Posted on 09/14/2005 3:30:24 AM PDT by Vaquero
Nursing Home Owners Charged in Louisiana By DAVID CRARY, AP National Writer 17 minutes ago
NEW ORLEANS - Homicide charges were filed against the husband-and-wife owners of a nursing home where 34 elderly patients are believed to have drowned in Hurricane Katrina's floodwaters, the first major criminal case related to the storm's still rising death toll.
For Louisiana alone, the toll surged by more than half Tuesday to 423, and officials fear the numbers could climb as floodwaters recede and more of the city becomes accessible to search teams. Including deaths in four other states, Katrina's overall death count stood at 659.
"It's the water. Everything is driven by the water," said Lt. Col. Mike Thompson of the Oklahoma National Guard.
Authorities said the toll would be lower if Salvador and Mable Mangano, owners of the St. Rita's nursing home in town of Chalmette, had heeded warnings to evacuate their patients as Katrina came ashore Aug. 29.
"The pathetic thing in this case was that they were asked if they wanted to move them and they did not," said Louisiana Attorney General Charles Foti. "They were warned repeatedly that this storm was coming. In effect, their inaction resulted in the deaths of these people."
The Manganos were released on $50,000 bond each; each of the 34 counts against them carries up to five years in prison. Their attorney, Jim Cobb, said his clients were innocent and had waited for a mandatory evacuation order from the officials of St. Bernard Parish that never came.
Cobb said the Manganos were forced to make a difficult decision as Katrina approached: risk the health of the patients — many of them frail and on feeding tubes — in an evacuation, or keep them comfortable at the home through the storm.
Tom Rodrigue, whose mother died in the home, was not satisfied. "She deserved the chance, you know, to be rescued instead of having to drown like a rat," he said.
The attorney general is also investigating the discovery of more than 40 corpses at flooded-out Memorial Medical Center in New Orleans. A hospital official said the 106-degree heat inside the hospital as the patients waited for days to be evacuated likely contributed to their deaths.
The updated Louisiana death toll was released
"
OK....so...then by extrapolation, the Governor of LA and even more so, the Mayor of New Orleans should be charged with MURDER.
" Their attorney, Jim Cobb, said his clients were innocent and had waited for a mandatory evacuation order from the officials of St. Bernard Parish that never came.
Cobb said the Manganos were forced to make a difficult decision as Katrina approached: risk the health of the patients — many of them frail and on feeding tubes — in an evacuation, or keep them comfortable at the home through the storm."
The facts will comes out eventually. Moving the elderly infirm is not an easy task. Most have to be lifted in Hoyer hoists and depending on the weight, two people are needed. Where do you put bedridden patients? Van, ambulance, truck, car? How many people are available to attend them in the vehicles? You just cannot leave Alheimer's and dementia patients alone in an open area for any amount of time.
I have to ask, although I already know the answer in most cases:
Where were the children of these elderly men and women? And why didn't they take the time, knowing the storm was coming and knowing the vulnerability of the geography and the patients themselves to get them out of there?
I don't like this case one bit. If there wasn't a mandatory evacuation order and the nursing home owners believed they were doing what was best, it sure seems like a waste of time and resources to go after them. Plus, it puts the nursing home owners' freedom in jeopardy.
The state sure as hell better have overwhelming evidence that the owners didn't give a damn about their patients. Otherwise, filing this case is just making the disaster worse than it already is.
Seems to me that things are pretty skewed in NO.
You are right.
They might want to be careful slappin lawsuits around.
Seems to me that the state and city could be charged for thousands of cases of neglect...especially since they knew the storm was coming and all the reasons they gave for charging the Manganos.
Aside: is the mayor still the mayor if he lives in Dallas?
You're right. How can the nursing home owners be held to a higher standard than the government officials? If there was no mandatory evacuation order, then I don't see how they can be charged. The previous poster also raises an excellent point-- where were the patients' families? Easy now to say the patients should have been evacuated, but the state and the families apparently didn't think so earlier. Without more evidence, I don't see a crime here.
Somehow I think the operative factor here is "husband and wife ownership" =easy ltigation target= as opposed to some of the large nationwide chains which have the resources to give the prosecutor a hard time
Don't know where they were then...but now they're out getting attorneys, assuming that the Manganos have insurance.
Criminal negligence, anyway
Aaron Broussard's, the liar/crier, counter part let his friends mother die?
My mother is in a nursing home. I would never, ever count on anyone there to take responsibility for her in these circumstances. She is barely ambulatory, and while it wouldn't be easy, I'd take her with me. Then again, the nursing home she's in is a new, very modern facility with a wonderful, loving, and caring staff. Not a pole barn-like building like St Rita's in St Bernard Parish with clueless owners.
Democrats are quite simply shameless.
The shoulda, coulda, woulda excuses of the govenor, mayor, owners of the home for the aged and hospital workers just do not cut it!!!!
I just don't see that happening.
Didn't say it will happen....just said it should happen.
Incidentally, I could have written these exact words:
My mother is in a nursing home. I would never, ever count on anyone there to take responsibility for her in these circumstances. She is barely ambulatory, and while it wouldn't be easy, I'd take her with me.
I am happy to report that my mother will be discharged and returning home next week.
I'm happy for your family that your mother is going home. We tried for 10 years to keep my mom from having to go to a nursing home. After all the struggle, she is very content where she is now. There are tons of activities, she has friends there, and as I said before, the staff is fantastic. But there's no place like home!
The count is now 35 (although I don't know if they'll count the last one) because one lady who was pulled to the roof by a nurse died last night in the hospital just after the family was interviews by ABC according to GMA this morning.
LOL!
They could have gone ANYWHERE, even on a "safari".
To be somewhat fair, no one really could know the levees and floodwalls WOULD for sure fail. In fact, after the storm had passed, everyone was glad they had "dodged a bullet".
By that time, communications had failed to the point that even a "run for your lives!" order would not have reached many people.Nagin could have positioned buses on high ground and taken those who fled away...but for days folks languished in the Superdome and convention center. Thats what I fault him for....and thats not Bush's fault.
I don't see any other city being able to cope any better given the circumstances,on any level.[Of course, not many other cities are built in a hole either....]
Thats why the blame game is so silly.
Is this the one where the residents were there for a week before they drowned? If it is, then there would certainly be a case for a lawsuit, IMO. I remember hearing about a guy whose mother called him everyday asking if she'd be rescued and he kept promising her she would. I still wonder why he didn't go do it himself. Nevertheless, the nursing home should have told those who called that if they wanted to take their loved ones, by all means do so. It would have saved at least some lives instead of making promises you weren't wure you could keep.
wure=sure
I imagine a scenario where people show up to get on a bus, any bus ... and when the driver has a full load he grabs a map and just heads out for any place inland and uphill. Maybe the Mayor would even have enough foresight to give them some cash for groceries, etc. Regardless; when they arrive somewhere upstream, they pull into a church or community center and announce that they are from New Orleans seeking shelter from the storm.
Any guess as to how many of them would have been raped, robbed or turned away?
MSM too!
A wild guess....much less than in NOLA after the storm?
VERY good question.
Part of most nursing home admission policy is to ask 'if we need to evacuate, will you come get your relative'?
Most people say yes on the form,
but I swear, when the day comes....
Most say "I think Mom would be better off with you..." or "I wouldn't know how to take care of her!"--
out of 120 who had capable family, only 8 were taken with them.
One woman even BROUGHT us another elderly relative to take with us!
It's pretty horrific the numbers that were left in our care (to ride on school buses) while the children bugged out in comfy cars.
As an asside, school bus seats are very hard on fragile, elderly skin.
Sadly, many children deposit their parents in nursing homes and wash their hands of them.
My mother's been in one for 66 days and it's been a horrid experience. She lost 13 of her 90 pounds in the first 20 days. I had to call our priest for Last Rites a month ago, and basically had to "come untrained" to insure she received care free of major errors. I go by their twice a day, know everyone on the staff by name, and still have to provide my mom with basic items - water for one! (I understand she is in the best facility in our county.)
During the incredible number of hours I've spent in the place, I have only seen one other resident receive a visitor.
I must question the morals and motives of the children of these patients.
Working in NH is a real eye-opening experience. The biggest lesson I learned is it wasn't how expensive or 'nice' the home was. The staff pool was the same for the best and the worst in the same town. It was how agressive managment was about assuring care.
I've seen horrors in homes with Aubouson carpets and cherry highboys. I've seen fabulous care in cinderblock 'county' homes. So I used to get a giggle when someone would brag about how they had put Mama in ________, 'you know the home on the marsh with the crystal chandeliers'.... which was ALSO the home that had a record number of federal violations. (So much for doing research).
You're doing the right thing by going in every day. Those residents are always the ones who do the best in the long run. Staff knows you're watching, and you can catch problems before they become life-threatening.
And yeah, kids do abandon family all the time. I've actually heard of children showing up at what staff thought were childless resident's funerals...and they even lived in the same town!
With weight loss, make sure they are being agressive in care planning how they are dealing with it....there are so many things that can be done these days.
As for water, that isn't news. It's one of those things that just slides through the cracks. I used to make 'supper' rounds in a couple of homes to see if the feeders were being fed. I can't tell you the number of times I would see trays put out and then picked up 20 minutes later untouched...by staff that didn't even uncover the plate.
IMHO, they were in a no win situation, and according to their lawyer, they saved over 50 of their residents but could do nothing for the other 34. I've seen the Louisiana attorney general all over TV this morning, and he strikes me as a weasly character, and his answers to some very interesting questions are overly defensive. Consequently, I would not be surprised if this is an early attempt to scapegoat these two individuals to deflect blame away from Nagin and Blanco for those nursing home deaths.
" I would see trays put out and then picked up 20 minutes later untouched...by staff that didn't even uncover the plate."
Or left on the rolling bedtray that was next to the door, not even by the non-ambulatory resident's bed.
The ones with the chandeliers and carpets in the front reception area are usually the ones whose staffing is one LPN for medications and three aides for 30 to 50 residents.
Gotta keep those shareholders happy. The residents are going to die anyway.
Btw, did you hear the one that added in maintenance, office staff, administration and janitorial as healthcare staffing?
What more "overwhelming" evidence do you need? They left their patients and fled the scene leaving the elderly to fend for themselves. They should be convicted of first-degree murder and sentenced to drown.
LOL! I wouldn't be surprised. I was in an "assisted" living one weekend that had ONE LPN in the building, plus the guy in the kitchen for 50 of some of THE most fragile elderly I'd ever seen. At the time, by putting 'assisted' in the name meant you could have brass fixtures and walnut doors...and NO staff!
One facility I consulted in hired everyone on a 38 hour work week (no benefits), so they had a constant turnover, to the point that you couldn't keep staff trained on THE most basic procedures. I would walk in the kitchen every week to see a brand new batch of folks who couldn't boil water.
This same facility, owned by a well-known healthcare corp, had the kitchen walk-in go down for 4 days! The refrigeration company wouldn't even go out there without a check waiting on them (seems they'd been shafted before). I could go on and on and on....bottom line is that just cuz it's purdy, don't mean it's good ;)
Nursing home owners booked in 34 deathsThe couple own St. Rita's Nursing Home near Poydras, where Katrina's massive storm surge flooded the one-story building to the ceiling in 30 minutes, overwhelming bed-ridden patients in one of the deadliest storm-related incidents....
As the hurricane raged Aug. 29, neighbors and firefighters rescued about two dozen of the nursing home's residents, many of whom were floated out on their mattresses. But the waters rose too quickly to save the rest, Foti said....
Echoing assertions made last week by parish officials, Foti said Mable Mangano, the home's licensed administrator, refused two evacuation buses the day before the storm. He said she also failed to call an ambulance company under contract to provide ambulances and helicopters for patients with special needs......
But Foti said the nursing home owners had no choice at all. He said they were required by law to follow a mandatory evacuation plan filed with the parish government for hurricanes stronger than Category 2. Katrina made landfall as a Category 4......
[end snips]
NURSING HOMES TOLD TO PREPARE
PLANS NEEDED FOR EVACUATION
Times-Picayune, The (New Orleans, LA)
June 11, 1996
Author: JENNIFER BAGWELL St. Bernard/Plaquemines bureau
Estimated printed pages: 3
Nursing home residents could be stranded in St. Bernard Parish if they don't leave two to three days before a severe hurricane, local emergency preparedness officials said Monday.
Bob Bracamontes, director of the local Office of Emergency Preparedness, said it's crucial for nursing homes to have plans to evacuate their residents 48 to 72 hours before a severe storm.
"When you get winds up to 50 to 60 mph, you're not going to be able to have them out on the road," Bracamontes told a gathering of nursing home administrators, a retirement community official and representatives from community homes for the handicapped. "If you wait too late, you could be trapped. You have to be very careful."
It's the first month of the 1996 hurricane season and Bracamontes said his office has received a written evacuation plan from only one of St. Bernard's six nursing homes, St. Rita's Nursing Home.
The Louisiana Office of Emergency Preparedness has been trying for years to persuade the state Department of Health and Hospitals to make written disaster plans a licensing requirement for nursing homes, and Bracamontes warned nursing home administrators Monday that the plans may soon be mandated.
Bracamontes and other emergency preparedness officials say they fear lack of planning could be especially dangerous this year because the Red Cross won't open shelters in Louisiana south of Interstate 12 before or during a severe hurricane - a slow-moving Category 3 or any Category 4 or 5 hurricane.
Local Red Cross director Judy Hoffmeister said that in the past, evacuating families have forgotten to pick up their relatives from nursing homes. Others have abandoned nursing home residents at Red Cross shelters.
"People take their loved ones out of the nursing homes and, like during Hurricane Andrew, they ended up on the doorstep of the Red Cross with their catheters and things," Hoffmeister said. "Then it becomes a Red Cross problem. Then we have people with serious medical needs in the Red Cross shelter."
During past hurricanes, the Red Cross opened Chalmette and St. Bernard high schools to evacuees.
But Hoffmeister said top Red Cross officials clarified last November the organization's policy on opening shelters in flood-prone areas, saying such areas - including all of Louisiana south of Interstate 12 - will have no shelters until after a severe storm. As a result, nursing home officials will have to bus their residents north to places such as Baton Rouge, Alexandria or Monroe. Without local shelters, nursing home administrators say they will have to evacuate not only residents, but often residents' spouses, too.
"You've got to call all of their families, get all of their medications, you've got to worry about food," said Julie Johnson, administrator of Maison Orleans Nursing Home in Arabi. "It's a nightmare."
Mabel Mangano, administrator for St. Rita's Nursing Facility in St. Bernard community, agreed.
"We're dealing with lives here," said Mangano, who showed a copy of her home's written evacuation plan to the group. She said she has sent the plan to the state Department of Health and Hospitals. "It scares you, with all of these people who are really helpless."
All of the administrators said they have evacuation plans, but most haven't submitted them to local or state emergency preparedness officials or the Department of Health and Hospitals.
Many said they have access to school buses and contracts with transportation companies so they can take their residents to nursing homes and other facilities north of I-12 in the event of a hurricane.
http://www.nola.com
Did they let the Medicaid people die and save the private pay? Did they leave the most vulnerable and take those easiest to take? Here's my guess - they took the private pays and maybe someone they were attached to...
In small homes like this one everyone pays a different amount.
Though Gov. Kathleen Blanco’s Health Care Reform Panel considered increasing sanctions against nursing homes, it did not include that recommendation in its March report on ways to improve long-term care in Louisiana, and it is not a part of the package Blanco has proposed for the legislative session that begins Monday. Deaton said she sees no reason to beef up penalties. She said it’s not her job to punish nursing homes for harming residents. She said her goals are simpler: to point out when a home has made a mistake and leave the job of improving care to them. "I don’t think punishment makes a good nursing home," Deaton said.
In September 1998, during the massive evacuation for Hurricane Georges, two nursing home residents died after they were moved out of the New Orleans area. An 86-year-old woman had a heart attack after being stuck on a bus without air conditioning, where she was given nothing to eat or drink for 10 hours, according to Hood and a lawsuit filed on the woman’s behalf by her family. Another lawsuit alleges that a diabetic resident died after he was accidentally given orange juice and went into a coma. Hood said he ordered an immediate investigation of the homes, both owned by Bob Dean Jr., a Baton Rouge businessman. Hood said he was flummoxed by the results. "The word I got from our investigators was, ‘We investigated this, and we didn’t see any problem. The lady was going to die anyway,’ " said Hood, referring to the bus incident. "When I heard those words, I freaked out. I said, ‘I want you to do another investigation, and I dare you to tell me that again.’ "
STATE OF NEGLECT -
Families trust nursing homes to care for loved ones, not leave them unsupervised to drown, like Gregory Thompson. But in Louisiana, where at least 33 people have died in the past six years because of poor care, punishment is usually only a slap on the wrist.
Times-Picayune, The (New Orleans, LA)
April 17, 2005
Author: Story by Jeffrey Meitrodt
and Steve Ritea
Staff writers
Estimated printed pages: 14
Gregory Thompson was 43 when he drowned alone in a whirlpool bath at Maison Orleans I Nursing Home.
Severely brain-damaged after being hit by a car while crossing a New Orleans street, Thompson had a history of wandering and was prone to seizures. But his roommate told state inspectors that Thompson frequently went into the whirlpool alone, even though the home’s policy ordered staff to "never leave a patient unattended" there.
Records show that on the afternoon of April 14, 1999, nobody had checked on Thompson’s whereabouts for nearly two hours. No one was there to help Thompson after he suffered a seizure and slipped beneath the water to his death.
State regulators placed the blame for Thompson’s death on Maison Orleans I, noting a lack of proper supervision. The home reached an out-of-court settlement with the family. The state issued no fine or other sanction after the home promised to correct its mistakes.
In a similar tragedy, at Maison Hospitaliere in 2001, Margaret Marino, who had Alzheimer’s disease, wandered into another resident’s room and ate a jar of potpourri, a combination of dried flowers and spices. The 82-year-old woman threw up repeatedly that night and the following morning, but staff members didn’t take her to the hospital or seek advice from the Poison Control Center for more than 24 hours, inspectors said. Marino never recovered and died two months later.
Though inspectors cited the New Orleans home for failing to properly supervise an Alzheimer’s patient and for responding slowly to her distress, regulators pursued no penalties after the home submitted a "plan of correction" to the Louisiana Department of Health and Hospitals. Maison Hospitaliere settled a wrongful-death lawsuit brought by Marino’s daughter in 2004.
In 2002, a resident of Maison De Ville in Harvey was taken to the hospital after red ants ate away the top layer of skin over a large part of her body. Home employees first saw ants in the woman’s bed July 17, but she and her roommate weren’t moved out of the room until four days later, when an aide saw red ants swarming over the woman’s body.
According to an inspection report, the aide entered the woman’s room and screamed at the sight of ants "going in and out of her nose" and "even in the resident’s eyes." She arrived at the hospital with more than 500 ant bites.
More than a week later, red ants still infested the home, state inspectors reported. They also discovered that an employee had tried to hide the ant problem from inspectors during their visit.
The state did not fine the home for failing to promptly move the woman after the ants were sighted or for trying to conceal the situation. The regulators’ response was to fine Maison De Ville $900 for not having an effective pest-control program.
Paltry penalties
Those cases are not unusual.
Inspection reports show that most of Louisiana’s 300 or so nursing homes have been cited since 1999 for mistakes that harmed or endangered residents. But in the sometimes illogical world of nursing home regulation, facilities in Louisiana often pay little or no penalty for fatal errors. In fact, homes that make mistakes resulting in a resident’s death or serious injury often pay less than those cited for repeating minor violations, according to The Times-Picayune’s review of more than 3,000 inspection and enforcement actions taken by state and federal regulators since 1999.
Among the newspaper’s findings:
-- The average fine for causing or contributing to the death of a nursing home resident in Louisiana was $1,970, well below the state’s legal maximum of $10,000. Of the 33 fatal incidents reviewed by state inspectors since 1999, nine deaths drew no fines or sanctions, even though inspectors said the homes contributed to the fatal outcomes through significant mistakes in caring for the residents. By comparison, similar cases in California -- which has some of the toughest penalties in the nation -- drew average fines of $70,000. Data for other states were unavailable.
-- State regulators closed none of the facilities they blamed for the death of one or more residents. The only nursing home to undergo license revocation is a Madison Parish home that consistently failed to correct problems such as skipping a resident’s dose of medicine in 2004.
-- Though state regulators say the process of seeking "plans of correction" forces nursing homes to fix their problems, records show such improvement usually is short-lived. More than half of the state’s nursing homes have been repeatedly cited since 1999 for violations that harmed residents or jeopardized their safety.
-- Though the state says nursing homes must report all "suspicious deaths" not related to murder or suicide within 24 hours, only 15 deaths that couldn’t be traced to natural causes were reported to the health department since 1999. By contrast, state inspectors linked at least 33 deaths to poor nursing home care, records show. However, even when the nursing homes filed reports, the state Department of Health and Hospitals usually didn’t send an investigator. Under state and federal law, the department is required to conduct an investigation only when someone, such as a family member, files a complaint against the home.
-- Including state and federal fines, Louisiana nursing homes have been penalized a total of $1.2 million since 2001. In the past four years, federal officials have issued fines of $2.6 million in Arkansas, $3.8 million in Alabama and $4.2 million in Mississippi. Instead of letting the federal government issue all fines for violations, Louisiana is one of a handful of states that typically imposes its own penalties, and the state has one of the weakest enforcement records in the country.
Message to providers
Elder-care advocates around the country said they were shocked at the size of fines in Louisiana, especially in cases where residents died.
A penalty of "$2,000 for a life is unforgivable," said Candice Carter, an AARP lobbyist in Texas, where nursing homes can be fined as much as $20,000 per day.
A former inspector said it sends the wrong message to care providers.
Levying a fine of "$2,000 is nothing to a nursing home, not when you’re getting $3,000 a month for each resident and you’re providing minimal care," said Linda Weaver, a registered nurse who spent four years as a state nursing home inspector in the Shreveport area before quitting last year.
But Lisa Deaton, the state’s top nursing home regulator, said the process is designed to work cooperatively with nursing homes to correct problems rather than to mete out punishment. She said the health department doesn’t issue a fine even in the case of a death unless the home has committed the same specific violation in the previous 18 months or if the same practice threatens the life or safety of other residents.
"Yes, any time there is a loss of life or serious injury as a result of someone’s failure to provide care or something they did inappropriately, that is a horrible tragedy," said Deaton, who has been director of the department’s health-standards section since 1998. "But that is not the essence behind our civil monetary penalties."
Critics say the state’s regulatory approach, especially when coupled with a Legislature that has given nursing homes legal protections against large jury awards and damages, ignores one of the major weapons -- financial sanctions -- that can be used to force homes to correct conditions that maim or kill.
"I can’t understand what they think they’re doing" in Louisiana, said Toby Edelman, senior policy attorney for the Center for Medicare Advocacy, a public-interest law firm that represents nursing home residents throughout the country. "Don’t they understand the purpose of the rules? Look at the federal law: It says the department has to enforce standards to protect the residents. That is the whole point of the regulatory system."
True numbers unknown
It’s impossible to determine how many people have died from neglect or abuse in Louisiana nursing homes because the agencies responsible for oversight do not keep such records. But in the past six years, state regulators have linked substandard care to the deaths of at least 33 residents. Another six deaths prompted state prosecutors or the facilities themselves to take action against nursing home employees.
During that same period, at least 250 wrongful-death lawsuits have been brought against nursing homes in the state’s civil courts, resulting in 88 settlements or jury awards. About 120 cases are pending. The rest were either dropped or dismissed, or their status remained unclear.
Experts say nursing homes are less likely to break the rules when they know they’ll be punished. A 1998 study on New York’s nursing homes found that the average number of violations dropped 36 percent to 78 percent at homes that were fined for violating regulations. The average fine during the four-year period was $7,500.
In California, where the maximum state fine for a nursing home death went to $25,000 in 1999 and then to $100,000 in 2001, the percentage of homes cited for serious violations dropped from 30 percent to 6 percent in the past six years, records show.
"Common sense tells us that when the penalties for abuse and neglect are severe, there is a higher incentive for facilities to abide by the rules," said Mark Beach, an AARP spokesman in California.
Though Gov. Kathleen Blanco’s Health Care Reform Panel considered increasing sanctions against nursing homes, it did not include that recommendation in its March report on ways to improve long-term care in Louisiana, and it is not a part of the package Blanco has proposed for the legislative session that begins Monday.
Deaton said she sees no reason to beef up penalties. She said it’s not her job to punish nursing homes for harming residents. She said her goals are simpler: to point out when a home has made a mistake and leave the job of improving care to them.
"I don’t think punishment makes a good nursing home," Deaton said.
U.S. Rep. Bobby Jindal, R-Kenner, who ran the state Department of Health and Hospitals from 1996 to 1998, sees it differently. He said homes should face severe consequences when their mistakes result in the loss of life. And, he said, state officials should not shy away from revoking licenses and closing repeat offenders. But he said the department’s record on enforcement is so poor that it no longer can be trusted to determine the penalties for such facilities. He said the state should let federal regulators call the shots or set up a health care team within another state agency -- such as the Governor’s Office of Elderly Affairs or the Legislative Auditor’s Office -- to review and approve sanctions.
"There cannot be the attitude within the department that this is tolerable, that this is the normal part of doing business," Jindal said. "It certainly appears that it is time to bring in a very strong external agency to review these findings and make sure appropriate actions are taken."
Annual inspections
The battle to improve nursing home care goes back decades. In 1987, after reports of widespread abuse and neglect in facilities across the country, Congress passed the Nursing Home Reform Act, which called for annual inspections of every nursing home in the country. States perform the work under rules and guidelines established by the federal Centers for Medicare and Medicaid Services.
The inspections, called surveys, typically take as long as five days and are done by teams of four or five state inspectors, most of whom are registered nurses. Each home must be visited every nine to 15 months, but inspectors also are required to investigate complaints and revisit facilities that have been out of compliance.
If inspectors find a problem, they write a citation. Deficiencies are divided into 17 major areas, such as resident assessment, dietary services, quality of care and physical environment. A total of 190 violations can be cited. The most common mistakes include unsafe food preparation -- such as defrosting a frozen turkey by letting it sit out all day -- and failing to take steps to prevent accidents.
Deciding how to punish nursing homes initially is left up to each state, but most health departments simply report findings and pass on the cases to federal regulators, who can fine a facility as much as $10,000 per day. In this region, the Centers for Medicare and Medicaid Services has issued several fines that topped $100,000.
Louisiana, however, is one of the few states that typically chooses to impose its own fines. Most states take that route because they want to slap bigger penalties on nursing homes, experts said. But under Louisiana law, the maximum penalties are much smaller.
In this state, a violation that results in the death or serious injury of a resident qualifies for a maximum penalty of $5,000. The health department is barred from imposing more than $10,000 in fines on a home in any given month, which means that homes with multiple violations sometimes are not required to pay all the fines initially assessed, records show.
Not once in the past six years has the state given a nursing home the maximum fine in a death case. In that time, the state levied one Class A fine of $3,450, despite the 33 deaths linked to poor care.
Jindal said the health department’s enforcement division resisted his efforts to crack down on nursing homes when he took over in 1996.
At the time, he said, the department was notorious for its kid-gloves approach to the nursing home industry. Jindal said homes weren’t being inspected enough, and major violations were being ignored. To top it off, he said, he suspected that many homes were being tipped off in advance about pending inspections by department employees.
"Surprise inspections weren’t surprises at all," he said. "It was obvious that homes were being alerted."
To improve the state’s oversight of the industry, Jindal said he increased the frequency of inspections and set up a toll-free hotline for people to report abuse and neglect allegations.
Uphill battle
David Hood, who succeeded Jindal at the Department of Health and Hospitals in 1998, said he also had to fight the institutional culture when he tried to hold nursing homes accountable for the deaths of residents.
In September 1998, during the massive evacuation for Hurricane Georges, two nursing home residents died after they were moved out of the New Orleans area. An 86-year-old woman had a heart attack after being stuck on a bus without air conditioning, where she was given nothing to eat or drink for 10 hours, according to Hood and a lawsuit filed on the woman’s behalf by her family. Another lawsuit alleges that a diabetic resident died after he was accidentally given orange juice and went into a coma.
Hood said he ordered an immediate investigation of the homes, both owned by Bob Dean Jr., a Baton Rouge businessman. Hood said he was flummoxed by the results.
"The word I got from our investigators was, ‘We investigated this, and we didn’t see any problem. The lady was going to die anyway,’ " said Hood, referring to the bus incident. "When I heard those words, I freaked out. I said, ‘I want you to do another investigation, and I dare you to tell me that again.’ "
Hood said he had to send inspectors out three or four times on the incidents, but eventually the state imposed large fines in both cases, he said.
Dean declined to comment through a spokesman.
That same year, Hood announced plans to tighten the inspection process. To make inspections less predictable, he told inspectors to start showing up on weekends and during late-night shifts, instead of always arriving during regular business hours. He also doubled the number of standard surveys for poorly performing facilities and created specialized survey teams of experienced nursing home inspectors to target homes with repeat deficiencies.
The department started taking a harder line on sanctions. Though nursing homes were slapped with just $25,408 in fines in 1998, penalties climbed to a record of $317,300 in 2004, Hood’s last year on the job.
"We are not perfect in Louisiana," Hood said. "Just like every other state, you can go into the files and find examples that raise questions, and you can find instances where you can argue about whether or not they did the right thing. And in many cases, you’ll be right. But looking at the big picture, through statistics generated by the state and federal government, I think there is a clear pattern that we are getting better."
’Provider-friendly’
Others aren’t so sure.
"I have been on too many inspections where the administrator tells you, ‘Hey, we’ve been expecting you,’ and they’ve got doughnuts in the room. Any surveyor will tell you that," said Weaver, the former inspector. "Something is skewed somewhere. But you never can figure out how they know.
"I think there is a tendency to be provider-friendly," Weaver said. "If we find a deficiency, we give them another chance. And if they’re still out of compliance, we give them another chance. And another chance. And then you come back six months later, and you see them doing the same thing. . . . You want to enforce the regulations, but if it is just going to be a paperwork shuffle, that is totally useless."
Joseph Donchess, executive director of the Louisiana Nursing Home Association, said his more than 260 members have no serious concerns about the state’s enforcement program.
"Do I think we have a fair system in Louisiana? Yes, I do," Donchess said.
The Louisiana process relies heavily on nursing homes reporting their own errors and coming up with solutions for the problems.
Deaton acknowledged that the health department does not send out inspectors to investigate every report of abuse or neglect, even when it involves a suspicious death and there is evidence that a nursing home employee was responsible.
In three cases, she said, the department chose not to investigate because the home had suspended the employee responsible for the incident. "The facility did the right thing by taking action against the employee," she said.
Deaton said the home-generated reports were turned over to the nursing board for possible action on the employee’s license and to the state attorney general’s office for possible criminal charges.
In five other cases, the department chose not to investigate after the nursing homes told the state the deaths were purely accidental. One of those cases involved Maison Orleans II, another New Orleans nursing home owned by Dean.
Deaths on highway
On Jan. 9, 2001, a resident was killed when he left the home on Chef Menteur Highway to buy a 2-liter soft drink. It was after 5:30 p.m. and getting dark, according to an incident report filed by the home. An employee tried to talk him out of walking to the store, but didn’t stop him. A few minutes later, the man was run over by a pickup truck.
Though it was the second time in less than a year that someone from the home had been killed on the busy highway, the report did not trigger an immediate investigation.
"If the facility did not determine it to be abuse or neglect, it was not a reportable event," Deaton said.
Inspectors didn’t look into the accident until they arrived 16 days later to conduct the home’s annual inspection. After a quick review, they decided there was no evidence that the home made any mistakes that contributed to the death, records show.
The situation was different in 2000, when another resident of the home was hit by a minivan and thrown 30 feet on the same stretch of highway. Walter Kerry James, 59, died of his injuries eight hours later.
Inspectors showed up within three days to investigate because someone outside the home had filed a complaint. Such complaints are confidential.
Additionally, inspectors found that James was one of three residents who had wandered away from the home and been hit by cars because the facility had let confused and demented residents leave the facility, a major violation. The other two residents -- one of whom wandered from the facility another 107 times after his accident -- survived.
Maison Orleans II initially took steps to keep James from leaving the facility, inspection records show. When he had been admitted to the home in December 1999, he was equipped with a "wander guard" bracelet that would set off an alarm to alert staff whenever he left the home. Employees decided James needed the bracelet because of his "acute confusional state," inspection records show. He had memory problems and often got lost in the facility.
A week before the accident, the home gave his bracelet to another resident who also had been identified as a wanderer. Administrators told inspectors they couldn’t explain why they failed to replace James’ bracelet.
When James walked out of the home the day he died, his wrist was bare and the home’s front desk was empty. No one had checked on his whereabouts for at least an hour, records show.
"Someone just didn’t care," said James’ ex-wife, Audrey Raymond. "It’s like people in the nursing home were just there to help someone make money."
A jury awarded $840,000 to James’ children and their guardians, finding Maison Orleans II responsible for his death because the home failed to take steps to curb his wandering. State regulators came to the same conclusion and fined the home $1,500, well below the $10,000 limit.
Three residents have died in the past six years from poor care in Dean’s Maison Orleans II, according to state inspection records. Wrongful death lawsuits against Maison Orleans II were settled in another four cases. The facility has paid just $11,050 in state fines since 1999, less than a dozen other facilities.
"Maison Orleans II is not on my radar screen as the worst-performing facility in this state," Deaton said.
Deaton said she couldn’t come up with a list of the state’s worst homes. "That is not my thought process as a regulator," she said. "I don’t retain that knowledge."
Record of neglect
Maison Orleans II is one of eight nursing homes scattered across southern Louisiana owned wholly or in part by Dean, a multimillionaire with a passion for antique cars and historic hotels. In 2003, he auctioned off nearly 50 cars in his collection, including a 1962 Rolls-Royce and a 1930 Model J Imperial Cabriolet Duesenberg once owned by William Randolph Hearst that went for $535,000.
In the past six years, five people have died after receiving inadequate care in Dean’s facilities, according to inspection records. The nursing homes settled wrongful death lawsuits in another seven cases.
Over the same period, Dean’s homes have been cited 40 times for violations that caused harm or put residents in immediate jeopardy. At one home, inspectors found rotten hamburger, moldy cucumbers and roaches crawling out of an open carton of milk. At another, they found maggots crawling out of a resident’s breathing tube. Another citation came when three residents had to be taken to a local emergency room for dehydration; one of them was so weakened that she subsequently lost most of her leg to gangrene.
Dean’s homes also include Maison De Ville in Harvey, the home infested with ants in July 2002, and Maison Orleans I, where Thompson drowned in the whirlpool.
William Treeby, a lawyer who has represented Dean on several matters over the years, said his client would have no comment.
Last month, the Kenner City Council voted to rezone property on West Esplanade Avenue so Dean can construct a 120-bed nursing home there.
In 2000, Dean’s sister, Debra Dean Cook, filed a civil lawsuit alleging he improperly used a $7 million line of credit from Hibernia bank for personal expenditures instead of using the money to renovate his nursing homes or buy more facilities. The suit was later settled. Cook, Dean’s partner in several nursing homes, couldn’t be reached for comment.
’It’s very pathetic’
On any day of the week, people in wheelchairs can be seen rolling up and down Chef Menteur Highway, sometimes darting into the paths of 18-wheelers that typically tear down the eastern New Orleans thoroughfare.
"People from that nursing home come over here all day and night every day," a convenience store manager told inspectors in 2000. "They beg money from our customers, and they curse at them. When we call the nursing home and ask them to come and get them, they get mad and tell us if we wouldn’t sell them alcohol, they wouldn’t come over. They tell us to call the police, don’t call them."
Merchants say they worry that more residents will die while making their way to their stores for booze and other supplies.
"These people, it’s very pathetic to see them; they’re very disabled," said supermarket manager Anna Tran, who said she refuses to sell alcohol to the home’s residents. "They can’t even get up themselves. . . . It’s terrible. This has been a problem for years."
http://www.nola.com
When did they leave - long before the storm hit or as the flood waters came in?
Here is a good article that clarifies what actually happened:
Rescuer recounts panicked attempt to flee home (St. Rita's)
Rescuer recounts panicked attempt to flee home
By Laura Parker, USA TODAY
NEW ORLEANS
The water came up quickly in St. Bernard Parish and engulfed the one-story St. Rita's Nursing Home, where about 60 terrified residents were trapped.
Inside were four or five nurses, several relatives and the owners, Salvadore and Mabel Mangano.
Steve Snyder, a nearby resident, passed the nursing home in St. Bernard in a boat about noon Aug. 29, as he fled the storm with his brother-in-law, Val Manguel, 30. "We saw lots of activity going on. I told my brother-in-law this is going to be bad. We have to go help them out," he said in a phone interview from Lafayette, where he is staying with relatives.
Snyder, 29, pulled up his boat and stepped onto the roof. He saw about 15 other boats loaded with patients — two or three to a boat. Several nurses, and other neighbors were pulling the residents through holes chopped in the roof.
Snyder, an oil rig worker, said he dropped through one of the holes into the building. Water was up to the ceiling tiles, but there was an air pocket in the crawl space. Some nursing home residents, who were floating on mattresses, had pushed up tiles to breathe.
Snyder and Manguel had to duck under the water to pass through doorways. Some residents were hanging onto floating debris. "We had to persuade them to put their heads underwater to get to another room," he said.
Snyder said he and Manguel found several bodies in the cafeteria. "In a way, it was like, this guy's dead, put him here until we can deal with him and move on to find a survivor. We stayed there for about two hours. We searched as much as we could. We didn't leave the nursing home until we couldn't find anyone else alive."
The evacuation order had been issued Aug. 28, as Hurricane Katrina bore down in the Gulf of Mexico. But the Manganos decided to ride out the storm and declined help from parish officials who offered to help them evacuate the nursing home, according to state Attorney General Charles Foti. The couple was charged Tuesday with negligent homicide.
St. Rita's, which was licensed in 1985, had an evacuation plan, as required by state law, and a contract with an ambulance company to transport residents. But they were never called, Foti said.
The morning after the storm, Steve Gallodore, a St. Bernard Parish firefighter, went to St. Rita's in a boat to search for his 82-year-old father, Tufanio, who had been disabled by a series of small strokes.
He didn't find him. Galladore left to get help from sheriff's deputies after encountering three floating bodies at the nursing home, one on the patio and two in the lobby.
Galladore said he went to the parish school where some nursing home residents had been taken. He saw a nurse from St. Rita's. "She couldn't talk to me at first. She looked at me again and said she was sorry," he said. "I asked her, 'Does that mean he wasn't one of the survivors?' All she could say was, 'I'm sorry.' "
Galladore said he would never have left his father if the owners were not going to evacuate.
Cheryl Emmons, Galladore's sister, said she will always be haunted by her conversation with her father shortly before Katrina struck. She wanted to evacuate him but was unable to take him in her car because he was paralyzed. She said her brothers had assured her they had talked to the nursing home staff and that he would be cared for.
"I went to visit my dad Saturday night," she said. "He had trouble speaking. He kept looking at me, he kept saying, 'Hurricane is coming, are you coming to get me?' He asked several times. It was hard to look him in the face and say, 'No, we're not coming.' "
Well, well, well. This article clearly spells out what happened, minute by minute, day by day. We need the video clip from Meet The Press posted right next to this article. I thought I saw it on FR a few days ago, but can't find it now. Does anyone remember the thread that contains the clip?
They Terri Schiavo'd a whole group in one fell swoop.
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