Last August, after a staffer was charged with molesting elderly patients—some of whom were too ill or frail to plead for help—at a Bristol, Va., nursing home run by Murfreesboro-based National Healthcare Corp., whistleblowers hoped that the ensuing attention would create an inhospitable climate for serial predators.
Instead, an October survey of the nursing home's staff obtained by the Scene—prompted in part by a sexual-abuse complaint lodged in September—found that most of its employees don't even know they are required by law to report abuse allegations to the state.
Twenty-one of 35 staff members interviewed by surveyors for the Centers for Medicare and Medicaid Services were not aware they must report allegations of abuse to the appropriate state agency. The survey findings are particularly troubling for a nursing home company—which also has facilities in Hendersonville, Murfreesboro, Columbia and Cookeville—that current and former staffers say has swallowed up complaints against its employees.
James Wright, 35, was arrested in late August on a four-count indictment charging that he sexually abused Bristol nursing home residents in his care. Through affidavits and interviews with current and former NHC Bristol employees, a Scene story ("Unsafe in Their Beds," April 9, 2009) uncovered multiple allegations of abuse, to which employees said management turned a deaf ear.
After a 2007 Bristol Police investigation turned up nothing—though some familiar with the investigation say his name was never mentioned to police—Wright was forced to resign, say nursing home employees familiar with his departure. He left NHC Bristol with a flawless record and went to nearby Grand Court Bristol, where another abuse allegation surfaced against him in May 2008. Wright has since lost his license and is being prosecuted.
How could this happen? Staffers cited such problems as chronic understaffing—a persistent complaint against NHC nursing homes, which are frequently dinged for running a skeleton crew where profits flow and patients suffer. NHC facilities in Hendersonville, Murfreesboro, Columbia and Cookeville all have below average and way below average ratings from Medicare for their staffing levels.
Even so, NHC Bristol may serve as an extreme example of just how bad a nursing home can be. The allegation of sexual abuse wasn't the only complaint that prompted the survey in October. According to Brenda Bagley, supervisor of the complaint unit for the Office of Licensure and Certification at the Virginia Department of Health, the nursing home had been reported for a "general lack of care."
One particularly egregious case the survey cites is that of a man who was nearly killed by a pressure ulcer, or bed sore, on his tailbone. He lost more than 12 pounds over the course of nine days. After a wound-care nurse initially treated the ulcer, it wasn't treated again for four days, the report says. Only after slipping into a delirious state and crying out from the pain was the patient transported to the hospital. By then the advanced state of the ulcer had caused sepsis, or blood poisoning. Worse, it had rotted its way down to the bone, requiring surgical treatment.
Another resident with a wound on her heel didn't receive treatment for a week after it was ordered. Even then, help came only intermittently.
There's nothing inexplicable about these lapses in care. The facility receives a "Much Below Average" rating from Medicare for staffing and health inspections. In spite of this, a spokeswoman for the Centers for Medicare and Medicaid says NHC Bristol has no violation on record that would threaten its participation in Medicare.
Nurses, aides and one nurse in a management position all said the chain of command is paramount at NHC Bristol, which makes proper reporting of abuse allegations crucial. Then again, they say, the higher links of that chain never acted on the majority of complaints made against Wright. If those accusations are true, that inaction allowed him to abuse, by the Scene's estimate, at least eight different residents over nearly a decade.
"There seems to be a reluctance for people to come forward. They felt like they had reported it to the authorities and nothing happened in 2007 with the [Bristol] police and others," says Chris Durrer, director of the Office of Licensure and Certification at the Virginia Department of Health. "I don't think we've seen this in other situations.
"We're puzzled by some of this occurrence."
Asked about the results of the survey, NHC says in an emailed response to the Scene that some of its employees were tripped up by the wording of the questions—specifically the term "mandated reporter," meaning someone bound by state law to report allegations.
"While all staff members were instructed regarding their responsibility to follow the appropriate reporting process, not all of them were familiar with the specific term 'Mandated Reporters' as presented in the interview," says Gerald Coggin, NHC senior vice president.
The question, however, was asked by surveyors in several different ways: To whom would they report abuse? What would they do if they felt their report was not acted upon? Could they could identify what a "mandated reporter" was and if they themselves were mandated reporters?
Twenty-three of the 35 NHC employees interviewed said they would simply follow the "chain of command."
But this startling ignorance of proper abuse reporting, whether willful or not, wasn't found only among low-ranking nurses and nurse aides. The administrator of the nursing home, Charlotte Wilson, failed to report allegations of abuse involving a resident to the resident's responsible party—usually a family member or guardian, in contravention of state law and NHC's own policy. "I figured they were already aware of it since it was being investigated," Wilson told surveyors.
Coggin says "the Administrator was not informed of the allegation until 2009. She was informed by authorities who were already investigating the matter. These authorities had already advised the patient's family of the allegation."
"When any allegation of possible abuse was reported to the Administrator, it was reported to the authorities, whose investigation revealed no evidence of abuse," Coggin adds, referring to the single Bristol Police investigation in 2007. "More recent investigations suggest that some potential abuse may not have been reported to the Administrator. This issue is still under investigation and NHC Bristol is cooperating fully in that investigation."
It's difficult to tell how far complaints against Wright made their way up the chain of command at the nursing home. NHC Bristol employees have told the Scene they witnessed Wright groping residents' breasts, caught him with his hands between a resident's legs while he pleasured himself, and found a suspicious bruise around the anus of a patient in his care. They also say they reported these incidents to charge nurse Helen Roberts, former director of nursing Ann Franklin and former director of nursing Evelyn Nunez. Whether the top brass told the administrator, the top link in the proverbial chain, is difficult to divine.
What is known is that Wright was banned from a number of residents' rooms. Attorney Parke Morris obtained a settlement for the families of some of the victims from NHC for an undisclosed amount. He declined to comment for this story.
Meanwhile, NHC Bristol has submitted a plan to correct these shortfalls. The state Department of Health will make unannounced visits for some time afterward. But even with increased scrutiny on the halls of NHC Bristol—albeit by a maddeningly complex and nearly inscrutable patchwork quilt of state and federal oversight—there's no way to know whether an insular culture of squelching abuse complaints will continue at NHC Bristol.
As Virginia Department of Health's Bagley puts it: "How do you know if there's a reluctance [to report] if it's not being reported to you?"
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