These results come from an annual survey done by the CMMS. Last year, Tennessee nursing homes ranked third worst in the country. That Tennessee inched up the list is not necessarily a sign of improved conditions in the State’s nursing homes and certainly we should not be proud that our nursing homes rank as the 45th best as opposed to the 47th best out of 50 states.

According to the Tennessean, the staffing levels are once again the most detrimental factor in pushing the ratings down in Tennessee’s nursing homes. One factor that plays into the low staffing levels in Tennessee is that state law requires facilities to have less staff than are recommended by Medicare. Medicare sets guidelines on staffing levels that it feels are necessary to properly care for the residents of each particular facility. In Tennessee, the State has largely ignored these staffing recommendations and requires even less staffing than Medicare feels is necessary to properly function and care for patients. According to the survey results, nursing homes in Tennessee have followed suit and mostly staff at levels that Medicare finds insufficient to meet the needs of patients.

Not having a sufficiently number of trained and dedicated employees makes it almost impossible for a nursing home to provide the kind of quality care that the residents deserve. If the home is understaffed and the staff that is available has to work beyond what should be expected of a normal employee, that can lead to the errors in medication and treatment that lower the overall scores for the facilities.

Moldy-smelling, musty bottles of Tylenol Arthritis Relief caplets were first reported 20 months ago, and since people have complained of digestive problems, including nausea, vomiting and stomach pain. Apparently FDA officials knew about the odor in 2008, having received over 100 complaints by August 2009, but only took critical action recently.

Kickbacks were the cause of a False Claims lawsuit against nursing home pharmaceutical provider Omnicare for which J&J was implicated. The $98 million settlement was based on allegations that the nursing home pharmacists were unnecessarily, and dangerously, prescribing nursing home residents with dementia the antipsychotic drug Risperdal. Unfortunate for the nursing home resident, Risperdal isn't approved to treat agitated patients with dementia, but, according to the Justice Department (DOJ), this kickback scheme worked extremely well for J&J, tripling Omnicare’s sales of J&J drugs, from $100 million to $280 million with Risperdal making up $100 million of the latter sales figure.

Tavaria Merritt, formerly the youth minister at Lebanon’s True Vine Church, allegedly used the families’ trust to allow the children to occasionally spend the night at his home under the guise of his position as youth minister.

Apart from the obvious criminal elements of this case and the prosecution of Mr. Merritt on the child rape charges, there are also civil lawsuit ramifications that will likely be involved. Similar to the cases brought against the Catholic church for abuses by priests and other staff, the question can turn to what the church knew or should have known about it’s employee and his wrongful actions.

These types of cases are very difficult to pursue and involve a subject matter that is ultimately very private. Other sexual assault victims have not stepped forward with allegations at this time and it may be limited to the victims referenced in the indictment.

The operation of heavy equipment near power lines has been the subject of recent product’s liability litigation focusing on the ways and manners in which the manufacturer of heavy equipment can design and manufacture their equipment to eliminate, or at least lessen, the risk of this type of tragic accident. The litigation is separate and apart from any claim that the deceased is entitled to under the Tennessee Workers’ Compensation Act for injuries sustained on the job.

Some of the issues that arise regarding the operation of tall, heavy industrial equipment near power lines look to the probabilities that the equipment could contact power lines and the things a manufacturer can or should do to avoid this. There have been many instances where heavy equipment has come into contact with power lines resulting in death and/or serious injury. It can be argued that the risk of death from this type of event is so great that the manufacturer has a duty to do what it can to prevent its equipment from being operable near power lines.

Unfortunately, many manufacturers turn a blind eye to the problem and do not develop or incorporate available solutions into their equipment. One potential solution is the incorporation of signal alarms that sound an alarm when the equipment gets within a certain distance of live power lines. Another solution is the inclusion of a shut-off device that is activated when the equipment gets within a specified distance of live power lines. A final solution would be to incorporate into the equipment an operator’s platform that is insulated against electrical current from the mast or other part of the equipment that potential may contact power lines or to develop an operation system that allows the operator to work the equipment by remote control.

Lamb, the second nurse's aide at Madison Manor to plead guilty, was sentenced to 12 months in the Madison County Jail, a sentence which may be postponed or commuted if the defendant cooperates in pending cases against other former employees at the Kentucky nursing home.

In other nursing home abuse and neglect news, ABC World News ran a report last week titled Nursing Home Patients Killed by 'Chemical Restraints' to bring attention to chemical restraint use in nursing homes. California Attorney General Jerry Brown (previously making an appearance in the Tennessee Employment Law Blog) is pursing charges of elder abuse against three nursing home officials who could face up to 11 years in prison.

The act of restricting or suspending admissions to a nursing home is only exercised by the State, through the health department, in drastic cases. The department has the several options available when faced with a noncompliant nursing facility, ranging from citations, fines, orders for re-inspection, and ultimately, closure of the facility. In the instant case, the department suspended admissions and imposed a $1,500.00 fine on the facility. The state has requested a fine of $4,550.00 per day against the facility for the duration that the violations continue.

From a practical standpoint, the facility will continue to operate while they attempt to resolve the violations found by the Tennessee Department of Health; they will simply not be allowed new admissions. This remedy does not provide recompense for people that are already residents of the facility who may be receiving or may have received inadequate care during their stay. This point is important as the violations giving rise to the closure involve the care of the people already in their facility. The department of health will suspend admissions only when violations are found that are or can lead to conditions that are detrimental to the health, safety and welfare of the residents.

Danzy died in 2003 of an infection the nursing home neglect lawsuit claims was caused by nursing home bedsores. In his short nine months' stay, Danzy, according to the lawsuit, developed more than 20 nursing home bedsores on his body when the family removed him from the environment of neglect and into a better home.

The employees will receive some help through unemployment benefits. Also, if any of the employees have had a prior workers compensation claim they may be able to reopen the claim and get more money. Specifically, in Tennessee if you have a workers compensation claim the amount of money you receive is often capped if you return to your same employer. However, if you later loose the job through no fault of your own the case can ofter be reopened to get money above the cap. This is known as reconsideration.

In recent news, Centers for Medicare and Medicaid Services surveyed the Virginia NHC nursing home's employees after a sexual abuse complaint was filed against a staffer, a survey that the Scene reporters procured and whose results were shocking. Instead of the sexual abuse allegations leading to swift education to address the persistent problem, the survey found that 21 of the 35 nursing home employees interviewed were oblivious to their legal requirement to report suspicions of abuse to state agencies.

A Smithsonian spokeswoman has said that the settlement is not an admission of guilt, an odd statement given that Mr. Pullman has worked the majority of his life at the National Air and Space Museum and that inhaling asbestos, speaking realistically, the only cause of asbestosis.

Initially, Mr. Pullman was denied a worker's compensation coverage claim for asbestosis, though he would win on appeal. He is now allowed worker's compensation for treatment of asbestosis-related injury and benefits if he becomes disabled or dies from the disease.

A year-long study concluded last August by the U.S. Government Accountability Office (GAO) listed Richmond Health and Rehabilitation Complex — a.k.a. Madison Manor — among the worst nursing homes in the nation.

Madison Manor nursing home was not alone.

Each year, over 100 nursing home residents die in Minnesota after suffering a fall in the nursing home. According to the Star Tribune’s investigation of death certificates of MN nursing home residents from 2002-2008, the state averages a nursing home resident death every two days from nursing home falls, for a total of over 1,000 nursing home deaths in Minnesota alone in this period.

Some of these nursing home deaths from falls are quick, such as when severe internal bleeding occurs or fragile bones break in a resident’s neck. More often, the fall causes long-term, deleterious injury, leaving the resident bedridden in extreme pain, if conscious. Too often, the fall sets off what the reporters call, poetically and accurately, “a deadly systemic chain reaction, hastening the end of life."

Foreign particles including bits of steel, non-latex rubber, and fiber have been identified in five Genzyme drug products used to treat rare genetic disorders. Two affected drugs - Cerezyme and Fabrazyme - have had their production reduced after the viral contamination was detected in its Allston Landing plant this June.

FDA officials suggest potential serious drug contaminant injury could include blood vessel blockages and life-threatening allergic reactions, though no such adverse events have been reported.

Injuries from the illegal burning include chronic asthma, kidney disease, and cancer. Though various toxic chemicals were burned, including lithium batteries, human corpses, paints and solvents, medical supplies, and plastic water bottles, perhaps most alarming in my view as an asbestos lawyer was the quantities of asbestos insulation thrown into the pyres and reports of lung injury. Burning plastic releases dioxins, a known carcinogen. Asbestos inhalation, of course, is a major cause of mesothelioma.

Also alarming is the report that the burn pits are still in operation at Joint Base Balad (formerly Balad Air Base), the largest base in Iraq.

These KBR-operated burn pits were frequently located near soldiers’ and contractors’ quarters and were so thick that visibility through the multi-colored smoke was reduced to only a few meters. Smoke was so bad in some instances that it interfered with our troops’ military mission, compromising base security.

The most common errors bringing the scores down included, but were certainly not limited to, medication errors, mislabeled medications, understaffing, improper use of physical restraints, and unnecessary use of catheters. Shortcomings in these areas can lead to drastic results for nursing home residents. Sadly, nursing home neglect is easly avoidable.

According to the area’s long-term care ombudsman, Sandy Smegelsky, who is an advocate for nursing home patients and their families, the lack of quality nurses is a major issue and contributing factor to the low scores in the area. The lack of a sufficiently sized, trained and dedicated nursing staff makes it almost impossible for a nursing home to provide the kind of quality care that nursing home residents deserve. Naturally, if the facility is understaffed and the staff that is available has to work beyond what should be expected, that can lead to the errors in medication and treatment that lower the overall scores for the facilities.

Abuse and neglect are the natural result of systematic problems within nursing homes. The lack of adequate staff, poorly trained and/or supervised staff, and overworked staff all contribute to an environment where care and treatment of the elderly is jeopardized.