Kentucky prosecutors, law enforcement officers, coroners and officials have said they think it would be helpful if coroners were called whenever someone dies in a nursing home. Evidence could be gathered and, if abuse or neglect had occurred, cases could be prosecuted.
But a bill that would require Kentucky nursing homes to report all deaths to the local coroner is in trouble in the General Assembly.
Tracey Corey, the state's chief medical examiner, estimates that if even 10 percent of the additional cases generated by the proposed law are turned over to her office for further evaluation, she would need three more doctors, more support staff and additional equipment for the required investigations, said Jennifer Brislin, a spokeswoman for the Justice Cabinet.
Despite concerns about costs, Corey supports the intent of House Bill 69, Brislin said.
The bill, sponsored by state Rep. Tom Burch, D-Louisville, would require a specific staff member at a long-term care facility and hospice to report all deaths to the county coroner within 24 hours.
But Burch said if Corey's financial concerns lead to the bill being sent to the committee making decisions about state spending, he thinks it "means sudden death" for the legislation.
The medical examiner is working with Burch to "develop legislative language to ensure these vulnerable citizens are protected better during life, and that the appropriate cases are reported to the M.E.'s office," Brislin said.
Brislin said Corey had not conducted a financial analysis to see how much the bill would cost.
Currently, state law does not require nursing homes to report most deaths to coroners, who are rarely called in such cases.
The proposed law also requires coroners to involve law enforcement officers or prosecutors if they suspect abuse. It gives coroners discretion in choosing which deaths need to be reviewed by other officials.
It has been assigned to the House Health and Welfare Committee, chaired by Burch. In an interview, Burch said he hasn't called the legislation for a vote because he is trying to address Corey's concerns.
After the Herald-Leader published articles last year about gaps in the system to investigate nursing home abuse and deaths, Gov. Steve Beshear ordered an internal review of those investigations by Janie Miller, secretary of the Cabinet for Health and Family Services.
Beshear ordered that the 20 recommendations made after the review be implemented. One of them was that coroners be involved in death investigations at the facilities.
Burch said nursing home representatives are concerned that too much extra work would be generated for the facilities by the bill.
And he said nursing home officials don't like a provision that strengthens the criminal penalty for failing to report abuse and neglect of an adult.
Such a failure would become a Class A misdemeanor, punishable by up to 12 months in prison and a fine of as much as $500. It is now a Class B misdemeanor, punishable by up to 90 days in jail and a fine of up to $250.
Tim Veno, president of the Kentucky Association of Homes and Services for the Aging, said his group has not taken a position on the bill, but "our membership agrees to comply with anything that is worked out by the General Assembly and put into law."
Officials from another industry group, the Kentucky Association of Health Care Facilities, did not return telephone calls seeking comment.
If the law passed, Kentucky would join two other states that have the requirement.
Nursing homes in Arkansas and Missouri are required by state law to contact coroners whenever nursing home residents die. In some Texas and Illinois counties, coroners and medical examiners require nursing homes to report deaths to them even though it is not a state law.
Coroners and medical examiners in those states recently told the Herald-Leader that the workload created by reviewing cases from nursing homes had not overwhelmed them and had improved conditions in nursing homes.
As part of the review by Miller's group, prosecutors and law enforcement officers said it would be helpful if coroners were called about nursing home deaths.
Often, state investigators don't know that a nursing home death might have been caused by abuse or neglect until a family member or another individual makes a complaint.
At a news conference Friday, Beshear lent his support to other elder-abuse bills, including Senate Bill 44 sponsored by Sen. Tom Buford, R-Nicholasville. However, he did not mention HB69.
SB44 would require criminal background checks for all nursing home employees such as cooks and janitors. Under current law, only employees who provide direct care to residents must have criminal background checks.