“My mom is in a nursing home and I noticed some bruises and sores. I think they are bedsores—what should I do?”

Bedsores are often a sign of neglect and sometimes a sign of abuse. The first thing you should do is speak to a nurse on duty and begin to remedy the situation. Be aware that the nurse may not have a full understanding of these injuries and you will likely need the attention of a wound care specialist and medical doctor. If you have a cell phone take some pictures of the wound for documentation. Bedsores and Pressure Sores, also known as Decubitus Ulcers can progress quickly and can be deadly. They occur when someone is immobile and there is not adequate blood flow. Then the affected tissue dies and an ulcerated sore develops. In a nursing home, hospital or other care facility it is their responsibility to check and turn the patient regularly. There are laws in place that protect patients and you should know that these injuries are not the fault of the patient. The patient is the victim. If a loved one you know is suffering they may have a significant, financially rewarding lawsuit. Read more about this on our website, http://www.RaphanLaw.com.

As an Elder Law firm we see these cases often. Whether malpractice, abuse or neglect it is simply unjust for it to happen to an innocent victim. Do not put off addressing the issue. Call me for a free consultation (212-268-8200, 800-278-2960) or even to just guide you through the process of getting the proper medical and legal attention.

Visual Stages of Bedsores:

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Read our Frequently Asked Bedsore Lawsuit Questions here>

By Brian A. Raphan, Esq.

What Rights Do Bedsore Victims Have?

You’d be surprised how many times we hear the following from clients…”the nursing home said our dad’s skin condition was broken down and poor health led to bedsores”, or some similar version of this. These comments  inappropriately lead people to believe they or there loved ones do not have legal rights when it comes to bedsores or pressure sores (decubitus ulcers). Of course they are not the fault of the bedsore victim. Especially when they are in the care of professionals of a hospital, medical or nursing facility. Patients, elders, unhealthy or not do have legal rights–which also includes the right to sue for bedsores. Read more about the Rights of Bedsore Victims below:

bedsore treatment, bed sore malpractice

  1. The defendants insurance company may ask you for a recorded statement describing the appearance of bedsores and your treatment. Remember you have no obligation to give them such a statement, nor is it wise to do so.

  2. The defendant’s insurance company will ask you for authorizations to obtain your medical records. Let your attorney release your records after he or she has reviewed them. It’s best not to offer information by yourself. 

  3. Some insurance companies will offer you money to settle the case before you contact an attorney. In this situation the insurance company knows they will have to pay out money and they hope to settle the claim before you hire an attorney who can negotiate and demand a higher amount. Always consult an attorney if an insurance company is offering you money. By doing so you will in all likelihood increase your net recovery even after taking out the lawyers fee.

  4. Once a bedsore case is settled and the defendant is released, regardless of whether you make a full recovery or not, the money you received cannot be taken away, it is your money…tax free.

  5. If you need surgery, it is important to go forward with that before you settle your pressure sore or bedsore lawsuit.

  6. If you are persuaded by a hospital or nursing home and settle a case on your own, only to find out 6 months later you have more serious conditions than first thought, you have forfeited your rights to recover additional money. That is why it is so important to contact an experienced bedsore attorney before you sign anything.

  7. You are able to sue for and recover a monetary award from new injuries and infections and the aggravation of old ones caused by bedsores or pressure ulcers.

Additional Bedsore information & Guides:

THE DOCTOR WEIGHS IN BEDSORE ARTICLE by Attorney Brian A. Raphan

HOW MUCH IS A BEDSORE LAWSUIT WORTH: CASE EVALUATOR

DOWNLOAD: BEDSORE LEGAL & MEDICAL GUIDE

Grades of pressure sores
If a person is bedridden for long enough, the areas of skin constantly in contact with the mattress
or chair will start to discolor. This shows that the skin is in danger of ulcerating.
Pressure sores are graded to four levels, including:
• Grade I – skin discoloration, usually red, blue, purple or black
• Grade II – some skin loss or damage involving the top-most skin layers
• Grade III – necrosis (death) or damage to the skin patch, limited to the skin layers
• Grade IV – necrosis (death) or damage to the skin patch and underlying structures, such as tendon, joint or bone.

Complications of pressure sores
Untreated pressure sores can lead to a wide variety of secondary conditions, including: • Sepsis (bacteria entering the bloodstream)
• Cellulitis (inflammation of body tissue, causing swelling and redness)
• Bone and joint infections
• Abscess (a collection of pus).

For more helpful information  or a free consultation you may contact me by email here: Contact

Regards, Brian A. Raphan

‘Smart bandage’ detects bedsores before they are visible to doctors

BERKELEY — Engineers at UC Berkeley are developing a new type of bandage that does far more than stanch the bleeding from a paper cut or scraped knee.

Thanks to advances in flexible electronics, the researchers, in collaboration with colleagues at UC San Francisco, have created a new “smart bandage” that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be seen by human eyes – and while recovery is still possible.

Associate professor Michel Maharbiz explains how the smart bandage works to detect bedsores. (UC Berkeley video by Roxanne Makasdjian and Phil Ebiner)

“We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin,” said Michel Maharbiz, a UC Berkeley associate professor of electrical engineering and computer sciences and head of the smart-bandage project. “We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it’s healing.”

The researchers exploited the electrical changes that occur when a healthy cell starts dying. They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (Image courtesy of UC Berkeley)
The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (UC Berkeley image)

Tackling a growing health problem

The findings, published today (Tuesday, March 17) in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million U.S. residents at an annual cost of $11 billion.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin. Areas that cover bony parts of the body, such as the heels, hips and tailbone, are common sites for bedsores. Patients who are bedridden or otherwise lack mobility are most at risk.

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

Bedsores are associated with deadly septic infections, and recent research has shown that odds of a patient dying are 2.8 times higher when they have pressure ulcers. The growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

“The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison. “It’s tackling a big problem that many people have been trying to solve in the last 50 years. As a clinician and someone who has struggled with this clinical problem, this bandage is great.”

Cells as capacitors and resistors

The researchers printed an array of dozens of electrodes onto a thin, flexible film. They discharged a very small current between the electrodes to create a spatial map of the underlying tissue based upon the flow of electricity at different frequencies, a technique called impedance spectroscopy.

Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The "reversible damage" example highlights sensitivity of the "smart bandage" impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)
Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The “reversible damage” example highlights the sensitivity of the “smart bandage” impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)

The researchers pointed out that a cell’s membrane is relatively impermeable when functioning properly, thus acting like an insulator to the cell’s conductive contents and drawing the comparison to a capacitor. As a cell starts to die, the integrity of the cell wall starts to break down, allowing electrical signals to leak through, much like a resistor.

“Our device is a comprehensive demonstration that tissue health in a living organism can be locally mapped using impedance spectroscopy,” said study lead author Sarah Swisher, a Ph.D. candidate in electrical engineering and computer sciences at UC Berkeley.

To mimic a pressure wound, the researchers gently squeezed the bare skin of rats between two magnets. They left the magnets in place for one or three hours while the rats resumed normal activity. The resumption of blood flow after the magnets were removed caused inflammation and oxidative damage that accelerated cell death. The smart bandage was used to collect data once a day for at least three days to track the progress of the wounds.

The smart bandage was able to detect changes in electrical resistance consistent with increased membrane permeability, a mark of a dying cell. Not surprisingly, one hour of pressure produced mild, reversible tissue damage while three hours of pressure produced more serious, permanent injury.

Promising future

“One of the things that makes this work novel is that we took a comprehensive approach to understanding how the technique could be used to observe developing wounds in complex tissue,” said Swisher. “In the past, people have used impedance spectroscopy for cell cultures or relatively simple measurements in tissue. What makes this unique is extending that to detect and extract useful information from wounds developing in the body. That’s a big leap.”

Maharbiz said the outlook for this and other smart bandage research is bright.

“As technology gets more and more miniaturized, and as we learn more and more about the responses the body has to disease and injury, we’re able to build bandages that are very intelligent,” he said. “You can imagine a future where the bandage you or a physician puts on could actually report a lot of interesting information that could be used to improve patient care.”

Other lead researchers on the project include Vivek Subramanian and Ana Claudia Arias, both faculty members in UC Berkeley’s Department of Electrical Engineering and Computer Sciences; and Shuvo Roy, a UCSF professor of bioengineering. Additional co-authors include Amy Liao and Monica Lin, both UC Berkeley Ph.D. students in bioengineering; and Yasser Khan, a UC Berkeley Ph.D. student in electrical engineering and computer sciences, who fabricated the sensor array.

Study co-author Dr. David Young, UCSF professor of surgery, is now heading up a clinical trial of this bandage.

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To learn about other bedsore and pressure sore treatments click here.

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Bed and/or Chair Rest + Neglect = Bedsores

Article by Brian A. Raphan. Published 3/17/15 in ‘THE DOCTOR WEIGHS IN’

When a patient develops pressure ulcers, it is often a sign of neglect and can even be the result of hospital malpractice, nurse malpractice or nursing home negligence.

Any time a patient is confined to a bed or chair for a period of time and not provided proper and adequate care, the risk of pressure ulcers increases.

The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure ulcer as a “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.” Illustrations of the stages of pressure ulcers are shown below:

stages of bedsores

Sadly, pressure ulcers are the underlying cause of mortality and morbidity for several thousand patients across the country each year. Researchers analyzing the national Medicare Patient Safety Monitoring System (MPSMS) database found that the nationwide incidence rate for hospital-acquired pressure ulcers was 4.5 percent. The five states with the highest incidence rates are New York (5.2%), Missouri (5.3%), New Jersey (5.3%), Massachusetts (5.5%) and Pennsylvania (5.9%).

The federal government, in its first year of a federal initiative to improve patient safety, recently imposed penalties aimed at reducing preventable harm. Five states saw a significant percentage of hospitals being penalized: New York, where 26% of hospitals were penalized by having their Medicare reimbursements cut by 1%; Missouri, 25%; New Jersey, 37%; Massachusetts, 22%; and Pennsylvania, 25%.

In New York State, penalized hospitals included some well-known healthcare facilities, such as Beth Israel Medical Center and New York University Langone Medical Center.

All sedentary patients are vulnerable, but the elderly and patients whose skin condition has been compromised are especially at risk. Pressure ulcers are most common on bony prominences with little protective fat or muscle (such as heels, hips, shoulders, and tail bones), and they develop when patients stay in one position for too long without shifting their weight. The constant pressure against the skin reduces blood flow to contact areas. The skin begins to break down and the tissue dies, possibly in a matter of hours. Friction and shear caused by sliding down in the bed, or being moved improperly from a stretcher to a bed can exacerbate the problem. Pressure ulcers slow a patient’s recovery, can lead to other issues and infection and prolong hospital stays. The total annual cost for treating pressure ulcers in the U.S. is estimated at $11 billion. However, pressure ulcers (also known as bedsores and decubitis ulcers) are preventable.

To prevent pressure ulcers and damage to the skin, recent NPUAP recommendations can be summarized in seven steps:

prevent bedsores

Because these seven steps are so easy to follow, when a patient develops pressure ulcers, it is often a sign of neglect and can even be the result of hospital malpractice, nurse malpractice or nursing home negligence.

Upon admission to a hospital for another health concern the issues can go unnoticed, allowing further damage to take place in a relatively short time. This also creates liability on the part of the hospital.

In many lawsuits that we handle, the hospital is dealt a bad hand by receiving a patient from a nursing home where a skin breakdown or pressure ulcer has already begun. At times, due to dementia for example, a patient may not be able to express or know how to communicate pain upon entering the hospital. However, this is no excuse for not identifying a high-risk patient and making regular daily assessments.

To be clear, pressure ulcers are not the fault of the patient. The patient is a victim. Medical negligence by a hospital, doctor, nurse, aide or medical technician is unacceptable and may be the cause of pain and suffering, or even result in death. It is simply not acceptable for patients to develop bedsores or pressure ulcers while they are in the care of medical professionals and receiving medical care and treatment at a facility.

There is no doubt that hospitals and staff, from talented skilled doctors, nurses and medical professionals to support staff and administration, do their best to help and treat patients. However, protocols exist in every facility, and perhaps, it is just a matter of every individual being a bit more aware, and caring just a little more, when dealing with the elderly and at-risk patients.

By Brian A. Raphan (Principal Attorney, Law Offices of Brian A. Raphan, P.C.

Download a Free Bedsore Legal, Medical & Treatment Guide

Can you sue for Bedsores or Pressure Sores?

bedsore lawyer

Bedsores should not happen while in a nursing home or hospital. Often they are due to neglect and negligence.

Bedsores, Pressure Sores or Decubitis Ulcers are not the fault of the patient. At a hospital or nursing home there are federal laws in place to protect patients and assure they get the proper care. When these standards of care are not used sores can develop. Simple duties like turning an immobile patent frequently to relieve pressure, proper cleaning an hygiene are sometimes not provided. If a sore develops the patient has now become a victim. The sores can cause extreme pain and suffering and unfortunately even death. You can sue. And you have every right to do so and get financial compensation. Depending on the case, monetary awards can be in the millions. Below are some of the different types of lawsuits relating to sores.

Medical Malpractice

Medical Malpractice cases arise when a health care practitioner departs from the accepted standard of care in the medical community. In more simple terms, when a hospital, doctor, nurse, practitioner commits a serious error in his/her care and treatment, which results in further injury to the patient. Some common examples are failing to diagnose the bedsore; failing to report bedsores or pressure sores; failing to admit a patient into the hospital for bedsores when necessary; and failing to perform a medical procedure or provide treatment for bedsores that was otherwise indicated.

FREE BEDSORE FACTS BOOKLET>

Nursing Home Liability

The elderly population frequently suffers due to serious neglect once they become patients or residents in nursing homes or any long term care facility.  Some critical issues relating to sores are: over or improper medication; lack of supervision; inadequate wound care leading to infections; not reporting the issue in a timely manner and overall neglect.

The severe injuries that patients experience along with the constant pain and suffering associated with bedsores are often the result of preventable situations. In our experience in handling these types of cases we have found frequent examples of poor care planning; lack of stimulation; failures to turn and position patients; failure to provided adequate pressure relief devices to patients; and unbelievably, failure to change adult diapers and failure to provide sufficient quantities of food and water. As a result of neglect in Nursing Homes, the illnesses range from severe infections and amputations, to dehydration and, unfortunately, death. Bedsores and pressure sores often lead to further infections and illnesses.

Hospital Negligence

At one time or another we all go to hospitals. While patients there, we have the right to expect quality medical care and treatment.  The unfortunate reality is that there are often tragic outcomes that are the result of medical malpractice which should never occur. This is especially true with bedsores.

Hospital Negligence occurs when there are “departures in the standards of good and accepted medical practices” that one should be able to expect in the local medical community given the current state of medical treatment and technology. These departures in the standard of care can stem from negligent treatment on the part of Doctors, Surgeons, Specialists, Lab Technicians, Physician Assistants, Nurses, Nurses Aides, Therapists, Administrators, Pharmacists and any other member of the Hospital Staff whose conduct, actions, or inaction, causes injuries and suffering that should not have occurred.

Some examples of Hospital Negligence include failure to provide proper medication or medical devices; failure to provide proper monitoring and supervision; failure to order consultations to other medical specialists; failure to diagnose bedsores in a timely fashion; failure to prevent infection and amputation; failure to turn and position the patient resulting in pressure sores, bedsores or decubitus ulcers; failure to perform a medical procedure or surgery properly; failure to warn patient of risks of a surgery or medical procedure; failure to keep family members informed regarding medical decision making; and failure to provide safe and proper discharge instructions.

Wrongful Death

This type of lawsuit occurs when a spouse or close relative has a right to recover when a loved one dies due to the sores or a medical complication that was related to the sores. Recovery is from the at-fault or negligent party. Recovery can include loss of income, services, comfort and society. New York has a very restrictive and complicated wrongful death statute. Our knowledgeable lawyers take you through it one step at a time. We understand that dealing with the loss of a loved one is not easy, so we are extremely sensitive when dealing with family members. Unfortunately, left untreated or not treated in time, bedsores can rapidly progress from stage 1-4 and lead to further complications often resulting in a wrongful death.

If you or someone you know is a victim of bedsores, the first thing to do is get the stage of the sore identified and immediate and proper medical attention. If you think you have a lawsuit then contact me on how to proceed. You can also begin an evaluation online by clicking here. We can even help you get better medical attention at the same time. Feel free to email about these matters at bedsores@RaphanLaw.com

Regards, Brian

Some FAQ’s about Health Care Proxys

As an Elder Law attorney  for over 25 years  I have recently been getting more and more questions about Health Care Proxys. Below are some answers as well as a link to a Free Sample Draft so my readers can see what it’s all about:

 Why you need a will
Living Will
 

What is a Health Care Proxy?

A Health Care Proxy is someone you appoint to make health related decisions for you, in the event you can not.

Who decides that I’m not able to make my own healthcare decisions?

Your attending physician will decide whether you lack the capacity to make health care decisions. The decision is made in writing. A second doctor also must be consulted in the case of decisions to withdraw or withhold life-sustaining treatment.  You will be given notice of these decisions if there is any indication that you can understand it. If you object to this decision or to a decision made by your agent, your objection or decision will prevail unless a court determines that you are unable to make health care decisions.

 

What if I recover the ability to make my own healthcare decisions?

Your doctor is required to decide whether you can make your own health care decisions and confirm it in writing each time your doctor plans on acting on your agent’s health care decisions. If you have recovered the ability to make your own decisions, your agent will not be able to make any more decision for your unless you again lose the abilities to make them. 

 

How do I complete a Healthcare Proxy?

In New York State, laws set forth the requirements for completing a health care proxy. You must be at least 18 years old and have the capacity to make your own decisions at the time you complete the proxy.

You must state your name and the name of the person you want to act as your agent, and state that your want the agent to have the authority to make health care decisions for you. You also must sign and date your health care proxy in the presence of two adult witnesses who are not names as your agent and have the witnesses sign the proxy. Please note that there are also special rules for the execution of a proxy by residents of psychiatric facilities.

Please note that you do not need to have a lawyer draft your health care proxy, however, you may wish to consult with a lawyer for advice about a health care proxy.

 

When will my Healthcare Proxy end?

You can create a proxy that lasts for a limited period of time by including in the document the dates you want the proxy to be valid. You can also revoke your proxy if you wish and you are competent to do so.

If you have appointed your husband or wife as your agent, and then you divorce or legally separate, the appointment will be revoked unless you specify that you do not wish to revoke it. You should review your proxy periodically to be sure that it continues to reflect your wishes. 

 

 Where should I keep my Proxy?

It’s best to give a copy of your proxy to your doctor as well as to the agent named in your proxy. If you revoke your proxy, be sure to notify whomever you gave a copy of the proxy. Upon entering a hospital you may give it to an administrator in charge, as your doctor, or attending physician may not be there when you arrive. Also, keep a copy with your other important documents such as a Power of Attorney and Will. All should be reviewed every couple of years.

What if I don’t want a Healthcare Proxy?

You can’t be required to execute a health care proxy as a condition of receiving health care services or insurance. Also, the lack of a health care proxy or other specific instructions does not crate any presumptions regarding your wishes about health care.

If you have any questions feel free to contact me! You can also visit this page on our website and download a FREE SAMPLE DRAFT of a health care proxy.

Regards, Brian

info@RaphanLaw.com

The Law Offices of Brian A. Raphan, P.C.

7 Penn Plaza, New York, NY 10001

Can you sue a hospital if you develop bedsores?

Bedsores are often a sign of neglect and can be the result of hospital malpractice, nurse malpractice or nursing home negligence. It is simply not acceptable that they should happen while a person is at a facility in the care of professionals. Sadly, bedsores are the underlying cause of death for several thousand Americans each year. They are not the fault of the patient. The patient is a victim. A bedsore lawsuit is a way to seek justice for the pain and suffering and also a get a financial award for the victim or family of a deceased victim.

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Click for online Bedsore Lawsuit Evaluation.

Bedsores can develop quickly, progress rapidly and are often difficult to heal. Caring for them can cost into the tens of thousand of dollars. Often, due to the lower staffing in nursing homes, patients are forced to wait longer for care, such as simply being turned in a bed, or the changing of soiled linens and clothes. One example of how they can happen is if a patient cannot change themselves then they are forced to sit or lay in their own urine until a caregiver arrives. While the patient waits, their skin is being weakened by the moisture making them susceptible to bedsores. Health experts agree that bedsores do not have to occur. Preventive measures from a nursing home, hospital or health care provider are your legal right. It is the duty of a nursing home or hospital to follow proper procedures to prevent them.

Click here for information on treatment.

Click here for BedsoreHotline.com…Your hotline to legal information, treatment information, and to see if you have a lawsuit. Learn the importance of a dedicated bedsore legal team.

If you want further information on this subject, feel free to email or call me. bedsores@RaphanLaw.com. All conversations are confidential.

Regards,

Brian

212-268-8200

Judge: Casey Kasem’s daughter in charge of care

The Associated Press

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PORT ORCHARD, Wash. (AP) — A Washington state judge on Friday said Casey Kasem’s daughter, not her stepmother, is in charge of the medical care for the 82-year-old radio personality, who remains in critical condition with an infected bedsore.

However, all members of Kasem’s family can visit him at the hospital — just not at the me time, Kitsap County Superior Court Judge Jennifer Forbes ruled.

Kasem has been receiving intravenous antibiotics and other care at St. Anthony Hospital in Gig Harbor, Washington, for a serious pressure ulcer he had when he was admitted on Sunday, according to a hospital statement.

Hospital spokesman Scott Thompson said Friday he would make no comment beyond the statement that was issued Thursday.

“Right now, Casey Kasem’s health is declining and (he) won’t be with us much longer,” daughter Kerri Kasem’s spokesman, Danny Deraney, said in a statement.

“I want to be there for my dad,” Kerri Kasem said outside court Friday, KOMO-TV reported. “All of us. So if he does happen to open his eyes and look up, his entire family is there.”

The former radio show host is suffering from a form of dementia called Lewy Body Disease, according to court records.

His daughter said she is considering putting her father in hospice care at St. Anthony, the Kitsap Sun reported.

Kasem gained fame with his radio music countdown shows, “American Top 40” and “Casey’s Top 40.” He also was the voice of Shaggy in the cartoon “Scooby Doo.”

Wife Jean Kasem has been in control of her husband’s medical care and has controlled access to him as his children from an earlier marriage contested who should make those decisions. The couple have been staying for about a month at the home of friends in Kitsap County, west of Seattle.

On May 20, while Kasem and his wife were in Washington state, Los Angeles Superior Court Judge Daniel S. Murphy expanded Kerri Kasem’s power to determine her father’s medical care and ordered Jean Kasem to allow her stepdaughter to see him. Murphy also temporarily suspended Jean Kasem’s control over her husband’s medical care.

Forbes held Friday that the California court order prevails, with Kerri Kasem working in consultation with doctors, the Kitsap Sun reported.

The judge ordered separate visitation times because of the animosity between Jean Kasem and her husband’s children. Should the two sides meet, they must not speak to each other, she said.

The judge also found Jean Kasem in contempt of court for failing to allow Kerri Kasem to see her father the day the California court order was issued. However, the judge did not impose any sanctions.

“I don’t want to rub salt in the wound,” she said. “Mrs. Kasem is dealing with some of the worst times of her life. I feel for her.”

As Casey Kasem was removed by his daughter last weekend from the home where he has been staying, Jean Kasem tossed a package of ground meat at her stepdaughter.

“If you need to know why I did it — when a person is about to pass away, there are always rabid dogs,” Jean Kasem told reporters in response to a question after a court session Monday.

Bedsores & Nursing Home Obligations

Waiting – And – Waiting On The Nursing Home Inspector

This KHN story was produced in collaboration by Kaiser Health News

Mary Chiu was shocked by the bed sores on her 85-year-old mother.

One on her backside was so deep it exposed the bone; others formed on her left leg, heel and big toe. Half a dozen times, Sui Mee Chiu had to receive hospital treatment for the sores and bacterial infections.

bedsore lawsuit

The wounds persisted for months, until the day she died in April 2012 of respiratory failure.

“She suffered,” Mary Chiu, 56, said. “I don’t wish that on anybody.”

In September 2011, Mary Chiu sent a 7-page complaint to Los Angeles County public health officials requesting a thorough investigation of the nursing home where her mother had lived for nearly two years. That December, she sued the home, Arcadia Health Care Center.

The lawsuit is over: An arbitrator ruled that Sui Mee Chiu had been a victim of elder abuse, negligence and wrongful death and awarded her daughter more than half a million dollars. The public health department, however, still hasn’t finished its investigation. As a result, when consumers check public records on nursing home quality, they won’t find any report of Chiu’s case at Arcadia.

“The investigation is still in process and Public Health is inquiring into the circumstances behind the delay in the final report and closure of this case,” according to a statement last week from the Los Angeles County Public Health Department. “Public Health regrets the delay and is working to reduce the time from initiation of investigations until closure.”

The case is just one example of hundreds in Los Angeles County and thousands statewide in which investigations by nursing home regulators have remained incomplete for months, sometimes years. There were 3,044 open cases in the county as of mid-March, 945 of which date back two years or more, according to an audit released last week by the Los Angeles County Auditor-Controller.

Chiu’s attorney, Michael Moran, called the department’s delayed handling of her mother’s case by the public health department a “wholesale failure.”   “It is all about accountability,” he said.

In cases like Chiu’s, there is no information on state or federal websites about the complaint or inspectors’ findings. Consumers can see, however, that in 2011, while Chiu was living at the Arcadia nursing home, inspectors found some residents didn’t receive proper treatment to prevent new pressure sores or heal existing ones, according to federal documents.

But until a reporter called last week, the Arcadia Health Care Center website was highlighting its status as a five-star facility, the maximum possible rating on a U.S. official government database. Its actual rating is three stars. The claim has since been taken down.

Thomas Collins, Arcadia Health Care Center’s attorney, said he believed the rating was changed after the last inspection.

In a written statement, he said that the judge’s ruling in the Chiu case was “unwarranted and not supported by the evidence.”

“We were and remain extremely disappointed by the ruling,” he said.

Chu had a number of underlying conditions, and the nursing home successfully managed them,  he  said, adding that the family “always expressed their satisfaction with the care.”

The arbitrator’s ruling cannot be appealed. 

BEDSORE FACTS AND YOUR LEGAL RIGHTS>

Systemic delays

Statewide, delays in nursing home inspections have been a persistent problem. At a January hearing, legislators demanded more accountability and efficiency. A state Assembly bill would require investigations of mistreatment or abuse to be completed within 40 days.

The problem is particularly acute in Los Angeles County, which has a third of the state’s nursing homes. The county oversees nursing homes on behalf of the California Department of Public Health and the federal Centers for Medicare & Medicaid Services. Last month, Kaiser Health News and the Los Angeles News Group reported that L.A. County officials had attempted to clear their backlog in part by instructing inspectors to close cases without fully investigating them. Jonathan Fielding, who heads the county public health department, says all cases have been investigated but not all have been written up. Under questioning by Los Angeles County supervisors last month, Fielding said that the department does not have adequate funding or staffing to meet all federal and state requirements. The division has an annual budget of $26 million but needs $33.5 million, he said.

Supervisors ordered an audit, which was issued last week. It found a lack of central oversight over inspections, noting that the department did not set or track timelines for investigations. The department also didn’t properly manage its funding, leaving about $4 million in its budget unspent over the last two fiscal years, the audit reported.

These problems concern Molly Davies, coordinator of the WISE & Healthy Aging Long-Term Care Ombudsman Program for L.A. County, whose position is partially funded by the state and federal governments. She said she has recently come across seemingly egregious cases in which the investigations took too long.

Among the cases, as described in records:

*The county received a report in November 2009 alleging that a woman with diabetes and bipolar disorder had been sexually abused by a staff member at a Palos Verdes nursing home. An investigator visited the facility a few weeks later but didn’t issue a fine until October 2013. *A Culver City nursing home reported in March 2011 that an 87-year-old woman died after being given a narcotic at a dose 10 times higher than prescribed. Three years later, a fine of $20,000 was issued.

*In 2010, the department investigated an allegation that a certified nursing assistant at a Torrance facility was videotaped abusing a partially paralyzed man with brain damage. The case was not completed until this year, when a $20,000 citation was issued.

‘DPH was not doing their job’

Mary Chiu’s mother, a Chinese immigrant, loved to cook traditional food and watch Chinese soap operas. As she aged, she developed dementia, Parkinson’s disease and depression. Chiu decided her mother would be best taken care of in a nursing home. She said the Arcadia Health Care Center had five stars and was around the corner. Sui Mee Chiu moved there in May 2009. In late 2010, during a meeting with staff at the home, Chiu heard her mother had an infected bed sore, according to her September 2011 compliant. A few months later, the wound was so severe she had to be transferred to a hospital. Chiu then confronted the staff, who blamed her mother for being “non-compliant” and her father for interfering with the care during his visits, according to the arbitrator’s ruling.

Her father, now deceased, was then 89 and had a history of strokes. But he visited the facility twice daily, staying a total of about four hours.

“My parents have been married for almost 60 years and my father’s only concern is to make sure my mother is comfortable,” Chiu said in her complaint.

Chiu received a letter in October 2011 from the public health department acknowledging the complaint and saying an investigator had been assigned. In July 2012, after her mother had died, Chiu sent another letter and photos of the ulcers. She said she didn’t get any response until this week, after a reporter and she separately called the department.

According to the department’s recent statement, an inspector began the investigation in October 2011, within the 10 days required by law.  An inspector observed residents with similar medical conditions at the Arcadia Health Care Center, conducted interviews and reviewed records, the department said. Officials said they were not able to interview Sui Mee Chiu, who had been transferred by her daughter to a Monrovia facility after a hospital visit in April 2011.

No questions were raised about the care provided in Monrovia by Chiu or the arbitrator.

The  arbitrator, retired Superior Court Judge James Alfano, ruled in October 2013 that the nursing home was reckless in its care of Chiu, leading to the severe ulcer that contributed to her death. Her immune system was weakened by antibiotics for treatment of the pressure sore, he wrote. Among other things, he found that the older woman had not been turned properly, nor had she received proper wound care .

“The documentation presented in this case reflects a complete failure of the nursing staff to comply with their own guidelines,” he wrote. Chiu said that she was glad the nursing home had to take responsibility for its actions. But she wishes the public health department would, as well.

“At the end of the day, you have a duty to do your job,” she said. “DPH was not doing their job.”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Question: “I want to revise my Will… but it was prepared by another attorney”

Last Will & TestamentMany of my clients come to me by referral from other clients and other lawyers. And, many have had another lawyer prepare their Will years ago. It is not necessary for you to contact that lawyer or law firm if you want to make a revision. Changes in marital status, relationships, tax laws, assets, relocation or simply having different feelings are all valid reasons for you to review your Will and make a change if you desire. Once done you’ll feel better knowing your wishes will be met. Our documents are drafted using effective, but simple non-legalease “mumbo jumbo”, so that you can understand what you are signing.

Additionally, if you are the executor named in a Will of a friend or loved one, which was prepared by another Law Firm, you do not have to use that Law Firm to assist you with the estate proceedings when that friend or loved one dies. Often that firm, or the attorney, will be a stranger to you, may be in another state, may not have a helpful personality, may be non-responsive, or just may no longer be a practicing law.

Feel free to give me a call or email me in either situation. As your attorney I can be helpful in consolidating and simplifying the legal process for you.

Brian A. Raphan

braphan@RaphanLaw.com
http://www.RaphanLaw.com

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