It has been a while since we have written about the dangers of falsified medical records in Southern California nursing homes, but that is not because the problem has been resolved. On the contrary, falsified or inaccurate medical records occur with alarming frequency, and they can have life threatening consequences for elders residing in nursing homes.

Technology has made it easier for some nursing home employees to falsify medical records. In some cases, elder abuse attorneys are able to employ the services of forensic computer experts who can review and analyze electronic data with incredible skill to identify any evidence of medical record tampering. Elder abuse attorneys will look for signs that medical records have been:

• Destroyed
• Backdated
• Forged
• Deleted
• Modified

Falsifying medical records of elders is a misdemeanor under California law. The California Code of Regulations and Business and Professions Code both require mandatory reporting of the offense. Nevertheless, this is what some nursing homes in California do "to get the work done." Nursing assistants admit to charting "in bulk," documenting medication and treatment that were never given. Some even re-create records to hide neglectful care of elders in Southern California nursing homes. Others falsify forms to sedate patients or backdate forged documents to settle disputes. In a practice where providers rely upon the accuracy of medical charts, sloppy or fraudulent record-keeping takes a serious human toll.

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Investigation Reveals California Nursing Homes Falsify Medical Records

January 6, 2012


1370555_lots_of_files_2.jpgFollowing the death of Johnnie Esco at a Placerville facility, an investigation of similar complaints revealed nearly 150 cases of alleged chart falsification in California nursing homes. In Esco's case, the Department of Justice reopened its criminal investigation of El Dorado Care Center (Center), the nursing home that allegedly altered Esco's charts to reflect treatment she never received. After 13 days of neglect, Esco experienced massive bowel obstruction, ultimately leading to her death. Her family sued the Center, alleging fraud, elder abuse, and wrongful death. The family accused the Center of falsifying and altering Esco's medical charts since her admission. The facility remains under civil and criminal investigation for fraud.

Johnnie Esco, 77, was supposed to be recuperating from a bout of pneumonia at a nearby nursing home when her condition suddenly declined. Like many elderly patients, Esco suffered from chronic constipation, which could result in fecal impaction if left unmanaged. Esco's physician therefore ordered that nurses perform routine assessments, checking Esco on every shift for possible constipation. The physician also ordered that Esco receive a laxative or stool softener and milk of magnesia daily. Esco's chart, however, showed no history of constipation or laxative use. The nurses never performed an assessment or asked for Esco's history.

While Esco did not have a bowel movement for five consecutive days, her chart indicated a "zero" constipation. When the doctor ordered an evaluation of the patient's abdominal distention, no one performed it. Esco lay critically ill, but her chart showed she had an "extra large" bowel movement and a temperature of 98.8. While she was bedridden and unresponsive, the Center billed Medicare for 170 minutes of physical therapy and 65 minutes of occupational therapy. It seems nobody looked in on Esco before she died. An autopsy revealed a severe bowel obstruction and fecal impaction, contradicting the notes in Esco's chart.

Esco is not the only patient with a falsified medical chart. A supervisor at a Carmichael facility admitted altering the medical records of a 92-year-old with massive, rotting bedsores. A Santa Monica facility was fined $2,500 for claiming a patient received five days of physical therapy when the nurses responsible for performing the therapy were not at work on those days. Investigations into Medi-Cal Fraud and Elder Abuse reveal that falsification of records in nursing homes is an insidious practice, even when it leads to disastrous human consequences.

Falsifying medical records is a misdemeanor under California law. The California Code of Regulations and Business and Professions Code both require mandatory reporting of the offense. Nevertheless, this is what some providers do "to get the work done." Nursing assistants admit to charting "in bulk," documenting medication and treatment that were never given. Some administrators even re-create records to hide neglectful care. Others falsify forms to sedate patients or backdate forged documents to settle disputes. In a practice where providers rely upon the accuracy of medical charts, sloppy or fraudulent record-keeping takes a serious human toll.

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