An overhaul of the system for investigating deaths in Kentucky nursing homes is proposed in a bill pre-filed by state Rep. Tom Burch, D-Louisville, for the 2011 General Assembly.
Central to Burch's legislation is a provision that would require a specific staff member at long-term care facilities and hospices to report all deaths to the county coroner within 24 hours.
The proposal also requires coroners to involve police or prosecutors if they suspect maltreatment. But Burch said Monday the bill is intended to give coroners discretion in choosing which deaths need to be reviewed by other officials.
Currently, state law does not require nursing homes to report most deaths to coroners, who are rarely called even when abuse or neglect is suspected.
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Burch's proposal acts on recommendations made by Gov. Steve Beshear's administration after an internal review earlier this year of how nursing home abuse and neglect allegations are investigated. The review came after the Herald-Leader published a series of reports during the summer about gaps in the system used to investigate nursing home abuse.
The newspaper found that from 2007 to 2009, 18 deaths resulted in Type A citations — those issued by the Cabinet for Health and Family Services when a resident's life or safety has been endangered. As of early July, 15 of the deaths had not been prosecuted, and three deaths were considered to be open investigations.
Prosecutors and law enforcement officers polled as part of Beshear's review said it would be helpful to their investigations if coroners were called about nursing home deaths. Attorney General Jack Conway, whose recommendations were sought for the review, contacted prosecutors who said they never had a death case from a nursing home in which an autopsy had been performed.
Conway has said a current provision that requires caregivers to notify coroners about a death from any cause "other than natural" leaves nursing homes with broad discretion on reporting a case of potential abuse or neglect. Oftentimes, state investigators don't know that a death might have been caused by abuse or neglect until a family member or another individual makes a complaint.
Burch, chairman of the House Health and Welfare Committee, said he expects his bill will be fine-tuned in the coming months. For example, he noted that the legislation calls for deaths of terminally ill patients in hospice facilities to be reported to the coroner. He said hospices were included in an effort "to cover all the bases."
Officials with the Kentucky Association of Health Care Facilities could not immediately be reached for comment about the proposal.
Fayette County Coroner Gary Ginn said Monday that there were 531 nursing home deaths in Fayette County in 2009 and 9,374 statewide.
Ginn said he wanted to compare the provisions of the bill against the checks and balances now in state law before taking a position on the proposal. But he said he was concerned that coroners could be notified any time within the first 24 hours instead of at the time of death.
If a nursing home waits 24 hours to notify the coroner, the body already could be at a mortuary and embalmed, Ginn said.
In cases when a resident dies after being transferred to a hospital from the facility, the bill would require the nursing home or hospice to report the death within 24 hours of being notified of the death.
All nursing homes would have to give the attorney general's office the name of a specific employee whose job it is to report to the coroner or face fines of $200 for each week that the nursing home didn't comply.
A designated employee who failed to contact the coroner would face criminal penalties.
The bill also strengthens the criminal penalty for failing to report abuse and neglect of an adult. It would become a Class A misdemeanor, which calls for up to 12 months in prison and a fine of up to $500. It is now a Class B misdemeanor, punishable by up to 90 days in jail and a fine of up to $250 fine.
The legislation calls for specific training on abuse and neglect for nursing home staff and nursing home inspectors, and it requires the attorney general to establish a Kentucky Multidisciplinary Commission on Adult Abuse and Neglect. The commission would define the procedures for investigating adult abuse and neglect deaths in long-term care facilities.
Also, every death in which abuse or neglect is suspected would have to be investigated by a local multidisciplinary team that includes at least one law enforcement officer and a staff member from the Cabinet for Health and Family Services.
Currently, a state regulation requires a nursing home to notify the physician and the family whenever a resident's status changes. If there is a suspicion of abuse or neglect, the nursing home administrator is required to report the death or injury to the Cabinet for Health and Family Services' Office of Inspector General, which investigates.
The inspector general or Adult Protective Services office — both of which are part of the cabinet — can notify local police or prosecutors when criminal activity is suspected. A family member can ask for an investigation by the Office of Inspector General, the county coroner or local police.