Sunday, May 20, 2007

Home nursing: Rethinking elderly care

New Hampshire's county nursing homes exist for what purpose? If you listen to some county commissioners and nursing home administrators, you'd think they exist for the purpose of existing.

Last week Health and Human Services Commissioner John Stephen received approval from the Joint Legislative Fiscal Committee to transfer $3 million from nursing home care to home-based care, and the nursing home administrators were not happy. They wanted that money. They also want the state to significantly increase what it pays homes for Medicaid patients. The administrators say the state refuses to pay the full 25 percent of Medicaid costs it has agreed to pay, and that amounts to an unfunded mandate that increases local property taxes.

The dispute over Medicaid payments is too complex to address in full here. It probably will have to be settled in court. Not complicated, however, is Stephen's plan to save the state money by keeping elderly Medicaid recipients at home. It's already saved money, and the more people it keeps out of nursing homes, the more it will save.

That upsets nursing home administrators and some county commissioners who see their clout shrinking with every patient lost to home-based care.

Though county nursing homes do serve a purpose, Stephen is right to rethink their usefulness. The goal should be to get Medicaid recipients the best care at the best price. That usually means bringing care to their homes, not the other way around. And that means shrinking the role of county nursing homes. The day of the big, full county nursing home is over. Everyone will be better served when nursing homes house only those who absolutely need to be there and everyone else is cared for in the comfort of their own home.

Monday, May 14, 2007

Four named to Who's Who in Nursing Homes

Four local residents will be honored this week with inclusion into the Who's Who in Nursing Homes.

James Caperton, Lillian Kitchens, Arthur Dacosta Correia and Mattie Stewart will be recognized for the achievements during their lifetime.

The four will be presented certificates acknowledging their achievement during National Nursing Home Week, May 13-19. The Who's Who was developed by the Tennessee Health Care Association (THCA) to recognize citizens of their hometown in their golden years of life.

"Nursing home patients are treasures to their communities," said THCA Executive Director Ron Taylor. "These men and women demonstrate strength, bravery and wisdom and this program provides opportunities to recognize these accomplishments and how they've enriched the lives of their families and their communities."

Caperton has a long history of serving others having started working for his father's drugstore when he was only 12 years old. He grew from soda jerk to pharmacist, graduating from the University of Tennessee School of Pharmacy in 1939.

He returned to the pharmacy and served Bedford County until the store closed in 1995. Caperton was active in Rotary International with 58 years of perfect attendance.

A native of Bermuda, Dacosta Correia broadcast Christian programs over Bermudian radio and operated a Christian bookstore before moving to the United States in 1980. He is considered by other residents to be "up-lifting" in his daily walk, a source of strength he drew from his challenges when he was young.

As a child, Dacosta Correia contracted an illness that required treatment from the US Naval base. He was 11 before learning to walk again.

Stewart, a graduate of Tennessee State University with a master's degree in education, opened a boarding house after retiring from teaching. Her teaching days, in first through 8th grade, were in the rural community setting.

Stewart has been active in the Retired Teachers Association, garden clubs, the Baptist Association and as a volunteer in tutoring programs.

Kitchens has had a life of great color. She literally ran away with the circus as a youngster and traveled all over the country and Canada training horses and monkeys. In addition, she drove trucks and made costumes for the performers.

Her desire to become a nurse drove her to join the armed forces. Her education was instrumental in caring for her mother before her death. She used her many talents to tutor children and adults through her church's school.

Though each of these individuals reside in nursing care facilities, they have not stopped being a source of history and information about the Bedford County community. Caperton and Kitchens live at Glen Oaks Convalescent Center. Stewart and Dacosta Correia reside at Bedford County Nursing Home.

The Who's Who awards will recognize their achievements. Over 1,200 individuals have been awarded this title since the program was developed in 1983.

Tuesday, May 8, 2007

Georgia airplane crash begins nursing home’s trip into bankruptcy

Jimmy Mitchell knew what he wanted when he had to find a nursing home for his 88-year-old mother.

“Honesty, integrity with the patient’s concerns in heart and not just for financial gain,” the St. Matthews resident said.

He said he is satisfied with the care she has received at Orangeburg Nursing Home, and the S.C. Department of Health and Environmental Control reports no major quality-of-care problems at the home.

But Mitchell said he was surprised when told that the home had filed for Chapter 11 bankruptcy protection. He and at least three other residents’ families had not heard of the bankruptcy at least three weeks after its March 6 filing.

The 88-bed home’s financial difficulties appear to have started when its owners died in a plane crash in August 2000. During the following six years, court records and interviews show a tumultuous financial history including:

Multiple lawsuits in federal courts and courts in two states, with millions of dollars at stake. Cases have been argued in a Georgia probate court, two bankruptcy courts, Orangeburg County court, the Georgia Supreme Court and a federal appeals court.

Claims that the man who controlled the estate of the company’s late owner misspent hundreds of thousands of dollars.

Orangeburg Nursing Home Inc.’s Chapter 11 bankruptcy filing has drawn the attention of state and federal officials, who want to make sure that patients receive proper treatment and that the area has nursing home beds available for low-income Medicaid patients.

“Our level of concern is high to see that we make sure the level of care doesn’t change,” said Dale Watson, long-term care ombudsman of the Lt. Governor’s Office on Aging.

Aging spokesman David Lucas said it’s also important the Orangeburg area have enough nursing home beds available for low-income Medicaid patients.

“There’s sort of a generalized shortage of beds statewide,” he said.

A federal bankruptcy judge this month appointed Watson to oversee medical conditions at the nursing home. She must file reports with the court every 60 days.


On the morning of Aug. 8, 2000, the tarmac at Augusta’s Daniel Field was filled with smoke and torn metal from the plane crash that killed Thelma Allgood; her husband, former Georgia Senate Majority Leader Thomas Allgood, and the pilot.

The crash set off a series of battles over the couple’s holdings that included Orangeburg Nursing Home, a nursing home management company and five nursing homes in Georgia.

By December 2001, after a dispute among survivors, a judge in Richmond County, Ga., placed Clyde Ray in charge of the estate of his late sister.

After nearly three years in charge of the Allgood estate, an October 2004 decision by the probate court in Richmond County, Ga., removed Ray as the administrator. The court found that Ray had:

Transferred Orangeburg Nursing Home to his ownership.

Paid himself $42,000 over two months from the estate.

Loaned $375,000 from the estate to Orangeburg Nursing Home.

Paid himself and his sister more than $360,000 from the sale of a portion of the estate’s property.

The probate court ordered Ray to repay the money with interest, a decision upheld by the Georgia Supreme Court. Richmond County Probate Court records show that Ray has met his obligations.

In an interview, Ray said his time as administrator was “a nightmare,” and he was not aware that his actions were wrong. He refused further comment.

Battles with lenders

While Ray was running the estate, its Georgia nursing homes and its nursing home management company, Allgood Health Care Inc., landed in bankruptcy. Court records show that the companies’ largest creditor, National Health Investors Inc., decided in December 2002 to collect more than $20 million in loans. By January 2003, the Allgood companies filed for Chapter 11 bankruptcy protection, in which debtors seek to reorganize their debts and stay in business. But by February 2006, the case had been converted to Chapter 7 bankruptcy, which liquidates the business.

Following the deaths of the Allgoods, National Health Investors took another look at the loans it had made between 1992 and 1998.

“NHI thought all this money would be in the estates, and they tried to force it into bankruptcy,” said Allgood Health Care’s former accountant, George Clark.

According to Clark and the debtors’ bankruptcy attorneys, James McCallar and James Wilson, the estate was making its payments to National Health and its other creditors when National Health demanded full repayment. Each reflected a degree of uncertainty as to why National Health decided to push Allgood into bankruptcy by claiming a default on its loan.

“It was like it was something personal going on,” Clark said.

However, McCallar said that the end of the three-year bankruptcy reflected the intentions of National Health.

“They just wanted possession of the nursing homes; it’s what they wanted from the beginning,” he said. “Obviously, look at the end result. Their (NHI) desire was to take control of the nursing homes, and ultimately they did.”

National Health, a publicly traded company based in Tennessee, would not comment.

Wilson repeated Clark’s assertions and said the move by National Health was unexpected.

“There were a lot of personality differences between the Allgoods and the lender,” Wilson said. “A lot of the personality differences were directed at Clyde Ray.”

National Health and the Allgood companies disagreed over issues involving collateral for the loans. Initially, McCallar said National Health claimed a default on its $22.75 million in loans because of a $100,000 credit that it could not account for. National Health used the dispute to start foreclosure proceedings against Allgood’s Georgia assets, which led to the bankruptcy filing.

The $100,000 was “extremely insignificant” compared to the size of the loan, McCallar said. “Defending the companies, it’s a diverting and expensive proposition.”

Wilson said that during the 3-1/2-year bankruptcy, National Health was unwilling to negotiate with Allgood over its plans to reorganize and repay its creditors. National Health “never made an offer,” Wilson said, and court records show that National Health opposed several of Allgood’s reorganization plans.

“So it was thought best to convert it to Chapter 7,” McCallar said.

By August 2006, National Health, the estate and the Ray family settled their claims and parceled what was left of Thelma Allgood’s once-prominent nursing home group. Court records show that the settlement included:

Transfer of Orangeburg Nursing Home to National Health.

Payment of $411,926 to the estate by Clyde Ray.

Payment of 96 percent of the estate’s remaining cash to National Health.

A quick sale

Four days after National Health received ownership of Orangeburg Nursing Home, the company sold it to a single investor, Calvin Alexander II, of Escondido , Calif. Efforts to find documents showing the sale price were unsuccessful.

More legal issues started a short time later, when mortgage company Capmark Finance Inc. claimed that the nursing home defaulted on a $3.6 million loan.

According to foreclosure documents filed by Capmark in December 2006 in Orangeburg County, the company claimed that Orangeburg Nursing Home, which grossed $4 million last year, had not made mortgage payments since June.

Capmark also claimed in court records that it paid $42,000 in city and county taxes last November to keep the home from government seizure.

Capmark said in October it told Orangeburg Nursing Home that it was in default.

Capmark filed foreclosure proceedings in January, and Orangeburg Nursing Home filed for Chapter 11 bankruptcy on March 6, court records show.

Efforts to reach Alexander were unsuccessful. A call to the phone number he filed with the Department of Health and Environmental Control was answered by an individual claiming to represent Alexander. The man would not identify himself.

“I can summarize Mr. Alexander’s position in two words: ’No comment,’” he said before hanging up.

The chief administrator of Orangeburg Nursing Home and its lawyers have refused to comment on its bankruptcy.

’A mess’

Despite more than six years of lawsuits, Jimmy Mitchell is only concerned with the outcome of one company. He said he hopes that Orangeburg Nursing Home will make necessary changes and continue what he said has been the quality service his mother has received there.

However, he said the government is “failing people” in its lack of regulations on the nursing home industry.

Mitchell was not the only one surprised by the bankruptcy. So were state regulators.

“Expected? Not for us. I know the local ombudsman was certainly surprised also,” said Watson, ombudsman of the state’s Office on Aging. “From what I understand, the care has been good there.”

Watson said she was aware of “the big mess down in Georgia.”

“People could possibly have seen it” headed toward Orangeburg, she said. “But a lot of times you see something coming, but you hope it will right side before it makes its way.”

She said no agency regularly inspects the finances of a nursing home, so the only warning about a home’s financial difficulties would come through complaints by residents, family or staff.

“It’s pretty much like a business,” she said. “As long as they’re meeting payroll and things of that nature, and no one alerts DHEC to the fact that something is wrong, then they’re going to assume as long as patients are being fed, as long as they’re meeting payroll, that everything is OK.”

State records show no major quality-of-care issues involving Orangeburg Nursing Home, and federal Medicare and Medicaid laws require weekly inspections of medical facilities operating under bankruptcy protection.

“We’ve seen facilities in the past stumble through some difficulties, then they move forward and become strong facilities again,” Watson said. “I’m not sure if one instance is going to make people say, ‘You’re weak and something’s wrong.’ All businesses have an ebb and a flow kind of thing.”

From The Carolina Reporter, a publication by senior-semester students at The University of South Carolina’s School of Journalism and Mass Communications. This story was edited by John Murray.

Wednesday, April 25, 2007

Nurse charged in death of Wellington woman

WEST PALM BEACH — A 47-year-old registered nurse who lives in Loxahatchee has been charged with culpable negligence in the 2005 death of a 74-year-old Wellington woman.

News that Lorri Ann Depasqua faces a misdemeanor charge in the death of Camilla Combs came Tuesday as the Combs' two daughters gathered at their lawyer's office to announce they had filed a civil lawsuit against the nurse and the home health agencies that employed her.

Julie McPherson, who represents her late mother's estate, said she and her siblings filed the lawsuit to raise awareness about the power of blood-thinning medication.

"It's important for people to understand with these drugs there needs to be monitoring," said McPherson, who lives in Wellington. "If you're not monitored properly, you could die."

That's exactly what happened to her mother, according to the lawsuit and the investigation that led to a criminal charge against Depasqua this month.

According to the investigation by the Florida Attorney General's Office, Depasqua repeatedly gave Combs injections of the blood-thinner Lovenox but did not draw blood to be tested to make sure the amount in her system was within acceptable limits. Combs also was taking Coumadin, another blood thinner, as part of treatment for heart problems.

According to doctors orders, which were given to Depasqua, Combs' blood was to be tested daily, according to the investigative report.

When Combs was admitted to the hospital on Aug. 14, 2005, the amount of anti-coagulant in her system was roughly four times normal levels. She died four days later of massive internal bleeding.

Craig Goldenfarb, who is representing Combs' adult children in the civil lawsuit, has to prove that the conduct of Depasqua, licensed practical nurse Erica Reynolds and the home health agencies, High Tech Home Health, Private Care Inc. and Option Care was "outrageous."

Such a finding must be made for the children to pursue a medical malpractice suit.

In Florida, only spouses or children under the age of 25 are allowed to file wrongful death cases involving medical malpractice. The only exception is if the conduct that led to a death was particularly egregious.

McPherson, her sister, Patricia Jennings, and brother, Daniel Jennings, believe the circumstances surrounding their mother's death meets the test, Goldenfarb said.

Their mother went into the hospital for surgery after she broke her knee. After coming through the surgery unscathed, they say she died because she didn't get a simple blood test.

"She was healthy. She was vital," McPherson said. "She had slipped and fell and broken her knee. It wasn't supposed to end up in death."

Nurse talks continue

Talks between the unions and the Health Service Executive are continuing today.

They are being supervised by the National Implementation Body (NIB).

General secretary of the Irish Nurses Organisation (INO), Liam Doran, said yesterday that proposed nurse stopworks will be reviewed every day, depending on the progress of the talks.

The NIB, which oversees the social partnership between workers and employers, stepped in to call the warring sides back to negotiations.

A series of one-hour stopworks had already taken place across the country, in support of 40,000 nurses' pay and conditions claims.

The Psychiatric Nurses Association (PNA) is also involved in the talks, and the national work-to-rule which is stopping nurses from using computers or answering phones.

The nurses want a 10.6% pay increase and a working week shortened by four hours.

It is understood that the HSE has proposed an initial reduction of one hour a week, with certain conditions.

Nurse found guilty of hacking up hubby

SHE wanted her husband dead so that she could be with her boss and lover.

So Melanie McGuire (right), a 34-year-old nurse, killed her husband MrWilliam McGuire, hacked up his body and dumped the parts into Chesapeake Bay using three matching suitcases.

Yesterday, she was convicted of murder, desecration of a corpse, perjury and a weapons offence and faces 30 years in jail.

During the six-week trial, prosecutors said McGuire, 34, organised the 2004 murder using her expertise as a nurse.

They said that Internet searches on topics such as 'undetectable poisons' and 'ways to kill people' were made in the couple's home.

Assistant attorney general Patricia Prezioso told jurors McGuire forged a prescription for a powerful sedative, chloral hydrate, using the name of a patient from her clinic on 28Apr 2004, the day her husband disappeared.

Two days before her husband was last seen alive, McGuire bought a gun and bullets that matched those in her husband's body.

The verdict from the jury of nine women and three men came after about 13 hours of deliberations over four days.

McGuire's attorney, Mr Joseph Tacopina, had argued that the petite nurse was physically incapable of killing her 190cm-tall, 95kg husband and it would have been impossible to do so without neighbours hearing something or leaving behind some physical evidence.

The prosecutor acknowledged that there were some unanswered questions, but said there was still 'overwhelming' evidence to convict the mother of two.

The defence portrayed Mr McGuire as a man with gambling debts who might have been killed by a creditor.

The guilty nurse, who sobbed as she heard the verdict, was acquitted on two counts of hindering prosecution and falsifying evidence.

The defence said that they will be appealing the decision.

Nurse is discriminated against on grounds of race in St James's job

The largest hospital in the country, St James’s, discriminated against an employee on the grounds of race, the Equality Tribunal has found.
The equality officer awarded the complainant €20,000 compensation for the discrimination and €5,000 for loss of earnings because she was not appointed to the position, which would have been a promotion.

The case against was brought by a Ms Mey. The Tribunal’s case report, which was issued recently, explained the complainant “is from South Africa and is non-white”.

The equality officer decision found: “St James’s Hospital did discriminate against Ms Mey on the grounds of race within the meaning of Sections 6(1) and 6(2) (h) of the Employment Equality Acts, 1998-2004, and contrary to the provisions of Section 8 of that Act when they did not appoint her to the position of Rheumatology Clinical Nurse Manager II even though she was better qualified and had more experience than the successful candidate”.

Ms Mey began work with the hospital in February 2001 and applied for the new post after it was advertised in September 2004. The hospital denied the allegations from Ms Mey, who was represented by the Irish Nurses Organisation (INO).

In its conclusion, the Tribunal explained: “The Equality Officer found that the respondent had failed to implement fair, open and transparent procedures in the interview process for the position of Rheumatology Clinical Nurse Manager II position. The Equality Officer noted that the respondent had found that the complainant was both better qualified and had more experience than the successful candidate. The Equality Officer held that in these circumstances the respondent has failed to adequately discharge the burden of proof.”