Articles Posted in nursing home negligence

Nursing homes in Florida and throughout the country are highly vulnerable to what federal officials say is the rapid spread of “nightmare bacteria.”

Our Deerfield Beach nursing home negligence lawyers understand that these strains – including the so-called “superbug” that hit the National Institutes of Health a couple years ago – are resistant to all forms of antibiotics. That includes antibiotics of last resort. They are also deadly. That means by the time patients catch it, there may be little that health care officials can do to treat it.

The bacteria are known as Carbapanem-Resistant Enterobacteriaceae, or CRE. Survival rates for those who are infected are abysmal. About half of all those who catch the bacteria will die, primarily of bloodstream infections.

Even more troubling, this strain has the ability to transfer its antibiotic resistance to other strains, which means many other kinds of seemingly innocuous bacteria could become untreatable too.

The example given by the CDC was regarding a form of CRE known as Klebsiella. This bacteria has been shown in labs to have the ability to transfer antibiotic resistance to E. coli. If this were to happen in a real-world setting, the results would be devastating.

And it appears to be already happening. The CDC reports that in the last decade, the percentage of bacteria that are resistant to antibiotics as a result of CRE transfers has nearly quadrupled, from 1.2 percent in 2001 to 4.2 percent in 2011.

Throughout the first half of last year, nearly 200 nursing homes and hospitals treated at least one individual for an infection of this nature. There were no immediate figures to indicate how many of those patients died.

CRE are a family of about 70 or so bacteria, which includes E. coli. These are bacteria that would normally reside in our digestive system. But over time, they have developed a virile resistance carbapenem antibiotics. These are powerful, “last-resort” drugs.

In the last 10 years, the CDC was able to show how a single case at a one health care facility spread to hundreds of locations in 42 states. Still, there are only a handful of states that require CRE infections to be reported to state health departments. Florida isn’t one of them.

The 2011 outbreak in NIH sickened nearly 20 people, killing a dozen.

Almost all CRE infections so far reported have involved patients who were either in a nursing home or whose immune systems were weakened by serious conditions like cancer. Often, patients were on some kind of treatment, like ventilators or catheters, that allowed ample opportunity for infection.

But the disease was also frequently spread from the hands of health care professionals.

This means that that nursing home facilities have a clear and important responsibility to use better practices and proper precautions to ward off further infections. Part of that means only prescribing antibiotics when it’s absolutely necessary, so that more strains don’t have an opportunity to build up a higher wall of resistance. It also involves ensuring proper cleansing of individuals, equipment and facilities.
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An 87-year-old woman collapsed in the dining room at the California independent living community where she resided.

Our Riviera Beach nursing home negligence lawyers understand she gasped for breath as the nurse on duty phoned 911 for assistance. When the 911 operator inquired about performing CPR on the woman, the nurse responded that to do so was against policy.

The exasperated 911 operator pleaded with the nurse, saying “It’s a human being,” and asking if anyone was there who was willing to help this woman and not allow her to die.

The nurse’s response? “Um, not at this time.”

The case has gotten a great deal of national attention due to that level of callousness with regard to the life of another.

The nursing home has defended its actions by saying the woman had a “do not resuscitate” order on file, and the family has actually backed the facility. The director of the home stated that the nurse did in fact follow protocol. The policy, according to the director, is that when a medical emergency occurs, 911 is contacted and the staffers wait with the individual until emergency crews arrive.

However, by the time they got there in this case, the woman was already gone. It seems a bit odd that a facility would have health professionals on staff if it was policy that they couldn’t actually aid someone in a medical crisis.

The director of the facility said that all patients are told upfront about the no-CPR policy when they first move into the independent living community. That same policy is inapplicable to the skilled nursing facility and the assisted living facility nearby.

A spokeswoman for the National Consumer Voice for Longterm Quality Care said she was “appalled” to learn that any nursing home would have such a policy. Yet this same chain of facilities is operational in 36 states.

The advocacy group’s spokeswoman underscored that people must be “extremely vigilant” with regard to where they choose to receive care, particularly in assisted living and independent care settings. No one can read through every word of a contract, especially because the entire process can be emotionally and mentally overwhelming for everyone involved.

Such facilities are extremely expensive, but keep in mind that the amount you pay is often tied directly to the amount of medical care that is being required of the staff. Independent living facilities tend to be less expensive than assisted living or nursing homes because residents aren’t expecting 24-7 medical care.

Still, many probably don’t expect staff to stand by and watch them die when they could be offering help.

Not all independent living facilities have that kind of policy, but it’s incumbent upon consumers to do the research and be clear on what the facility deems its responsibilities to be in these situations.

A spokesman for the California Nurses Association coined the industry of nursing homes as the “Wild West of health care.” It’s the worst-regulated. It involves patients who are the most vulnerable. And it involves a high number of companies that are in the market to make money. That combination makes it a hotbed of abuse. More oversight and industry-wide standards should be implemented, he said.
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In nursing homes throughout the country, some 35 percent of patients with advanced cognitive impairment are fed with feeding tubes.

However, our Sebastian nursing home negligence lawyers know there are often little proven benefit. In fact, the American Academy of Hospice and Palliative Medicine and the American Geriatrics Society recommend against feeding tubes for people who have advanced dementia.

Nursing home administrators and caregivers have known about the dangers of feeding tubes for at least the last 15 years, yet many continue to use them. A major problem with the devices, according to a geriatrician from the University of California, quoted recently in The New York Times, is that they don’t prevent aspiration pneumonia. Additionally, they do nothing to prolong the life of the dementia patient. In fact, they may actually serve to shorten it, as they are associated with:

–Exacerbation of bed sores;
–Cause major distress;
–People who try to pull them out often end up being in restraints.

With dementia patients, many geriatric researchers instead recommend careful hand feeding. But this takes time, and sometimes it’s easier for doctors to simply have them inserted anyway.

For family members, it can be incredibly difficult to refuse a feeding tube to a loved one, especially when a doctor is recommending it. Some believe that this means they are condemning their loved one to starvation. But surgically-implanted feeding tubes have not actually been shown to do anything to improve their survival rates or improve quality of life.

The majority of dementia patients will have some type of swallowing or eating problems as their disease worsens. Feeding tubes don’t do much to improve this.

A recent study published in The Journal of the American Geriatrics Society found that in about 15 percent of cases, feeding tubes were inserted by doctors without family consent at all. Of those who were consulted, another 13 percent said they felt pressured by the physician to have the feeding tube inserted. Nearly half said that the discussion about the feeding tube took less than 15 minutes. More than 33 percent said that during the discussion, the doctor never mentioned the potential risks.

That study also found that nearly half of family members whose whose loved one had a feeding tube reported seeing their loved one in distress. Even though the average age of the patients in this study was 88 years, medical staff responded to this distress by either tying the patient down or injecting them with powerful drugs to sedate them.

In addition to bedsores, feeding tubes have also been associated with nausea, diarrhea and vomiting.

Twenty-five percent of family members said they regretted consenting to have the feeding tube inserted.
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In Laizure v. Avante at Leesburg, et al., the Florida Supreme Court has held that nursing home patients and their families are bound by arbitration agreements signed in valid contracts – even in cases where a family member plaintiff, who never signed the agreement, wants to bring a wrongful death lawsuit on the basis of negligence.

Our Stuart nursing home abuse attorneys are troubled by this for a number of reasons. To begin, arbitration (as opposed to litigation) tends to be more beneficial to the defense because the burden of proof falls on the plaintiff. Secondly, arbitrators aren’t necessarily bound by the law. Their decisions are, well, arbitrary. And finally, every bit of evidence is admissible in arbitration. In litigation, meanwhile, the defense has major obstacles to overcome in terms of proving their case. For example, rather than paying thousands of dollars for a medical witness to testify on their behalf, the defendant can simply hand over a peer review report, and that can suffice.

Our concern is that with the state supreme court backing the nursing home in this instance, many more nursing homes are going to compel new residents and their families to sign arbitration agreements in an effort to cover themselves if they are later found to be negligent or abusive.

You should not sign one of these agreements without first having it reviewed by an experienced nursing home abuse attorney.

According to court documents, here’s what happened in this case:

An older male patient was admitted to Advante back in the spring of 2006 after he underwent rehabilitation surgery. The day after he was admitted, he reportedly signed an arbitration agreement, probably not understanding the full implications of his signature. We don’t know the exact details of what happened after that, except that he died a few days later. We also know that his family members claim his rights under the Florida Nursing Home Residents’ Rights Act were violated. A representative of his estate subsequently filed a wrongful death suit against the nursing home.

However, the nursing home fought back, arguing that the estate was bound to arbitrate rather than litigate, based on an arbitration agreement signed by the patient upon his admittance. The estate countered that the arbitration agreement didn’t encompass the wrongful death claim because that claim was filed by independent parties, i.e., the patient’s survivors, who did not sign that agreement.

The binding nature of the arbitration agreement was upheld by the trial court as well as the Fifth District Court of Appeals, but the latter then certified the question of whether the case had to be arbitrated or whether it could be litigated to the Florida Supreme Court.

The high court noted that the question before it was not an issue of the quality of care or whether in fact the nursing home actually was negligent. Rather, the issue pertained to Florida law relative to wrongful death cases.

The court reasoned that because parties in personal injury lawsuits – including a decedent’s estate and heirs – are bound by arbitration agreements, so too are the parties in a wrongful death case.

While our Stuart nursing home abuse lawyers are disappointed by this ruling, we remain nonetheless committed to aggressively fighting to protect your rights, interests and entitlement to compensation.
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For tens of thousands of people across the country, kidney dialysis is a life-saving treatment without which they would surely perish.

However, our Davie nursing home negligence attorneys know that the treatment is expensive, and too often patients are put at grave risk.

A report from investigative news site ProPublica recently detailed that many dialysis facilities report poor patient outcomes, with far too many deaths or severe illnesses caused by staffer negligence.

It’s worse for nursing home patients. A report by USA Today indicates that within one year of starting dialysis treatments, more than half of older nursing home residents die. Almost another third experience a significant decline in their abilities to perform even basic tasks, like feeding themselves.

We’re likely to see these kinds of issues balloon over the next decade, as baby boomers age. For one, those over the age of 75 are the fastest-growing group of dialysis patients. Secondly, baby boomers are known to have higher rates of the renal failure-causing virus hepatitis C.

Dialysis is a treatment that is usually performed about three days a week for roughly three or four hours each time. It involves patients having their blood pumped through a small machine, which then filters out the extra fluids, salts and harmful waste. This allows the body to maintain a good balance of chemicals like sodium and potassium and in turn keep blood pressure under control.

ProPublica found that despite the enormous costs we as a country shell out for these treatments (about $77,000 a year for each patient – more than any other developed country in the world), the outcomes are too often lacking.

Part of the problem is that facilities are often not manned full-time by a doctor or even a nurse. In many cases, you have LPNs or aides doing the work. That has led to major problems when needles either aren’t installed properly or become dislodged. In some cases, there are reports of aides panicking at the sight of blood when needles become dislodged, resulting in a delay in proper response action and care.

Federal inspection reports have also revealed that many dialysis facilities are sorely lacking with regard to cleanliness, pest control and prevention of cross-contamination infection, such as staph infections, HIV, hepatitis C and others.

Roughly 80 percent of these facilities are for-profit (research has been conducted into heightened problems with for-profit nursing homes versus not-for-profit facilities), About two-thirds of all centers are operated by two major chains. One of those, Fresenius, is currently facing numerous lawsuits over a dialysis IV drug it produces called GranuFlo, which reportedly puts patients at a markedly higher risk for stroke, cardiac arrest and death.

ProPublica maintains a searchable dialysis database for patients or family members interested in learning more about the facilities located near them. In Davie, one of the three facilities has had troubling results in recent federal inspections.

A review of the facility found that mortality rates were 65 percent worse than expected, hospital admissions nearly 30 percent higher than expected, number of days in the hospital more than 50 percent higher than expected and emergency room visits about 15 percent higher than expected. Additionally, rates of septicemia blood infections were well above both the state and national average. During the last inspection, 10 standard deficiencies were reported.

At another Davie dialysis center, mortality rates are 30 percent higher than expected, as were hospital admissions rates, At a third location, mortality rates are 25 percent higher than expected, as are hospital admissions, rates of septicemia and rates of other access-related infections.

It’s worth noting that nursing home patients should also expect that nursing home staff and doctors will closely monitor them as well following each treatment to ensure there have not been complications. Unfortunately, that doesn’t always happen either.

All of this suggests that older patients – particularly those who reside in nursing homes – should carefully weigh their options before having dialysis treatments. Those who receive negligent dialysis treatment should contact our offices as soon as possible.
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So often when our Pembroke Pines nursing home negligence attorneys are talking to doctors, it’s in the form of a deposition or questioning them in open court about an oversight or inadequacy.

These are the people we expect and hope will look after our loved ones as if they were their own – or at the very least, maintain a basic standard of care. As we’ve seen all to often, though, that doesn’t happen.

In light of this, it was interesting to read an account by a first-year medical student – now doctor – of how the hellish months preceding her mother’s death were marked by multiple instances of preventable medical errors and and sometimes outright neglect. In her own words, the doctor says, speaking to investigative news agency ProPublica, “It was really eye opening for me to see the reality of how difficult it was to keep her safe.”

Her mother was young, in her early 60s, when she was diagnosed and treated for breast cancer. Among the instances the new doctor now recounts:
–Her mother, hallucinating, pulled a series of head staples following a recent procedure. Her daughter arrived to find her mother covered in blood. Staff members were nowhere to be seen.
–Her mother’s eye was blackened after a stethoscope fell on her face.
–Her mother suffered a number of falls;
–Her mother suffered severe side effects as a result of staff not properly monitoring her condition;
–She only narrowly avoided having unnecessary brain surgery and being given a drug that was not prescribed to her.

All of this, her Harvard Medical School graduate daughter says now, hastened her death. Her mother passed away four years ago, six months after being admitted for care.

Given her experience up until that point, the doctor believed she and her family were doing everything right. They chose a nationally well-ranked facility. The daughter says that many times when there were problems, it stemmed from seemingly understandable oversights. Still, it didn’t make the results any less painful – or the staff any less responsible.

For example, one day when her mother fell from bed, the alarm didn’t go off. That was because there were two alarms – one for the chair and one for the bed – but only one electrical outlet. Both alarms had identical cords, and the wrong one was accidentally plugged in. So her mother lie there for a long time before someone found her.

She said medication errors were a constant problem. Her seizure medication, for example, was supposed to be closely monitored and adjusted depending on her nutrition level. With hand-off after hand-off, from doctor to doctor, she says her mother was accidentally overdosed on numerous occasions, causing her to sleep for days. Perhaps this wouldn’t seem like the worst side effect, but this was a woman who was given months to live.

The new doctor says looking back, the biggest mistake happened during her chemotherapy treatment, which involved fluid being sent straight to her brain. The chemo was supposed to be once a week and the treatment was supposed to last her for that entire week. But the wrong drug was administered, and the treatment only lasted a day. Not having the appropriate chemotherapy for that amount of time, the doctor now says, could have been deadly.

Again, the new doctor notes the name and label of both drugs were nearly identical, and the facility didn’t have a pharmacist with specific knowledge of cancer drugs. In the end, the hospital ended up hiring a pharmacist who specialized in those medications, but it doesn’t prevent the same thing from happening somewhere else.

Although the setting of this situation was in a hospital, it bears many similarities to what happens in nursing homes across the country each and every day.
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Occasionally when you’ve gone to visit your loved one, you may have seen medical students practicing their rotations, particularly if they are preparing to enter geriatric medicine, where there is an increasing demand in coming years with aging baby boomers.

Our Boca Raton nursing home negligence lawyers wouldn’t be surprised if you noticed these doctors-in-training with serious bags under their eyes too. That’s because the Accreditation Council for Graduate Medical Education allows most residents to work up to 28 hours in a single stretch, as well as 88 hours in a week and 24 days in row – so long as they have a four-day break.

It’s an impossible schedule, and following some recent fatal car accidents involving these exhausted students who were leaving their shifts, many in the medical field are beginning to ask whether the current standards pose significant danger to patient safety and well-being. The answer thus far is a resounding: Yes!

The Wall Street Journal recently explored this issue in depth, speaking with a neuroscientist who serves as an associate professor at Harvard Medical School as well as the in the division of sleep for a Boston hospital. According to Dr. Steven Lockley, his own research found that first-year residents working a usual 24 to 30-hour shift in an intensive care unit were 36 percent more likely to have made a serious medical error than those who worked 16-hour shifts. What’s more, they were more than twice as likely to unintentionally fall asleep at work.

These same medical students were 60 percent more likely to accidentally harm themselves, such as poking themselves with needles.

Lockley’s team also reviewed nearly 25 studies conducted in 2010 on this issue and found that those medical students whose work limits were reduced reported vastly lower rates of error.

Unfortunately, little has been done to curb this problem. There are some who argue that these marathon shifts prepare students for what it is like to be a doctor. Others say that it’s especially important with medical residents that patients have continuity of care in order to reduce mistakes.

But any benefit either of these might offer is offset by this simple fact: Doctors are not inhuman. Neither are doctors-in-training. They are not immune to the effects of sleep deprivation. These are the people we trust with the care and well-being of our loved ones, who many times can not advocate for themselves. Yet here they are, charged with making sometimes critical care decisions about everything from medication and surgical options to long-term therapies and diet plans.

If you remain unconvinced, consider this: Driving drowsy is often considered to be just as dangerous as driving while intoxicated. Cognitive research conducted by the AAA Foundation found that people who hadn’t slept for 20 hours had response times that were 50 percent lower than those who had a full 8 hours of sleep. Their performance behind the wheel was in line with a person whose blood alcohol content was at 0.05 percent. After 24 hours, it’s akin to having a blood alcohol level of 0.10 (above the 0.08 percent legal limit). We’re asking medical students to be awake and working for stretches even longer than that, while expecting they will provide an appropriate level of care to our loved ones, both in the nursing home and in the hospital.

More most be done to address this critical issue.
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Families of Florida’s disabled children whose medical needs are incredibly complex should no longer have to worry that they will be forced to send the child to an ill-equipped nursing home.

At least, as our Fort Lauderdale nursing home negligence attorneys understand it, that’s the goal of new state reforms handed down by the Florida Agency for Health Care Administration.

The moves come on the heels of heartbreaking tales, published last year, of families who were forced to give up custody of their children to the state – only to learn those children were being neglected or not properly cared for by staffers at facilities that were designed for elderly people – not kids.

The proposed changes are numerous, and have yet to be formally approved. The ultimate goal is to increase the kind of in-home, community-based services that these children can access, which would in turn increase the likelihood that families can continue to care for them, as opposed to being forced to turn to institutionalization.

One of those changes includes assigning care coordinators for each child who receives private-duty nursing services through Medicaid.

Additionally, teams of parents, doctors and other health-based professionals would try to negotiate on a treatment plan that would first and foremost work to keep a child in their home. This would also serve to cut down on the number of regular hearings held by the state to determine whether a child should be kept at home or sent away.

The state’s Medicaid director called such hearings excruciating for loving families whose priority is to maintain the right to care for the person they love.

There are a number of issues that could contributed to the potential for additional services. For example, if a parent begins to suffer a medical issue of their own or has work schedules that fluctuate, it could directly impact his or her ability to care for the child and provide the necessary hours of care or services that the child needs. However, by working with a solution to keep them home with increased options for stay-at-home care, the decision wouldn’t automatically be a question of whether a child should be shipped to a nursing home.

The Department of Justice in previous reports has indicated that the state has come to this conclusion needlessly, senselessly – and at added cost to taxpayers, as well as the emotional toll for these families. In fact, a federal class-action lawsuit is currently pending in South Florida on behalf of at-risk children who were swiftly and wrongfully placed in nursing homes before the state took any action to try to work with families to keep them at home. The DOJ is specifically alleging that these actions are violations of the Americans with Disabilities Act – an assertion that AHCA officials of course adamantly deny.

Again, these changes won’t be automatic. They will still have to be wrung through the regular rule-making process, but many expect they will pass and be effective within the next three months or so.

In all, it’s expected some 1,600 children would be directly affected.
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Lake Worth Manor, the Florida nursing home that late last year was ordered to pay $2 million to the family of a patient who died due to staffers’ neglect, has been denied an appeal requesting a new trial.

Our Lake Worth nursing home abuse lawyers are familiar with many instances of negligence on behalf of facilities all over the state – and this was truly one of the worst.

The Manor Care nursing home, operated by Lake Worth Enterprises, has even moved to further distance itself from the incident by changing its name – from Lake Worth Manor to Oasis.

The patient in question suffered numerous diseases and by the time of his death, had to be treated by four different facilities for severe complications.

The case gained notoriety because the patient was George Dahmer, a former Boynton Beach resident best known for his 32 years as a professional wrestler known as “Chief White Owl.” He died a horrible death in the spring of 2008, following egregious and neglectful treatment by Manor nursing home employees.

Court documents revealed that Dahmer was first admitted to the home five years ago, after he was hospitalized amid increasing bouts of dementia. Soon after he arrived, the 72-year old began to decline – rapidly. In two months, he lost more than 30 pounds. He suffered from severe dehydration. He entered as a man who communicated well and had no need for a wheelchair. However, it wasn’t long before he had lost his ability to both walk and talk.

His false teeth were lost by staffers who never even attempted to replace them. With no one acting to appropriately turn or bathe him, he began to suffer severe skin infections. Ulcers began to form on his heels and tailbone. These sores were visible down to the bone. He was literally rotting away before staffers’ eyes – and they did nothing to stop it.

By the time he was eventually transferred to a different location, at his wife’s behest, the infections were so bad that doctors were considering a dual amputation of both feet. However, Dahmer was in such bad shape that his body couldn’t even withstand the stress of a feeding tube.

He died shortly thereafter.

In November, a jury sided with the Dahmer’s family after a week-long trial, and awarded his widow nearly $2 million.

However, the nursing home facility promised to fight that verdict, saying his condition was the result of complex medical issues – not their negligence. The agency filed a motion for a new trial, but the judge has since struck down that request.

Manor Care says it is continuing to explore its legal avenues to try to avoid simply paying Dahmer’s family for not only the horror that he endured, but for what they had to witness and the immense hole his loss has left in their hearts.

Meanwhile, his family is channeling their sorrow into action, having founded an online petition with the goal of pushing nursing home reform in Florida. So far, www.chiefwhiteowlwon.com has collected almost 2,000 signatures, according to The Palm Beach Post.

His daughter has been quoted as saying that the ordeal has been arduous and difficult, but they take some solace in the support they have received from other families seeking change – families who have no doubt endured similar pain and trouble.

It is our hope, as well, that another patient or family would never again have to endure such heartache. Until that time, we are dedicated to fighting aggressively for each patient, each family – one case at a time.
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Flu season rolls around every year like clockwork, and many people view it as an uncomfortable inconvenience in which the worst side effect is having to miss a few days of work.

However, our West Palm Beach nursing home negligence attorneys know that for elderly and ill people living in assisted living or nursing home facilities, the virus can be deadly.

Already, there have been two flu outbreaks reported at local nursing homes in Palm Beach County, in addition to the fact that more people of all ages are being raced to the emergency room with flu-like symptoms.

All of this prompted local health officials to boost ratings of the local flu impact from “mild” to “moderate” in documents filed recently with the state. That upgrade is expected to continue through this month and into March. Other areas to report a moderate spread of the virus were St. Lucie and Martin Counties. As of yet, we have not seen the highest-level rating, which is “widespread.”

Last month, the U.S. Centers for Disease Control reported that pneumonia deaths and flu-like symptoms had risen to the level of an epidemic nationwide – with the most common thread, a strain called A H3, causing the most fatalities in the elderly.

When analysts researched hospitalization rates for all ages, it stood at nearly 20 per 100,000 people. But when they looked solely at the over-65 population, they found it was more than quadruple that, with about 82 per 100,000 being rushed to the ER.

In Florida, the state health department reports that another strain, called influenza A, is most commonly occurring in nursing homes, skilled nursing facilities as well as other long-term care centers.

The nursing homes in Palm Beach County that reported outbreaks to the health department weren’t named, but it is known that one was located in the south and the other centrally. In one case, nursing home staff reported nearly a dozen residents who had fevers, coughs, aches and runny noses. A quarter of them were sent to the hospital.

In the other nursing home, five residents had fallen ill.

While the flu vaccine being produced this year has reportedly proven more than 60 percent effective in helping to ward off the illness, CDC officials say they are gravely concerned that vaccination rates among nursing home employees was so incredibly low.

Even though about 85 percent of other health care workers (nurses, doctors, nurse practitioners, etc.) got the flu shot this year, fewer than half of all health care workers at nursing home had done the same.

We find this troubling as well, when you consider all of the facts:
–You have a virus that is particularly harmful and potentially deadly to older populations and has been deemed an “epidemic” by federal authorities;
–Nursing homes have an opportunity to curb the transmission of that virus by more than half by vaccinating its workers – the ones most likely to bring in outside germs and pass them from patient to patient;
–Those precautions aren’t being taken.

In situations where a resident subsequently falls ill and dies, this is clearly negligence.
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