CHARLESTON, W.Va. -- Federal authorities temporarily stripped Heartland of Charleston's Medicare and Medicaid funding in September after inspectors cited the home for several serious violations -- one of which left an elderly dementia patient in pain from a head wound that staff failed to assess for nearly half a day.On Sept. 8, the Center for Medicare and Medicaid Services revoked the nursing home's funding for new admissions after administrators failed to fix numerous deficiencies that state inspectors found in June, officials confirmed last week.The agency also levied a $72,280 fine on Heartland -- the highest penalty the home has been forced to pay in five years, according to CMS records.Authorities lifted the sanctions Oct. 24."There are no enforcement actions currently issued for Heartland of Charleston," said Marsha Dadisman, spokeswoman for the state Department of Health and Human Resources, the state agency charged with inspecting federally funded nursing homes, and reporting violations to CMS. "All is clear now."The violations listed in the initial 156-page inspection report ranged from administrators failing to keep notifications of procedures and nurse availability posted to more serious cases where one patient bled profusely from a pressure sore after nurse's aides failed to check whether a blood-clotting test had been performed.A supplemental report lists several instances where the home's administrators failed to properly investigate allegations of staffers abusing patients, including one case where a patient had accused two nurse's aides of beating him in a shower room.News of the sanctions comes as Heartland's corporate owner continues to battle a lawsuit that resulted in a $90.5 million verdict. In August, a Kanawha County jury found that Heartland staffers indirectly allowed an 87-year-old woman to die of dehydration in 2009, and awarded her son the verdict.Other deficiencies listed in the inspection report included: A resident, labeled as a fall risk, was found face down on the floor six hours after she was admitted. Nurse's aides had placed a fall mat on one side of the woman's bed. She would have struck a tile floor had she rolled off the other side, the report states. One resident had an unnecessary catheter for more than two months, while two more residents were not given proper treatment after doctors had declared them incontinent. The inspector found that one of those residents had been sleeping on a bed with a large wet ring stretching across the bottom sheet. Some residents were taking medications they did not need. According to the report, nurses continued to give one resident "sliding scale" insulin doses despite a pharmacist's recommendation to stop. The pharmacist noted that the resident's blood sugars were in "excellent control, " and detailed the facility's need to closely monitor the resident's future insulin intake. Staff had not checked the resident's hemoglobin levels in months, according to the report. Nurses found one resident on the floor at least five times in two months. In January, the elderly patient fell twice in a span of about 12 hours. Staff labeled some of the falls as "attention-seeking behaviors," according to the inspector's notes. Inspectors found that the home's medications were not properly labeled. One resident lost seven pounds in three days because staff had failed to provide dietary supplements a doctor had prescribed. A resident with a right hand muscle contracture (a permanent shortening of a muscle or joint) was not fitted with a device designed to help minimize the loss of range of motion. The resident's care plan noted a need for the device in February -- four months before the June inspection.
Nursing staff took 10 to 20 minutes to answer several residents' call lights. One nurse's aide was fired after intentionally unplugging a resident's call light. Administrators did not report the incident to Adult Protective Services within the required timeframe. Resident No. 228
At noon on May 18, the state inspector met a Heartland resident identified in the report as No. 228.The inspector could see dried blood on a cut above the 76-year-old woman's left eye, which was still swollen and bruised from a fall she had while trying to pick up a bag of birdseed at about 2:30 that morning, according to the original inspection report.
The woman's nursing notes revealed that she was admitted to the facility at 8:30 p.m. the previous evening. A doctor wrote on her admission form that she suffered from dementia and had a history of falling.The fall earned her a trip to the emergency room, where doctors assessed, cleaned and repaired her head wound, according to the inspection report. She was back in her bed at Heartland by 6:30 a.m. with a doctor's instructions for follow-up care."They have not give me my medicine since I been here," the woman said, "and I need my medicine."The inspector asked what medicines she took."I don't know," the woman answered. "But I do know my head hurts."The inspector later noted that the elderly woman was required to take 14 different medications daily -- including life-saving high blood pressure medication.Later, the inspector interviewed several Heartland employees charged with taking care of resident No. 228. At that point the woman had been back from the emergency room for nine hours, and the inspector could not find any evidence that staff had completed a pain assessment.
Heartland officials, as required by the Medicaid sanction, assessed each deficiency state inspectors found and issued a correction for them.For resident No. 228, the inspection report notes that staff completed the woman's pain assessment after the inspector brought the failing to their attention and "resolved" her injury.The report also states that nurses will now include on a patient's admission status whether he or she is in pain and notify the facility's attending physician of recommendations to alleviate the pain.The report also states that the nurses will conduct random medical record reviews on residents and implement procedures that doctors have ordered for them."Nothing seems to change,"
Since 2006, federal authorities revoked Heartland's Medicare and Medicaid funding three times and have fined the home a total of $232,375. On Nov. 11, 2006, CMS imposed a funding sanction that lasted more than five months after inspectors found a high-level deficiency that caused actual harm to at least one resident. Authorities lifted that sanction March 8, 2007.Toledo Ohio-based HCR Manor Care, Heartland's overarching corporate owner, operates hundreds of nursing homes across the country and lists assets of more than $8 billion.The company, which itself falls under the ownership of equity giant Carlysle Group, has attracted criticism for reportedly hiring too few staff at low pay in order to maximize earnings."They keep the staffing number low to keep profit high," Mike Fuller, a lawyer for Missouri-based firm McHugh-Fuller told the Gazette-Mail in an August interview.Fuller and his firm represented Tom Douglas, who filed a lawsuit against Heartland of Charleston in 2009, when his mother died from dehydration after a three-week stay. In August, a jury found that Manor Care's failure to properly train and retain staff caused the woman's death, and awarded Douglas and his family $91.5 million in punitive and compensatory damages. A judge later reduced the award to $90.5 million to comply with the state's medical malpractice caps.Fuller said he has spoken with several Heartland staffers who say that the home's administrators are not committed to providing permanent solutions to its problems."Nothing seems to change, according to the employees at Heartland of Charleston," Fuller said.Heartland officials declined to comment directly, and instead referred inquiries to Charleston lawyer Brian Glasser.Glasser's firm, Bailey and Glasser, represents Heartland in the Douglas case, and is gearing up for a likely appeal of the massive jury verdict."As I understand," Glasser said of the recent sanctions, "there are no outstanding deficiencies, and the problems have been abated satisfactorily."Glasser did not know if the company fired any administrators or made other staff changes as a result of the poor inspections.When asked about previous sanctions indicating that administrators are not learning from past mistakes, Glasser said: "Obviously it's not ideal, and they're doing everything they can to improve."Since 2009, the state's six Heartland homes have settled 27 lawsuits and two claims for more than $13 million, according to filings in the Douglas case. Fuller estimated that his firm alone is in litigation for 10 to 20 lawsuits involving HCR Manor Care at any given time."They told me they do not have any ice"
Resident No. 228 picked at the smatterings of blood above her eye. The state inspector noticed that the woman had dried blood under her fingernails. She asked if her eye still hurt."What do you think? Look at it."The woman's nursing notes stated that at 6:30 a.m., when she was released from the hospital, she refused to let staff put ice on her eye.The woman told the inspector that wasn't true."They told me they did not have any ice," she said, according to the report.The woman's aftercare instructions indicated that Heartland staff was to give her Tylenol or ibuprofen to mitigate her pain, and apply an ice pack for 20 minutes every two hours to control the swelling. The woman told the inspector that the nurse's aides "don't even come in here."The inspector asked the woman if she would like some ice for her eye."Yes, if they have some," she answered. "Maybe that would make the pain go away."Reach Zac Taylor at Zachary.Taylor@wvgazette.com or 304-348-5189.