Following 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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