April 20, 2018

Tenth Circuit: Nursing Home Liable for Abuse to Resident

The Tenth Circuit Court of Appeals issued its opinion in Racher v. Westlake Nursing Home Limited Partnership on Thursday, September 28, 2017.

Mrs. Mayberry was abused by two certified nursing assistants while in Quail Creek Nursing Home, which is owned by Westlake. This case was filed against Westlake under Oklahoma law for negligence, negligence per se, and intentional infliction of emotional distress. At trial, the jury found for plaintiffs, Westlake appeals.

The two nursing assistants involved, Kaseke and Gakunga, worked at Quail Creek and were Mayberry’s caretakers. Both assistants had numerous write-ups in their personnel files for infractions and refusal to complete assigned duties, including sleeping on the job, which was grounds for immediate termination; however, neither were terminated for that infraction.

One of Mayberry’s daughters testified that the family began to notice bruising on Mayberry’s hands and arms soon after moving Mayberry to Quail Creek. These concerns went unexplained by Quail Creek. Although it was difficult for Mayberry to communicate due to dementia, Mayberry began to cry out to the family for help and that someone was hurting her mouth. To monitor Mayberry, the family placed a hidden camera in her room. The videos show Gakunga slapping Mayberry, forcibly stuffing Mayberry’s mouth with wadded up gloves, and performing compressions on Mayberry’s chest to force her to empty her bladder. Kaseke is seen watching this take place. Both assistants are seen roughly lifting Mayberry from her wheelchair and pushing her to lay down. Mayberry’s family brought the videos to Quail Creek’s attention. Both assistants were arrested. Mayberry died three months after the abuse was discovered.

Plaintiffs brought suit against Quail Creek due to the abuse that occurred and was perpetrated by Quail Creek employees, and on the grounds that Quail Creek is directly negligent in failing to investigate and report the incidents of abuse. At trial, the jury found that Westlake, the owner of Quail Creek, was liable on theories of negligence and negligence per se, that Westlake acted with reckless disregard for the rights of others, and that plaintiffs were entitled to compensatory damages in the sum of $1.2 million.

Westlake raised four issues on appeal: (1) whether the district court erred by failing to reduce compensatory damages to the statutory cap of $350,000; (2) whether the district court erred by failing to reduce the allegedly excessive compensatory damage award of $1.2 million or, in the alternative, to grant a new trial; (3) whether the district court erred by allowing allegedly improper closing argument regarding punitive damages during the first phase of the trial; and (4) whether the district court erred by admitting evidence of an unrelated incident subject to a limiting instruction.

As for the first issue, Oklahoma law caps noneconomic damages at $350,000 unless special findings are made. The district court concluded that the requirements for lifting the cap were satisfied in this case. The Tenth Circuit affirmed the district court decision. Because Westlake failed to raise the statutory damage cap at any point before the trial was completed, the Tenth Circuit held that Westlake waived the defense.

Next, Westlake argued that the compensatory damages awarded by the jury were excessive and that the district court erred by declining to either reduce the award or grant a new trial. The district court denied this motion because it concluded that there was substantial evidence in the record to support the jury’s award. Oklahoma recognizes a broad jury discretion in determining the amount of damages to award. The Tenth Circuit considered the entire trial record and viewed the evidence in the light most favorable to plaintiffs in concluding that the damages awarded were not excessive. The Circuit found that the jury could have reasonably concluded that Mayberry was abused on a daily basis and that the abuse caused emotional distress that was significant enough to have contributed to her death.

Westlake then argued that the district court erred by allowing counsel for plaintiffs to make arguments that invited an award based on consideration of deterrent and punitive rather than compensatory factors. Although the Tenth Circuit agreed that portions of the argument were improper at the time they were presented, Westlake failed to show that the argument led the jury to return a verdict based on passion or prejudice rather than the evidence presented at trial. The Tenth Circuit noted that not all errors require reversal. In this case, the Circuit found that the jury was not prejudiced by the poorly timed statements regarding the award of punitive damages. The jury was clearly instructed as to the correct procedure and the size of the awards, when considered in the context of the evidence presented at trial. The Tenth Circuit declined to warrant a new trial based on these circumstances.

Lastly, Westlake argued that the district court erred by admitting evidence of another incident subject to a limiting instruction. Prior to trial, Westlake had filed to exclude any evidence that Kaseke caused any physical or mental harm to any residents at Quail Creek on April 4th. This evidence at issue included two more instances of abuse, where two nursing students testified that Gakunga struck Mayberry on the forehead and put her into a cold shower, and Kaseke sprayed an unnamed resident in the face with cold water so violently that the resident’s dentures fell out. The district court denied Westlake’s motion because the evidence would be relevant, not unfairly prejudicial, and admissible if the abuse in Mayberrry’s case occurred after April 4th. The Tenth Circuit agreed with the district court because there was a limiting instruction given to the jury that properly allowed the jury to consider the incidents only if they took place before the alleged abuse of Mayberry.

The Tenth Circuit AFFIRMED the district court’s judgment.

Social Media Abuse of Elders

Editor’s Note: This post originally appeared on Barbara Cashman’s Denver Elder Law Blog on August 10, 2016. Reprinted with permission.

CashmanBy Barbara Cashman, Esq.

I recently came across this horrifying article published Monday in ProPublica, entitled “Federal Health Officials Seek to Stop Social Media Abuse of Nursing Home Residents.” It seems that some staff members of nursing homes are publishing photos, audio and video recordings of some residents in the social media like Snapchat, Facebook or Instagram, or sent in text messages as multimedia attachments. These pictures, audio, and video files often depict elder residents of the facilities in demeaning and humiliating ways so as to result in mental abuse. The Centers for Medicare and Medicaid Services has recently sent out a memorandum concerning this to the State Survey Directors.

Do the skilled nursing facilities have prohibitions against such intrusions in place? Some evidently did not, but there can be little doubt that nearly all will have such protections in place soon in light of these disturbing developments. Here’s an article about such violations in Ohio nursing facilities.

The CMS memo referred to above defines mental abuse as that abuse which:

[M]ay occur through either verbal or nonverbal conduct which causes or has the potential to cause the resident to experience humiliation, intimidation, fear, shame, agitation or degradation.  Examples of verbal or nonverbal conduct that can cause mental abuse include but are not limited to: nursing home staff taking photographs or recordings or residents that are demeaning or humiliating using any type of equipment (e.g., cameras, smart phone, and other electronic devices) and keeping or distributing them through multimedia messages or on social media networks.  Depending on what was photographed or recorded, physical and/or sexual abuse may also be identified.

ProPublica has been following this following these developments for many months; this article from December 21, 2015 details some of the incidents this mental and physical abuse of incapacitated elders perpetrate by the nursing home staff members. In a case in New York where a nurse aide took photos of an incontinent resident’s genitals covered in fecal matter and shared them with another staff member on Snapchat, he was fired and pleaded guilty to a misdemeanor count of willful violation of health laws. What I found particularly disturbing was the comment of one home’s administrator to ProPublica that “[t]echnology is a problem for us, for everybody, these days… The resident involved was not harmed but certainly it was a serious incident.” Are incapacitated nursing home residents not entitled to any human dignity and to be free from such exploitation for someone’s entertainment?

One of the incidents described by ProPublica is from August 2015. It occurred in a rural area of Colorado and involved a youth volunteer at a nursing home who took a selfie which showed a 108-year-old resident urinating. The volunteer apparently shared the photo with her friends at school and the facility did not learn of the offending photo until months later. The volunteer was not monitored by the facility but did report to the local police, and was later charged with invasion of privacy.

What is human dignity when it cannot be defended by an incapacitated elder? What is human dignity when it is not readily apparent or recognized in places where people are institutionalized for the paramount concern of their safety?

Dignity, as in the legal right, is not easily defined. In fact, you would be hard pressed to find many references to it in our laws. International law, specifically the international law of human rights, has much more to say about human dignity, but that is another blog post!

I will close with just a couple observations and questions.

If humiliation is the opposite of being treated dignity and respect, is our system of laws really equipped to deal with this type of new frontier of the rights of incapacitated persons to be free from intrusions by others who humiliate them for sport or humor?

Is the dignity of or respect for elders a right in this context or is it overshadowed by our concerns for safety, and how does an incapacitated elder’s diminishing bailiwick of autonomy factor into this equation?

On this note, here is a link to an interesting article about the dignity of elders. More to come on this very challenging topic.

© 2016 Barbara Cashman  www.DenverElderLaw.org

 

Barbara Cashman is a solo practitioner in Denver, focusing on elder law, estate law, and mediation. She is active in the Trust & Estate and Elder Law sections of the CBA and is a past chair of the Solo/Small Firm section. She is a CAMP mentor and blogs weekly on her law firm blog, where this post originally appeared. She can be contacted at barb@DenverElderLaw.org.

The opinions and views expressed by Featured Bloggers on CBA-CLE Legal Connection do not necessarily represent the opinions and views of the Colorado Bar Association, the Denver Bar Association, or CBA-CLE, and should not be construed as such.

Let’s Raise Awareness About Elder Abuse!

Editor’s Note: This post originally appeared on Barbara Cashman’s Denver Elder Law blog on June 29, 2016. Reprinted with permission.

CashmanI wanted to circle back on the importance of raising awareness of elder abuse. You can read the Presidential Proclamation on June 15, 2016, for World Elder Abuse Awareness Day right here and if you’re curious about the language of the Elder Justice Act, passed as part of the Affordable Care Act (as Title VI subtitle H, §§ 6701, et seq.), read this link.

In Colorado, as in nearly all other states, adult protection units are responsible for the reporting and investigation of elder abuse (along with law enforcement agencies). The Elder Justice Act is federal legislation that requires the U.S. Department of Health and Human Services “to oversee the development and management of federal resources for protecting out seniors from elder abuse.” Additionally, the U.S. Department of Justice is charged with taking action to prevent elder abuse.

The effective coordination of these county, state, and federal efforts is of course a work in progress. What we do know about raising awareness of elder abuse and exploitation is that it will lead to more reporting of such abuse. Here is a link to a recent article in the Sacramento Bee which links the raised awareness of such abuse to a dramatic increase in reports to local law enforcement. This is important to bear in mind as the baby boomers begin to become a greater proportion of the cohort affected by elder abuse and exploitation. In my practice, I have unfortunately become familiar with national and international internet scams which relieve elders of their hard-earned retirement money. This is a particular area in which the federal government might play a unique role as so much of our law of the internet is based in federal law.

Another tragic side effect of the victimization of elders, besides the shame, victimization and impoverishment which results from financial exploitation is that these elders, along with elder victims of all types of elder abuse — including physical and sexual abuse — are likely to die much sooner than their peers who were not victimized. But many pieces of this puzzle remain unidentified due to the lack of long term studies which collect valuable statistics about elder abuse of various types! This is of course another aspect of the importance of raising awareness. Because so much of elder abuse still remains unreported, this is a major quality of life challenge not just for elders and their loved ones and community, but also for those of us of “a certain age” who might be looking forward to a safe and meaningful elderhood. How can we make things better for elders at risk now and in the future?

What is elder abuse and who are its primary victims of such elder abuse? By the numbers, they are largely women and the “old” of the elder population — meaning folks over 80. Sadly, the vast majority of the abusers are family members of the elder or trusted friends or advisors. Because most elders live in the community — not in institutions — this is a particular challenge for all of us who are community members to become familiar with the signs so that we can report concerns about safety, suspicious behaviors and the like to local law enforcement.

First — what are the kinds of elder abuse that we’re talking about? Here is a helpful listing from the U.S. government’s Administration on Aging website, which also has many helpful resources:

  • Physical Abuse—inflicting physical pain or injury on a senior, e.g., slapping, bruising, or restraining by physical or chemical means.
  • Sexual Abuse—non-consensual sexual contact of any kind.
  • Neglect—the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.
  • Exploitation—the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.
  • Emotional Abuse—inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g., humiliating, intimidating, or threatening.
  • Abandonment—desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
  • Self-neglect—characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his or her own health or safety.

And what about the warning signs of elder abuse of which we can be more aware?

  • Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
  • Bruises around the breasts or genital area can occur from sexual abuse.
  • Sudden changes in financial situations may be the result of exploitation.
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
  • Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
  • Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.
  • Changes in the elder’s personality or behavior, especially if the elder becomes withdrawn or despondent, questions to her or him can be very important in identifying a situation which may be the cause of the elder’s silent suffering.

Lastly, here is another helpful self-help resource specifically for Colorado residents – from Colorado Legal Services.  That’s all for now – but don’t forget . . . . Denver’s Senior law Day is coming up on Friday July 29, 2016 and will be held at the Denver Police Protective Association’s Event Center.  More details later.

© Barbara E. Cashman 2016   www.DenverElderLaw.org

Barbara Cashman is a solo practitioner in Denver, focusing on elder law, estate law, and mediation. She is active in the Trust & Estate and Elder Law sections of the CBA and is a past chair of the Solo/Small Firm section. She is a CAMP mentor and blogs weekly on her law firm blog, where this post originally appeared. She can be contacted at barb@DenverElderLaw.org.

The opinions and views expressed by Featured Bloggers on CBA-CLE Legal Connection do not necessarily represent the opinions and views of the Colorado Bar Association, the Denver Bar Association, or CBA-CLE, and should not be construed as such.