The industry—led by National Healthcare Corp., which owned the Nashville nursing home where 16 residents died in a fire four years ago—showered lawmakers with $85,000 in campaign contributions in the last election cycle, and it has hired two dozen luminaries of the state lobbying corps—including Betty Anderson, wife of House Speaker Jimmy Naifeh—to grease the skids for its legislation.
The House sponsor is Rep. Randy Rinks, longtime Naifeh minion and chair of the House Democratic Caucus. Handling publicity is the governor’s favorite PR firm—McNeely, Pigott & Fox, which is brassy enough to describe the bill in a press release as “a move aimed at protecting the stability of community nursing homes.”
The industry makes the curious argument that the cost of defending all those pesky patient lawsuits alleging poor care—say, failing to treat an old lady’s broken hip or starving residents on feeding tubes, just to name a couple of horror stories from state inspectors’ thick files—is actually leading to poor care.
“The average annual cost of items like liability insurance, legal services and other liability-related issues is now $500,000 per Tennessee nursing home, enough to hire and pay for 10 new nurses,” says Steve Flatt, a senior vice president for National Healthcare. “The problem is that our laws right now allow the filing of limitless lawsuits claiming tens of millions of dollars in damages. The result is that the big-money personal injury lawyers from Texas and Florida have been arriving regularly to pelt our courts with lawsuits.”
Something definitely is causing things to go very wrong inside many Tennessee nursing homes. But according to Tennessee Citizen Action—a coalition of trial lawyers, advocates for the disabled and labor unions—it’s not the cost of defending too many lawsuits. Only four medical negligence verdicts were awarded against Tennessee nursing homes in the past two years. Residents and their families sued in those cases for death, injury and neglect.
Nursing homes, meanwhile, were cited last year for 152 “immediate jeopardy” violations—that is, violations that put residents in imminent danger of injury or death—and 22 nursing homes had their admissions suspended as a result. The state has suspended admissions at two more nursing homes already this year.
According to records at the state Department of Health, the violations include:
• Maggots were discovered in the wound of one resident at a Memphis nursing home. A nurse failed to administer physician-ordered treatments.
• A resident who fell and broke her hip in Ripley waited four days before being sent to the hospital.
• A resident in Memphis went a month without a shower.
• Residents suffering needless pain for lack of medication. “My pain is a 14,” one told inspectors, “but since we can’t go that high, I will say it’s a 10. I got tears in my eyes. They didn’t call the doctor.” Another said, “I just dread having to get up to go to that beside potty because I know how much it will hurt and I just cry until I finally go back to sleep.”
• A nursing home in Milan failed to provide enough calories and nourishment through feeding tubes, causing one resident to lose 47 pounds in a month.
Flatt of National Healthcare, which reported $500* million in profits in 2006, blames a “stricter interpretation” of the law for the increasing number of findings of patient neglect and suggests many nursing homes in Tennessee may eventually close unless the legislature caps lawsuit damages. Flatt says unscrupulous out-of-state lawyers are targeting Tennessee nursing homes solely because there are no limits now on damages.
Of the $960 million spent for nursing home care this year in Tennessee, $115 million or 11 percent will be spent directly on attorneys’ fees, expert witnesses and other costs defending against lawsuits, according to Flatt. If Tennessee nursing homes spent the national average on liability defense, that cost would drop to $35 million.
“There are a handful of out-of-state law firms specializing in nursing home suits and because of our lack of liability reform, they’ve targeted Tennessee,” Flatt says. “Frankly, they troll for business with billboards just outside nursing homes and buy newspaper ads, and they prey on the emotional vulnerability that’s associated with having loved ones in nursing home care. The nursing home industry expects and desires accountability. Our state’s doing an excellent job of making sure the quality of care in nursing homes is adequate. But when you’re taking away 11 percent of revenue, you’re setting yourself up for poorer quality care in the long run.”
For undisclosed sums, National Healthcare settled more than 30 lawsuits resulting from the 2003 fire at its NHC HealthCare facility. To opponents of the industry’s bill, the fire is Exhibit A for why the legislation shouldn’t become law. Plaintiffs alleged the nursing home and its workers failed to suppress the fire quickly enough and allowed it to spread.
But if the industry’s bill had been law then, residents and their families could have won no more than $300,000 in any lawsuit for so-called non-economic damages—intangible harm such as pain, emotional distress, disfigurement or loss of a loved one. In addition to capping those damages, the bill would place health services provided by nursing homes under the same rules as medical malpractice cases, making it harder and costlier for residents to prove negligence. Even better for the industry, residents entering nursing homes could be required to sign away their right to have a jury decide any future claims and to agree instead to arbitration.
“This proposed legislation is a slap in the face to some of Tennessee’s most vulnerable citizens, the residents of nursing homes and their families,” says Karla Hewitt, a trial lawyer and president of Tennessee Citizen Action. “Nursing home residents are suffering. Inspectors have found residents with maggots in their wounds and broken bones that aren’t treated. And now this billion-dollar industry wants to take away the rights of individual residents to sue? This shows how low the nursing homes will go to protect their shareholders’ profits.”
*This figure was corrected in the March 6, 2008 issue of the Scene. The company actually posted profits that year of $36.7 million.