A lawsuit headed to trial this year in Lewis County Superior Court alleges that a Centralia nursing home failed to monitor a patient’s most basic bodily functions, leading to her death about a month after she was first admitted to the facility.
“Her death, it was entirely preventable,” said attorney Stephen Hornbuckle, of the Hornbuckle Firm in Bellevue, who represents the plaintiff.
Bessie Ritter was admitted to Prestige Post-Acute & Rehabilitation Center in Centralia in July 2014 following a surgery to clear a bowel obstruction, he said.
According to the complaint filed with the court, the facility’s staff did not adequately monitor Ritter’s bowel movements “for an extended period of time” in August 2014. She was taken to the emergency room on Sept. 1, 2014, and died after surgery.
While the lawsuit only pertains to one case of alleged malpractice, inspections by the federal Centers for Medicare & Medicaid Services (CMS) and the state Department of Social and Health Services show “deficiencies” in care at Prestige at twice the state average.
Deficiencies documented cover patient mistreatment, quality of care, resident rights, nutrition and dietary problems, pharmacy, environmental and administration issues, according to medicare.gov.
Inspection records note two other instances of deaths at the facility after patients were left unsupervised or unmedicated, report that residents did not have access to food or water other than scheduled meal times, and stated residents getting hospice care had little access to programs that could have improved their quality of life.
In one deficiency noted in a January 2016 report, a surveyor from CMS noted that, while residents have the right to refuse care and treatment, staff at Prestige tricked a patient who did not wish to take antipsychotic medications by concealing the medication in peanut butter.
Hornbuckle, who said he has participated in similar cases against nursing homes, believes many problems at such facilities can be blamed on cost-cutting practices and lack of oversight.
“It always goes back to that,” he said. “They’ll overwhelm the nurses and the aides with tasks and operate the facility at kind of the lowest margin possible in terms of staffing. People’s entire lives fall through the cracks.”
Firmani + Associates Inc, a public relations firm based in Seattle, issued a statement to The Chronicle Monday on behalf of their client, Prestige Care Inc, regarding both the lawsuit and inspections from CMS.
“Our latest report from the state showed areas where we needed to improve, and they have been pleased with our progress,” the statement reads. “Specifically, we’ve continued refining our best practices by providing additional training to staff, we’ve restructured our leadership team to provide additional clinical oversight at every management level within our center, and we regularly test our systems to be sure we’re improving and welcome visits from the state to ensure our progress.”
Ritter’s daughter, Geraldine Iverson, filed a medical malpractice lawsuit in Lewis County Superior Court against Prestige Care Inc. and Northwest Country Place Inc, in April 2015, arguing that her mother was a victim of medical negligence and abuse as a vulnerable adult before her death.
At the time, Northwest Country Place owned the facility, but it was managed by Prestige.
Prestige Post-Acute and Rehabilitation Center, at 917 S. Scheuber Road in Centralia, specializes in short-term rehabilitation for patients who have been injured or ill or who are recovering from surgery, according to its website. It is a part of Prestige Senior Living LLC, which has assisted living facilities in eight states.
A pretrial hearing for the case is scheduled for July 28 and a trial is scheduled to begin on Nov. 1.
The statement from Prestige asserts that it has attempted to resolve the case quickly, but has been unsuccessful. The statement notes that Prestige cannot comment on the particulars of the case.
“What we can share is that the Washington State Department of Health’s investigation did not find issue with the caregivers involved in Mrs. Ritter’s care,” the statement reads. “We understand, as well, that prolonged litigation is terribly difficult on everyone involved, most notably Mrs. Ritter’s family, and we’ve been working to try to reach a resolution to the case as quickly as possible, but the attorney representing Mrs. Ritter’s family has delayed the process.”
However, according to an inspection report conducted by the state Department of Social and Health Services on the incident, Prestige did not meet a requirement to “provide the necessary care and services,” to Ritter and “failed to consistently implement monitoring and treatment of constipation.”
Hornbuckle said Ritter was in fairly good health before the alleged neglect.
“A little over 10 days before she died (Iverson) took her mother shopping and they had an enjoyable family outing,” he said. “(Prestige) knew that she didn’t have any bowel movements in those 10 days and didn’t call the doctor. They ignored their own policies.”
Ritter was taken to the emergency room on Sept. 1, 2014, and died a few days later from complications from surgery, according to the complaint.
Documents submitted by Iverson and her attorney also argue that staff at the facility failed to respond to Ritter’s call light and handled her roughly.
“The negligence of Prestige Care Inc. and Northwest Country Place Inc. were a proximate cause of Bessie Ritter’s constipation, bowel obstruction, wrongful death and other injuries resulting from neglect and negligence,” the complaint reads.
The complaint also asks for unspecified damages pursuant to rights under the Abuse of Vulnerable Adults Act, defined in RCW 74.34.200. Iverson also asks for unspecified damages for pain and suffering, physical impairment, loss of consortium and past medical care.
“I think (Iverson would) really like to see this not have to happen to anyone else. She also wants to hold the facility accountable for what was an avoidable death,” Hornbuckle said.
He said the amount of the award would be up to a jury.
“We think a human being’s life in a preventable death is worth a great deal.”
According to health-inspection information available on its website, the Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS) documented 20 “deficiencies” in care at Prestige Post-Acute Care in Centralia in its most recent survey of the facility this January.
The facility is listed as “much below average” for both its overall rating and health inspections, according to information on medicare.gov.
The average number of deficiencies found at Washington nursing homes in 2016 is 10 and the national average is 6.9, according to CMS. The range of deficiencies at Washington facilities was zero to 43 in 2016.
The 2016 survey also found six fire safety deficiencies.
This is compared to 29 deficiencies at Prestige in Centralia in a January 2015 inspection — when it had the highest number of deficiencies among surveyed Washington facilities. In a January 2014 inspection, 12 deficiencies were identified.
A Prestige nursing assistant was accused in 2015 by the state Department of Health of unprofessional conduct after allegedly taking a photograph in February 2014 of a woman with dementia who was sitting on a toilet with her pants down. The nursing assistant allegedly shared the image with a coworker. The nursing assistant was terminated.
Prestige has been fined $8,450 by CMS since 2014, according to medicare.gov, and has been denied a federal payment once, in January 2015.
CMS inspects facilities it works with to make sure that facility meets the conditions of participation with medicare and medicaid. If facilities do not meet those conditions, CMS can terminate its relationship with the nursing home, meaning it would no longer reimburse the facility for caring for Medicare and Medicaid patients, said Steven Chickering, manager of the Survey and Certification staff at CMS’ Seattle Office.
“They’re supposed to be of compliance at all times,” Chickering said. “If there are a lot of deficiencies that’s a concern.”
In addition to the deficiencies themselves, surveyors look at the scope and severity of the problem, examining how pervasive the problems are at the facility, he said.
The deficiencies range from minor — affecting few people with little actual harm to residents — to major, including cases in which residents died or were injured.
In the most serious deficiency recorded in the 2016 survey at Prestige, a staff member found a resident dead in their bathroom one morning when bringing their medications. The CMS surveyor found that the patient had not been checked on for about 10 hours and wrote, “The facility failed to monitor the resident closely and did not provide care per the standards of practice.”
The inspection also determined that the patient’s medical record did not include accurate or complete information, making it difficult to determine if staff took appropriate action after finding the patient unresponsive.
In 2015, a surveyor found that a patient who was having chest pain “did not receive the necessary medication to help relieve the chest pain.”
The resident was transferred to the hospital where she later died.
Other deficiencies in the past three years stated that residents’ illnesses worsened while recuperating in the facility, that staff did too little to prevent falls, that medications were not properly distributed, and that staff failed to follow doctors’ orders.
According to CMS, the deficiencies at Prestige were addressed within about a month of the inspections.
“As caregivers, there is nothing more important to us than the safety and well-being of our patients,” the statement from Firmani + Associates reads. “We are committed to continually improving our services to ensure patient needs are met and expectations are surpassed.”
After inspections, institutions are sent a Statement of Deficiencies from the Centers for Medicare & Medicaid Services. The institution has 10 calendar days to respond to each deficiency and come up with a plan to correct it.
If the institution does not respond within 10 days, the institution would receive a warning letter from CMS informing them that, if the problems are not addressed, CMS would recommend termination of the facility’s agreement to work with medicare and medicaid in 90 days.
Facilities can address deficiencies in a number of ways, Chickering said, including instituting new policies, better following existing policies or addressing competency of staff.
“Once they receive the report and the findings that contribute to the decision whether it’s in compliance or not, it’s up to them,” he said. “We would hope they would look at what was the system or part of the system that failed.”
In extreme cases, CMS can also impose monetary penalties for repeated violations. Chickering said CMS staff hope facility managers look at and address the “root causes” of problems identified in surveys.
“We don’t want to wait until someone gets seriously hurt, or the extreme that they die,” Chickering said. “We can only do what the law allows us to do.”
Prestige is not the only nursing home in Centralia with low health inspection scores. In comparison, Riverside Nursing and Rehabilitation Center and Sharon Care Center also had “much below average” health inspection scores, according to medicare.gov, while making up ground on their overall rating with staffing levels and good health outcomes for patients.
Sharon Care Center had 22 recorded health deficiencies found on its most recent surveys from CMS from August 2015 and this March, including findings of possible neglect and mistreatment of three residents, which could cause “immediate jeopardy to resident health or safety,” according to records on medicare.gov. The survey also noted four fire safety deficiencies.
The deficiencies from the August inspection were listed as corrected by October, 2015 and the deficiencies in March were corrected that month.
However, Sharon Care’s staffing and quality were each rated at “much above average.” The facility exceeded statewide averages for the percentage of patients who make improvements, are successfully discharged, and who receive influenza and pneumococcal vaccines. The facility has not received any fines from CMS or federal payment denials for at least the past three years.
Riverside Nursing had nine recorded health deficiencies as of its most recent inspection, in January, according to Medicare.gov, below the state average of 10.6. However, it was still ranked “much below average” on health inspections. Three fire safety deficiencies were noted.
One of the health deficiencies reported that the facility did not conduct a background check before hiring a new employee. All of the deficiencies were marked as corrected as of March.
The facility is ranked “much above average” in both staffing and quality. It was fined $1,700 in February 2015 and had a federal payment denial in 2013.
Prestige, Sharon Care and Riverside are the only nursing homes with inspections by CMS available on Medicare.gov.
By Natalie Johnson / njohnson@chronline.com | Posted: Thursday, June 30, 2016 10:45 am
