Author Archives: David Tate, Esq.

Using Risk Management – Citations Against Nursing Homes – Criteria for Determining the Amount of the Civil Penalty – California Health and Safety Code Sections 1424 and 1424.5

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California in part uses risk management principles to determine the amount of civil penalty to levy against a nursing home for a care violation. I would prefer, however, that in addition to the Section 1424 facts listed below, that the facts considered as criteria for determining the amount or increased amount of penalty also specifically include (1) the nursing home’s care policies, procedures and practices in place before the violation, and whether or not the nursing home was following those policies, procedures and practices, and (2) the nursing home’s timely payment of the penalty.

California Health and Safety Code Section 1424 in part provides that citations issued against nursing homes shall be classified according to the nature of the violation and shall indicate the classification on the face of the citation.

(a) In determining the amount of the civil penalty, all relevant facts shall be considered, including, but not limited to, the following:

(1) The probability and severity of the risk that the violation presents to the patient’s or resident’s mental and physical condition (i.e., traditional risk management, the likelihood of the occurrence and the possible severity of an injury that could result from the breach or continuing breach).

(2) The patient’s or resident’s medical condition.

(3) The patient’s or resident’s mental condition and his or her history of mental disability or disorder.

(4) The good faith efforts exercised by the facility to prevent the violation from occurring.

(5) The licensee’s history of compliance with regulations (this criteria should get little or no weight – tell this criteria to a severely injured or dead elder or dependent adult and his or her family – the fact that a facility has a history of compliance, or that noncompliance has not been noticed in the past really isn’t relevant to the injured or deceased elder or dependent adult and isn’t a criteria in traditional tort law, so why is it relevant at all for the purpose of citation penalties levied?).

(b) Relevant facts considered by the department in determining the amount of the civil penalty shall be documented by the department on an attachment to the citation and available in the public record.

This requirement shall not preclude the department or a facility from introducing facts not listed on the citation to support or challenge the amount of the civil penalty in any proceeding set forth in section 1428.

California Attorney General Office Information On Elder and Nursing Home Abuse

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The following information is provided by the California Attorney General Office, see, e.g., http://oag.ca.gov/bmfea/elder. The numbers all point to staggering statistics, and the following information is only for reported cases – as I have previously written, the information available indicates that cases of abuse very significantly outnumber the reported cases, perhaps by a 24 to 1 ratio.

Elder Abuse

      • The United States Census Bureau projected in 2000 that California’s elderly population will have doubled by 2025 to 6.4 million – a larger growth rate than any other state
      • The California Department of Finance projects that the number of California residents aged 65 and older–those who are most likely to need nursing homes or other long term care–will nearly double between 2010 and 2030.
      • About 110,000 Californians live in about 1,300 licensed nursing homes and about 150,000 live in about 7,500 licensed residential care facilities for the elderly. Another 150,000 or more Californians are estimated to live in unlicensed assisted living facilities that may or may not be able to care for them properly.
      • Many residents of both licensed and unlicensed facilities suffer from dementia and may be given dangerous antipsychotic drugs to sedate or restrain them improperly
      • In 2009 the California Senate Office of Oversight and Outcomes reported that 13% of all complaints to the California Office of the State Long Term Care Ombudsman involved abuse, gross neglect, or exploitation, over twice the national rate of 5%
    • The California State Department of Finance claims that the number of California residents age 85 and older – those who are most likely to need nursing homes — will nearly double by the year 2030, when the bulk of baby boomers will come of age.
    • In 2005, the Office of Statewide Health Planning and Development reported that one-fifth of California’s nursing facilities did not meet state-mandated requirements for staffing levels.
    • In 2006, Centers for Medicare and Medicaid Services reported that twice as many of California’s 115,000 plus residents are placed in physical restraints as are nationally.
    • From 2001 to 2005, the California Department of Health Care Services, found that two-thirds of all reported deficiencies caused or could have caused significant harm to one of more residents in nursing homes. More than half of all complaints in nursing homes are related to poor quality of care. Eighteen percent of substantiated complaints were related to mistreatment or abuse.

Together, these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California’s skilled nursing facilities.

Facilities Enforcement Team

The Facilities Enforcement Team investigates and prosecutes corporate entities, such as skilled nursing homes, hospitals, and residential care facilities, for adopting policies or promoting practices that lead to neglect and/or poor quality of care. Institutional neglect or substandard care includes:

  • Failure to provide medical care for physical and mental health needs
  • Failure to attend to hygiene concerns
  • Failure to provide adequate staffing
  • Failure to prevent malnutrition and dehydration
  • Falsification of patient chartsThe primary goal of the Operation Guardians program is to help protect and improve the quality of care for California’s elder and dependent adult residents residing in California’s approximately 1300 skilled nursing facilities. The Operation Guardians team identifies instances of abuse or neglect for further investigation and possible criminal or civil prosecution by the Bureau of Medi-Cal Fraud and Elder Abuse.
  • Operation Guardians
Fraud: 10/11 11/12 12/13 13/14 14/15
Criminal Filings 75 60 63 59 94
Convictions 58 46 35 32 56
Acquittals 3 1 0 0 2
Criminal Restitution $504,403 $279,228 $542,962 $180,017 $378,765
Civil Monetary Recoveries $6,145 $0 $0 $0 $0

 

San Mateo County’s New Elder and Dependent Adult Protection Team – The Good and the Insufficient

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You may have heard that the San Mateo County Board of Supervisors this month passed a resolution funding the Elder and Dependent Adult Protection Team “EDAPT” (also sometimes known as or similar to “FAST” or “Financial Abuse Specialist Team” in other counties such as Los Angeles) for two years from the County’s Measure A funding. The initiative is funded with approximately $3.13 million taxpayer dollars over two years with the funding to begin July 1, 2015 and will run through June 2017. Click here for the link. The comments in this blog are my own. As you may know, I have handled trust, estate, conservatorship and elder abuse litigation cases for over 20 years. I have become a bit more expressive or activist in my comments. These comments are not criticisms of anyone who is trying to combat elder and dependent adult abuse. But the fact is that resources are inadequate to identify and then to stop and remedy abuse. And although resources will always be inadequate, one resource, private attorneys, is entirely or almost entirely unutilized in this battle. Until entities that receive reports of abuse arrange for a procedure to refer cases to private attorneys there is absolutely no way that those agencies, including Adult Protective Services (APS), the District Attorney, the police, county counsel, etc. can come close to protecting the abused and remedying the damages that they suffer. In fact, the link above seems to indicate that the new EDAPT initiative is primarily a community educational program, which does not involve legal or court system remedies.

Let me provide you with a quick example that should help to explain the situation and the grossly inadequate resources. The Link above states “Research shows that for every one case of older adult abuse [note that this apparently does not include dependent adult abuse] that is reported – there are another 24 that go unreported.”  The link also states “Reports of older adult abuse have been on the rise as the county’s older adult population continues to grow – which is estimated to grow by over 70% by 2030.” I don’t know how many incidents of abuse Adult Protective Services receives in an average month in San Mateo County – maybe one of my readers will respond with the average monthly number. Let’s just say that in an average month APS receives 30 reports of elder or older adult abuse (again, we are not even counting the additional cases of dependent adult abuse reporting). I suspect that the reports exceed 30 per month; however, if research indicates that for every report of older abuse there are another 24 that go unreported, that would be 30 x 25, or 750 incidents of adult abuse in an average month. Do you know how much time and effort it takes to stop and then remedy just one case of elder abuse through the court system? Well . . . that number does vary from case to case, but I can tell you that based on my experience in my cases, the number of hours is huge and the time (i.e., months or even years) that it can take also can be staggering. I can also fully confirm that abusers actively fight legal actions that are brought against them. They know or believe that resources are limited and inadequate, and that they might stand a reasonable chance of beating the system.

The new initiative is for two years, at an average funding of roughly $1.5 million per year. The funding started July 1, 2015, so we already have 3 months done in the first year of the initiative. I have been looking for a detailed two-year plan for the initiative – perhaps one of my readers can tell me where I can find that plan. I have written and videoed about this topic before, and the inadequate resources. Again, I fully support the efforts of everyone who is fighting elder and dependent adult abuse, but let me say that resources are inadequate, and you really, really need to bring vetted private attorneys into the effort through referrals or by whatever means makes the report receiving agencies (i.e., APS, etc.) comfortable.

Best, Dave Tate, Esq. (and licensed inactive CPA), San Mateo County, San Francisco Bay Area, and throughout California

FBI raids California nursing home – from the Sacramento Bee

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The following is a link to a story by the Sacramento Bee about the FBI raid of a California nursing home over issues of alleged abuse. Click on the following link for the article, CLICK HERE.

The article provides relatively little detail; however, I did find the discussion about abuse reporting, or the lack thereof, interesting. I provided a talk about mandated reporters earlier this year for the Professional Fiduciary Association of California. Mandated elder abuse reporting is important, but you certainly do not see many discussions about it in the news. You can find the statutory reporting provisions at California Welfare & Institutions Code sections 15630-15632, pertaining to both physical and financial abuse, and for care provider and financial institution reporters.

Dave Tate, Esq., San Francisco and throughout California.

Ombudsman Services – San Mateo County – Annual Report 2014-2015 – 4,497 Care Facility Visits – 1,624 Investigations – And More Good Work

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Ombudsman Services SMC Visits Investigations FY 2014-2015

Below is a link to the San Mateo County, California, Ombudsman Services annual report for 2014-2015. The report shows amazingly substantial services for the year, including for example, 4,497 facility visits, and 1,624 investigations. As you might know, Ombudsman Services of San Mateo County, Inc. is committed to working with residents, families, facilities and stakeholders to create a community dedicated to protecting the rights of all residents living in long term care in San Mateo County. They challenge long-term care facilities to deliver the highest standards of individualized care for their residents, and advocate for the health, safety, and dignity of these residents and broader changes in the system.

The following is a link to the annual report – please take a look at this worthwhile organization that does good work on behalf of and protecting the rights of residents living in long term care facilities in San Mateo County, CLICK HERE

And please do pass this information and blog post to other people who would be interested in these very important services. Thank you.

Dave Tate, Esq., San Francisco and throughout California, civil, trust, estate, conservatorship and elder abuse litigation, and contentious administrations. My two blogs: http://californiaestatetrust.com and http://directorofficernews.com

Elder Abuse In Australia On The Rise – Government Makes A $100 Million Pledge

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Click on the following link for an article out of Australia, elder abuse is domestic violence and is on the rise – the government makes a $100 million pledge: Click Here For The Article

AU Elder Abuse Article

Blog Stats. Chart – Oct. 2015: 1,000 Views/700 Visitors – 2015: 9,000 Views/6,000 Visitors

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Blog Stats. - Oct. 2015

Updated Elder Abuse and Protection Presentation Slides – Please Read and Forward

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I have provided below a link to a PDF of my October 12, 2015, updated elder and dependent adult abuse and protection presentation slides. The slides are extensive. This is an important topic – and the resources are not sufficient to prevent or remedy the problem.

Please read and also forward this post and the materials to other people who would be interested. Click on the following link for the PDF and slides, ELDER ABUSE AND PROTECTION 10122015 FINAL

You can also find other discussions about this topic on other blog posts.

Thank you. Dave Tate, Esq., San Francisco and throughout California

The New California End of Life Option Act – Undue Influence Is Listed 5 Times

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Click on the following link for a copy of the new California End of Life Option Act, End of Life Option Act. I’m just spotting elder and dependent adult abuse issues here – I’m not discussing political, religious, personal, ethical or other issues.

The Act proposes to include protections to ensure that a person who uses the Act is not being unduly influenced. Obviously undue influence, duress, fraud, etc. are concerns in any situation. By my count undue influence is listed 5 times in the Act, so it is an obvious concern. You can match that concern with similar efforts to influence an elder’s estate planning or gifting, and also with the new California revocable transfer on death deed which I discuss at this prior blog post http://wp.me/p1wbl8-cI.

Having an outside third person, as the Act provides, assert that the person using the Act hasn’t been unduly influenced is not necessarily trustworthy as the third person has not been personally present to observe and hear what influence, fraud or duress, if any, has been attempted, including simply negative statements about how awful or useless life has become.

I have also seen situations where it was thought that a person was ill or injured, and would die, only to find out later that the cause was improper medications or some other undiagnosed reason, and the person recovered with proper diagnosis and treatment.

As I said, I’m just spotting issues here. People need to be vigilant.

Dave Tate, Esq., San Francisco and throughout California, http://californiaestatetrust.com