Cost-Cutting Can Cause Nursing Home Residents’ Deaths

Like other insurers, health insurers make more money when they pay fewer claims. UnitedHealthcare aggressively pursues this not only by requiring preauthorization or denying claims. They want to be contacted while treatment decisions are being made. This has resulted in wrongful death lawsuits claiming nursing home residents covered by United Healthcare were prevented from obtaining life-saving medical treatment.

Medical malpractice in Kentucky nursing homes happens far more often than we would like to believe. Satterley & Kelley, PLLC holds nursing homes and insurance companies accountable when their negligence harms residents. Learn more by calling us at 855-385-9532.

A Guardian report details several related lawsuits pending against UnitedHealthcare. The company denies wrongdoing and claims it’s trying to improve resident care by preventing unnecessary hospital treatment. While it’s true you can’t be harmed in a hospital if you aren’t in one, hospitals also provide critical medical care that nursing homes aren’t capable of giving.

There’s a conflict of interest when someone making decisions about a nursing home resident’s care is judged by their employer on how little hospital treatment the resident gets. According to multiple lawsuits, a system to keep residents away from hospitals has caused deaths due to delayed or denied hospital treatment.

United Healthcare Employee Claims Company Upset When Out of the Loop

Maxwell Ollivant worked as a nurse practitioner for UnitedHealth’s direct care subsidiary, Optum. He visited and checked on seniors at nursing homes in the Tacoma, Washington, suburbs. He thought his goal was to identify medical complications early so they could be treated successfully before hospitalization became necessary.

After less than a year, Ollivant claims he was concerned his employer was going too far by inserting itself into medical emergencies. This was delaying or discouraging necessary hospital treatments, according to his lawsuit.

Ollivant states that when he visited nursing homes, he saw large red “STOP” signs in patient charts. These signs instructed nursing home staff to call Optum before an independent primary care doctor if a patient’s health worsened.

He claims that he and his co-workers were directed to “chastise” nursing home staff if a patient went to the hospital without first contacting Optum and following their protocols. Ollivant cites a case where a nursing home resident was sent to a hospital because she was drooling, unresponsive, and had a “slant to the side,” symptoms of a possible stroke, an emergency requiring urgent treatment.

It turned out that the nursing home acted correctly by quickly getting her to the hospital because the resident was admitted to its intensive care unit because of her “intra-brain bleeding,” a potentially lethal type of stroke.

After the transfer, Ollivant’s manager emailed her employees complaining that the nursing home ignored company protocol by failing to first call Optum’s hotline, “This is bypass…  Nursing did not call Optum on call.” The manager later met with the nursing home’s director of nursing services and scheduled training to re-educate the facility’s nurses on how UnitedHealthcare wanted the situation handled.

Ohio Nursing Home Resident Dies After Facility Told Not to Transport Her to a Hospital

Seventy-year-old Mary Grant lived in a Cleveland nursing home. Two years ago, an employee accidentally knocked her out of her wheelchair, she fell, and struck her head on a cement floor, causing a bump on her head. The next day, a nurse at her facility found her low on oxygen and covered in vomit. These are symptoms of internal brain bleeding.

The nurse called the Optum hotline, not an independent doctor. Her family’s lawsuit claims she should’ve been taken to a hospital for a CT scan or MRI to see if her brain was bleeding and whether she needed surgery.

The Optum hotline employee didn’t “order” that she go to a hospital. They decided a transfer wasn’t necessary, but Grant should be monitored, medicated, and given a chest x-ray. A log by the employee states, “The goal is to treat in place.”

The following day, Grant was dead. Optum’s plan of care coordinated with the nursing home didn’t factor in the fact that Grant suffered a traumatic head injury, causing a pool of blood to compress tissues in her brain.

The Grant family’s wrongful death lawsuit against Optum claims that Optum wasn’t “an independent and objective medical professional,” but “an insurance adjuster… preemptively deny(ing) Mary Grant necessary medical care…” The company denies the allegations.

Optum Tells Georgia Nursing Home Unresponsive Resident Need Not Go to Hospital

Cindy Deal lived in a nursing home in 2022 when she suffered an apparent seizure. She became unresponsive and foamed at the mouth. The facility’s nurse called Optum, whose nurse told them to medicate her, not transfer her to a hospital. Three hours later, after an Optum shift change and another employee got involved, the facility was told to call 911 for an ambulance.

Paramedics found Deal in bed, unconscious, her skin pale, with large open pupils and discolored lips. Deal was pronounced dead shortly after arriving at the hospital. Her family filed a wrongful death lawsuit against Optum and the nursing home, which has settled the case.

A medical expert hired by the family states the following:

• Deal’s symptoms showed she was “experiencing a potentially life ending medical emergency”
• “Based on a reasonable degree of medical certainty or probability,” Deal died from cardiopulmonary arrest because those involved with her care “failed to appreciate the significance associated with Cindy Deal’s declining health and promptly request medical transport to a hospital”

Optum claims its nurse practitioner “met or exceeded the applicable standards of care.”

Speak To a Nursing Home Negligence Lawyer Today

Satterley & Kelley, PLLC attorneys will fight for your loved one to obtain respectful care, compensation for their injuries, and accountability from all those responsible for the harm. To set up a free initial consultation with an experienced lawyer at our firm, call our Louisville office at 502-589-5600 (toll-free at 855-385-9532) or contact us online.