Just a week after Elder Abuse Exposed.com said in its October 23, 2012 article, “Governor Jerry Brown Vetoes Smoking Ban inside California Nursing Homes,” that Governor Brown was disregarding evidence in the U.S. surgeon general’s 2006 report on the deadly health effects of secondhand smoke exposure and was continuing to disregard the rights of vulnerable nursing home residents, a new University of California, San Francisco study on smoke-free laws shows that Governor Brown’s September 27, 2012 veto of Assembly Bill 217 was not in the interest of public health. The new study, which appears in the American Heart Association journal Circulation (October 30, 2012), is called “Association between Smoke-Free Legislation and Hospitalizations for Cardiac, Cerebrovascular, and Respiratory Diseases: A Meta-Analysis.” The authors of the study are Crystal E. Tan, MS, and Stanton A. Glantz, Ph.D., who is a professor of medicine and the director of the Center for Tobacco Control Research and Education at UCSF. (Photo (right) credit: Office of Attorney General)

Elder Abuse Exposed.com selected as one of the “leading online resources for . . . elder advocacy and abuse prevention” by Nursing Assistant Guides.com

Elder Abuse Exposed.com is proud to be featured in Nursing Assistant Guides.com’s just-published, newest feature article, which is a collection of “leading online resources” on home health care, assisted living, long-term care, elder advocacy and abuse prevention, and general senior care.

The Nursing Assistant Guides.com website “is dedicated to providing updated, quality information for those interested in a career as a nursing or medical assistant. Here you’ll have access to an abundance of information about becoming a CNA [certified nursing assistant], and you can request additional information from qualified, accredited online degree programs across the United States.” Nursing Assistant Guides.com is “a dedicated resource for anyone interested in earning the required credentials to work in this field.”

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The California Department of Public Health’s (CDPH) Licensing and Certification Program—hardly an aggressive watchdog of wealthy, politically connected nursing homes—issued a class “B” citation and monetary fine in October 2011 to North American Health Care Inc.’s client nursing home Lake Balboa Care Center, in Van Nuys, California. CDPH said that Lake Balboa Care Center failed to administer oxygen to a fainting patient at a flow rate required by physician orders and the patient’s care plan. At that time, the unfortunate, 88-year-old victim suffered rapidly declining oxygen saturation levels, cardiopulmonary arrest, and unexpected death. In its citation, CDPH said, “The above violation had a direct relationship to the health, safety and security of Patient 1.” Despite CDPH’s findings, tantamount to obvious elder neglect, the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) chief of prosecutions, Mark Zahner, based his decision to file no criminal charges in the case, not on the assigned BMFEA special agent’s expert opinion, but instead on the different opinion of BMFEA medical consultant Kathryn L. Locatell, M.D. Dr. Locatell shockingly said, “There were no breaches of any applicable standards of care in the events leading to Mr. [patient’s name deleted] death. I see no indication of neglect whatsoever. . . . [W]hether or not oxygen was administered, or administered timely . . . was immaterial.”

New California nursing home video camera bill proposed to combat elder abuse and neglect

Dear Friend:

We at Elder Abuse Exposed.com hope that Democratic California state senator Lois Wolk or another member of the California Legislature will accept our proposal to introduce a nursing home video camera bill like the recently enacted bipartisan Oklahoma law (Senate Bill 587), which was approved unanimously by both the Oklahoma State Senate and House of Representatives. It confirms the right of consenting, vulnerable nursing home residents to install, at their own expense, video surveillance cameras in their own private bedrooms. Our proposal also confirms the right of consenting residents in residential care facilities for the elderly (RCFEs), also known as assisted living facilities, to choose to have the protection that in-room video camera monitoring can provide.

In addition, our video camera proposal ensures and vigorously protects the privacy rights of those RCFE and nursing home residents who do not consent to video monitoring. In other words, only consenting residents who want to exercise their right to video monitoring in their own private bedrooms could be monitored, and residents who do not consent could never be monitored by video cameras in their bedrooms.

Sadly, while many nursing homes and RCFEs provide good care, there have been abuses and instances of very poor care, including false or misleading nursing notes to cover up abuse and poor care. Our proposed nursing home and RCFE video camera bill would serve as a strong deterrent to this abuse, poor care, and falsification of patient records. The video camera bill, which would provide for proper resident consents, video monitoring warning signs, and strict privacy safeguards, would permit facility management and residents’ family members to monitor facility staff inside rooms when no one else is watching the staff. As a result, the facility management could improve staff training, take appropriate disciplinary action, and reduce or even eliminate poor and neglectful care.

We think that a nursing home video camera law in California would make it very difficult for nursing home and RCFE operators to understaff facilities and thereby overload nursing staff to the point of making the well-meaning, caring staff hardened and desensitized to patient neglect and suffering. Equally important, video camera monitoring would deter facility staff from falsifying patient records to cover up poor care and neglect because facility administration and cooperating family members could easily verify the actual care through video camera recordings.

Please help now by signing our petition supporting a nursing home video camera bill with strict privacy safeguards

Please help us get this bill launched by taking just a minute or two to sign a petition which says simply:

Get the California government out of elderly citizens’ private bedrooms. I support a bill that would allow video camera monitoring with the proper resident consents and strict privacy safeguards, like the recently enacted bipartisan Oklahoma law, to combat elder abuse.

Please click here to sign the petition, which a growing list of prominent geriatricians and elder abuse experts (below) have already signed (as individuals and not on behalf of the entities for which they work):

• Laura Mosqueda, M.D., director of geriatrics, chair of and professor in the Department of Family Medicine, Ronald W. Reagan Endowed Chair in Geriatrics, and director of the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine School of Medicine

• James Spar, M.D., director of the Division of Geriatric Psychiatry Inpatient Program and professor of clinical and geriatric psychiatry in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA

• Robert Neshkes, M.D., chief of the geriatric psychiatry treatment unit at the West Los Angeles VA Medical Center and retired clinical assistant professor of psychiatry in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA

• Deborah Newquist, Ph.D., M.S.W., assistant clinical professor of gerontology at the University of Southern California (USC), former director of geriatric services for international chronic care services company ResCare Inc., and founder and president of Southern California-based geriatric care management and home care company Senior Care Resources

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Some of the benefits of video camera monitoring in California nursing homes and residential care facilities for the elderly

What are the benefits of video camera monitoring? One good example is a San Diego County residential care facility for the elderly (RCFE) named Vista Gardens Memory Care, in Vista, California, which was built with video cameras installed for the protection of the residents who want video monitoring. If the California Department of Social Services’ (DSS’) Community Care Licensing Division (CCLD), which regulates RCFEs, did not prohibit Vista Gardens Memory Care residents from benefiting from the safeguards of in-room video camera monitoring, then:

• If there was any question about whether a staff person misbehaved, Vista Gardens could find out if it occurred and correct it immediately.

• If, for example, a resident was found on the floor with a bruise on the head, Vista Gardens could review the video recording to see how and if the bruises occurred when the patient fell out of bed reaching for a nightstand or in some other manner.

• If the bruising was caused by a fall from reaching for a nightstand while in bed, the recording would show this, and Vista Gardens would simply move the nightstand closer to the bed.

• If the recording showed any other reason for the bruising, Vista Gardens would also be able to take corrective actions immediately and notify the appropriate authorities and individuals.

• Vista Gardens could also review the video of the resident falling to relay pertinent information to paramedics or the emergency room for treatment decisions.

• If a hallucinating resident claimed that something improper occurred (e.g., a lady claiming a naked man was in her room), Vista Gardens could review the video to ascertain that it did or did not happen.

Calif. Dept. of Social Services infringes on RCFE residents’ right to use video cameras in their private bedrooms

Unfortunately, the California DSS’ CCLD has prohibited video monitoring in the residents’ rooms at Vista Gardens Memory Care. Neither the resident, his or her family, nor Vista Gardens may have video camera monitoring in the residents’ private rooms, according to CCLD, even though residents or the residents’ health care agents have given written consent for and fervently want the video monitoring for their own protection.

DSS’ CCLD told Vista Gardens that in order to operate the video cameras, Vista Gardens had to apply for an exception request for a camera monitoring program. Although Vista Gardens applied for the exception request on July 21, 2011, Vista Gardens has predictably not received any response from DSS’ CCLD.

But the fact is that no California or federal law prohibits video cameras in consenting residents’ rooms, where there is a reasonable expectation of privacy only for the residents. The residents or their health care agents have a right to waive the privacy in a limited way for video monitoring.

Bottom line: DSS’ CCLD and the California Department of Public Health’s (CDPH’s) Licensing and Certification Program, which regulates nursing homes, do not have any legal authority to prohibit video camera monitoring. But DSS’ CCLD, which we believe acts as a proxy for the California Assisted Living Association (CALA) and the California Association of Health Facilities (CAHF), unjustifiably infringes on vulnerable elderly residents’ right to use video monitoring in their own private bedrooms to protect against elder abuse and poor care.

California government (CCLD and CDPH) should not even concern itself with what private citizens do in their own private bedrooms. California government should get out of our private bedrooms.

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(Part 2 of 3)
Read part 1 »
Read part 3 »
Updated, October 21, 2013, 11:00 p.m. PDT

U.S. Supreme Court Justice Louis D. Brandeis, in the public domain. (Photo credit: Harris & Ewing Collection at the Library of Congress, Prints & Photographs Division, circa 1916)

Blowing the lid off 12 more troubling secrets about the Medicare Nursing Home Compare five-star rating system

Two weeks ago, in part 1 of the three-part exposé “Medicare Nursing Home Compare Five-Star Rating System: A Fraud on the Public?,” Elder Abuse Exposed.com revealed four of 16 secrets that the Centers for Medicare and Medicaid Services (CMS) and “five-star” nursing homes, especially in California, will not tell you about Medicare’s nationally promoted, frequently visited Nursing Home Compare website:

• Secret #1: Medicare’s misleading Nursing Home Compare website excludes all deficiency citations and penalties that inspectors for the California Department of Public Health’s (CDPH’s) Licensing and Certification Program have issued to noncompliant nursing homes when referring only to state law and not federal law.

• Secret #2: CDPH has not clearly explained why many nursing home citations that CDPH inspectors have issued for even the most serious misconduct, including elder abuse and patient homicides, have referred only to state law and have thereby been excluded from the Medicare Nursing Home Compare five-star rating system.

• Secret #3: Even though CDPH has claimed that its inspectors will now be issuing dual citations, which refer to both state and federal law and which CDPH has referred to as “the federal process with dual enforcement,” the Medicare Nursing Home Compare five-star rating system will likely continue to exclude serious misconduct by wealthy, politically connected nursing homes in California.

• Secret #4: The Medicare Nursing Home Compare website excludes even the highest-level state enforcement actions, including elder abuse and patient homicides, against “five-star” nursing homes in California.

Today, in part 2 of the three-part exposé, Elder Abuse Exposed.com blows the lid off seven more secrets (numbers 5–11) that the CMS and “five-star” nursing homes throughout the U.S. do not want you to know about the Medicare Nursing Home Compare five-star rating system. While exposing these seven new secrets in part 2, Elder Abuse Exposed.com is continuing to explore if there is truly a useful correlation between a nursing home’s star rating on Nursing Home Compare and the quality of care that a nursing home provides. Elder Abuse Exposed.com is also continuing to explore whether the Medicare Nursing Home Compare five-star rating system is a fraud perpetrated on consumers searching for a high-quality nursing home without a history of elder abuse and homicides.

Within the next week or two, in part 3 of the three-part exposé, Elder Abuse Exposed.com will reveal the remaining five of the 16 secrets (numbers 12–16). Armed with this pertinent information, professional geriatric care managers, hospital case managers, elder care referral services, and consumers throughout the U.S. will finally be able to decide for themselves if Medicare’s Nursing Home Compare provides reliable, accurate information on the quality of care in the more than 15,000 Medicare- and Medicaid-certified nursing homes in the U.S. People who rely on the Medicare Nursing Home Compare five-star rating system can also decide if they agree with 31 state attorneys general who signed an August 20, 2009 letter to Kathleen Sebelius (email), secretary of the U.S. Department of Health and Human Services.

The letter said:

As a result of the current Five Star methodology, comparison of individual nursing home ratings can be misleading and create significant confusion for consumers. In the interest of consumers as well as providers, we believe it imperative that the current Five Star System be suspended temporarily and revised using a more appropriate criterion-referenced evaluation methodology.

Secrets 5–11 of 16 secrets Medicare does not want you to know about its five-star rating system on Nursing Home Compare

5. Consumers must rely on a state website that is not as heavily promoted as Nursing Home Compare to see state enforcement actions against California nursing homes.

Elder Abuse Exposed.com informed CDPH that Nursing Home Compare excluded an October 6, 2011 class “B” citation issued to “five-star” Lake Balboa Care Center

While doing research for this exposé, Elder Abuse Exposed.com emailed CDPH officials to inform them that Nursing Home Compare excluded a state law-based class “B” citation that CDPH issued to a “five-star” nursing home in California on October 6, 2011. (The October 6, 2011 class “B” citation involved “a complaint alleging Patient 1 was not provided an adequate amount of oxygen during an emergency situation when the patient became unresponsive” and, according to the patient’s death certificate, suffered fatal “cardiopulmonary arrest.”) Elder Abuse Exposed.com asked the CDPH officials if CMS’ calculation of a California nursing home’s Medicare star rating disregards citations that Nursing Home Compare excludes. Elder Abuse Exposed.com told CDPH officials that the excluded October 6, 2011 class “B” citation had been issued to “five-star” nursing home Lake Balboa Care Center, in Van Nuys, California.

Lake Balboa Care Center and the nursing home featured in part 1 of this exposé—Cottonwood Healthcare Center, in Woodland, California—are two of the 34 “five-star” client facilities of North American Health Care Inc. According to John Sorensen—the president, CEO, and chairman of the board of Dana Point, California-based North American Health Care Inc.—“Thirty Four of its Thirty Five affiliated client facilities are five star rated and one is four star rated.” North American Health Care also advertises on its company website, “As of June 2013, Medicare awarded 34 North American Health Care Inc. client serviced facilities with their highest honor – a Five-Star Rating.”

A CDPH official did not explain why class “B” citation issued to Lake Balboa Care Center was disregarded by Medicare’s Nursing Home Compare

Although a CDPH official responded to Elder Abuse Exposed.com’s email, the official did not address Elder Abuse Exposed.com’s concern that Medicare’s Nursing Home Compare excluded the October 6, 2011 class “B” citation that CDPH issued to Lake Balboa Care Center. The CDPH official also did not respond to Elder Abuse Exposed.com’s request for a referral to a state or federal official who could ensure that Medicare’s Nursing Home Compare would include state law-based enforcement actions against California nursing homes, such as the October 6, 2011 class “B” citation issued to North American Health Care’s “five-star” client facility Lake Balboa Care Center.

CDPH official said information about class “B” citation issued to Lake Balboa Care Center was included, not on Medicare’s Nursing Home Compare, but on CDPH website

But the CDPH official, Lunghwa Yung, a staff information systems analyst for the Los Angeles County Department of Public Health’s Health Facilities Inspection Division, was very kind to refer Elder Abuse Exposed.com to a valuable resource for consumers searching for information specifically on California nursing homes. The resource, which is not as heavily promoted as CMS’ Nursing Home Compare and which does not have a star-rating system for California nursing homes, is CDPH’s Health Facilities Consumer Information System (HFCIS).

CDPH website includes critical information on California nursing homes’ misconduct that Medicare’s Nursing Home Compare completely ignores

The HFCIS is the State of California’s website and database that allows the public to search for information on California nursing homes that Medicare’s Nursing Home Compare totally disregards. For instance, the HFCIS  allows the public to view summary information on California nursing homes’ substantiated and unsubstantiated complaints, incidents self-reported by facilities, and deficiency citations and penalties referring to state law violations during the past 10 years. The HFCIS also allows the public to download and view actual deficiency statements and to request from CDPH detailed ownership information about each nursing home in California.

Consumers who want information on state enforcement actions against California nursing homes should not waste their time with Medicare’s Nursing Home Compare

If consumers want information about the state violations and enforcement actions against a nursing home in California, such as the North American Health Care “five-star” client facility featured in part 1 of this exposé, Cottonwood Healthcare Center, consumers should not waste their time at Nursing Home Compare. Instead, consumers should search CDPH’s HFCIS. At this State of California website, HFCIS, unlike at CMS’ Nursing Home Compare website, consumers can see all the substantiated complaints, incidents self-reported by facilities, deficiency citations, and fines that Nursing Home Compare completely ignores.

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The California Department of Public Health’s (CDPH) Licensing and Certification Program—hardly an aggressive watchdog of wealthy, politically connected nursing homes—issued a class “B” citation and monetary fine in October 2011 to a Los Angeles-area nursing home that negligently failed to administer oxygen to a fainting patient at a flow rate required by physician orders and the patient’s care plan. At that time, the unfortunate, 88-year-old victim suffered rapidly declining oxygen saturation levels, cardiopulmonary arrest, and unexpected death. In its citation, CDPH said, “The above violation had a direct relationship to the health, safety and security of Patient 1.” Despite CDPH’s findings, tantamount to obvious elder neglect, the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) chief of prosecutions, Mark Zahner, based his decision to file no criminal charges in the case, not on the assigned special agent’s expert opinion, but instead on the different opinion of BMFEA medical consultant Kathryn L. Locatell, M.D. Dr. Locatell shockingly said, “There were no breaches of any applicable standards of care in the events leading to Mr. [patient’s name deleted] death. I see no indication of neglect whatsoever. . . . Whether or not oxygen was administered, or administered timely . . . was immaterial.”

Mark Zahner, chief elder abuse prosecutor for CA AG Kamala Harris’ DOJ, steps down amid criticism of selective enforcement

California’s chief elder abuse prosecutor is leaving office amid sharp criticism that he has selectively enforced criminal elder abuse laws against a small number of vulnerable small-fries while sparing the principal malefactors of systemic elder abuse—the wealthy, politically connected, corporate-owned nursing homes.

According to reliable sources, Deputy Attorney General Mark L. Zahner, who, since at least 2003, has been the chief of prosecutions for the Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA), in the California attorney general’s Department of Justice (DOJ) in Sacramento, is stepping down from his position at the end of this month. Mr. Zahner is reportedly leaving his office to head an association of district attorneys in California.

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In March 2012, Attorney General Kamala Harris, the chief law enforcement officer for the people of California, and her Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) reopened a closed criminal investigation and belatedly charged two licensed nurses, Donna Darlene Palmer and Rebecca LeAn Smith, with felony elder abuse four years after the March 2008 death of a 77-year-old woman, Johnnie Esco, in nursing home El Dorado Care Center in Placerville, California. However, Attorney General Harris and BMFEA, which is headed by its director, Mark Geiger, and its chief of prosecutions, Mark Zahner, filed elder abuse charges against the nurses, but not the nursing home, only after the Sacramento Bee’s embarrassing September 2011 exposé on the the Esco case, on the widespread falsification of patient records in California nursing homes, and on the case’s rejection by the BMFEA and El Dorado County district attorney. The Sacramento Bee’s March 16, 2012 “Nurses Face Felony Charges in Death of Cameron Park Man’s Wife,” by Marjie Lundstrom, chronicled the four-year crusade of the victim’s 81-year-old widower, Don Esco, who “made hundreds of phone calls and personal visits to local, state and federal authorities to get someone held accountable.” (Photo (right) credit: Office of Attorney General)

Elder abuse victim’s daughter complained to Sen. Dianne Feinstein about alleged misconduct by Calif. DOJ’s Bureau of Medi-Cal Fraud and Elder Abuse

An elder abuse victim’s daughter in California has shared with Elder Abuse Exposed.com the email response from U.S. Senator Dianne Feinstein (D-Calif.) to a complaint about alleged official misconduct by Attorney General Kamala Harris’ Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA).

Newport Beach, California, resident Deborah S. Calvert contacted Senator Feinstein’s office earlier this year, just after Elder Abuse Exposed.com posted on its website Ms. Calvert’s allegation that BMFEA prosecutors in Sacramento failed to prosecute, and even condoned, flagrant elder abuse leading to several deaths in a Sun Healthcare nursing home. Ms. Calvert wanted to inform Senator Feinstein about the futility of the elder abuse and death reports Ms. Calvert had filed with BMFEA concerning her mother, Evelyn Calvert, and other neglected nursing home residents in a Sun Healthcare nursing home in Newport Beach, California. According to Ms. Calvert, because of corruption, BMFEA’s prosecutors, including former deputy attorney general Claude W. Vanderwold and Deputy Attorney General Mark Zahner, refused to enforce “a 2001 California state injunction [regarding Sun Healthcare’s] understaffing and broken equipment that was killing patients.”

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