Sep. 18, 2011
THE SERIES
Today: The practice of nursing homes altering patients' medical records masks serious conditions and covers up care not given. A Bee review of nearly 150 cases of alleged chart falsification in California reveals how the practice puts patients at risk and sometimes leads to death.
Monday: Don Esco sought skilled nursing care at a Placerville facility for Johnnie, his wife of nearly 61 years, when she was recuperating from a bout with pneumonia. She died 13 days later. Esco sued, alleging that the medical charts lied about Johnnie's treatment.
A supervisor at a Carmichael nursing home admitted under oath that she was ordered to alter the medical records of a 92-year-old patient, who died after developing massive, rotting bedsores at the facility.
In Santa Monica, a nursing home was fined $2,500 by the state for falsifying a resident's medical chart, which claimed that the patient was given physical therapy five days a week. The catch? At least 28 of those sessions were documented by nurse assistants who were not at work on those days.
In Los Angeles, lawyers for a woman severely re-injured at a convalescent home discovered a string of false entries – several written by nonexistent nurses.
Phantom nurses. Suspicious entries in medical charts. Phony paperwork, hurriedly produced after an injury or death.
While regulators have dogged facilities for years over fraudulent Medicare documentation, the issue of bogus records is more than a money matter. In California and elsewhere, nursing homes have been caught altering entries and outright lying on residents' medical charts – sometimes with disastrous human consequences, according to a Bee investigation.
Medications and treatments are documented as being given when they are not. Inaccurate entries have masked serious conditions in some patients, who ultimately died after not receiving proper care, The Bee found.
Fear of costly lawsuits has driven some nursing home administrators to re-create medical records to hide neglectful care.
"The idea that they chart things before they happen or make things up way after the fact if something hits the fan – those are things that we're familiar with," said Mark Zahner, chief of prosecutions for the attorney general's Bureau of Medi-Cal Fraud and Elder Abuse.
"And we see (this) with regularity."
Some of California's most experienced elder abuse attorneys, who sue nursing homes for civil damages, say that suspicious or sloppy record-keeping is so common they encounter some aspect of it in virtually every case they investigate.
While some states have aggressively pursued nursing homes that falsify records – imposing hefty fines and charging workers with felonies – California's enforcement efforts have steadily waned, or been short-circuited by the courts.
Falsifying a medical record is a misdemeanor in California, but nursing home workers are rarely charged criminally for the offense.
For state licensing workers, detecting phony records is time-consuming and difficult to prove, officials say. Records falsification is the least common citation issued to nursing homes by the California Department of Public Health, despite claims by attorneys and elder-care advocates that paperwork fraud runs deep.
"It's extremely prevalent," said Sacramento attorney Ed Dudensing, a former prosecutor who won a record $29.1 million jury verdict last year against an Auburn nursing home.
Abridged
SOURCE: The SACBEE
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