Saturday, August 15, 2015

Why home care workers struggle with low wages


GWEN IFILL: We now turn to another in our occasional series on long-term care.

As Americans age, most prefer to stay in their own homes and get help when needed with the basics of daily living. A nationwide campaign kicked off last week calling attention to the jobs and the wages of home care workers.

Special correspondent Kathleen McCleery reports.

OLA MAE JONES: Good morning.

THERESA KING: Good morning.

It’s a passion job, so it takes a lot of patience, a lot of kindness.

KATHLEEN MCCLEERY: In Long Beach, California, Theresa King cares for 88-year-old Ola Mae Jones, who suffers from Alzheimer’s disease.

THERESA KING: I’m cooking you some fish.

KATHLEEN MCCLEERY: From cooking, to cleaning, to comfort.

THERESA KING: Don’t you love me, huh?

KATHLEEN MCCLEERY: The job is physically demanding and emotionally draining. King makes $9.70 cents an hour, almost exactly the average for the nation’s two million home care workers.

THERESA KING (singing): I want to shout about it.

KATHLEEN MCCLEERY: About 90 percent are women. Half are people of color. Like King, many don’t work full-time and don’t get benefits. She qualifies for food stamps and says, on her income, she can’t afford some basic necessities.

THERESA KING: It’s not enough to have your own apartment. You know, it’s not enough to have your own transportation without a struggle. You don’t really get to live a good life on the income of a home care worker.

KATHLEEN MCCLEERY: King’s employer, Cambrian Homecare, charges between $18 and $22 an hour for its caregivers. Rhiannon Acree, the company’s founder and president, says her costs go far beyond the workers’ wages.

RHIANNON ACREE, Founder and President, Cambrian Homecare: Your workers’ comp alone will add you $3. So, then you have got your unemployment, and you have got your taxes to match, and you have got your liability insurances on top of that.

The other next big cost is the background check. Then you want to staff, get the coordinators to place the right caregiver at the right house, and you need to make some profit.

KATHLEEN MCCLEERY: With 10,000 baby boomers turning 65 every day, the need for caregivers like Louasa Grant-Morrow in Philadelphia is skyrocketing. Home care work is one of the nation’s fastest growing industries.

But, unlike most other jobs, there’s no federal guarantee these workers get minimum wage or overtime. That’s because the Fair Labor Standards Act, signed into law by President Franklin Roosevelt in 1938, exempted domestic service workers. The reason given?  They performed companionship jobs similar to baby-sitters.

In 2013, the Department of Labor issued new rules narrowing the companionship exemption and extending federal minimum wage and overtime protection to home care workers. But, before the rules took effect, a federal judge overturned them, saying only Congress can change the law. The Department of Labor appealed, and a decision is expected later this year.

Over the years, caregivers’ responsibilities have grown. Grant-Morrow keeps track of medications and helps 85-year-old Elsie Wise transfer from one wheelchair to another. She’s worked for Home Care Associates in Philadelphia for four years. That tenure is unusual for an industry where turnover rates are 50 percent each year.

HCA believes it can retain workers by offering them a better deal. Though Grant-Morrow’s pay is low, just $8.20 an hour, she’s guaranteed full-time work, and she gets a transit pass to use any time she needs transportation. That’s just part of the company’s benefits package, says HCA’s president, Karen Kulp.

KAREN KULP, President, Home Care Associates: They get paid time off, health insurance, dental insurance, a life insurance policy, a 401(k) plan, disability insurance, and the ability to become worker-owners.

KATHLEEN MCCLEERY: That’s right, ownership in the company and a chance to serve on the board of directors.

KAREN KULP: One share is $500. And the way we do it is that we loan you $465 of that $500, so you, from your first paycheck, we take out $35, and then you can pay that back over as many months as it takes to do that, paying $3 a week.

LOUASA GRANT-MORROW: I’m a part of the company. I have a part to the company.

KATHLEEN MCCLEERY: Grant-Morrow bought in, and her investment has paid off.

LOUASA GRANT-MORROW: And if we’re having a very excellent year, of many clientele and so on, a lot of us get nice — we get a nice prize as far as bonuses, gifts, and so on by the end of the year, so it pays off. It really does.

KATHLEEN MCCLEERY: So you have — you have gotten your $500 back?

LOUASA GRANT-MORROW: Oh, I have got my $500 back.

KATHLEEN MCCLEERY: In California, Theresa King would like benefits, but, right now, she’s focused on getting a hike in pay.

THERESA KING: We’re supporting everyone that’s wanting increased wages in America.

KATHLEEN MCCLEERY: She’s spoken at rallies, part of a national effort by a group called Fight for 15 backed by unions to boost wages to $15 an hour for a variety of workers.

THERESA KING: Fifteen an hour would change my life. You know, it would change my life. When you’re making more money, it takes away worry and stress, when you’re making more money. So, of course, releasing me of worry and stress would help me in a whole lot of ways.

KATHLEEN MCCLEERY: Labor unions argue that increasing wages by 50 percent would put billions of new dollars in the hands of workers and would ripple through the economy, creating thousands of jobs.

RHIANNON ACREE: Everybody would like caregivers to make more money.

KATHLEEN MCCLEERY: Rhiannon Acree says agencies like hers have to strike a balance between what families can pay and what caregivers need to make.

RHIANNON ACREE: And, like everything else, if you have to pay more to produce something, and in this, we produce a service, then somebody has to pay for it, and what happens when they can’t afford it?  I think that’s our worry, is, when clients can’t afford home care anymore, what happens?

KATHLEEN MCCLEERY: Karen Kulp in Philadelphia echoes that concern.

KAREN KULP: It would be great to be able to pay folks that. Again, it’s like, where is that going to come from?  Is it going to come from private payers?  You know, are people who employ somebody privately willing to pay that much?  Is it going to come from the government?  Is it going to come from Medicare or Medicaid?

KATHLEEN MCCLEERY: Bridging the gap between livable wages and reasonably priced care is the challenge facing policy-makers and families who need caregivers.

I’m Kathleen McCleery, reporting from Philadelphia for the PBS NewsHour.

JUDY WOODRUFF: And we have more reporting from our series, including options on how to pay for long-term care. That’s on our home page,

Why home care workers struggle with low wages

Commentary: As nation ages, we must do more to care for family caregivers, Collins says

WASHINGTON — Over 40 million individuals in our nation know all too well the compassion, commitment and endurance that it takes to be a caregiver of a loved one. They also know the frustration and exhaustion that often result.

Our caregivers devote their time and attention, and they frequently must make many personal and financial sacrifices to ensure that their loved ones have the care they need day in and day out. Most important, America’s caregivers enable many of our nation’s seniors to remain living in the safety and comfort of their own homes.

Basic demographics illustrate some of the challenges faced by our family caregivers. Simply put, our nation is aging.

According to Census Bureau projections, 21 percent of our population will be 65 and older by 2040, up from just under 14 percent in 2012. Every day, 10,000 baby boomers celebrate their 65th birthdays, and many have chronic health conditions.

Americans 85 and older are the fastest-growing segment of our population. This is the very population that is most at risk of multiple and interacting health problems that can lead to disability and the need for round-the-clock care.

At the same time that our population is aging and the need for care and support is increasing, declining birthrates mean that the population of caregivers is shrinking. In Maine, where we’re already the oldest state in the nation by median age, this trend poses a particular challenge.

Today, there are seven potential caregivers for each person over 80 and at the highest risk of requiring long-term care. By 2030, there will be four, and by 2050, the number drops to fewer than three. As a consequence, more people will have to rely on fewer caregivers.

Families will likely continue to be the most important source of support for people with long-term care needs. In 2013, family caregivers provided an estimated $470 billion in uncompensated long-term care – in Maine alone, that estimate is $2.2 billion.

Family caregivers face tremendous challenges. The typical family caregiver is a 49-year-old woman who takes care of an older relative. Thirty-four percent of family caregivers, however, are seniors age 65 or older. Nearly one in 10 is 75 or older.

Many of these caregivers are putting their own health at risk, since caregivers experience high levels of stress and have a greater incidence of chronic conditions like heart disease, cancer, and depression.

Most family caregivers are employed and struggle to balance their work and caregiving responsibilities. Nearly seven in 10 caregivers report making sacrifices in the workplace because of their caregiving responsibilities. Family caregivers age 50 and older who leave the workforce to care for a parent lose, on average, nearly $304,000 in wages and benefits over their lifetime.

As a nation, we must do more to care for our family caregivers.

I have introduced bipartisan legislation, which has been endorsed by the AARP and the Alzheimer’s Association, to require the secretary of health and human services to develop a national strategy to support family caregivers. Titled the Recognize, Assist, Include, Support, and Engage, or RAISE, Family Caregivers Act, the legislation is based on a recommendation of the bipartisan Commission on Long Term Care.

It is modeled after a law that I co-authored in 2010 with then-Sen. Evan Bayh, D-Ind., that created a coordinated strategic national plan to combat Alzheimer’s disease and has made a real difference in our fight against Alzheimer’s.

The RAISE Act directs HHS to establish a National Family Caregiving Project to develop and sustain a national strategy to support family caregivers. The bill would create a Family Caregiving Advisory Council composed of relevant federal agencies and non-federal members.

It would include family caregivers, older adults with long-term care needs, individuals with disabilities, employers, health and social service providers, advocates for family caregivers, state and local officials and others with expertise in family caregiving.

The Advisory Council would be charged with making recommendations to HHS. The strategy and plan would be updated annually to reflect new developments.

The plan would include an initial inventory and assessment of federally funded caregiver efforts. It would then identify specific actions that government, communities, employers, providers and others can take to support family caregivers.

The project would be funded entirely from existing HHS funding.

Family caregivers are an invaluable resource to our aging nation. Chances are that, sooner or later, we will all either be family caregivers or someone who needs one. We need to do more to support those who have given so much to care for a family member with significant long-term care needs.

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Commentary: As nation ages, we must do more to care for family caregivers, Collins says

Police: Employee stole $4.6K from elderly victim

Andi Michelle Shaw
A 24-year-old Gulf Breeze woman is facing felony charges after police said she stole $4,600 from an elderly person while working at The Blake, an assisted living facility in Gulf Breeze.

Andi Michelle Shaw was arrested Aug. 12 on 11 counts of writing bad checks; 11 counts of forgery; one count of exploitation of the elderly; and one count larceny.

Deputies responded to The Blake on July 30 after a friend of the victim reported several “unusual transactions” on the victim’s checking account statement. She told police checks were made out to Shaw, which the victim never authorized.

According to the report, Shaw told the friend that the victim wanted her to have the money and that she used it to pay bills. The victim said she had no knowledge that Shaw used her checks.

Shaw was released on $14,000 bond.

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Police: Employee stole $4.6K from elderly victim

Friday, August 14, 2015

California’s largest nursing home owner sued

Shlomo Rechnitz, a Los Angeles entrepreneur
By Marjie Lundstrom

The family of a 57-year-old nursing home resident who committed suicide last year by lighting herself on fire in public has sued the state’s largest nursing home owner over the woman’s gruesome death in suburban Los Angeles.

The lawsuit, filed Wednesday in Los Angeles Superior Court, accuses businessman Shlomo Rechnitz and several companies of operating a facility in South Pasadena that endangered patients and allowed mentally ill residents to languish in order to “maximize profits.”

The facility, Mission Grove Healthcare & Wellness Centre, situated in the city’s historic downtown district, has been an ongoing source of public controversy. South Pasadena police say they have been burdened by calls for service in and around the nursing home, often related to criminal activity by residents.

Courtney Cargill’s suicide last November capped a tumultuous year for Rechnitz and the nursing home, which failed four consecutive inspections in 2014 by health officials.

Formerly known as South Pasadena Convalescent Hospital, the facility was one of three California nursing homes owned by Rechnitz to be decertified by the federal government between October and January – stripping all three of their vital Medicare and Medi-Cal funding.

Rechnitz, 44, has quickly become California’s most influential nursing home owner, controlling 1 in every 14 skilled nursing beds across the state, according to a Sacramento Bee investigation published in June. His mushrooming network of 81 facilities, as of March, included Roseville Point Health & Wellness Centre in Placer County and 25 more facilities in Northern California, according to a list his company provided.

Rechnitz’s spokeswoman, Sallie Hofmeister, declined Wednesday to specify the current extent of his California nursing home holdings.

In the past year, his facilities have become the focus of state and federal scrutiny and a flurry of citations and fines for alleged poor quality care. The South Pasadena facility, for instance, was hit with 24 citations in March and April and $195,500 in fines from the California Department of Public Health. State inspectors identified a host of problems, including the facility's alleged failure to properly supervise Cargill, a resident known by staff to be suicidal with a history of schizophrenia, anxiety disorder and involuntary psychiatric holds.

Hofmeister declined to comment on the lawsuit. In a March interview, Rechnitz and his attorney contended that the business owner had been unfairly targeted by government regulators.

In that interview, Rechnitz expressed pride in the South Pasadena operation and its history of generally positive inspections. Rechnitz said he was “shocked” by last year’s failure of four consecutive surveys that led to the facility’s decertification.

The Cargill family’s lawsuit contends that Courtney, who had been placed there by the public guardian, was not treated for her mental health problems. Instead, the nursing home housed her in “a ‘room and board’ fashion, content to let her smoke cigarettes and watch TV all day,” according to the complaint.

“It wasn’t the right place for her,” said attorney Jody Moore, who is representing the family. “She wasn’t getting the services she needed.”

Despite Courtney Cargill’s poor decision-making capabilities and irrational behavior, the lawsuit states, staff members made arrangements allowing her to leave the facility “on pass,” alone and unsupervised. The lawsuit contends that the sign-out sheet “falsely” indicated that Cargill returned to the facility at 9:30 a.m. on the morning she lit herself on fire – even though she was immediately rushed to a hospital, where she died the next day.

“It’s just really impacted the small family we have,” said her sister Casey Cargill, 62, of Costa Mesa.  “Nobody helped her in any way over there. To let her languish without any treatment – it’s just so sad.”
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California’s largest nursing home owner sued

Announcer accused of financial exploitation

Husker football game announcer Patrick Combs has been accused of stealing the money of two elderly women after manipulating them into signing away their powers of attorney.

Combs, 49, of Gretna, was booked into the Lancaster County Jail about 6 a.m. on Thursday and was released that evening, a jail spokeswoman said.

The Lancaster County Attorney’s Office has charged Combs with five felonies: abuse of a vulnerable adult, attempted theft, two counts of theft by unlawful taking and unauthorized use of a financial transaction device.

Combs has been the public-address announcer for Husker games at Memorial Stadium for more than 10 years. The University of Nebraska-Lincoln has touted him as a distinguished alumnus who graduated in 1988 after studying political science and communications.

His contract with the University of Nebraska Athletic Department expired on Aug. 1.

“Under the circumstances, we will not consider renewing the agreement until all legal issues are resolved,” Keith Mann, a spokesman for the university, said Thursday in a statement.

In an affidavit written by Lincoln Police Detective Cynthia Koenig-Warnke, Combs is accused of spending more than $360,000 belonging to an 88-year-old widow who had suffered dementia since 2012.

Combs is also accused of taking more than $20,000 from the estate of the dead brother of a 92-year-old woman. Combs did not respond to a call Thursday seeking comment.

Authorities say Combs told the women he would help them take care of their finances. Instead, authorities allege, Combs dipped into their accounts to buy four cars, make home improvements, pay off his debt and to make other personal purchases.

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Announcer accused of financial exploitation

Man indicted for taking money from his elderly father

By Tom Smith

FLORENCE — A Florence man remains in jail after he was accused of using his elderly and disabled father’s debit card to withdraw more than $10,000 from the account and then trying to use the same card to bond himself out of jail.

Roger C. House, 63, 1828 Nassau Blvd., Florence, is charged with fraudulent use of a credit card, first-degree financial exploitation of the elderly and second-degree theft of property.

Police Detective Justin Wright said House was taken into custody Tuesday after being indicted during the July session of the Lauderdale County grand jury. He said House was indicted on the charges of fraudulent use of a credit card, and financial exploitation of the elderly.

The second-degree theft of property charge was added after House tried to use the same debit card to bond himself out of jai, Wright said.

House is accused of going to businesses and using the card to buy items and get $200 cash advances.

Wright said this went on for more than a year, with House taking more than $10,000 out of his father’s account.

“His father got suspicious but never would say anything to his son,” Wright said. “He finally did tell someone what he suspected was going on, and that third party called us.”

Jerry Groce, district specialist for the Alabama Department of Human Resources, said financial exploitation is a growing problem for the elderly.

“We see more and more financial exploitation cases, where family members, usually children, are tapping into their parent’s resources, savings, checking account, and even their trust funds,” Groce said.

“Unfortunately, this type of elder abuse goes unnoticed a lot of times.”

Groce said many older residents can be very trusting. “They are sometimes afraid to say anything because they don’t have anyone else to look after them, or they’re ashamed to say their family members are taking money from them.”

House is being held in the Lauderdale County Detention Center on bail totaling $12,500. He is scheduled to be arraigned Aug. 19 by Lauderdale County Circuit Judge Gil Self.

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Man indicted for taking money from his elderly father

New law to help protect seniors from exploitation

Missouri lets brokers delay trades when financial abuse is suspected

A Missouri law that goes into effect later this month could help protect older investors and adults with certain disabilities from financial exploitation. The Senior Savings Protection Act, effective August 28, will enable certain brokerage employees to delay investment trades requested by people ages 60 and up, and adults ages 18 to 59 with certain disabilities, if they think completing the trades would result in financial exploitation.

The investment professional must then notify the Missouri Department of Health and Senior Services; the state's commissioner of securities; and individuals connected with the account or the vulnerable adult, including family members, conservators, guardians, and those with powers of attorney.

The delay can only last up to 10 days. The law protects the professionals from civil lawsuits resulting from the trading delay if they act in good faith. The law doesn't apply to all disabled adults; rather, it focuses on people with physical or cognitive disabilities that might interfere with good financial decision-making, said Ron Long, director of regulatory affairs and elder client initiatives for St. Louis-based Wells Fargo Advisors. His company and three other brokerages pushed for the legislation.

The law also allows for brokers to contact relatives or other people close to the senior who aren't even named on the account, Long explained. That could be crucial if a guardian or person with power of attorney is the one actually doing the exploitation, a common occurrence. "This law allows a firm suspecting misconduct to have the eyes of a regulator and adult protective services agency to look at a situation at the time of or soon after financial misconduct occurs," Long said. "It is that extra scrutiny that often is missing in the majority of financial abuse cases."

Brokers can't act spontaneously in blocking trades; they must first check with a compliance officer, legal department or supervisor. The law only applies to employees of broker-dealers, though Long said he thought other types of financial entities could be subject to similar regulations in future years.

The law doesn't require brokers to report abuse. Rather, it offers guidelines in the event they do. It also mandates that, by September 2016, the state's commissioner of securities set up a training website for those professionals, including how to identify elder financial fraud, and how to report it.
Delaware and Washington have similar statutes.

The Department of Labor has proposed that broker-dealers be subject to fiduciary standards that require financial advisers to act in their clients' best interests. Consumers Union, the advocacy arm of Consumer Reports, supports that initiative. But Long maintained that new fiduciary standards would not prevent adult financial exploitation, because the rules relate to investment recommendations, not to actions an investor takes on his or her own.

"The fiduciary rule does not say a client must act in her own best interests," Long noted. "No fiduciary rule will allow an adviser to say, 'I know you want to sell this XYZ stock, Mary, to use the proceeds to gamble in Las Vegas. But as your fiduciary, the law requires me to prohibit you from doing it because it is not in your best interest.'"

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New law to help protect seniors from exploitation

Thursday, August 13, 2015

Colorado lawmaker pledges probate reform after hearing victim stories

By David Olinger

A state senator plans to introduce legislation next year that would provide greater protection to families who saw their estates diminished or wiped out by court-appointed fiduciaries.

Laura Woods, an Arvada Republican, took statements from about two dozen people who went Wednesday to a hearing about probate reform. A Senate Democrat, Pat Steadman of Denver, joined her and took notes as family members angrily recounted personal stories.

The senators got about 50 suggestions. Woods said afterward that bipartisan probate court legislation "absolutely" will be on the Senate agenda next year.

The overall goal will be to protect families involved in the probate system, she said. She said those she has met see this pattern: "Instigate, litigate, isolate, medicate, liquidate, take the estate — celebrate."

Woods would like to see an outside review triggered automatically when a certain portion of an estate, perhaps as low as 10 percent, has been spent by a court-appointed fiduciary.

That might have helped Diego Conde, a 20-year-old man who came to the United States from Colombia at age 3.

Conde said his mother built a house-cleaning business and saved $20,000 for his college education before she died of stomach cancer. At 12, he became a foster child, he said, and a lawyer named Tamra Palmer was assigned to conserve his money.

When he went to college, "I had trouble getting her on the phone. My bills weren't getting paid on time. I got an eviction notice."

He said he was too embarrassed to ask classmates for food and soon learned that all his money was gone after Palmer deducted her fees.

"I was just very misguided throughout the whole process," he said.

Palmer was dismissed as Arapahoe County's public administrator last year after The Denver Post reported about her business relationship with Jennifer Gormley, a lawyer who collected substantial fees with Palmer in Arapahoe County probate cases.

Palmer could not be reached for comment immediately.

Public administrators are appointed in probate court cases where no heir is named or willing to distribute the assets of an estate. They also may be called as conservators of estates when people are judged incompetent to handle their own finances.

While some who came to Wednesday's hearing complained about Palmer and Timothy Fasing, the probate judge in Arapahoe County, others said they had been victimized by the probate systems in Jefferson and Denver counties.

Many expressed fears of retaliation. Two women donned masks as a television camera ran. "How many in this room have been threatened?" Senate aide Cheryl Steinberg asked. Nearly everyone raised a hand.

One common complaint: If a ward objects to the fees of a guardian, conservator, trustee or other court appointee, the fiduciary can spend the ward's money to battle the ward in court.

Reform ideas among the witnesses ranged from rotating probate judges to changing the judicial retention system, making probate records more accessible and reining in fees of multiple fiduciaries by creating a state Office of Public Guardian.

The latter idea is being promoted by Susan Scott, whose family spent 12 years in Denver's probate court before settling a dispute.

She said her father spent $1.5 million battling a court-appointed trustee and is still in debt from the case. The estate was salvaged only because the family home grew in value during the long court case, she said. Scott also suggested that legislators inquire about money kept in the Denver court's probate registry.

"How many cases? How much money is in there? How is it managed? (The answers) could be quite shocking," she said.

Woods said the probate problems raised at the hearing are not unique to Colorado.

"This is happening across the country," she said. "It's a big problem."

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Colorado lawmaker pledges probate reform after hearing victim stories

Lawmakers to take on receivership, probate abuse

ACCOUNT DRAINED: Aurora resident Diego Conde said half of the meager estate his mother left him was used to pay fees and expenses of a court-appointed guardian.
By Arthur Kane |

DENVER — When Diego Conde’s mother died in 2008 she left him a modest $20,000 inheritance to help pay for school and other expenses. But since he wasn’t 18, the court appointed a guardian to oversee the estate.

By the time he turned of age, the money was gone and, he said, half went to expenses and compensation for the guardian.

“My college bills weren’t being paid on time, I got an eviction notice and there was no food,” Conde told a bipartisan group of lawmakers who are looking to draft a bill to rein in abuses by court-appointed receivers, guardians, trustees and conservators.

A group of two dozen Colorado residents, some wearing masks for fear of contempt citations for speaking out against judges and their appointed trustees, gathered Wednesday to suggest changes to state law.

“I know you guys are hurting, I know you want to tell your story and I know why,” state Sen. Laura Woods, R-Arvada, told the attendees.

Woods tried to pass a bill last session that would have allowed lawsuits against receivers and quick appeals for people who felt their receivers weren’t doing a proper job.

The bill failed after opposition by attorneys and the Colorado Judicial Branch.

At Wednesday’s meeting, participants suggested 50 different solutions, including having a non-judicial committee review cases when 10 percent of the estate is spent and preventing sales of assets for less than market value or to friends or family of court-appointed overseer.

“I’m not sure that’s not borderline criminal,” said Woods, reacting to stories of assets bought a bargain prices, apparently by relatives of a trustee.

Woods also said she is urging the state Attorney General’s office to look into cases in which people are forced onto Medicaid after their assets are drained by an overseer appointed by the court. It’s a process that could be costing taxpayers substantial money.

Photo By Arthur Kane
Photo By Arthur Kane
FREE SPEECH?: Several people who say they were victims of court-appointed overseers refused to show their faces, fearing retaliation in court from judges or their appointees.

Conde, who lives in Aurora but was born in Colombia, said he didn’t know how to question the process or how severe the problem was until all the money was gone.

“I really depended on this lady and all my money was depleted,” he said.

Woods and state Sen. Pat Steadman, D-Denver, attended the meeting with staff. Woods said she hopes to have legislation drafted before the 2016 session.

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Lawmakers to take on receivership, probate abuse

Beaver County widow won't lose home over $6.30 late fee

By Adam Brandolph

A Beaver County widow whose house was sold out from under her because of a $6.30 late fee may keep her home. 

By declining Tuesday to hear the appeal of the Beaver County Tax Claim Bureau, the Pennsylvania Supreme Court upheld a decision reversing the auctioning off of Eileen F. Battisti's Beaver County home over a $6.30 delinquent tax fee and related charges. 

In December, a Commonwealth Court panel said the county Tax Claim Bureau failed to offer Battisti, 54, of Center an installment payment plan as real estate tax law requires. That opinion and order reversed the September 2011 sale of Battisti's house to S.P. Lewis of Imperial, who bought the Rosewood Drive property for $116,000, according to court records. 

Neither Battisti nor her lawyer, Ed Santillan, returned calls. Lewis could not be reached. 

Battisti argued in court documents that county officials improperly sold her home after failing to supply proper notifications about the sale or about the late fee that led to the auction. 

The $6.30 fee on her unpaid 2008 school property taxes had ballooned to $234.72 with interest and other costs by the time Lewis bought the home. 

The county court has allowed Battisti to continue living in the house. Court records said Battisti struggled to cope with household finances after her husband's death in 2004.

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Beaver County widow won't lose home over $6.30 late fee

Wednesday, August 12, 2015

Former Columbus attorney, guardian pleads guilty to theft

COLUMBUS, Ohio (AP) - A former Columbus attorney who served as a court-appointed guardian to nearly 400 Ohioans admitted he stole from four of his wards and from taxpayers.

The Columbus Dispatch reports ( ) 65-year-old Paul Kormanik pleaded guilty Tuesday to four counts of theft from an elderly or disabled person, one count of theft and five counts of tampering with records. The maximum combined sentence for the offenses is 23 years.

Prosecutors say Kormanik took just over $40,000 from accounts belonging to three of his wards after they had died and moved an additional $6,368 in life-insurance proceeds he received as guardian of another woman to his personal checking account.

Kormanik also falsified applications for city-paid funeral expenses on behalf of his wards by concealing their assets.

Sentencing is scheduled for Oct. 20.

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Former Columbus attorney, guardian pleads guilty to theft

See Also:
Lawyer charged with stealing from wards, bilking burial fund 

Investigations launched into billing by lawyers appointed as guardians

Wards of indicted guardian are missing items, relatives say

Guardianship bill needed

Owner of Detroit Home Health Care Companies Sentenced to 80 Months in Prison for Role in $12.6 Million Fraud Scheme

A Michigan resident was sentenced to 80 months in prison late yesterday for his leading role in a $12.6 million Medicare fraud and tax fraud scheme.  Eleven other individuals have been convicted in this case.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) Chicago Regional Office and Special Agent in Charge Jarod Koopman of the Internal Revenue Service-Criminal Investigation (IRS-CI) Detroit Field Office made the announcement.

Mohammed Sadiq, 67, of Oakland County, Michigan, pleaded guilty on March 13, 2015, to one count of health care fraud and one count of filing a false tax return.  In addition to imposing the prison term, U.S. District Judge Denise Page Hood of the Eastern District of Michigan ordered Sadiq to pay $14.1 million in restitution and entered a forfeiture judgment for the same amount, which represents the proceeds traceable to his criminal conduct.

Sadiq owned and directed operations at two home health care companies in Detroit.  In connection with his guilty plea, Sadiq admitted that, working with co-conspirators, he billed Medicare for home health services that were not provided.  Sadiq also admitted to paying kickbacks to patient recruiters in order to obtain the information of Medicare beneficiaries, which he then used to bill Medicare for services that were not medically necessary or were not provided at all.  Sadiq further admitted that he created fake patient files to fool a Medicare auditor by making it appear as if home health services were provided and medically necessary.  Medicare paid $12.6 million for these services.

In connection with his guilty plea, Sadiq also admitted that he received proceeds of the fraud through bank accounts that he controlled, that he withdrew substantial sums for his personal use and that he failed to report these amounts on his individual federal income tax return in 2008.  In total, Sadiq admitted that he owes approximately $1.5 million in taxes, interest and penalties for tax years 2008 through 2010.

This case was investigated by the FBI, HHS-OIG and IRS-CI, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Eastern District of Michigan.  The case is being prosecuted by Trial Attorneys William Kanellis, Christopher Cestaro, Brooke Harper and Elizabeth Young of the Criminal Division’s Fraud Section, as well as Assistant U.S. Attorney Patrick Hurford of the Eastern District of Michigan.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,300 defendants who have collectively billed the Medicare program for more than $7 billion.  In addition, HHS’ Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
Full Article & Source:
Owner of Detroit Home Health Care Companies Sentenced to 80 Months in Prison for Role in $12.6 Million Fraud Scheme

2 home health care workers accused of stealing from elderly clients

Kathy Elliott, 66, and Anita Puskas, 42

Two home health care workers have been accused of stealing from their elderly clients.

Kathy Elliott, 66, of Ruskin, and Anita Puskas, 42, of Riverview, are facing charges of exploiting the elderly women for whom they worked as in-home health care companions.

Investigators said Elliot took large amounts of jewelry from the homes of two women, ages 67 and 98, then pawned the items.

During the investigation, detectives learned about another case of elderly exploitation involving Puskas, officials said.

Puskas is accused of withdrawing large amounts of money from an 87-year-old woman's bank account.

Elliot was arrested Tuesday on two counts of exploitation of an elderly person, two counts of grand theft, two counts of dealing in stolen property and two counts of false information on a pawnbroker form. Additional charges are pending.

Puskas was arrested last week on charges of exploitation of an elderly person, grand theft and 12 counts of fraudulent use of a credit card.

Officials said both women were employed by Hanson Services.

Detectives are asking any other potential victims to contact the Hillsborough County Sheriff's Office at 813-247-8200.

The investigation continues.

Full Article & Source:
2 home health care workers accused of stealing from elderly clients

Tuesday, August 11, 2015

New Mexico nursing homes allegedly prioritizing profits over patients

Residents at Casa Real, a leading chain of New Mexico nursing homes, went hungry because they couldn't feed themselves, fell when they tried to make it to the bathroom unassisted, and languished for hours in soiled bedding, according to the state’s complaint. In this excerpt from America Tonight, Michael Okwu investigates whether for-profit nursing home chains put profits over patients in the Land of Enchantment.

New Mexico nursing homes allegedly prioritizing profits over patients

Alert: NYS Commission on Attorney Discipline


NYS Commission on Attorney Discipline

is holding the last of three public hearings

Tuesday, 8/11/15


Members in NY are encouraged to attend:

New York County Lawyers' Association,
14 Vesey Street,
New York, 10007

(lower Manhattan between Broadway and Church - 
just below City Hall).

From 11:00 a.m. to 2:00 p.m.

Woman accused of stealing more than $100,000 from 93-year-old mother

OVERLAND PARK, KS (KCTV) - Overland Park resident Christine Raya is charged with stealing more than $100,000 from her 93-year-old mother's trust fund.

Authorities said Raya used the money for all sorts of things: bills, outfits and even ballroom dance lessons.

Raya posted a YouTube video of her ballroom dancing. The folks at TEAH Ballroom Dance Studio at 90th Street and Metcalf Avenue in Overland Park said Raya was a frequent customer for the last two years.

Workers at TEAH told KCTV5 Raya said she had to give her dancing up to take care of her elderly mother. Authorities say the person Raya really took care of was herself with her mother's money.

She's been charged with mistreatment of an adult and theft. The charges allege Raya took advantage of her mom. Police say it's things like the ballroom dance classes that may have contributed to the charges.

"Lot of things the money was spent on paying bills, ballroom dancing lessons, and outfits and things like that. It was a lot of money. There were just a lot of different things where she was abusing the money that wasn't intended for her," said Overland Park Police Department Officer Gary Mason.

The dance studio changed ownership earlier this year and only a few people here knew Raya. Those who did know her didn't want to go on camera. We also knocked on the door of Raya's Overland Park home, but no one answered.

Police say someone at the financial institution where Raya's mother, Janet Bersbach, kept her money blew the whistle. Suspicions grew as more and more money was siphoned from her mother's account.

"The main point of this it was set up in a trust fund. The reason we do this is so it's not abused. It's designed to protect people. When it doesn't, it's a sad situation," Mason said.

Raya is out of jail tonight after posting a $10,000 bond.

Full Article & Source:
Woman accused of stealing more than $100,000 from 93-year-old mother

Monday, August 10, 2015

Court and Probation Company Are Running 'Extortion Racket,' Alabama Judge Says

If the city of Harpersville, Ala., intends to jail an individual for failing to pay a fine, it will first have to persuade Shelby County Judge Hub Harrington of the necessity.

Ruling last Wednesday in a suit claiming constitutional violations, Harrington said the Harpersville Municipal Court and a private probation company appear to be running “a judicially sanctioned extortion racket.” The Birmingham News has a story.

Depositions indicate that criminal defendants appearing in the Harpersville Municipal Court “have been subjected to repeated and ongoing violations of almost every safeguard afforded by the United States Constitution, the laws of the State of Alabama, and the Rules of Criminal Procedure,” Harrington wrote in an order (PDF) issued Wednesday.

Harrington temporarily enjoined the city from incarcerating individuals on probation or in post-conviction proceedings unless it first holds a hearing and then obtains his permission. He also said individuals who are convicted must have at least 30 days to pay fines and court costs without being assessed additional fines.

Harrington said the constitutional violations are “so numerous as to defy a detailed chronicling in this short space.” He listed “the most egregious abuses,” however.

Defendants are placed on probation with the company, he said, when they are unable to pay the entire amount of assessed fines and court costs on the day of trial. Defendants are jailed, without adjudication, for failure to pay fines or appear in court. Because of the failure to appear or pay, there is a new criminal charge for contempt of court with incarceration and additional fines, again without adjudication. In some cases, fines and fees amounts to “thousands upon thousands of dollars.”

Harrington wrote that he came to his conclusions while reviewing depositions. “When viewed in a light most favorable to defendants, their testimony concerning the city’s court system could reasonably be characterized as the operation of a debtors prison,” he wrote. “The court notes that these generally fell into disfavor by the early 1800s, though the practice appears to have remained commonplace in Harpersville. From a fair reading of the defendants’ testimony one might ascertain that a more apt description of the Harpersville Municipal Court practices is that of a judicially sanctioned extortion racket. Most distressing is that these abuses have been perpetrated by what is supposed to be a court of law. Disgraceful.”

Full Article & Source:
Court and Probation Company Are Running 'Extortion Racket,' Alabama Judge Says

UPDATE: Ex-Probate clerk Kim Birge to plead guilty in theft case on Friday

Former longtime Chatham County Probate Court Chief Clerk Kim Birge is scheduled to plead guilty Friday to charges of stealing or embezzling more than $700,000 from the court over a three-year period.

According to court documents, Birge has reached a plea agreement with federal prosecutors and will change her not guilty plea to some or all of the five-count indictment during a session before U.S. District Judge William T. Moore Jr.

The government’s notice of a plea agreement, which was entered on Monday, simply states “that a plea agreement has been reached by the parties which would dispose of the charges pending in the … case against the defendant.”

A copy of that agreement has been provided to Moore for his consideration, Assistant U.S. Attorney Scarlett Nokes said in the filing.

Typically a defense attorney, in Birge’s case attorney Tom Withers, will negotiate a deal where the defendant will plead guilty to some of the charges, with the government dismissing others in return for a plea agreement.

Final determinations on sentencing are the judge’s alone. Details of Birge’s accord will not be made public until the actual court hearing.

Birge, 61, remains free on a $40,000 unsecured bond pending disposition of the case.

Birge was named May 18 in a five-count indictment that included four counts of mail fraud by using the mail to defraud Chatham County out of $700,000 between January 2011 and November 2014 and then using the cash for her own benefit.

A fifth count charged federal program fraud. It alleged she stole about $767,218 between Jan. 1, 2014, and Dec. 31, 2014, from Chatham County, money that involved a federal grant.

The count included the same funds and time frame as the mail fraud counts.

Included in the indictment is a forfeiture allegation in which the government says, if she’s convicted, it will try to recover “any property, real or personal” derived from the offense.

The indictment charged that Birge in her capacity as chief clerk of Probate Court was authorized to conduct transactions in at least two court bank accounts but “was not authorized to conduct transactions in the Probate Court bank accounts for the benefit of herself or her family.”

It charges she would sign court orders to direct insurance companies, private businesses, public employers, banks and other entities to send funds to the court “for the benefit of minors and other individuals who had conservatorships” established in Chatham County.

A conservatorship establishes someone to watch out for money or property for minors or incompetents in the court.

Birge would then deposit fees paid to the court into one of two bank accounts maintained by the court and make representations that the money would be used for court matters, the indictment charged.

She would then forge the signatures of conservators and/or their attorneys to create false documents to disburse the money, would use the cash from negotiated checks for her personal use and would fail to disclose her activities to others in the court, the indictment charged.

Probate Judge Harris Lewis fired Birge on Dec. 2 in what was described as “in the best interests” of the court.

He had placed Birge on investigative suspension without pay Nov. 20 during a probe of “discrepancies with the services that you are responsible for handling,” Lewis said in a Nov. 20 letter.

As part of Lewis’ initial action, Birge has been barred from entering the Montgomery Street courthouse or discussing any matters related to the investigation “with anyone other than investigatory staff, unless otherwise directed to do so.”

The action came in wake of a reported federal/Savannah-Chatham police probe of undisclosed activity.

Full Article & Source:
UPDATE: Ex-Probate clerk Kim Birge to plead guilty in theft case on Friday

See Also:
Kim Birge pleads not guilty to Probate Court fraud charges 

Former Probate Court clerk Kim Birge indicted in theft of more than $700,000 from the court

Wells Fargo Risks Lawsuits to Protect Its Elderly Clients

Not waiting for regulators — including state-government agencies — to expand protection of senior customers, Wells Fargo has decided to allow its brokers to interfere, even if the action could lead to lawsuits, Financial Advisor magazine writes.

Regulators certainly seem to be looking into ways to curb elder abuse. Finra launched a senior help line in April and — according to Gerri Walsh, head of Finra’s Investor Education Foundation — has already received 1,000 calls from brokerage clients as well as executors and beneficiaries of estates, reports the magazine.

But Wells Fargo is preparing to tackle the issue. Appearing at a Practising Law Institute seminar last week, Wells Fargo managing counsel Beverly Jo Slaughter said the firm’s brokers will be able to stop transactions if they suspect fraud — regardless of whether they have legal authority — even at the risk of getting sued, Financial Advisor reports.

While Wells Fargo’s Elder Services Program is working with state regulators to grant brokers the right to stop transactions, some states apply the right only to abuse at nursing homes and not to financial exploitation, the magazine quotes Slaughter as saying.

One form of such exploitation, according to the magazine, stems from recently arrived young “foreign friends” — often grifters intent on wringing money from their victims — Joseph Peiffer, president of the Public Investors Arbitration Bar Association, tells Financial Advisor.

In a specific measure against such shenanigans, Slaughter says her employer is teaching its advisors how to take notes as concrete evidence of elderly customers’ intentions in the face of contrary — and potentially exploitative — directives, the magazine writes.

By Alex Padalka

Full Article & Source:
Wells Fargo Risks Lawsuits to Protect Its Elderly Clients

Sunday, August 9, 2015

Tonight on T.S. Radio: Lory Happeny: The Glen Campbell Story

Hosted by Marti Oakley & Debbie Dahmer

Lory grew up in the 1970's in a middle-class family in the beautiful state of Washington. Life was good, but not perfect. After school she would gather up some drinks and snacks and hide out in her room playing Glen Campbell's music. Her abusive step-father left her alone when Glen was playing. As an adult, she found herself in some unhappy relationships, but she overcame them and was blessed with two beautiful, smart daughters and two grandchildren.

After her father's death, Lory moved to another state to start anew. She began teaching medical classes for a private college, and did so for ten years before being let go with several of her co-workers. Her disabilities became too severe for her to work, but she donates her time, when physically able, at her local senior center. Lory has always been concerned about elders and the loneliness and abuse that so many of them suffer. She is ultimately concerned that no one is a voice for them.

When Lory heard that Glen Campbell, the man who had saved her childhood, protecting her from the abuses of her step father, had been institutionalized, she began looking into things and reading articles and realizing that pieces didn't seem to fit. Now she works hard to uncover all the disturbing facts about Glen. She also runs a growing Facebook page - called Glen Campbell is loved - where people remember and praise Glen, worry about Glen, and get strength and support from one another while providing care to their own loved ones with Alzheimer's.

LISTEN to the show live or listen to the archive later

Elderly millionaire’s estate battle takes a surprising turn

Hattie Poole
By Gilbert Garcia

There are few cases in our civil-court system more painful than those that deal with conflicts over guardianship of the elderly.

They bitterly divide families — turning siblings against each other, and children against parents. They also force proud, accomplished people to have their basic mental competence tested, dissected and discussed.

San Antonio recently experienced a prominent case of this kind, when the heirs of billionaire car dealer Tom Benson, owner of the New Orleans Saints and Pelicans, filed suit to remove him as trustee of a Texas trust fund, arguing that Benson was not competent to manage his own affairs.

Two months ago, I wrote about a similarly bitter San Antonio probate case, this one involving Hattie Poole, a widely admired 85-year-old millionaire and philanthropist whose late husband, Duane, passed away in 2012.

Poole, whose estate has been estimated to be at least $3 million, subsequently established a relationship with Ben Marek, a man 30 years her junior, and her three sons began to worry that Poole was being manipulated by Marek into burning through her estate.

Last December, Poole attempted to transfer $225,000 to Marek, and Frost Bank responded by freezing her account. She also transferred property to Marek and put him on the payroll at Industrial Communications, the company she inherited from her husband, despite allegations that he does not actually work there.

The case was referred to Adult Protective Services and a neuropsychological exam determined that Poole suffers from mild but substantial memory and executive function loss.

A common denominator in the Benson and Poole cases has been the involvement of Bexar County Probate Court Judge Tom Rickhoff, who placed Poole under the temporary guardianship of her son, Jeff.

Poole’s biggest source of frustration with Rickhoff was that he denied her the opportunity to pick her own attorney. She believed the decision rendered her powerless: not only denied control of her financial affairs but also forced to pay for a court-appointed attorney she believed did not represent her interests.

Rickhoff declined to be interviewed for this column.

Barry Snell, the attorney Poole selected, filed a motion in Rickhoff’s court on February 13, requesting that Snell be allowed to represent Poole. The motion argued that Poole is “mentally competent and has capacity to contract,” and that denying her the right to the counsel of her choice amounted to a violation of the due-process clause of the 14th Amendment.

In the two months since I wrote that column, Poole’s guardianship status has remained in limbo, but there has been a surprising development with her case.

During an Internet search, Poole noticed that local attorney Phil Ross has represented several elderly people in probate disputes, so she enlisted Ross to join Snell on her team. According to Poole’s daughter Laura, who has backed her mother in her legal fight, Snell subsequently decided to withdraw from the case.

It would be an understatement to say that Ross and Rickhoff have some history together.

They’ve often butted heads in the courtroom, and last year Ross decided to challenge Rickhoff in the Republican Primary. In March 2014, Rickhoff filed a complaint against Ross with the Texas Ethics Commission, alleging that Ross failed to include a disclosure statement on political advertising. TEC rejected the complaint, but Rickhoff won the primary with more than 70 percent of the vote.

On January 22 of this year, Rickhoff filed a grievance against Ross with the State Bar of Texas, stating that Ross had forced him to endure “the most bizarre behavior I’ve ever encountered from one lawyer.” (A decision is still pending from the State Bar.)

On July 27, Ross — acting as Poole’s attorney — filed a motion requesting that Rickhoff recuse himself from Poole’s case. Any further guardianship decisions must wait until the recusal issue is resolved.

Ross also contends that changes in the Texas Estates Code enacted on June 19 will protect Poole’s right to hire her own attorney. The law authorizes wards in guardianship cases to “petition the court and retain counsel of the ward’s choice.”

Two months ago, Poole told me: “I feel as though I’ve been pushed in a corner.” It’s a sentence that could be uttered by countless elderly people in estate cases.

Full Article & Source:
Elderly millionaire’s estate battle takes a surprising turn

Lancaster City District Judge Kelly Ballentine removed from bench


Kelly Ballentine
A Lancaster city district judge suspended for dismissing her own traffic tickets  and failing to file tax returns has been removed from the bench.

Pennsylvania's Court of Judicial Discipline, in a 5-3 ruling, filed an order Tuesday that removes Magisterial District Judge Kelly Ballentine from her Locust Street office.

She held the post in the city's southeast quadrant since January 2006.

"Judge Ballentine has failed to conduct herself at all times in a manner that promotes public confidence in the integrity and impartiality of the judiciary," President Judge Timothy F. McCune wrote for the majority.

McCune added, "The hypocrisy inherent in judging others for tax violations while she herself was committing those same violations certainly contributes to causing disrepute."

"The cumulative effect of all this misconduct over a period of years mandates a severe sanction," he wrote.

Ballentine's attorney, Samuel C. Stretton of West Chester, called the ruling "awfully harsh and wrong" and said Ballentine will appeal to the state Supreme Court, which must take the case.

"I'm not saying she should do these things. Don't get me wrong," Stretton said. "But the offenses were relatively minor. I don't think it warranted removal. We have suggested a suspension of several months without pay."

He said Ballentine was "very disappointed, surprised and shocked" by the decision.

Ballentine becomes the 13th Pennsylvania magisterial district judge removed from office since the creation of the Court of Judicial Discipline in 1993, according to Robert A. Graci, chief counsel of the Judicial Conduct Board of Pennsylvania.

Removal "appropriate"

Lancaster County President Judge Dennis Reinaker, who oversees the county's district judges, called the removal "entirely appropriate."

"Her behavior represents a personal shortcoming and is, in no way, a reflection of the honorable service of the women and men who so ably serve our county as judges," Reinaker said Wednesday.
Ballentine was in the midst of her second six-year term, to run through 2018.

Senior district judges have been presiding over Ballentine's cases since she was suspended in February.

Ballentine pleaded guilty in February 2013 to three misdemeanors for entering the magisterial district judge's computer system and dismissing three of her own traffic tickets between Dec. 29, 2010 and Jan. 27, 2011.

She paid a fine, was placed on probation and was suspended from her duties for 16 months before returning to the bench in June 2013 on probation.

While under probation, she heard cases until February 2015.

Unpaid sales taxes

The Court of Judicial Discipline said Ballentine also engaged in judicial misconduct when she failed to file sales tax returns from 2009 to 2012 while she owned Walk-In-Style Fashion Footwear, 356 N. Queen St.

Because her store didn't sell many shoes, she failed to submit only about $130 in sale taxes during those years, according to the court opinion.

The state Revenue Department revoked Ballentine's business license in January 2012, but in September 2012 the state cited her for operating the business without a license.

For that summary offense, she was found guilty in October 2013 of a summary offense, and she paid $369.45 in fines and costs.

A Judicial Conduct Board inquiry then found that Ballentine failed to submit timely individual federal and state tax returns for five years — from 2009 through 2013.

Although she failed to file tax forms, Ballentine did pay taxes during those year through paycheck withholding.

"I saw no disrepute here in terms of the judge not filing her taxes when she did pay her taxes," said Stretton, Ballentine's attorney. "And there was never any complaint about her conduct on the bench."

Dissent issued

In a dissenting opinion, Judge Charles A. Clement Jr. wrote that Ballentine ran "an orderly and proper court while administering justice fairly."

"Judge Ballentine's conduct might be described as negligent or reckless," said Clement, adding tha the "ultimate sanction" of removal from office "is more properly reserved for intentional misconduct."

Clement said voters should have the final say.

Separately, a state House committee in June unanimously supported investigating Ballentine for possible impeachment. The bill moved to the full House.

State Rep. Bryan Cutler of Quarryville led the charge for an investigation.

Full Article & Source: 
Lancaster City District Judge Kelly Ballentine removed from bench

See Also:
District Judge Kelly Ballentine suspended without pay for failing to file taxes

Pennsylvania District Judge Kelly Ballentine Suspended From Practicing as an Attorney, But Continues to Sit on the Bench  

Feds Call for More Scrutiny of Nursing Home Errors Involving Blood Thinner

Inspectors are being asked to pay greater attention following analysis showing mistakes resulting in injuries and deaths.

by Charles Ornstein

The Centers for Medicare and Medicaid Services office in Maryland. (Jay Mallin/Bloomberg via Getty Images)

This story was co-published with The Washington Post.
The federal government is asking health inspectors nationwide to be on the lookout for errors by nursing homes in managing the blood thinner Coumadin, including those that lead to patient hospitalizations and deaths.

In a memo sent last month to state health departments, the Centers for Medicare and Medicaid Services cited a report by ProPublica and The Washington Post that focused on the harm caused by homes’ failure to manage the drug.

The analysis of government inspection reports found that, between 2011 and 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin. In some cases, homes gave residents too much of the drug, which caused internal bleeding. In other cases, they gave residents too little, leading to blood clots and strokes.

ProPublica’s findings “highlighted the adverse effects of poor Coumadin management for our beneficiaries and nursing home stakeholders,” Thomas Hamilton, director of CMS’ survey and certification group, said in a written response to questions from ProPublica. “We wanted the public to have confidence that CMS is aware of this as well as other high risk medications.”

In its July 17 memo, CMS – the federal agency that regulates nursing homes – also told state health departments that inspect nursing homes on its behalf about a new tool for identifying and reducing medication errors. The tool, developed with the Agency for Healthcare Research and Quality, is designed to help determine whether nursing homes are taking adequate steps to prevent mistakes and whether they respond appropriately if they occur.

Although Coumadin has clear benefits and is life-saving for those taking the right dose, a number of peer-reviewed studies suggest that it is can be dangerous if not closely monitored. A 2007 study in The American Journal of Medicine estimated that nursing home residents suffer 34,000 fatal, life-threatening or serious events each year related to the drug.

Last year, the Department of Health and Human Services identified Coumadin and other anticoagulants as a category of drugs frequently implicated in “adverse drug events” and called on government agencies to work on solutions.

“Adverse events related to high risk medications can have devastating effects to nursing home residents,” the July 17 memo said. “We are very concerned about the prevalence of adverse events involving such medications.”

Despite such evidence, Coumadin deaths and hospitalizations have drawn far less attention than other problems in nursing homes, including the use of antipsychotic medications. Such medications can put elderly patients into a stupor and increase their risk of falls.

Officials with the American Health Care Association, a trade group for the nursing home industry, said that they want to know whether the government intends to use its new medication error tool as a means to help nursing homes improve or a way to punish them.

“This document is written to detect stuff after the fact, to catch folks if they’ve done something wrong,” said David Gifford, the group’s senior vice president of quality and regulatory affairs. “I’m a little worried about that. We’ll wait and see.”

About 1 in 6 of the nation’s 1.3 million nursing home residents take an anticoagulant, according to federal data from earlier this year; the majority are believed to be on Coumadin or its generic.
Newer anticoagulants such as Eliquis, Pradaxa and Xarelto have entered the market in recent years and, in some ways, are easier to use than Coumadin. Patients taking these drugs don’t need regular blood tests and don’t have to avoid certain foods.

But unlike Coumadin, the effects of which can be reversed with vitamin K, there’s currently no antidote if patients taking the newer drugs begin bleeding uncontrollably.

Janet Snipes, administrator at Holly Heights Care Center in Denver, recently discussed her home’s approach to preventing Coumadin errors on a national call with other nursing home leaders. Nursing supervisors in every unit monitor a document that tracks each patient on Coumadin, their dose, the rate at which their blood clots, their ideal clotting rate, when tests are ordered, whether they have been performed, and whether doctors have been identified.

“If there’s a mistake, we want a system in place so that it’s caught,” Snipes said. “People get busy and they forget things but if you have a system, then it gets caught.”

Look up a nursing home’s record using ProPublica’s Nursing Home Inspect tool.

Full Article & Source:
Feds Call for More Scrutiny of Nursing Home Errors Involving Blood Thinner