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In addition to investigating what exactly happened to a particular patient or resident, formal discovery through written discovery requests is effective in establishing a nursing home's or assisted living facility's pattern of institutionalized substandard care for purposes of the Elder Abuse Act's enhanced remedies, as well as punitive damage liability. The Los Angeles nursing home and assisted living neglect lawyers at the Law Offices of Ben Yeroushalmi have extensive experience conducting discovery in elder abuse and neglect cases and understand that it is generally the goal of facility defendants to delay and obstruct discovery as much as possible. It is not uncommon for elder abuse attorneys to file dozens of motions to compel, and even motions for sanctions for a defendant's failure to comply. Plaintiffs should therefore anticipate fighting for and compelling each and every discovery request sent to these defendants.
The following categories of information are typical to request of defendants in nearly all elder abuse and neglect cases:
The patient's or resident's facility records are undoubtedly discoverable and should be included when sending initial discovery requests. These documents may contain crucial information about any substandard care that was rendered and typically include a medical chart, business records, admission agreements, brochures and advertisements, and family and resident council meeting records. Policies and procedures of nursing and administrative staff during the patient's or resident's admission are also important to request to determine whether the facility was following its own guidelines in caring for a particular elderly individual. This evidence should be easily obtainable and is a good starting point for an elder abuse attorney's case investigation for a particular patient or resident. Evidence of abuse or neglect is often not found in these documents, however, either deliberately or negligently, and instead such evidence may emerge circumstantially or through logical deduction of information found in these records.
The singular issue that is common in almost all nursing home and assisted living abuse and neglect cases is facility understaffing. Skilled nursing facilities are specifically required to provide a minimum daily average of 3.2 nursing hours per patient day. (22 Cal. Code Regs. §72329(f).) Nearly 90% of all nursing homes and assisted living facilities in the United States are understaffed, either in number, training, or both, and cannot effectively render the proper care that is needed by all of the patients or residents of their facilities. This is often the result of facility owners and operators deliberately cutting hours and paying extremely low wages in order to save money and reduce their expenses. Consequently, patients and residents of these facilities suffer a lower overall quality of care.
Examples of these staffing records include, among others, sign-in sheets, time cards, employee work schedules, nursing hour per patient day (NHPPD) documents, and daily census records. These facility staffing records can and usually do show a pattern of insufficient staff that lead to a lower quality for care for patients and residents, including not turning and repositioning, not answering bed alarms and call lights, not feeding, not assisting to the bathroom, and not responding to signs of distress. This is undoubtedly evidence of abuse and neglect and is helpful when litigating a claim.
The elder abuse attorneys at the Law Offices of Ben Yeroushalmi in Los Angeles are very experienced in proving claims involving facility understaffing. We have a history of being certified as class counsel in multiple separate California class action lawsuits for understaffing and have been involved with the best experts.
A particular nursing home or assisted living facility is not usually comprised of a single entity. Most of these facilities are engaged in a massive "shell game" involving multiple companies, management entities, and owners who siphon funds and resources in and out of these companies to make maximum profit. Ownership is often complex and changes constantly, and it is difficult to determine who is making the decisions of facility operations, whose insurance carrier provides coverage, and what company's finances should be used to determine punitive damage liability.
Experienced elder abuse attorneys thus typically request a number of ownership, management, and administration records when sending initial discovery requests to discover information regarding the financial incentives and priorities of nursing home and assisted living management. These requests include information and documents specifying the identifying information of owners and management companies, facility applications to Medicare and Medi-Cal, financial performance records, and internal audits or evaluations conducted by defendant facilities that are sent to their operations staff.
In California, the Department of Public Health (CDPH) is responsible for certifying that skilled nursing facilities are in compliance with state laws and regulations. The CDPH conducts regular visits to facilities and issues citations to those that are found to have violated these regulations. CDPH survey and investigation results are encompassed in a report called a "Statement of Deficiencies and Plan of Correction." These are public records and are helpful in investigating the circumstances surrounding a particular patient's injury.
For assisted living facilities, the California Department of Social Services ensures that these facilities are in compliance with applicable regulations, and issues information regarding their investigations called a "Facility Evaluation Report" or "Complaint Investigation Report." These reports are also public record and list information about a specific deficiency issued with its associated plan of correction.
In addition to investigating the particular circumstances of a patient's or resident's injury at a facility, these reports are also helpful in demonstrating that a facility had previous knowledge of deficiencies in its operations for proving recklessness, or "conscious disregard," for purposes of enhanced remedies under the Elder Abuse Act. Evidence that a defendant facility knew of dangerous conditions or procedures were taking place at its facility, and that it failed to correct those conditions before injuring a plaintiff, can successfully satisfy this requirement.
Although these reports are public record, documents pertaining to how a facility is complying with its "Plan of Correction," such as facility policies, procedures, and in-service training records, are not. Experienced elder abuse attorneys usually request these documents in order to determine whether a facility has willfully ignored preventing similar injuries and violations.
Defendant nursing homes often argue that these "Statements of Deficiencies" and "Plans of Correction" are inadmissible at trial and thus undiscoverable during litigation. However, the standard for discovery is that any party may obtain discovery regarding any matter, not privileged, that is relevant to the subject matter involved in the pending action if the matter either is itself admissible in evidence or appears reasonably calculated to lead to the discovery of admissible evidence. (California Code of Civil Procedure § 2017.010.)
Information garnered from these reports are generally reasonably calculated to lead to the discovery of admissible evidence, which include internal reports written by the facility and the testimony of witnesses to the subject incidents. Further, the facility's knowledge of the fact that its operations were found deficient can be relevant to determine whether it acted with malice, fraud, oppression, or recklessness for the enhanced remedies under the Elder Abuse Act and punitive damage liability. These reports are also relevant to illustrate declarations against interest, inconsistent statements, and business records. (See Evidence Code §§ 1230, 1235, 1271; see also Evidence Code §§ 1220-1227.)
Nursing home and assisted living financial records are great sources of information to determine whether and why facility staff receive bonus compensation. Often, bonuses are paid for recruiting patients and residents to achieve a higher census and for meeting budget or profit goals. All of this information can evidence a corporate policy to prioritize higher revenues over patient care.
Veteran elder abuse litigators will investigate the relationship of facilities with management companies and owners to determine whether large "management fees" are being paid for minimal patient or resident services. Financial information can also be used to establish high profit margins where facilities claim that they are unprofitable. These requests include information and documents regarding the facility's accounting, payments, cost reports, and funding. Again, most nursing homes and assisted living facilities are involved in a "shell game" comprising of multiple owners and management entities to divert money and resources away from patient care and into their own pockets to make higher profits.
In most nursing home and assisted living cases, the enhanced remedies of the Elder Abuse Act and punitive damage liability depend on whether abuse or neglect was ratified by a corporate managing agent. (See California Civil Code § 3294; see also Welfare and Institutions Code §§ 15657, 15657.5.) Information flowing between corporate entities and the facility should therefore be requested in discovery. These requests typically include corporate communications, corporate policies, and licensing records. The elder abuse attorneys at the Law Office of Ben Yeroushalmi also have experience successfully obtaining corporate e-mail communications and phone call records to determine whether substandard care at a facility was ratified by a corporate entity.
Each discovery request listed in the tables below was carefully tailored by experienced elder abuse attorneys to garner information specifically pertaining to the elements of a typical elder abuse and neglect case, including enhanced remedies and punitive damage liability. Although each abuse case is distinct and requires a variety of different information from defendant facilities, persons, and entities, the categories of discovery in the tables are the items that an experienced elder abuse attorney would typically request in sending initial discovery requests. Also note that skilled nursing facilities and assisted living facilities are governed by different laws and regulations, and therefore, the information needed to prove the elements for an elder abuse claim will likewise vary. Therefore, it is in a plaintiff's best interest to retain an experienced elder abuse attorney to receive the best results for their case.
| Special Interrogatories (SI) | |
|---|---|
| Category | Timeframe |
| Employees employed at time of incident | Time of incident |
| Residents in facility at time of incident | Time of incident |
| Identity of administrator, DONs, NPs, CNAs, RNs, dieticians, consultants, etc. | Period of admission |
| Existence of documents | Period of admission |
| Persons with knowledge of events | Period of admission |
| Identity of management and consulting companies | Period of admission |
| Identity of Quality Assurance Committee members | Period of admission |
| Factual bases of defenses | Varies |
| Prior complaints | 1-year prior to admission - end of admission |
| Identity of investigations / violations | 1-year prior to admission - end of admission |
| Employee suggestions | 1-year prior to admission - end of admission |
| Citations / Deficiencies | 3-years prior to admission - end of admission |
| Prior lawsuits | 5-years prior to admission - end of admission |
| Requests for Production of Documents (RFPD) | |
|---|---|
| Category | Timeframe |
| Facility floor plan | Period of admission |
| Insurance policy | Period of admission |
| Nursing home medical chart (including ADL sheets, MDSs, etc.) | Period of admission |
| Assessments and care plans for resident | Period of admission |
| Narcotics logs | Period of admission |
| Revenue / remittance and reimbursements | Period of admission |
| Third-pty billing information for resident | Period of admission |
| Billing file for resident | Period of admission |
| Administrative / Nursing policies and procedures (including Resident Assessment Protocol (RAP)) | Period of admission |
| Personnel policies and procedures | Period of admission |
| Corporate structure / guidelines | Period of admission |
| Records related to ownership | Period of admission |
| Medical examiner documents and photos | Period of admission |
| Pictures of the facility | Period of admission |
| Employee personnel files | Period of admission |
| Employee job descriptions | Period of admission |
| Census sheets | Period of admission |
| Consulting / management agreements | Period of admission |
| Training and in-service records | 1-year prior to admission - end of admission |
| Staffing (work schedules and time cards) | 1-year prior to admission - end of admission |
| Staffing agency records | 1-year prior to admission - end of admission |
| Advertisements and brochures | 1-year prior to admission - end of admission |
| Financial and budget information | 1-year prior to admission - end of admission |
| Cost reports | 1-year prior to admission - end of admission |
| Property lease agreements | 1-year prior to admission - end of admission |
| Government surveys and reports | 1-year prior to admission - end of admission |
| Internal reports and external surveys and investigations | 1-year prior to admission - end of admission |
| Prior complaints | 1-year prior to admission - end of admission |
| 911, Police, Fire reports | 1-year prior to admission - end of admission |
| Customer satisfaction surveys | 1-year prior to admission - end of admission |
| Key factor summary reports | 1-year prior to admission - end of admission |
| Pressure wound reports | 1-year prior to admission - end of admission |
| Facility incident reports | 2-years prior to admission - end of admission |
| Resident Council minutes | 2-years prior to admission - end of admission |
For additional information, get in touch with an experienced attorney. The nursing home and assisted living neglect lawyers of the Law Offices of Ben Yeroushalmi in Los Angeles are dedicated to elder abuse and neglect cases and can be contacted online or at (310) 623-1926.