Saturday, October 01, 2011

False Records in Nursing Homes

False Charts - Fraudulent Nursing Home Records - 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.
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.
It is the untold story of nursing home care: falsification of patient records.
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."
The most common patterns include:
• Covering up bad outcomes. A patient dies or is injured, and the nursing home staff or administrators rewrite the records to minimize blame or liability.
• Fill-in-the-blank charting. Overworked or lazy staff members take massive shortcuts, filling out charts en masse, not knowing whether treatments took place or if the information is accurate.
• Missing medicines. Medications are checked off as being given, but investigators later find unopened boxes or discrepancies with pharmacy records.
Less common, but appearing in civil suits, are accusations that staff falsify consent forms to sedate patients, or backdate forged documents agreeing to settle disputes through arbitration.
Representatives of the nursing home industry dispute the contention that falsification of medical records is widespread, or even a matter of concern.
In long-term care facilities, a chart can become voluminous as staff members are required to chronicle everything from breakfast consumption to bowel movements to bumps and bruises and falls.
"The reality is, mistakes are going to happen when you have that much documentation you have to do," said a Sacramento attorney who has represented a nursing home chain in numerous lawsuits.
"The bottom line is – and should be – was appropriate care given?" said he, who believes that records falsification is an "exaggerated issue" cooked up by lawyers who sue nursing homes.
Elder abuse attorneys contend that accuracy of the medical record strikes at the heart of patient care. For some of California's most vulnerable populations, they say, falsifying medical records has proved deadly.
"Instead of providing the care, they're creating records – creating an illusion that care was there," said Michael Connors, a long-term care advocate for San Francisco-based CANHR.
Connors and other elder abuse experts agree that fraudulent charting often can be traced to understaffing. Public documents reveal tales of chaotic shifts on which certified nurse assistants are scrambling to provide care.
The resulting medical records sometimes border on the absurd.
The Bee found several falsification cases in which nursing staff continued filling in the "activities of daily living" on charts of patients who were already dead.

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