Summary:

In this mediation statement regarding a wrongful death claim, legal representatives for the plaintiff, the son of the deceased, challenge the care standards at a healthcare and rehabilitation facility, asserting a violation of the required standards of care under federal and state regulations. The facility, part of a larger healthcare conglomerate, is accused of systemic failures including chronic understaffing and financial mismanagement, contributing to a resident’s fatal fall and subsequent lack of appropriate medical intervention. Despite known mobility issues and the high-risk status of the patient, the facility allegedly failed to implement necessary safety measures and adhere to mandated staffing levels, underscoring a pattern of negligence. The plaintiff’s legal team underscores the correlation between the facility’s operational shortcomings and the tragic outcome, highlighting a breach of the duty to provide safe, competent care, which they argue directly resulted in the wrongful death of the resident.

The case was resolved before trial for a confidential amount.

I. Overview of [Facility Name] Healthcare Network

[Facility Name] Healthcare Inc., part of the broader [Facility Name] Network, is recognized as a leading provider in the national post-acute care sector. The network encompasses a variety of care facilities, including skilled nursing and senior living services, across a wide geographical spread covering numerous states and the District of Columbia as of the year ending December 31, 2017.

Our records from [Facility Name] Healthcare Inc.’s 2017 annual report highlight their emphasis on catering to high-acuity patients, necessitating extensive skilled nursing and rehabilitation services. The conglomerate prides itself on employing a substantial number of medical professionals across its facilities to ensure high-quality care and oversight.

However, it’s important to note the financial nuances highlighted in their report. A significant dependency on maintaining a mix of high-acuity patients and managing the implications of a larger Medicaid-reliant population pose potential risks to their financial stability and operational outcomes. They underscore the importance of adapting to patient census fluctuations and associated revenue challenges to preserve service levels and financial health.

The company’s strategies and operational models are essential to understanding the context within which [Facility Name] operates, especially in relation to the standards of care expected and delivered.

II. STANDARD OF CARE APPLICABLE TO THIS CASE

The applicable standard of care required the defendants to comply with the Omnibus Budget Reconciliation Act (OBRA) of 1987 and the [Redacted State] Rules of Department of Health and Senior Services Division 30—Division of Regulation and Licensure Chapter 85—Intermediate Care and Skilled Nursing Facility.

The applicable standard of care necessitates that the nursing home complies with the Omnibus Budget Reconciliation Act (OBRA) of 1987. Specifically, § 483.20(k) mandates that the nursing home must:

• Develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet a resident’s medical, nursing, and mental and psychological needs that are identified in the comprehensive assessment. The plan should detail the services to be furnished to attain or maintain the resident’s highest practicable physical, mental, and psychosocial well-being.
• Ensure that a comprehensive care plan is prepared by an interdisciplinary team, which includes the attending physician, a registered nurse with responsibility for the resident, and it must be periodically reviewed and revised by a team of qualified persons after each assessment.

Additionally, § 483.25(h)(2) of OBRA mandates that the nursing home must ensure “[e]ach resident receives adequate supervision and assistance devices to prevent accidents.” The guidance for surveyors indicates that the intention of this provision is for the facility to identify each resident at risk for accidents and/or falls and adequately plan care and implement procedures to prevent accidents. The definition here emphasizes that an accident is an unexpected, unintended event that can result in bodily injury to a resident.

An “Avoidable Accident” is defined as an incident that occurred because the facility failed to identify environmental hazards and the individual resident risk of an accident, including the need for supervision; and/or failed to evaluate/analyze the hazards and risks; and/or failed to implement interventions, including adequate supervision, consistent with a resident’s needs, goals, plan of care, and current standards of practice, in order to reduce the risk of an accident; and/or failed to monitor the effectiveness of the interventions and modify the interventions as necessary in accordance with current standards of practice.

An “Assistive Device” refers to any item (e.g., fixtures such as handrails, grab bars, and devices/equipment such as transfer lifts, canes, and wheelchairs, etc.) that is used by or in the care of a resident to promote, supplement, or enhance the resident’s function and/or safety.

“Supervision/Adequate Supervision” is defined as an intervention and a means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is defined by the type and frequency of supervision based on the individual resident’s assessed needs and identified hazards in the resident environment. Adequate supervision may vary from resident to resident and from time to time for the same resident.

The explanatory language for F-tag 323 under this regulation calls for evaluation and analysis data to identify specific hazards and risks and to develop targeted interventions to reduce the potential for accidents. Interdisciplinary involvement is a critical component of this process. Furthermore, F-tag 323 calls for the implementation of specific interventions to try to reduce a resident’s risks from hazards in the environment. The process includes communicating the interventions to all relevant staff, assigning responsibility, providing training as needed, documenting interventions (e.g., plans of action developed by the Quality Assurance Committee or care plans for the individual resident), and ensuring that the interventions are put into action.

The explanatory language for the F-tag under this regulation calls for monitoring to evaluate the effectiveness of interventions. Modification is the process of adjusting interventions as needed to make them more effective in addressing hazards and risks. Monitoring and modification processes include:

• Ensuring that interventions are implemented correctly and consistently;
• Evaluating the effectiveness of interventions;
• Modifying or replacing interventions as needed; and
• Evaluating the effectiveness of new interventions.

The explanatory language for the F-tag under this regulation specifies that proper actions following a fall include:

• Ascertaining if there were injuries and providing treatment as necessary;
• Determining what may have caused or contributed to the fall;
• Addressing the factors for the fall; and
• Revising the resident’s plan of care and/or facility practices as needed to reduce the likelihood of another fall.

III. Care Provided to the Deceased at the Facility

In early March 2017, assessments indicated that [Deceased’s Initials], a resident at [Facility Name], faced significant challenges with mobility, particularly noting instability transitioning between seated and standing positions. Despite these identified needs, the circumstances leading to her fall on March 26, 2017, suggest lapses in the facility’s adherence to the established care and safety protocols.

The incident resulted in a severe injury, with [Deceased’s Initials] found by staff in a distressed state, having fallen beside her bed. This event underscores potential deficiencies in the environmental safety measures and the level of supervision provided, raising concerns about the facility’s compliance with their mandated care standards.

Post-incident medical evaluations revealed a significant fracture, compounded by [Deceased’s Initials]’s pre-existing health conditions, which ultimately deemed her ineligible for surgical intervention. The trajectory of her health following the fall, leading to her eventual transfer to hospice care and subsequent passing, underscores the gravity of the incident’s impact.

This section scrutinizes the adequacy of interventions implemented for fall prevention and overall resident safety at [Facility Name], highlighting the discrepancies between the care expected and that which was provided. The failure to implement necessary measures such as nonskid strips, regular monitoring, or proper assistive devices illustrates the potential neglect of standard care practices.

IV Chronic Understaffing Issues at the Facility

Analysis of staffing levels at [Facility Name], as mandated by federal and state guidelines, reveals a chronic understaffing issue. These regulations require that nursing homes maintain sufficient staff to meet the comprehensive needs of each resident, aiming to secure the highest possible quality of life. However, data from the period in question illustrates a significant shortfall in the facility’s staffing, particularly in comparison to the expected standards set by the Centers for Medicare & Medicaid Services (CMS).

The discrepancy between the actual and expected staffing levels, particularly highlighted by the Payroll-Based Journal (PBJ) data, indicates not just a failure to meet regulatory expectations but also suggests a broader issue that could compromise resident care and safety. The shortfall in staffing on the day of [Deceased’s Initials]’s fall further underscores the potential link between inadequate staffing and the adverse outcomes experienced by residents.

V. Financial Misconduct and Its Implications on Care Quality

An alarming aspect of the case against [Facility Name] Healthcare and Rehabilitation Center involves financial decisions that seemingly prioritize profit over patient care. Allegations suggest that significant funds were diverted away from necessary staffing and resources that are critical for resident safety and well-being. This misallocation of funds represents not just a failure in ethical responsibility but also a direct violation of the trust placed by residents and their families in the facility to provide a safe and caring environment.

The financial strategies and decisions made by the defendants raise serious concerns about their motives, particularly regarding whether cost-cutting measures may have compromised the standard of care provided to residents. This becomes particularly egregious when considering the potential for these decisions to have directly contributed to incidents of neglect and harm.

VI. Pattern of Understaffing and Its Consequences

The case extends beyond individual incidents to suggest a systemic issue of understaffing within [Facility Name] and possibly throughout the entire network it belongs to. Historical data and staffing records indicate a pattern of failing to meet required staffing levels, a practice that not only undermines the quality of care but also poses a significant risk to resident safety.

This chronic understaffing issue is further exacerbated by the facility’s reported financial practices, suggesting a disturbing trend of sacrificing essential care to reduce costs. The repercussions of such practices are illustrated in the deteriorating health and safety conditions faced by the residents, as exemplified by the tragic case of [Deceased’s Initials].

VII. Legal Precedents and Judicial Scrutiny

The concerns raised in this case reflect broader legal and ethical issues that have previously been addressed in other judicial contexts. Several circuit court judges in [Redacted Location] have recognized the seriousness of similar allegations, granting motions for discovery into the financial assets and practices of care facilities under scrutiny. These legal precedents underscore the courts’ recognition of potential punitive liabilities in cases where financial mismanagement and understaffing are shown to compromise resident care.

The judicial responses to these cases highlight the legal system’s stance on holding facilities accountable for actions that endanger the well-being of their residents, particularly when motivated by financial gain or neglect.

VIII. Admissibility of Staffing and Financial Information

In building the case against [Facility Name], a critical element involves the admissibility of staffing data and financial records that provide a transparent view of the facility’s operations. This information, crucial for establishing patterns of neglect and mismanagement, has been authenticated according to legal standards, ensuring its relevance and admissibility in court proceedings.

The substantiation of these records aligns with legal requirements and underscores the importance of transparent and accountable operational practices in healthcare facilities, particularly when assessing their compliance with mandated care standards.

IX. Conclusion and Settlement Proposition

In conclusion, the wrongful death claims against [Facility Name] Healthcare and Rehabilitation Center raise significant concerns about the facility’s adherence to required care standards, staff adequacy, and overall operational integrity. The case presents a compelling argument rooted in documented failings, legal precedents, and the fundamental rights of residents to receive competent and compassionate care.

A settlement demand, reflective of the serious allegations and the facility’s apparent failures, has been put forth, underscoring the plaintiff’s commitment to seeking justice for [Deceased’s Initials] and ensuring that such failings are addressed to prevent future occurrences.

The plaintiff remains open to dialogue and resolution, urging the facility to respond to the allegations and engage in constructive discussions aimed at rectifying the identified shortcomings and honoring the memory and rights of [Deceased’s Initials].

The case was resolved before trial for a confidential amount.