2016 and Nursing Home Negligence

Having to place a loved one in a nursing home is one of the toughest decisions a family will ever make. While most nursing homes provide excellent care to residents, unfortunately mistakes and poor care resulting in nursing home negligence are far too prevalent. It’s important for families to do their due diligence when choosing a nursing home, even when circumstances arise requiring that placement must be done quickly.

Consider What Care is Needednursing home atlanta

What type and scope of care will a loved one need? Do they need assistance with daily living activities such as personal hygiene, mobility, eating, dressing, etc.? Are there special medical issues or conditions involved that require specialized medical care? Are there memory issues or some level of dementia that require a different expertise and setting? Individual needs and the type of skilled care offered by a facility are key factors in the selection process.

Ask People You Trust

If nursing home placement is imminent after a hospital stay, consult with the hospital’s social worker to get recommendations for appropriate facilities. Also talk to family physicians, trusted friends or family members to create a list of recommended facilities. Then go online and research the facilities, checking for complaints, patient reviews and the like. Also look for information provided by government agencies and third parties such as Medicare’s nursing home compare tool and third party websites like this one which compiles complaints, safety inspections and violations maintained by state agencies.

Contact Nursing Homes

Call facilities on the list and ask questions of each one. Find out exactly what skilled services are offered, staffing and patient-to-staff ratios, costs, whether there’s a waiting list, and other pertinent information for the decision process. Then, schedule an appointment to visit and meet with the director and nursing director in person. There is no substitute for first-hand observation to get a better sense of a facility and the people who will be cared for your loved one.

Ask Questions

While visiting a facility, ask questions about their Medicare and Medicaid certification. Take notice of whether the residents look well cared for, and how they are treated by staff. How responsive is the staff – are resident calls for assistance promptly answered? How do staff members talk to residents: with respect, disinterest, or worse, disdain? Be aware of bad odors or heavy chemical smells such as ammonia, poor maintenance, and general signs of lack of cleanliness. Observe a typical meal, including nutrition content, appearance and appeal of the food, and whether hot meals are timely served. Introduce yourself to staff members to get a feel for their demeanor, attitude towards family members, and manner when dealing with residents. These and other indicators can help identify signs of nursing home neglect or negligence. In short, do whatever you can to determine if a facility gives you confidence that your loved one will get the best possible care under the circumstances.

Make Unscheduled Visit

Before making a final decision on a facility for your loved one, if possible make one more visit – this time unscheduled. Arrive on a different day and observe another shift and staff from your scheduled visit.

Of course, your vigilance does not end after a loved one is placed in a facility. If you suspect your loved one is a victim of nursing home negligence, abuse or neglect, contact the law offices of Brownstein & Nguyen. We are experienced in helping families and their loved ones fight elder abuse.

Prescription Drug Costs – how much is too much?

There has a been a lot of talk in the news lately about the inflated costs of prescription drugs. It is now becoming increasingly common to see prescription drugs that have been on the market for over 50 years to suddenly quadruple in price or in one case, increase 5,000% percent. For many people, taking these prescriptions is a matter of life and death. Being suddenly hit with outrageous out-of-pocket costs to the tune of thousands of dollars are causing these individuals extreme financial and personal hardship. Some are forced to choose between eating and paying for needed medication to stave off debilitating, life-threatening medical conditions.

When prescription drugs first arrive on the market, it is expected to have to pay a higher price. This is because drug makers are seeking to earn a return on their investment for research, development, and drug trials that are required before the drug is released to the public. If a drug is commercially successful, though, the pharmaceutical company can make back its initial investment in a few short years. After that, the rest if pure profit. Real savings to consumers usually do not trickle down until after drug goes off-patent, typically between 7 and 12 years after a drug is approved for sale. However, to suddenly increase prices of drugs (even generic ones) to exorbitant levels is a form of medical extortion.

Rising Healthcare Prescription CostsWhat many people realize is that spiraling healthcare costs are nothing new. Hospitals have been getting away with it for years with overcharging patients for routine services such as diagnostic tests and X-rays, pain medication or medical supplies. Depending upon a patient’s coverage, their prices may be higher or lower with those with less coverage often being charged higher prices. Being charged $10.00 or more for one Tylenol is no longer a joke; it is a stark reality for many.

Some states have attempted to address the prescription drug crisis through legislation limiting patient co-payments or requiring cost transparency. So far, those efforts have failed largely due to the overwhelming money and influence of large pharmaceutical companies. On the federal level, there have been legislative efforts to allow Medicare to negotiate drug prices, price limits for seniors (under Medicare Part D), and cost transparency. Check out these and other proposals (including allowing easier access to Canadian drugs) supported by Democratic presidential candidate and U.S. Senator Bernie Sanders of Vermont.

As individuals, we might feel powerless to fight the cost of prescription drugs. However, if you or a loved one has been further victimized by the healthcare system due to medical negligence or mistake, there is something you can do. Contact the medical malpractice attorneys at Brownstein & Nguyen to see if you have a case.

Whistleblowing in the News

National headlines these days are full of news related to whistleblowing. Some headlines and situations are controversial due to their subject matter or details. However, the fact remains that individuals witnessing wrongdoing by the part of the government or private companies have the right to come forward with protections afforded under various state and federal laws, including the Whistleblower Protection Act of 1989. The act has played a major role in allowing government whistleblowers the confidence to come forward, knowing that their actions are legally protected.

One ongoing battle regarding whistleblowing involves the Food and Drug Administration (FDA) and medical device approvals. The Wall Street Journal reported that the claims of the whistleblowers  regarding imaging devices for the screening of breast cancer and colon cancer were rejected as unsubstantiated. While the case dates back to 2008, fresh controversy arose in 2012 after new evidence revealed that the FDA was monitoring employee activity on government computers. This led to further questions and debate regarding the rights of whistleblowers.

AtlantaIn more recent news, at a more local level and involving animals rather than the healthcare industry, is the case of Brittany Roberts. A former animal control officer, Roberts claims she was fired after bringing forth concerns of animal mistreatment within Detroit Animal Control. After her firing, Ms. Roberts filed a detailed whistleblower lawsuit against the department and certain officials. Only time will tell the outcome of that case. However, the City of Detroit has already begun making some changes. For starters, the city’s Animal Control department is being moved from the Detroit Police Department to the Department of Health and Human Services.

Criminal conduct or fraud by an employer,  healthcare provider, or government contractor should not be ignored or go unreported. As a government or private company employee with knowledge of serious wrongdoing, you should know your rights as a potential whistleblower. In addition to legal protections, whistleblowers can receive significant compensation under certain situations. We encourage all employees to visit whistleblowers.gov in an effort to be more aware of whistleblower protection programs.

If you or someone you know is dealing with blatant wrongdoing by their employer, we encourage you to call our law offices in Atlanta for guidance and advice in whistleblowing situations. With more than 25 years of experience in legal matters relating to business and employment situations, Jay Brownstein has expertly guided individuals faced with delicate whistleblowing decisions. Contact our offices today at 770-458-9060 for a consultation.

$2.3 Billion in Healthcare Whistleblower Recoveries

The False Claims Act is a federal law that was originally passed during the administration of President Abraham Lincoln. Over the past 150 years, the law has been revised several times.In the past few years, money recovered under the FCA has become big business for the government. In the fiscal year ending September 30, 2014, the federal government recovered a total of $5.7 billion. In addition, each year the number of new cases has increased. Much of the increase is as a result whistleblower lawsuits, also referred to as qui tam matters. Qui tam refers to an action brought by an individual who prosecutes a fraud case on behalf of the government and receives part of the final recovery. In 2014, whistleblowers received a total of $435 million, over $100 million more than in 2013.

Healthcare Fraud

Image via Flickr

The industry hit hardest by whistleblower lawsuits under the FCA in 2014 was banking with $3.1 billion in penalties and recoveries. But the healthcare industry continues to be a target for the government, to the tune of $2.3 billion recovered. This is the fifth year in a row that healthcare has paid back more than $2 billion under the FCA. Hospitals, pharmaceutical companies, medical device companies, physician groups, insurance companies, clinics – all sectors of health care have been the subject of FCA enforcement. For example, one pharmaceutical corporation alone had to pay $2.2 billion to settle allegations of kickbacks and promotion of off-label uses of medications in early 2014. A dialysis center had to pay $350 million in penalties for giving kickbacks for patient referrals. A medical device company paid out $30 million for marketing defective devices. A large home health service provider settled with the government for $150 million for charging Medicare for services not rendered, overcharging, and billing for medically unnecessary procedures.

With all this money being recovered, more and more whistleblowers are filing lawsuits. And whistleblowers are not just disgruntled current or former employees. In recent years, many qui tam matters have been initiated by competitors or consultants with inside information. Health care companies need to monitor their billing more carefully, and develop protocols to prevent the types of abuses for which the FCA collects billions.

Contact the law offices of Brownstein & Nguyen if you suspect that you might have information about healthcare or other government fraud. Our experienced team of legal professionals will answer questions and guide you in the steps to take as a potential whistleblower.

What you Need to Know About Non Emergency Medical Transport

Guest Post by Aaron Marks of the Marks Law Group

Non Emergency Medical Transport Accident Atlanta

Medical TransportThe elderly, sick and disabled often require specialized transportation, particularly non emergency medical transportation (NEMT), for attending doctors’ appointments and for receiving non-emergency medical treatment. NEMT is provided in vehicles that are equipped for accommodating people in wheelchairs, on stretchers, and who need to travel with other medical equipment. Just as with other motor vehicles, accidents can occur in NEMT, and cause injuries to passengers who are already injured, sick or frail.

Duty of Care for Atlanta NEMT Providers

Across the country millions of NEMT trips are made each year. In Georgia alone in 2012, the state Department of Community Health oversaw 3.6 million NEMT trips and, as the state has an ageing population and outside of the Atlanta metropolitan area, little public transit, the need for NEMT will continue to grow. Georgia state law currently has few safety regulations in place for NEMT. Unfortunately, some companies hire drivers who are neither adequately trained nor supervised. Because of this, vulnerable patients may be injured as a result of negligence by those people whom we trust to help them receive their much needed medical attention. Atlanta NEMT services have a duty to transport their passengers safely to their destination. Furthermore, drivers and staff of the service provider must ensure that all passengers, including the patient and their family members, are safely buckled and in a regular seat before moving the vehicle.

What are the Different Types of NEMT Accidents?

When transporting the elderly and the sick, accidents may occur as a result of:

  • A collision with another vehicle or another object
  • Carelessness in moving or transferring the passenger, or in failing to secure the patient sufficiently
  • Loading and transferring the patient
  • Improperly used chair lifts
  • Leaving the patient in extreme or unsafe conditions
  • Loading or unloading of a wheelchair or stretcher

What Forms of Negligence Cause an Accident?

Staff errors and carelessness in assisting passengers can increase the risk of passenger injury. Even a seemingly small slip or fall can aggravate the injury or poor health condition of the passenger. Other factors such as driver inexperience and inadequate training in the use and operation of specialized machines for transporting the patient, and certain behaviors such as driving recklessly and failing to restrain passengers sufficiently before moving the vehicle can also lead to an accident.

NEMT Accidents are NOT Merely Auto Accidents

NEMT collision cases are complex and require a thorough understanding of the current laws. They cannot be litigated as just auto accidents, nor are they seen as a form of medical malpractice. They are, in fact, a combination of unusual elements, including the following, which set these types of cases apart:

  • Broker relationship (NEMT brokers contract with state and local governments)
  • State regulations and policies, and
  • The particular special needs of those being transported

With the rapid expansion of the NEMT industry and a challenging regulatory environment, we expect to see preventable catastrophic injuries, including wrongful deaths, involving non-emergency transport vehicles in Georgia.

For more information about NEMT issues, contact the Marks Law Group. If you are in need of trusted personal injury, medical malpractice and elder abuse lawyers, contact Atlanta attorneys Brownstein & Nguyen.

Why are Medical Costs so High?

If you have ever found yourself sifting through medical bills that seem overwhelming, you are not alone. This is frequently true when trying to make sense of the costs associated with an emergency room visit. After all, no one plans a visit to an emergency room.

medical billsWhen faced with expenses that seem unreasonable, it is important to consider factors that might offer some sort of explanation as to why medical costs are so high. A blog in the Washington Post discussed a recent Rand Corporation study exploring the purported relationship between healthcare costs and medical malpractice.

Is there a connection between healthcare costs and medical malpractice?

The theory behind medical malpractice or “tort reform,” advanced in recent years by the insurance industry and special interest groups, is that physicians order unnecessary tests to protect themselves from the risks associated with medical malpractice. This is sometimes referred to as “defensive medicine.” The theory begs the question:  are all diagnostic tests ordered in emergency care medically necessary? The question is admittedly complicated, given the urgent nature of medical care provided in emergency rooms. Medical personnel must be able to rule out certain causes of symptoms for patients that they may not have a complete medical history of. Still, the question remains whether all tests are required for care, or if some (or many) tests are performed only to protect doctors from lawsuits.

The New England Journal of Medicine recently published an article regarding the Rand study, titled The Effect of Malpractice Reform on Emergency Department Care. The study compared costs associated with emergency patient care in states that have passed laws making it more difficult for patients to sue their doctors for negligence, compared to states without similar laws. The results of the study show that strict medical malpractice laws have made little difference in the spiraling cost of medical care. The study therefore goes a long way towards debunking the theory that the fear of lawsuits is the driving force behind rising healthcare costs.

While some individuals battle with a sea of bills, others are left sifting through a sea of research and data to determine how care has become so expensive. While defensive medicine may not play a role, perhaps more important is the connection with healthcare billing fraud. More information can be found regarding fraudulent billing of Medicaid and Medicare in the Primer on Whistleblowing in Healthcare , co-authored by Brownstein & Nguyen attorney Jay Brownstein. If you suspect that your medical expenses are unreasonable as a result of billing fraud or overbilling, contact our trusted Atlanta attorneys for a consultation about healthcare whistleblowing. Brownstein & Nguyen’s Georgia lawyers are experienced in handling complex litigation matters and have represented and consulted with clients in whistleblower cases.

A Back Up Plan to Avoid RSIs

Medical Malpractice in AtlantaThe occurrence of retained surgical instruments (RSIs) or unintended retention of foreign objects (URFOs), while not extremely common, is more frequent than one might imagine. Items left inside a patient after surgery, including instruments and other surgical tools or materials, can cause infection, medical complications, pain and discomfort, and may even lead to death.

Many hospitals and medical professionals follow strict procedures and policies in order to avoid the potential for RSIs. Even so, the Journal of American College Surgeons reported that an estimated 1 in 5,500 surgeries results in an RSI. While a variety of items have been left behind, the most common is a surgical sponge. These sponges, used to soak up blood during surgery, can be difficult to spot as they become camouflaged blood soaked objects. Often tucked into hard-to-see areas within the body, it is reported that sponges, surgical instruments and other items are most commonly left in the abdomen, thoracic cavity, vagina, and pelvis.

The traditional method used to prevent RSIs involved taking a manual count of all items used during surgery, including surgical sponges. Nurses compared a count before and after a procedure for an inventory of sponges and other surgical instruments. While this provided some accountability, there was still room for human error. With technological advances, however, surgical sponges are now fitted with a tiny chip that gives off a radio frequency. Surgical teams are then able to use a wand or a mat at the end of a procedure to verify if whether a surgical sponge has been left inside the patient.

This technology advancement has shown to significantly decrease the amount of surgical sponges left behind. As a result, hospitals are able to avoid costly legal ramifications, hazardous side effects, and the emotional distress that occurs when an RSI takes place. Find out more about RSIs with this CBS news report, or through the findings of the Joint Commission. Also, before going in for elective surgery ask what methods will be used in order to prevent the occurrence of an RSI.

While the frequency of these surgical mistakes is hopefully decreasing, it is important to know your legal rights. The medical malpractice and negligence attorneys at Brownstein & Nguyen have over 20 years of experience handling cases in Atlanta and throughout Georgia. Contact our legal offices today for a free case evaluation.

The Affordable Care Act and Whistleblower Lawsuits

Qui Tam Whistleblower ClaimsThe stated goal of the Affordable Care Act (ACA), also known as “Obamacare,” is to make healthcare affordable for the general public. With healthcare spending in the U.S in 2013 totaling $3 billion dollars, and projected to rise 6% annually, one can understand that healthcare costs are quite burdensome for individuals, families, and businesses.

While the ACA as a whole has received much media attention, one important aspect of the act has not. This portion of the law involves the enhancement of the False Claims Act (FCA) by which qui tam or whistleblower lawsuits are brought by individuals. These lawsuits bring fraudulent billing and other false claims in the healthcare industry to light. The FCA enables the government, with the help of private whistleblowers, to recover significant dollars that were fraudulently claimed as healthcare expenses. In 2013, some $2.6 billion was recovered from healthcare fraud cases.

While qui tam or whistleblower cases may be risky, whistleblowers do have an incentive to come forward with information regarding false claims and fraud against the government. Whistleblowers can receive 15-30% of what the government is able to recover as a result of a qui tam or whistleblower lawsuit. In 2013, FCA whistleblowers received $345 in incentive awards. This financial incentive is necessary to encourage private individuals to come forward, often at great personal sacrifice and expense, with information that helps taxpayers recoup billions of dollars lost annually to healthcare fraud, and to help ensure that fraud is minimized in these cases.

For more information regarding false claims and other fraudulent conduct the FCA prohibits healthcare facilities, providers, and drug manufacturers from engaging in, take a look at the The Affordable Care Act and Qui Tam Whistleblower Claims. This concise article, co-authored by Atlanta attorney Jay Brownstein, is quite informative on the topic.

Does healthcare insurance lower mortality rates?

The death rate in Massachusetts dropped following the 2006 adoption of mandatory healthcare insurance. Is this a coincidence, or is mandatory healthcare insurance responsible for the decreased mortality rate?

Is preventative care key?The New York Times reports that from a recent study of mortality rates in Massachusetts, which compares the death rates to counties with similar populations outside the state, we don’t yet know the answer to the question. However, the study, published in the Annals of Internal Medicine, provides some evidence that healthcare insurance may be closely linked to reducing mortality.

With coverage now being more widely available and accessible to those who would otherwise be uninsured, doctors and hospitals have observed a difference in the willingness of patients to pursue treatment. The New York Times referenced multiple reports by doctors in which uninsured patients would delay or forego medical care and treatment. More often than not, the ultimate reason they chose to do so was the financial cost involved. Unfortunately, medical conditions for some untreated patients grew into more serious (and costly) health issues that might have been avoided had treatment been sought early on.

As alluded to by the study, if more patients have healthcare insurance, they are more likely to pursue and receive preventative care, which leads to a healthier population, reduces overall healthcare costs, and relieves taxpayers of the burden of government care for the uninsured. It further suggests that to be effective, healthcare insurance must be within the financial means of families and individuals. Unfortunately, our current healthcare delivery system allows for hidden and questionable healthcare expenses that continually drive costs higher, making it unreachable for many.

If you, your family, or a loved one believe you have been overcharged, denied proper treatment or provided unnecessary treatment in connection with insurance or billing issues, you may have legal rights to pursue justice. Contact Brownstein and Nguyen, your Atlanta healthcare whistleblower attorneys, for assistance regarding healthcare coverage issues, medical expenses and billing fraud.

Bedsore Prevention and Awareness

Pressure ulcers or decubitus ulcers, commonly referred to as bedsores, are serious and sometimes fatal injuries typically afflicting the elderly, bedridden and wheelchair populations including stroke victims, paralysis and dementia patients. Most bedsores occur in hospital or nursing home settings. With proper care and prevention, however, the risk of bedsores and resulting complications can be greatly reduced, if not eliminated, for at-risk patients.

High risk population for bedsoresWhat is a pressure ulcer or bedsore?

A pressure ulcer or bedsore is as an area of unrelieved pressure in a defined area, usually over a bony prominence (such as the tailbone, ankle or elbow), resulting in ischemia, cell death, and tissue necrosis. Essentially, the pressure prevents blood from getting to the tissue, which breaks down and eventually dies. Once a bedsore develops, depending upon age, nutrition and other medical factors, the skin may not heal and a life-threatening systemic infection can result. Risk factors for pressure ulcers include inactivity, immobility, diabetes, advanced age, impaired cognition, and bowel or bladder incontinence.

Pressure ulcers are classified and treated according to clinical “stage” based on certain criteria. Assigning a pressure ulcer stage is based on visual inspection to determine the extent of tissue destruction and wound depth. Pressure ulcer staging also requires an understanding of the anatomy of skin and underlying tissues. In stage I, the skin is not broken but is red or discolored without fading thirty (30) minutes after pressure is removed. By stage II, the topmost layer of skin is broken, creating a shallow, open, painful sore.  A stage III pressure ulcer is a full-thickness skin loss involving damage or necrosis of the underlying tissue that may extend down to, but not through, muscle or bone. Drainage may or may not be present in stage II and stage III pressure ulcers. Stage IV describes a pressure ulcer involving extensive destruction of tissue with tissue necrosis or damage to muscle, bone, or supporting structures. Usually, dead tissue and drainage are present in stage IV pressure ulcers.

According to the National Quality Forum, a non-partisan consortium of healthcare professionals and organizations, stage III and IV and unstageable pressure ulcers that develop after admission to a facility are considered Serious Reportable Events (SRE) that are preventable and should never occur. Unfortunately, bedridden, wheelchair bound and other at-risk patients don’t always receive the necessary care to prevent pressure ulcers. All too often, infected pressure ulcers lead to systems failures and ultimately death for at-risk patients at hospitals, nursing homes, acute and long-term care facilities. According to the National Pressure Ulcer Advisory Panel, a non-profit devoted to the prevention and care of pressure ulcers, each year approximately 2.5 million patients are treated for pressure ulcers in U.S. acute care facilities and as many as 60,000 U.S. hospital patients die each year from pressure ulcer complications.

Causes and prevention of bedsores

Pressure ulcers or bedsores are commonly caused by a combination of four factors: pressure, shearing forces, friction and moisture. The key to prevention is pressure reduction.

Good skin care begins with an initial risk assessment and the creation of a skin care plan specifically tailored to the patient’s condition and setting. Prevention of skin breakdown, pressure ulcers and tissue or blood infections is an essential aspect of care. Upon admission to a hospital, acute care or other facility, patients should be evaluated by a physician, qualified nurse of other medical professional for the risk of skin breakdown taking into account numerous variables and risk factors. Thereafter, regular skin assessments should be performed on a regular basis (daily in an acute care setting), especially if a skin problem is suspected or has been observed. Initial and periodic assessments should contain accurate measurements of the length, width, and depth of a wound. Drainage type, color and odor, and the color of wound tissue should be noted, as well as staging of the wound.

At a minimum, patients identified as at-risk for skin breakdown should be repositioned at least every two (2) hours. However, regular repositioning may not be enough for patients at higher risk levels or if a pressure ulcer has already formed. A pressure-reducing surface like a foam or inflatable mattress cushion should be used for those patients. To minimize the risk of skin breakdown from shearing forces, the head of the bed should be maintained at the lowest degree of elevation necessary based on medical conditions and other factors. Friction injuries may be reduced by the use of protective dressings and barriers. Pressure ulcers must be kept clean, dry and protected from sources of contamination such as feces and urine. This typically requires frequent cleaning of the patient and changing of the wound dressing.

What to look for?

Pressure ulcers can develop quickly – within days or even hours – depending on a patient’s condition and setting. The most common site where pressure ulcers occur in bedridden patients is the buttocks area, over the tailbone. Because of this, developing bedsores may be difficult to detect for family members not involved in the daily care of a patient. There are, however, certain observable factors and symptoms might indicate the presence of a bedsore warranting further examination and treatment. They can include:

  • lengthy period of immobility
  • generalized or local discomfort or pain when not being moved or touched
  • generalized or local discomfort or pain when being repositioned, turned, or moved
  • foul odor from of undetermined origin
  • evidence of lack of proper turning or re-positioning
  • poor hydration and/or nutrition
  • lack of proper hygiene and cleaning of incontinent patients

What to do?

If you suspect that a family member or loved one is at-risk or suffering from a bedsore, you should immediately notify the healthcare professionals in charge of their care. Proactive oversight and management of your loved one’s care is the best way to ensure they are receiving the proper care.

If your loved one is the victim of negligent care resulting in a pressure ulcer or decubitus, contact the experienced Atlanta Georgia elder care, bedsore and medical malpractice attorneys at Brownstein & Nguyen today for a free consultation. We handle cases involving preventable bedsores and the serious health complications and deaths that result. We’ll confidentially review the case, and discuss your legal rights with you.