Articles Posted in Certification and Licensure

bookingpicretamays-150x150She was a 46-year-old Army veteran hired by the Louis A. Johnson Medical Center in 2015 with no certification or license to care for patients. Reta Mays worked in the middle of the night, tending to elderly, onetime service personnel, sitting bedside and monitoring their vitals, including their blood sugar levels. Mays went room to room, largely unnoticed for three years on Ward 3A.

But as unexplained deaths mounted on the surgical unit between 2017 and 2018, the bespectacled mother of three — who had served in the Army National Guard and had deployed to Iraq and Kuwait — shifted from being a nurse’s aide to becoming a murder suspect.

She now has confirmed in court that she injected multiple doses of insulin in at least seven patients in the rural Veterans Affairs hospital a few hours away from the nation’s capital, causing the frail victims’ blood glucose levels to plunge in fatal fashion.

cmschiefSeemaVerma-150x150With the calendar pages flying off to the fall presidential elections, why isn’t today an excellent time for President Trump to thank Seema Verma for her service and send her packing as head of the Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services?

Two news organizations — Vox and Politico — have posted detailed and disturbing takedowns of CMS and its oversight failures that have helped to worsen the terrible Covid-19 toll in the nation’s nursing homes and other long-term care facilities.

CMS, for example, halted nursing home inspections as the pandemic broke out — with disastrous consequences, as the Washington Post explains in a separate report. The agency earlier had also acceded to industry bleating about tough regulation, with Verma and her agency relaxing fines on owners and operators for detected problems and easing training requirements for under paid, over worked, and already ill-trained caregivers. The training standards have gotten so lax that a reporter, in 40 minutes of online effort, became certified temporarily to be a 24/7 caregiving aide.

covidSEvetcenter-300x200To paraphrase the late, great writer and activist Maya Angelou, nursing homes and other long-term care facilities are showing the public in the middle of this pandemic just truly what they are.

It is hard to believe, still, the shabby way they are treating the aged, sick, and injured. Just consider this sampling of recent news reports:

“Care” facilities — including centers dealing with veterans — have been too willing to subject residents to risky medical experimentation to fight the novel coronavirus, including what appear to be  inappropriate treatments with a much-promoted anti-malarial drug. This echoes a situation involving nursing home residents in Galveston, Texas,  and their facility’s dosing them with hydroxychlorquine without their loved ones’ knowledge and iffy circumstances about their individual capacity to consent to receiving the drug. As the Washington Post reported of a Philadelphia area veterans’ facility (shown in federal photo above):

covidpleasantview-home-300x111Owners and operators of nursing homes and other long-term care facilities have mounted a “nimfy” (Not My Fault) defense for the tens of thousands of deaths and infections of their residents during the Covid-19 pandemic. They claim they did the best they could under tough circumstances. And now they want not only special legal protections from those who suffered harms but also taxpayer bailouts.

But the industry’s disingenuous bleating has a big problem: It gets undercut by the second by infuriating actions — including by profit-mongering facilities “dumping” thousands of aged, sick, and injured residents on the streets or into flophouses, and by homes that still fail — despite warnings and penalties — to take basic steps to safeguard the vulnerable.

The New York Times — conducting the kind of sleuthing that real federal watchdogs could be taking on — reached out to “more than 80 state-funded nursing-home ombudsmen in 46 states” to detail “involuntary discharges.” As the newspaper explained of these inappropriate evictions by care giving centers, which may number more than 6,400 nationally:

capnurse-300x169What’s in a name? The Covid-19 pandemic should force a major change in the big misnomer of long-term care institutions: Let’s stop labeling them with the term nursing — as if they provide significant medical services to the elderly, sick, and injured.

Instead, the coronavirus may lead the public to bust the myth put forward by owners and operators of nursing homes, skilled nursing facilities, assisted living centers, and other similar centers about how they treat some of the nation’s most vulnerable people, especially based on growing evidence amassing in news reports.

The care facilities knew they were not hospitals, with extensive equipment and highly trained doctors and nurses. The facilities found they often were sorely lacking gear — especially personal protective equipment. They too many times did not have the staff with the skills or training to treat already fragile residents infected with the novel coronavirus or recuperating from significant bouts with a debilitating illness. They did not have the Covid-19 tests they needed. They struggled to isolate the infected.

cmsnursinghomecases-300x146Federal regulators have issued, at long last, the data they have collected on the novel coronavirus’ effect on nursing homes, giving an incomplete but still  devastating look at how in just a few months some of the nation’s most vulnerable people have been savaged by Covid-19.

With 12% of the nation’s nursing 15,000 homes yet to report, the Centers for Medicare and Medicaid Services (CMS) has tallied “25,923 resident deaths tied to Covid-19 … and 449 deaths among the facilities’ staff. The [U.S.] survey also found about 95,000 infection cases at nursing homes across 49 states, about a third of them among staff members,” the Wall Street Journal reported.

The newspaper finds that figure far too low, noting:

chartGAOnursinghomeinfection-300x300Is the coronavirus’s staggering toll on patients in nursing homes something to be written off as a force of nature for which humans bear little fault? Or are there lessons to be learned about shortcomings that could help preserve lives the next time?

News media reports keep unearthing institutional misery and a blindness to the suffering of the aged, chronically ill, and seriously injured. Bad luck, shrug facility owners and operators, seemingly joined in by regulators and some politicians. Couldn’t be helped. Did the best we could.

In fact, investigations — by journalists and watchdogs — have shown the toll taken by nursing homes’ sloppy disregard for infection control, press for profits, and unacceptable paralysis as situations headed south.

covidmdnatguard-300x174Federal and state officials almost seem as if they are competing with each other to race to new lows in their wrong-headed failure to protect elderly, sick, and injured Americans who require institutional care and whose health and lives are being savaged by the novel coronavirus.

An estimated 1.5 million Americans live in long-term institutions, including nursing homes, assisted living centers, skilled nursing facilities, memory care hospitals and the like. Covid-19 has taken a terrible toll on these frail, chronically ill, or seriously injured and debilitated people with more than 27,000 residents and staff dying from the novel coronavirus — roughly a third of all the disease fatalities nationwide. A third of the coronavirus deaths in the District of Columbia have been in skilled nursing facilities, while 40% of the Covid-19 deaths in California, the nation’s largest state, have been in nursing homes.

In the latest baffling response, President Trump and Vice President Mike Pence both suddenly have  “recommended” that states get nursing homes and other similar facilities to step up the testing of residents and staff.  They did not make this common-sense step mandatory, nor did they offer any word on how the federal government could help achieve this. As the Associated Press reported:

ihs-300x197Although doctors, hospitals, and insurers may howl about the professional harms they claim to suffer due to medical malpractice lawsuits, research studies show that it’s just a tiny slice of MDs who  lose in court and must pay up for injuring patients. Further, the data show that the problem few doctors don’t rack up one, but two or three malpractice losses before they even start to see their work curtailed.

Common sense would suggest that if judges and juries find doctors’ conduct egregious enough to slap “frequent flyers” with multiple losing malpractice verdicts, these MDs might best be parted of the privilege of treating patients. Not only doesn’t that occur often enough, a Wall Street Journal investigation has shown the terrible consequences that can result for patients and taxpayers alike when it doesn’t.

The federal government, the newspaper reported, long has struggled to provide promised care through the Indian Health Service (IHS) to those who live on rugged, spare, and sprawling reservation lands. This obligation to provide such medical services is embedded in the Constitution and old treaties. But if it’s tough to get doctors to practice in rural America — where the hours may be extra long and the pay decidedly lower than cities — it had become a nightmare for the IHS to fill its many vacancies.

ambcenterleapfrograting-300x109They may be more appealing and convenient because they’re located in the neighborhood with better hours and more parking. They also may be less costly because they lack the high overheard of big hospitals. But those booming same-day surgery centers have patient safety issues of their own.

Their doctors and nurses may not be as well-trained as patients might find at big hospitals or academic medical centers, with 1 in 3 centers not having staff who were all board-certified, according to the Leapfrog Group, a consortium of big companies and other major health care users focused on patient concerns.

Leapfrog has issued — to its considerable credit — its first safety and quality study of the facilities, also finding that, “not all ambulatory surgery centers and hospital outpatient departments provide surgery consent materials before the day of surgery. Just 14% of ambulatory surgery centers provided the information one to three days before the surgery, while just 20.7% of hospital outpatient departments do so,” Modern Healthcare, an industry news source, reported.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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