Russell Balisok has devoted most of his near 40-year career as a litigator to the field of elder abuse litigation. There is no end to descriptions of the schemes, both in and outside the health care industry, to neglect, exploit and abandon our elders. Where money can be earned by denying care to our elders, our elders will endure pain and privation even in a care setting supposedly designed for their protection. Mr. Balisok is at his best speaking for those who cannot speak for themselves.
Mr. Balisok has tried many cases of elder abuse based on neglect and financial abuse. He has also participated in most of the appellate proceedings in California involving legal issues related to elder abuse litigation. These include several matters before the State Supreme Court. His thorough understanding of the Elder Abuse Act is evident in his practice guide, Elder Abuse Litigation (The Rutter Group)
, which he updates annually. Mr. Balisok is interested in cases of neglect against board and care facilities, nursing homes, physicians, hospitals, and managed care businesses such as medical groups and HMOs. He is also interested in cases of financial abuse under the Elder Abuse Act.
Our elders have been placed in care settings operated by very sophisticated and large financial companies.
Residential care facilities:
These facilities provide care to elders who are generally able to live and go about their daily lives with minimal support from caregivers. These facilities may simply provide room and board, or they may assist with medication, bathing and hygiene. In California there are clear restrictions on the types of health needs such facilities may provide. As an example, a patient with a stage 4 pressure sore may not be accepted and must be transferred. But financial incentives to increase patient census may lead the operators of such facilities to accept patients with restricted conditions. In just one such case in 2013, in Sacramento, attorney Lesley Clement successfully argued to a jury that Emeritus should be punished for such conduct and was awarded a total of $27 Million.
Skilled nursing facilities:
These facilities provide care to elder who generally need 24-hour nursing care, in order to meet their health deficits. According to federal and state law, these facilities must meet the physical and mental health needs of each patients. Patients must be assisted as necessary with feeding, they must be assisted with hydration, their need for mobility both in and out of bed must be met, falls must be prevented, and pressure sores prevented or addressed. Patients must be continually assessed so that changes in condition are promptly noted and reported to the physician and to family. But skilled nursing facilities are generally paid a standard rate, whether or not the facility does a good job. It follows that the less spent on patient care, the more money can be realized as profit from operations. In addition, the operators of nursing facilities preplan the profit to be derived from operations in order to meet their profit expectations or the requirements of lenders, in either case leaving insufficient sums for care giving. The result is the typically understaffed nursing facilities, and helpless patients and their families bearing the consequences.
Hospitals, too, are under immense financial pressure. One hears everywhere that a patient going into a hospital needs a 24-hour advocate, guarding against the wrong medicine, the wrong treatment, and the cutting of corners on patient needs.
"Managed care" of the sort imposed by HMOs means that the care received by patients is reviewed to ensure that patients only receive care which is "reasonably appropriate" or "reasonably necessary." The patient’s physician or surgeon may conclude a patient needs a treatment or procedure, but the reviewing managed care entity may simply disagree, and the result is that the care recommended by the physician will be denied. This could result in the denial of hospitalization and other necessary treatment or medication. But the question whether a treatment is "reasonably necessary," in no way implicates consideration of the cost of the treatment. The question is simply whether the treatment is reasonably needed by the patient-enrollee. Nonetheless, a denial of a request for authorization is much more likely to occur when the price tag is high. And denial is much more likely to occur when the patient-enrollee is elderly or chronically ill. When such patients die, the managed care system may save the considerable cost of providing further care. Finally, when a managed care patient-enrollee is in a skilled nursing facility, the financial incentives to keep the patient in the nursing home and not transferred to a hospital for acute care, are very strong. But considerations of cost should not enter into the analysis of whether care which has been requested is "reasonably necessary."
In summary, Mr. Balisok’s practice is focused on cases against residential care facilities, skilled nursing facilities, hospitals and HMOs (and other managed care entities) where the denial of care is best explained by an illicit financial incentive.