The Front

Nursing Home Abuses

AN INVESTIGATION INTO the deaths of two Pennsylvania nursing home residents has led to charges of involuntary manslaughter against four officials at two West Philadelphia nursing homes.

"We allege that each of the victims died from massive and infected bed sores that resulted from criminally negligent and grossly incompetent care," says Pennsylvania Attorney General Ernie Preate. "The victims were in these nursing homes because they required skilled care," he explains. "Instead, they allegedly were neglected, mistreated and forced to suffer greatly prior to their deaths."

 Margaret White lived at Care Pavilion nursing home in Philadelphia, from June 1988 until her death on November 29, 1991 at the age of 75. Elizabeth Ellis was admitted to Cobbs Creek nursing home in Philadelphia in August 1986 and died at a Philadelphia hospital on September 1, 1990 at the age of 69.

 According to Preate, his office, which routinely investigates Medicaid fraud charges, launched the investigations as a result of complaints he had received about the level of care provided to Medical Assistance recipients at Care Pavilion. Preate says the investigation is continuing, with as many as five additional deaths to be examined.

 According to the attorney general, state law holds nursing home administrators responsible for enforcing state regulations pertaining to the health care and safety of patients and for the protection of patients' personal and property rights. The law also makes the director of nursing responsible for the activities of the nursing services staff. The charges allege that while the nursing home employees in question were aware of White's and Ellis' conditions, they failed to act to ensure that the women received adequate care at their respective facilities.

 The attorney general says his office also filed criminal charges, including counts of involuntary manslaughter, against GMS Management of Philadelphia, alleging that the corporation failed to discharge its duty under the law to provide adequate care for patients. GMS is a subsidiary of Geriatric and Medical Centers, Inc., which operates the nursing homes under a contract with Resource Housing of America in Atlanta, the owner of the homes, according to state officials.

"The grand jury found that GMS Management's alleged failure to correct continuing deficiencies in management and staffing of the homes contributed to the deaths and constituted criminal behavior," Preate says. In a statement, GMS counters that it "strongly denies these allegations and is confident it will prevail when all of the facts are presented."

 The attorney general's charges against GMS Management include a count of Medicare fraud, based on the nursing homes' alleged failure to provide White and Ellis minimal accepted levels of care required by state law. According to Preate, because both White and Ellis were Medical Assistance recipients, the homes billed the state Medicaid program for the care the women received.

 The complaints note that the grand jury reviewed reports about White and Ellis from health care experts, including Dolores M. Alford, a gerontic nurse consultant. Alford's report states that her review of White's records "tells the story of a frail woman who went to Care Pavillon because she was in need of care and compassion. That she did not get. She was sorely abused physically and mentally by a most incompetent and uncaring staff, who willfully and wantonly destroyed her body. Mrs. White had to die to get some relief."

 Alford's report on Ellis states that the staff at Cobbs Creek "willfully and callously disregarded the basic needs of a human being for food, water and personal care." Alford concludes that the staff at Cobbs Creek "made her [Ellis] into a living cadaver. This staff did not afford her the dignity of a humane life."

 At a news conference, Preate said that, "one sore was so deep it penetrated the victim's internal organs and her bowels drained out of her hip." Medical experts told the grand jury that bed sores - technically known as decubitis ulcers - result from the failure of nursing care providers to reposition bedridden patients regularly and from inadequate food and water. Such sores can be prevented and, when they do develop, can be cured, by proper medical treatment, the experts testified.

White and Ellis also developed other health problems while at their respective nursing homes, according to the charges. Ellis, for example, developed severe contractures of her limbs. According to an affidavit of probable cause filed with the complaints, "her arms and legs were contracted up into her body. Her left arm was twisted and contorted in a fashion such that her hand was pressing into her armpit. The flesh at her left wrist was ruptured open and the bone was protruding."

 Janet Wells, editor of Quality Care Advocate, a publication of the Washington, D.C.-based National Citizens Coalition for Nursing Home Reform, says that the deaths of White and Ellis are part of "a repeated pattern of deficiencies" in nursing home care in the United States. She contends that poor conditions in U.S. nursing homes are due in part to the failure of the federal government to enforce federal standards for care in nursing homes. According to Wells, since the Nursing Home Reform Act was passed in 1987, no federal enforcement regulations have been implemented to guarantee humane care to nursing home residents.

 - Russell Mokhiber