Wrongful Death at Robbinsdale Rehab and Care Center- On December 12, 2009, the Star Tribune reported that Extendicare's Robbinsdale Rehab and Care Center, in Robbinsdale, Minnesota, has lost federal assistance for new patients "because of errors and the failure in care that included those that led to two patient deaths." Click here to access the Star Tribune article. The article reports that "Robbinsdale Rehab has far more violations that most MInnesota facilities, which were cited for an average of 10 deficiencies in 2008. Inspectors found 19 violations at Robbinsdale Rehab in 2007, 25 in 2008 and 37 so far in 2009." Mistakes by Robbinsdale Rehab's employees involved the deaths of two residents. One resident "was showing signs of a possible heart attack" but "staff members failed to quickly notify her doctor, even though the facility's medical director acknowledged that the resident was displaying four "red flags" of distress. The resident was found dead in her bed." The second resident was found shaking and unresponsive in his wheelchair in Robbinsdale Rehab's dining room. "Alarmed staff members immediately reported the incident to nurses, but no one called an ambulance for five hours." The resident died on the way to the hospital." Other mistakes at the Robbinsdale Rehab nursing home included "the mishandling of narcotic painkillers, involving seven residents. One of those residents was taken to the emergency room ... after a nursing home employee mistakenly gave him dangerously high doses of painkillers. ... A subsequent investigation determined that 120 tablets of Oxycodone were missing from the nursing home's allotment for the resident." This is not the first problem for an Extendicare nursing home, in Minnesota or elsewhere around the country. Extendicare Homes on list of 100 worst nursing homes in the country- The Centers for Medicare and Medicaid Services (CMS), the federal agency that runs Medicare, has published a list of more than 100 of the worst nursing homes in the country, based on how they fared during government inspections. The homes on The List are known as “Special Focus Facilities,” which means they get inspected more often than other nursing homes and can be subject to more stringent penalties over time, up to being barred from receiving Medicare dollars. One such facility is the Madison Manor nursing home in Richmond, Kentucky, which was just added to the list. The Madison Manor is owned by Extendicare. The Lexington Herald-Ledger reports that “The Kentucky Attorney General’s office has filed criminal charges against three individuals in connection with conduct caught on a video camera placed in the room of [an 84-year-old female resident]. One person has pleaded guilty. [The resident]’s relatives placed the video camera in her room after they found more than 30 unexplained bruises. According to state records, the videotape shows nine nursing assistants at Madison Manor physically abusing [the resident] and failing to feed and clean her.” In Michigan, the Traverse City Record-Eagle reported in April 2009 concerns about Extendicare’s Birchwood nursing home. The paper disclosed that an 86-year-old resident was transferred to the hospital with “extreme” pressure ulcers (bedsores) that stretched across his pelvic area. The previous month, the Record-Eagle reported that Extendicare’s Birchwood facility had been investigated by the state’s nursing home regulators and fined a total of almost $38,000 in 2007 and 2008 for a series of violations, including patient assaults, falls and bedsores. The paper also reported that “State inspectors also discovered reports of physical and sexual assault among residents going back as far as 2006. A department report indicated that Birchwood staff failed to report the incidents to the state, or protect the residents in their care. A state attorney general spokesman said a criminal investigation continues.” Extendicare operates 31 nursing home facilities in Michigan. Until recently, Extendicare’s Golden Valley Rehabilitation and Care Center was on CMS’s List for 22 months. In fact, CMS identified Golden Valley Rehabilitation and Care Center, which is a 180-bed facility to be one of the 50 worst nursing homes in the country due to its significant history of deficient patient care. A State survey, conducted June 15, 2007, identified deficiencies in 31 health-related areas at Extendicare’s Golden Valley Rehabilitation and Care Center (compared to an average of 10 deficiencies in other Minnesota nursing homes). Deficiencies were cited in areas where the Golden Valley facility had been previously found deficient: administration of drugs; patient assessments; assessment after a significant change; development, preparation, and review of comprehensive care plans; services by qualified individuals in accordance with the care plans; provide necessary care for highest practical well-being; proper treatment or care for special care needs; and proper clinical records. Deficient respritory care at Extendicare's nursing homes- - In July 2001, a Golden Valley resident was found with his feeding tube pulled halfway out and his oxygen tanks empty. In January 2003, Golden Valley failed to address a resident’s complaints of difficulty breathing. On January 30, 2003, the resident’s breathing became worse and the resident was sent to the emergency room.
- In May 2003, a Golden Valley resident was transferred to the emergency room due to respiratory difficulty. Golden Valley staff had allowed her oxygen saturation level to plummet to 55%.
- On February 16, 2005, a 57-year-old Golden Valley resident with a history of COPD and chronic hypoxia was short of breath, asking for oxygen, and requesting to go the hospital. Extendicare’s records reveal that GV staff failed to assess the resident’s condition and failed to provide oxygen or check her oxygen saturation levels between 3:30 pm Feb.16th and 2:00 pm Feb. 17th, despite a physician’s order to provide oxygen at 2-3 liters to keep her oxygen saturation level above 90%. The resident called 911 for herself at 3:15 pm on Feb. 16th, but Extendicare’s staff turned the paramedics away when they arrived at the facility. This resident repeatedly removed her oxygen canula and was short of breath throughout Feb. 17th. Her oxygen saturation was as low as 57%. Despite this significant change in condition and the resident’s repeated removal of her oxygen, Golden Valley staff did not notify her physician. GV staff did not call for an ambulance until 30 minutes after the resident’s oxygen level had dropped to 35%. The resident died before paramedics arrived.
In addition to the substandard respiratory care at Extendicare’s Golden Valley Rehabilitation and Care Center, Extendicare’s other Minnesota nursing home facilities have a long history of providing deficient respiratory care. Examples of such substandard care include: - In September 2003, a resident of Extendicare’s ROBBINSDALE REHAB & CARE CENTER was admitted to the hospital in a state of extreme neglect. He was dehydrated and malnourished. His tracheostomy tube had not been changed for a very long time, and could not be suctioned because it was so clogged. As a result of Extendicare’s neglect, the resident was left in a persistent vegetative state,
- In February 2003, a comatose tracheostomy patient died at Extendicare’s ROBBINSDALE REHAB & CARE CENTER when she was left unattended with her alarm turned off. She was discovered not breathing.
- In August 2004, a resident of Extendicare’s ROBBINSDALE REHAB & CARE CENTER was found with her tracheostomy tube uncared for and not suctioned.
- In May 2004, the Minnesota Department of Health determined that the Director of Nurses at Extendicare’s ROSE OF SHARON MANOR had failed to assure that policies and procedures were available on how to administer CPR for residents with tracheostomies.
- In April 2004, a resident at Extendicare’s TREVILLA OF NEW BRIGHTON (now known as HEALTH & REHABILITATION OF NEW BRIGHTON) facility was found to have an excoriated area around his tracheostomy site.
- Extendicare’s TREVILLA OF NEW BRIGHTON facility failed to initiate contact precaution guidelines for residents with tracheostomies. These precautions are a necessary element of infection control at such facilities.
- In April 2002, a resident of Extendicare’s RICHFIELD HEALTH CENTER was brought to the emergency room with “green ooze” coming from the stump of an amputated limb. This resident also had fluid in his lungs and was severely dehydrated. The hospital doctor said that the Extendicare’s facility had “really dropped the ball."
- In August 2004, the Minnesota Department of Health found that Extendicare’s RICHFIELD HEALTH CENTER had committed neglect of health care by failing to ensure that a resident was provided supplemental oxygen in accordance with physician’s orders.
- On a July 2004 morning, a resident at Extendicare’s ROBBINSDALE REHAB & CARE CENTER was discovered to have an oxygen saturation level of only 80%. (An acceptable level of oxygen saturation is 90% or better.) Extendicare’s facility failed to follow up on the resident’s respiratory distress. By evening, paramedics had to be summoned for the resident. When the paramedics arrived the resident’s oxygen tank was empty. When the resident reached the hospital, his oxygen saturation had fallen to 70%. Hospital doctors found the resident to have a urinary tract infection, sepsis, and numerous bruises on his body.
- In May 2004, Extendicare’s TREVILLA OF NEW BRIGHTON was found by the Minnesota Department of Health to have failed to ensure that residents who were identified with oxygen therapy received adequate assessment and monitoring for treatment and intervention.
- In January 2004, Extendicare began accepting residents with tracheotomies to the ROSE OF SHARON MANOR skilled nursing facility. The staff, however, was not trained or qualified to provide the care necessary for tracheotomy patients. A 46-year-old male resident was admitted to Rose of Sharon Manor in March 2004. The facility did not have the supplies and equipment required for his respiratory care. On the evening of March 29th, the resident complained that he felt like his tracheotomy tube was plugged and asked that it be suctioned. No one attempted to suction his airway until the next day. The resident continued to complain of breathing difficulty. The airway was never cleared and a physician was never called. On April 1st, the resident complained of breathing difficulty to a staff aide. The aide was unfamiliar with the oxygen tank and went for help. The aide returned to the room and saw the resident sitting on the side of the bed. The resident turned blue, fell back and stopped breathing. He went into cardio-respiratory arrest. There was no one at Rose of Sharon with a valid CPR certification. CPR was not attempted. When the ambulance arrived the tracheotomy tube was promptly cleared. However, the resident could no longer be resuscitated and he died.
Litigation Testimony by Former Extendicare Management Employees (the following details have been made public by litigation against Extendicare in Minnesota):
-
An Interim Nursing Director told Extendicare’s upper management that she was concerned about losing her nursing license due to the lack of full time nursing director and licensed administrator at the nursing home. She also reported her concerns that Extendicare could be denied Medicare payments if it had no licensed administrator at the nursing home.
-
A Nursing Director denied a prospective resident who weighed 900 pounds admission because she believed that the Extendicare facility could not care for a person of his weight. While the Nursing Director was on vacation, however, Extendicare approved the patient’s admission without the Nursing Director’s knowledge. After the Nursing Director complained to Extendicare’s upper management about the improper admission, her superior told the Nursing Director that he did not care about her staffing concerns and ridiculed her.
-
The Nursing Director learned that Extendicare’s nursing home had not obtained physician certifications and re-certifications – which were required before a health care facility could receive Medicare reimbursements.
-
The Nursing Director reported that Extendicare was discriminating in favor of Medicare patients, keeping such residents longer than medically necessary because higher reimbursements were received from Medicare than from other payor sources.
-
The Nursing Director on several occasions reported that Extendicare was holding beds open for Medicare patients while unlawfully denying beds to others.
-
The Nursing Director received a citation from the Minnesota Board of Nursing which alleged that the Extendicare facility had neglected health care during her tenure as the nursing director.
-
The Nursing Director believed that Extendicare retaliated against her for the numerous reports she had made to Extendicare’s upper management and others regarding Extendicare's violations of the law.
-
The Nursing Director also believed that Extendicare created an unbearable work environment.
-
The Administrator of an Extendicare facility believed that Extendicare terminated her employment because she complained about, and refused to participate in, practices she believed to be illegal.
-
The Administrator believed that Extendicare discriminated in the admission and treatment of patients based on payor source. She specifically alleged that:
-
Extendicare held rooms open for higher-paying Medicare patients in violation of federal law, state law, and Medicare guidelines;
-
Extendicare held Medicare patients longer than necessary in violation of federal law, state law, and Medicare guidelines (the Administrator testified that she was directed to take measures to convince Medicare patients to extend their stays beyond any medically necessary length);
-
Extendicare moved non-Medicare patients to less desirable rooms to make desirable rooms available for Medicare patients in violation of federal law, state law, and Medicare guidelines; and
-
Extendicare cut staffing to levels that were adverse to the patients' interests in violation of federal law, state law, and Medicare guidelines.
-
The Administrator testified that the atmosphere changed when Extendicare hired Laurie Bebo as a Vice-President for the region. According to the Administrator:
-
The Vice-President aggressively pursued an increase in the number of Medicare patients and aggressively pursued cost-cutting measures.
-
Under the Vice-President, the Administrator and other employees noticed a strong emphasis on profitability that they believed impeded the provision of good patient care.
-
The work atmosphere under the Vice-President was one of pressure to increase the number of Medicare patients by whatever means possible.
-
The Administrator described a number of specific policies designed to maximize the admission and retention of Medicare patients to the detriment of patients covered by other payor sources. These policies served as a framework that permitted and concealed payor source discrimination.
-
The Administrator testified that the Vice-President instituted a target Medicare patient quota for each facility. Administrators' compensation was linked in part to meeting the quotas for their facilities. The Vice-President and an Extendicare director held weekly conference calls with facility administrators and nursing directors who failed to meet their quotas. The Administrator testified that Extendicare’s upper management would belittle and yell at staff who failed to meet these quotas.
-
The Vice-President directed the Administrator to keep beds available in more desirable rooms for Medicare patients, even if it meant turning away Medicaid or private source-payor patients. This policy also required the Administrator to move non-Medicare patients out of the desirable rooms and into less desirable rooms if a Medicare patient called to be admitted. The Administrator considered this practice of discriminating against patients based on payor source to be in violation of Minnesota law.
-
The Administrator testified about Extendicare’s “green light” or “green flag” admissions policy, a practice that that prohibited the rejection of Medicare admittees. The policy first changed to require a regional nurse's approval before admission could be denied to a prospective Medicare patient, regardless of the facility's ability to handle the patient's needs. Later, even regional nurses and facility administrators could not approve such denials, and only Extendicare’s Vice-President could approve the rejection of a Medicare patient.
-
The state conducted an inspection that revealed safety violations at the nursing home.
-
The Administrator’s attorney accused Extendicare of improperly withholding documents that had been requested during the litigation.
The Vice-President (Laurie Bebo) has since been re-assigned to a new Extendicare company, Assisted Living Concepts, which collected $234,000,000.00 in revenue last year, according to the Des Moines Register. Bebo is the CEO of Assisted Living Concepts, which runs 216 care facilities in 20 states, seven of which are located in Iowa. One of the Iowa facilities is the Dubuque Retirement Community, which houses 116 seniors. The Des Moines Register reported on July 13, 2009 that “Iowa's largest assisted living center has found a loophole in the law that will enable it to avoid all future government oversight and regulation even though it has been repeatedly penalized for poor quality care…. Assisted Living Concepts plans to operate the building as if it were an apartment complex subject only to landlord-tenant laws.” The newspaper identifies the conflict between the corporate motive and patient safety – the corporate strategy will allow the company to operate “without a license and all of the regulations that go with it. That means state health inspectors and the long-term-care ombudsman won't be visiting the home and checking on the quality of care that's being delivered.”
The Des Moines Register subsequently reported on July 29, 2009 that the "Dubuque Retirement Community ... will give up its license on Sept. 14 and become an unregulated retirement home. The residents' medical services will be provided by home health agencies, one of which is unregulated and owned by the facility's parent company." The article reported that CEO Laurie Bebo visited Dubuque and answered questions about the change: "Bebo answered dozens of questions during the meeting, but some of those answers weren't as nuanced or detailed as the state officials would have liked. Bebo said the company considers the Dubuque transition to be a pilot program that will be evaluated over the next three to six months. 'We need to see what the repercussions are,' she said." |
