Lawsuit: Penn Village missed shoulder break, gave wrong data for Medicare reimbursement

Apr. 29—The estate of a late Northumberland woman received a $75,000 arbitration award from a Valley nursing home and malpractice claims remain pending in court against other medical providers on accusations they missed a severe shoulder break causing the woman to suffer a "dead arm."

Mary Dietrich, who died in 2020 of unrelated causes, left the Manor at Penn Village in 2017 after five weeks of inpatient therapy the same as when she was admitted into the Selinsgrove facility: in severe pain and with no improvement in the right arm that plagued her after falling and suffering an injury, according to the lawsuit filed in Northumberland County Court.

A discharge assessment submitted by the skilled nursing facility used for Medicare reimbursement didn't reflect that, records provided by an attorney for Dietrich's estate show.

Instead, it claimed Dietrich, 81 at the time and with dementia, met her treatment goals. The assessment claimed she needed no assistance to feed herself, sit up in bed, stand up from a chair, or walk 50 feet and make two turns.

A nurse at Penn Village who cared for Dietrich was deposed as part of the lawsuit and denied under oath that Dietrich was capable of any of that fully on her own, a deposition transcript shows.

Dietrich had undergone surgery and five weeks of physical therapy only to learn the severe pain she experienced wasn't being treated at all.

"(Dietrich) came into Penn Village and was expected to make a full recovery and regain full function of her arm. Not only did she lose function but it became extraordinarily painful from the slightest movements. It's one thing to make mistakes, but it's another thing that Penn Village was profiting from misrepresenting her condition on discharge," said Amber Falkenbach, an attorney representing Dietrich's estate.

Missed shoulder breakIn a single hours-long visit on April 26, 2017, two days after discharge, a home care specialist paid mind to the pain in Dietrich's upper right arm that caused her to cry out loud with the slightest movement. It led to shoulder x-rays confirming her injuries were far more severe than simply the wrist fracture as first diagnosed.

Dietrich suffered a four-part fracture of her shoulder's humeral head. It'd been left untreated long enough to heal disjointedly, causing the woman's dominant arm to become a "dead arm."

The medical staff at Penn Village missed the shoulder fracture even as Dietrich suffered pain throughout the physical therapy sessions. So, too, did the orthopedic surgeon, radiology group and emergency room doctor who all saw Dietrich prior to admission into the skilled nursing facility.

A chest x-ray taken in the ER in March 2017 after the fall showed an incidental finding of the shoulder fracture but it was missed, according to the lawsuit. Only a wrist fracture was diagnosed at that time. After surgery on the wrist, Dietrich immediately transferred to Penn Village for inpatient rehab.

Initially expected to make a full recovery, Dietrich left Penn Village and moved permanently from her granddaughter's home in Northumberland to a 24-hour care facility. She died at age 84.

Yelled when arm moved

"I couldn't believe it," said Larissa Savitsky, of Northumberland, Dietrich's granddaughter and administrator of the late woman's estate.

"She was depressed because her arm was just hanging there, she wasn't able to use it at all," Savitsky said. "She would yell when it would move."

Savitsky said she leaned on the medical advice of multiple professionals who cared for Dietrich. She and Falkenbach said they wanted Dietrich's story to become public so that it might help others.

"It was shocking that who knows how many people cared for her within that time frame and nobody said anything," Savitsky said.

Dietrich first filed suit in 2018 against Penn Village. Medical malpractice litigation is still pending in Northumberland County through her estate against additional defendants: the estate of the late Dr. Richard Waldman, the emergency room physician who first examined Dietrich at Sunbury Community Hospital, along with Waldman's employer Sunbury Community Hospital; Dr. John Frankeny, the orthopedic surgeon who performed surgery on Dietrich, and his employer, Orthopedic Institute of Pennsylvania; and Dr. James Zola, who was leading Dietrich's care at Penn Village, and Zola's employer, Geisinger Medical Group.

An expedited trial was sought so Dietrich might directly benefit from a favorable judgment. That didn't happen.

An arbitration panel ruled in the estate's favor, subsequently confirmed on March 25 by a Northumberland County judge, ordering the facility's operators to pay $75,000 to the estate, which Falkenbach said it did.

An attorney representing Penn Village and a facility administrator did not return messages seeking comment.

The role of MDS formsThe discharge assessment form filled out at Penn Village is a MDS form, known as a Minimum Data Set. According to the Office of Disease Prevention and Health Promotion, the form is "a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid."

The forms are used in profiling nursing homes and "plays a key role in the Medicare and Medicaid reimbursement system and in monitoring the quality of care provided to nursing facility residents."

Maggi Barton, deputy press secretary with the Pennsylvania Department of Health (DoH), said that DoH reviews the MDS forms to identify a resident's care needs and make sure the facility is meeting the needs as they were assessed.

The Pennsylvania Department of Human Services, meanwhile, reviews the data for reimbursement, Barton said.

"DHS reviews the accuracy for the MDS for Medicaid reimbursement purposes. At the federal level, the Centers for Medicare and Medicaid Services use the data to rate a facility's performance," Barton said.

The reimbursement and subsequent performance rating is what Falkenbach refers to when saying Penn Village profited from misrepresenting her client's condition at discharge.

"Had Mary not filed suit, the family would never have known these records are there," Falkenbach said.

The state performs patient care inspections at long-term care facilities. One wasn't conducted during Dietrich's stay. Later in 2017, Penn Village had been noted in three separate surveys as having failed for specific patients to either maintain accurate MDS records, failed to make corrective actions for patient care and failed to maintain accurate medical records including in one instance a patient's end-of-life wishes.

As recently as January 2021, the DOH found failings at Penn Village with respect to maintaining accurate MDS records. Corrective actions included re-education for staff. A revisit survey completed March 16, the results of which were released this week, concluded that Penn Village corrected all federal deficiencies identified in the January survey.

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