References
Care in Beverly Facilities

---

Beverly's reputation for care is extremely poor and it is used as the vehicle for exposing nursing home problems in several press reports. Beverly has a track record for staffing deficiencies, failures in care, problems with regulators and for conflict with the nurses going back to the early 1980's at least. Eric Bates writing for The Nation in March 1999 said of Beverly in the 1980's

Across the nation, health officials filed reports on Beverly nursing homes documenting filthy living conditions, infected bedsores and painful deaths. The State of Washington banned the company from opening any new homes because of its poor track record.

Bates' article "The Shame of OurNursing Homes" describes Beverly's history, its understaffing, its conflict with nursing unions, and its failures in care during the early years and subsequently. I do not have other references to this period and I have provided a full copy of this article on a separate page.

Note that when Beverly shareholders commenced action against Beverly because of its mismanagements and deceptive practices they not only alleged fraud, but also understaffing. (see Beverly fraud page)

The articles are in rough date order except where the content refers specifically to earlier events.

References

Nursing home pleads guilty to defrauding federal Medicare program
San Jose Mercury News February 4, 2000, Friday

Overall, Beverly operates 500 nursing homes in 32 states. Five of the 10 nursing homes specifically targeted in the investigation were in California, where Beverly has had a checkered past with regulators. At one point during the 1980s, California put the chain on probation as a result of widespread reports of neglect in its facilities, including those in Los Gatos, Santa Clara and Santa Cruz.

Beverly to settle negligence suit
Modern healthcare Tuesday, Nov. 25 1997

A Henderson, Texas, jury reportedly ordered FortSmith, Ark.-based Beverly Enterprises to pay $83 million to the family of a former resident in one of its nursing homes. As part of a negligence lawsuit, the jury awarded the family $13 million in actual and $70 million in punitive damages. The jury found the company had ignored complaints that its Borger, Texas, nursing home was understaffed and its workers were insufficiently trained. The jury concluded such conditions led to the 1994 death of Ruth Waites. Beverly intends to appeal the verdict.

Wrongful death suit filed by granddaughter of dead patient
The Associated Press State & Local Wire October 26, 1998

A Jacksonville nursing home ordered by state officials to shut down by Nov. 13 is also the target of a wrongful-death lawsuit. The lawsuit filed by Kim Holdford of Sherwood claims Beverly Health and Rehabilitation Center failed to administer medicine properly to her grandmother, Jewell Elizabeth Forester, who died of a drug overdose at the home in June 1997.

Ms. Holdford's lawsuit, filed last month, also accuses the nursing home operator, Beverly Enterprises Inc. of Fort Smith, of not training nurses and staff properly, and claims that nurses failed to report Ms. Forester's condition accurately to her family and physician.

On Oct. 15, the state Department of Human Services ordered the nursing home to close. DHS said the closure stemmed from an investigation that showed that "standard practices were not followed when a patient pulled out a freshly inserted gastrostomy tube" and the patient, Howard Holderfield, later died.

In addition to naming the nursing home and Beverly Enterprises as defendants, Ms. Holdford's suit in Pulaski County Circuit Court targets Dr. Chris Wormuth of Jacksonville as a defendant.
---------------------
Beverly officials declined to comment on the lawsuit.

Regulators tell 3 nursing homes to stop accepting new admissions
The Associated Press State & Local Wire October 26, 1998

Three of Florida's 18 worst nursing homes are under orders not to accept any new residents and could lose their Medicaid contracts and be fined, as well, the state's top regulator said Monday.
----------------------------
The three homes with a moratorium on new admissions are Park Lake Nursing and Rehabilitation Center, in Maitland; Atlantis Rehabilitation and Nursing Care Facility, in Lantana; and DeSoto Manor Nursing Home, in Arcadia, according to AHCA.
--------------------------------
"Our findings clearly show the homes lack the necessary commitment to provide quality health care," said AHCA Director Douglas Cook. "The agency must take quick and aggressive measures for the sake of the health, safety and welfare of the residents."

Park Lake, owned Beverly Enterprises of Florida, has 146 residents. Atlantis, owned by Genesis Elder Care, is home to 89 people. And DeSoto, owned by Diversicare Leasing Corp., has 76 live-in clients.

NURSING FACILITY GETS ULTIMATUM; THE WINTER PARK CENTER, WHICH WAS CITED FOR NEGLECT, MUST GET A NEW OWNER OR CLOSE.
THE ORLANDO SENTINEL October 27, 1998

Neglect of elderly patients, abusive or demeaning treatment, sloppy dispensing of drugs and unsanitary bathrooms, bed linen and underwear led regulators to one conclusion:

Park Lake Nursing and Rehabilitation Center in Winter Park must be run by someone else - or shut down.

The state's Agency for Health Care Administration said Monday that it has ordered a halt to new admissions of Medicaid patients at Park Lake and is looking for a new operator.

Within 45 days, the nursing home, which has 146 residents, will have to find a new owner or regulators will seek a court-appointed receiver to run it, said Pat Glynn, a spokesman for the agency.

The facility, at 1700 Monroe Ave., is owned by Beverly Enterprises, a Fort Smith, Ark., company that operates more than 500 nursing homes nationwide, including 35 in Florida, Glynn said. The company's stock trades on the New York Stock Exchange.

"We're pretty surprised by the state of Florida's action, and we will appeal it," Beverly spokesman Dan Springer said.

"Substantive corrective actions have been under way since AHCA identified specific areas for improvement," he said. But regulators "pre-empted the time line" established for responding to its complaints.
---------------------------------
Park Lake still has "significant patient-care deficiencies, which in turn forces the agency to take quick and aggressive action," said Douglas M. Cook, director of the Agency for Health Care Administration.

The facility, he said, still lacks the "necessary commitment to provide quality health care."
--------------------------------------
In a report based on an inspection of Park Lake on Sept. 9-10, the agency cited repeated problems ranging from undiagnosed pressure sores on patients, unauthorized restraints on patients and failure to change soiled underwear and sheets. Inspectors cited dried feces on a toilet seat and urine odors in several wings.

The staff report also listed a dirty food-storage area, and complaints of rampant cockroaches and other insects.

One patient said staff members who were called to help another patient simply laughed at her and her room mate.

COMMENT:- There has been prolonged and ongoing conflict between Beverly and the nursing unions. The acrimonious nature and Beverly's behaviour can be deduced from the fact that the "National Labor Relations Board cited 106 instances of anti-union activity by the company at 26 facilities in 15 states. There is more information about this on another web page.

NURSING HOME FIRM FACES MORE PROBLEMS; THE OWNER OF A WINTER PARK UNIT THAT MUST BE SOLD IS ALSO UNDER FEDERAL SCRUTINY.
THE ORLANDO SENTINEL October 29, 1998

State regulators' demand that Beverly Enterprises Inc. sell its troubled Winter Park nursing home is just one more setback for a company that operates 570 nursing homes nationwide.

Those problems include a federal probe into Medicare billing, accusations that it bullied workers who wanted to unionize and chronic problems at five of its 62 Florida nursing homes.
-----------------------
The state's Agency for Health Care Administration said it has repeatedly cited Park Lake for serious violations, including soiled linens, shoddy housekeeping and patients found with bed sores.

The nursing home, with 145 residents, was among 18 identified last month as the state's worst. Beverly had five facilities on the list, more than any other company. The four others are in Fort Myers, Hollywood, Pompano Beach and Tampa.
-----------------------------
Of the company's 62 nursing homes in Florida, eight have conditional ratings, which mean they have serious problems that must be fixed, state records show. Locally, only Park Lake is in that group.

But 29 of its homes - including Beverly Healthcare-Winter Garden and Beverly Health and Rehabilitation Center-Rosemont in Orange County - have superior ratings. That means they surpass state standards. The rest are rated as achieving standards.
-------------------------------
"Five years ago, they (Beverly homes) were mediocre-to-bad. Now, I'd say they're mediocre-to-good," he (John Ransom, a senior analyst with Raymond James Financial Inc.) said. The company has closed or sold its worst facilities. It now has 570 nursing homes nationwide, down from 1,000 a decade ago.
--------------------------------
In a separate dispute in August, the National Labor Relations Board cited 106 instances of anti-union activity by the company at 26 facilities in 15 states.

Click Here for the company's responses to these allegations

COMMENT:- The following article is a very long one but it gives an excellent description of the sort of care received in many corporate nursing homes. I include extracts only. Groups of citizens across the USA are deeply disturbed about what is happening and extremely angry that regulators have gone along with this sort of thing. The community, confused by misleading advertising is more concerned about the mistreatment of animals than their grand parents and there has been no ballot box prodding.

Political influence, lobbying,and campaign donations have prevented politicians from acting. Citizens have taken to the courts targeting poor facilities. The courts have taken the punitive action which regulators failed to take. Beverly has been singled out because of situations like that described in this article. It is crying foul!

The article describes a truly disgusting situations with residents living in what can only be described as a pig sty. The home was given multiple opportunities to fix the problems and promised to do so. In visit after visit more problems and more unheigenic practices surfaced. It took 15 months for lenient Arkansas regulators to close the home. I have only included a few of the accounts of the findings on multiple inspections.

Beverly shutdown long in coming; Nursing home deficiencies persisted in inspections from July 1997
The Arkansas Democrat-Gazette November 01, 1998

Untreated bedsores. Urine-soaked sheets. Feces in the showers. Flies. Roaches. Medication errors. An 80-year-old woman's death.

State officials now call the conditions found in a July 1997 inspection of the Beverly Health and Rehabilitation Center in Jacksonville "extremely troubling."

But it took more than 15 months, at least 11 more inspections and another death before the Arkansas Department of Human Services closed the nursing home.

That delay, and the grim conditions each inspection uncovered, point up the vulnerability of many of Arkansas' aged. It also shows how a ponderous and often lenient regulatory system can fail the very people it was created to protect. The officials now running the state Office of Long Term Care say the agency should have acted sooner.
-----------------------------------
For their part, executives at Fort-Smith based Beverly Enterprises Inc. -- the facility's parent company and the world's largest nursing home operator -- say that the state erred in closing their facility. And they say that the Jacksonville home, however troubled, isn't typical of the rest of its facilities.

"I believe that our organization and our management team did everything it could within their power to address those issues," says Jerry Halley, a senior vice president at Beverly.

"If you look through those statements of deficiencies [in state inspection reports, you see] that we were able to develop plans, submit those to the agency and, with the agency's reviews, we were able to correct issues," Halley says. "Unfortunately, we couldn't sustain that activity all the time, I guess."

But Hemingway sees it differently. He accuses the nursing home of "yo-yo compliance," in which administrators fixed problems only after investigators uncovered them, often letting new problems arise in their place. "This sort of performance on the part of this facility is not acceptable," Hemingway says.
------------------------
PATIENT'S DEATH
State orders to shut down the facility by 4:30 p.m. on Nov. 13 came after Hemingway's office investigated the Sept. 14 death of Howard Holderfield, a resident of the Jacksonville home. Accompanying it was the maximum fine the agency could levy -- $ 5,000. Beverly has promised to appeal.
-------------------------
- - when one of the unlicensed LPN's [licensed practical nurse] performed a reinsertion of a gastrostomy tube on a resident, the LPN caused a perforation of the resident's peritoneum, resulting in the resident's death. - - - - the nurse who had replaced the tube was not trained to do so, the state report said, and the nurse's license had expired almost a year before. Investigators found no record that doctors were notified of the event. Three other nurses on duty that day also had expired licenses, officials say, and nursing home staff never contacted Long Term Care about Holderfield's death. The state agency learned of the man's death only when an anonymous witness contacted it on Oct. 1.
-------------------------------
OTHER FINDINGS
Though Holderfield's death spurred Hemingway to close the home, state survey teams had been uncovering serious problems there for a long time. Twenty-one months before, in a January 1997 inspection, Long Term Care officials found seven invalid patients -- nearly half of the 18 they checked -- unkempt and with dry, cracking lips or flaking skin: signs of dehydration or malnutrition.
----------------------------
Just six months later, on July 3, 1997, state investigators filed a 42-page report with dozens of violations -- from filthy floors to growing bedsores -- and the story of Jewell Elizabeth Forester's death.
---------------------
Like Forester, that patient was admitted to a hospital June 9, 1997, with more than three times the maximum therapeutic level of the medication in her system, the report says. She died nine days later.

Investigators - - - - were unable to find the necessary records at the nursing home, the report says. Relatives are suing the home.

During the inspection, investigators found that nurses made mistakes in 11 percent of medications administered on the morning of June 24, 1997, more than double the federal limit of 5 percent.

Two errors were considered significant: One resident didn't get the drug he needed to prevent seizures, while another received a powerful bronchodilator that wasn't prescribed. In an interview, a state medical official called both mistakes potentially deadly.
-----------------------
Nurses turned many patients too infrequently. The residents developed bedsores, or open wounds caused by prolonged pressure on fragile or damp skin. In a survey of nine residents known to suffer from the sores, five weren't properly treated by nursing home staff.

In their report, investigators also described:

• 130-degree water coming from the bathroom taps in three rooms -- 20 degrees hotter than regulations allow;
• a hallway left slippery for more than two hours despite repeated warnings by investigators;
• a room with a full whirlpool bath left unlocked and unattended;
• too few employees on duty for 70 percent of the days they examined, with staffing as low as 58 percent of required levels on one day;
• a filthy kitchen with food served dangerously close to room temperature, risking spoilage and food-poisoning;
• roaches, ants and other vermin throughout the facility, including flies on a feeding tube and on bedridden patients;
• ragged and stained diapers and incontinent pads;
• too few clean bed sheets to go around;
• several patients reeking of perspiration or urine, some with unkempt hair and dirty fingernails;
• generally unsanitary or dangerous conditions including a pervasive smell of urine, wads of gum stuck to handrails, chipped and gouged doors, dried feces in a storage room, moldy and mildewed showers, dirt and wax built up on floor tiles and baseboards, cracked and missing floor tiles, used mouth swabs and soiled incontinent pads littering the floor, water stains in the ceiling and an ice machine rigged to drain into a shower.

FURTHER INSPECTIONS (Note:- This list is compiled from a lengthy listing of findings on multiple inspections in the article. I have shortened the original by simply listing the findings)

• medication errors for missed dosages of multivitamins and a fiber supplement.
• the case of a man whose family wasn't told for more than eight hours that he had broken his hip and was hospitalized.
• the smell of urine throughout the facility and extensive sanitation problems in the kitchen:
• dried food stuck to dining tables, dishes washed but still coated in thick grease, and a roach crawling on clean plates.
• beds unchanged, sores untreated, sinks clogged, patients unbathed.
• a woman treated inconsistently for a serious bedsore on one finger. After a week, it had doubled in size and penetrated to the bone.
• On two separate days during that inspection, a man was left for several hours in bed, naked from the waist down and soiled with his own feces.
• housekeepers cleaning up feces with paper towels and no gloves
• a nurse's aide changing a soiled patient, then failing to wash her hands afterward.
• residents suffered from bedsores
• Dust-caked air-conditioning units remained dirty.
• Nurses weren't bathing some residents, brushing their teeth or trimming their nails.
• a resident couldn't reach the button that would summon nurses. waited as long as 14 minutes for help to come when they did press their call buttons.
• One resident,- - - was left lying on her side in bed for nearly four hours without the repositioning necessary to prevent bedsores. Later, she was found lying on her feeding tube, the bottle of intravenous nutrients empty and a sensor beeping. A nurse's aide walked by but did nothing.
• a resident with dementia who hadn't been walked for exercise as doctors had ordered.
• flies in the kitchen, showers, day rooms and residents' beds.

Deficiencies in care at country's largest nursing home noted
The Associated Press November 15, 1998

Beverly Enterprises Inc., the country's largest nursing home company, says federal nursing regulations are nearly impossible to meet but the company does better than average in caring for its residents.
-------------------------
"Jacksonville is an embarrassment," said William A. Mathies, executive vice president. But "I don't want it to be the barometer of Beverly."

Beverly has 41 homes in Arkansas.

An Arkansas Democrat-Gazette review of inspection reports for four of Beverly's homes - in Hot Springs, Rogers, and Junction City - shows three fared worse than the state average on three of their last four annual inspections.
-------------------------------
Inspections at the Rogers Health and Rehabilitation Center, the Beverly Health and Rehabilitation Center on Park Avenue in Hot Springs and the Beverly Health and Rehabilitation Center on Golf Links Road in Hot Springs turned up an above-average number of violations, the newspaper reported Sunday.

At the Rogers home, inspectors tallied 61 violations over four inspections, nearly double the state average of 31.2 for the same period and more than double the national average of 24.1, federal records show.

In October 1997, inspectors listed 28 violations.

(Note:- I have simply tabulated the findings from multiple inspections. The original article describes each one)

• "The facility failed to provide baths on a regular basis,
• failed to provide oral and nail care,
• failed to provide timely incontinent care,
• failed to answer call lights in a timely manner,
• failed to change linens and soiled clothing in a timely manner" for 14 residents
• Nurses made mistakes with nearly one in 10 medications they distributed while investigators were watching
• errors in the narcotics log and unlabeled medicines.
• More narcotics-log errors
• a resident with bleeding ulcers who didn't get enough of a medicine for suppressing stomach acid because
• failed to check the criminal backgrounds of some employees.
• two residents were given antipsychotic medication when there was no documentation that they needed the drugs.

In July 1995, Beverly Health and Rehabilitation Center on Golf Links Road in Hot Springs was in violation of 19 federal nursing-care regulations. A year later, it violated six. In May 1997, it violated 17. Twice, in 1995 and 1997, the 152-bed home more than doubled the state average.

(Note:- Once again the list is from multiple inspections)

• feces and urine odors;
• ants in a resident's bathroom;
• no hot water in some rooms;
• a freezer that was 18 to 30
• degrees warmer than regulations allow;
• a kitchen worker wrapping silverware without gloves, then wiping his nose with his hand and not washing his hands before continuing.
• Residents were left unbathed, underweight, developing bedsores, at risk for infections,
• Staff members made mistakes giving out medications and
• checking employees' backgrounds. Floors were sticky.
• The kitchen was dirty.
• incorrectly kept logs of when and how narcotic medications were used;
• a single nursing aide responsible for feeding nine residents, many of whom she didn't have time to help;
• a quadriplegic at risk for developing bedsores who sat in the same position for more than four hours;
• wheelchairs dirty with dried spills and food.

Since December 1995, Beverly's home on Park Avenue in Hot Springs has been cited for 47 deficiencies. (among them)

• switched seven residents to a new pharmacy (owned by Beverly), violating their federal right to choose their own.
• one resident was improperly given Haldol Decanoate, an antipsychotic that has a powerful effect on the elderly.
• Three other patients were given a wrong dose or the wrong medicine altogether
• hadn't properly screened a resident with schizo-affective disorder 

COMMENT:- The next extracts are from an introductory article for a series of outstanding analyses of the aged care marketplace in Florida. The series "Money or Mercy" is an excellent introduction into what is happening.

Money or mercy?
The Tampa Tribune November 15, 1998

In the glossy pages of corporate literature from Florida's largest for-profit nursing home chains there is a repeated image: a frail person gazing with trust and gratitude at a health care worker holding their hand.

The brochures promise compassionate care and healthy profits for the people who invest in their companies. But the reality of life in some of those nursing homes is another thing - quality care and big profits do not always go hand in hand.

A six-month Tampa Tribune investigation has found that residents of for-profit homes had higher than average rates of reported neglect and abuse. Homes owned by four large chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - were more likely to fall below state standards than other homes.

Profits can come at high costs
The Tampa Tribune November 15, 1998
LINDSAY PETERSON and DOUG STANLEY

Corporate chains increasingly run the nursing home industry, and research shows they have a large share of problems in Florida.

Mary Johann died alone.

She lay on a plastic sheet that covered her bed at a nursing home, her neck pinned between the mattress and bed rail. The same thing had happened 10 days earlier, but a worker had found her before she strangled.

Not this time. Mary Johann was alone too long this night.

Her death came three days after the nursing home's corporate leaders delivered good news to shareholders.

Profits were up, they said, higher than in years because cost controls were so tight.

Tight cost controls mean tight staffs at homes like Johann's, Wellington Specialty Care and Rehabilitation Center of Tampa.

More than 10 years ago, Congress heralded its passage of new laws to ensure humane treatment of people in nursing homes. Another institution, however, has quietly imposed its own standards: Wall Street.

The nursing home industry, once a collection of individual operations, is dominated increasingly by companies that thrive only when they take care of shareholders. Their stocks have soared in the 1990s as Americans have poured money into the market.

The six largest nursing home companies in Florida are traded on Wall Street. They control the lives of roughly 20,000 people, about one-third of the state's nursing home population.
----------------------------
Caring for them requires attention and tenderness. And many nursing homes are filled with people who chose the hard work because they love and revere older people.

But many of their bosses have other priorities, such as satisfying investors who expect steadily rising profits.

State and federal records show business profits can come at a high human cost.

About one-quarter of Florida's nursing homes fell below state standards during annual inspections between January 1997 and March 1998. Among four of the state's six major chains - Beverly Enterprises Inc., Integrated Health Services Inc., Vencor Inc. and Mariner Health Group Inc. - the substandard rate was 32 percent to 40 percent.

Federal data show these chains had higher-than-average rates of reported neglect and abuse, as did many smaller companies with publicly traded stock.
--------------------------------
"All you have to do is look at the nonprofits to see what's happening," said Jean Venturino, a visiting nurse who sees patients in several area nursing homes.
-------------------------
In 1995, Beverly Enterprises came under scrutiny after some high-priced purchases.

"We have been concerned for some time about the prices (the company) paid for the recent pharmacy acquisitions and the company's ability to cut costs quickly enough to achieve a reasonable and timely return on these investments," wrote two stock analysts in a 1995 news release.

Ten months later, Beverly boasted to business reporters it would bring in its highest nursing home profits in years, crediting an increase in high-cost treatments and "tight internal cost controls."

From 1995 to 1996, the number of Beverly homes cited for harming or endangering patients in Florida doubled from 13 to 27.

In early June 1996, the one where Mary Johann died, Wellington Specialty Care, landed on the state's substandard list. State inspectors had found a string of problems in March; the home was dirty and understaffed.

By late June, the deficiencies were considered corrected.

Mary Johann arrived in September.
---------------------------------
(After Mary Johann died)

State inspectors descended on the home Feb. 5, then again Feb. 13. They found six residents at risk of getting caught in their bed rails. Others suffered from dehydration and advancing bed sores. Again, the inspectors found too few workers. The Wellington administrator was replaced in June 1997. But when inspectors returned in December, they found the home still understaffed.

Under almost daily scrutiny from regulators in 1998, the home passed inspection in May. But by September, it had problems again.

Wellington is one of five Beverly homes on a list released by the state in September of 18 Florida homes with repeated, serious problems.
--------------------------------
But O'Brien said the problem is not only that people die unnecessarily; it's the lack of warmth when a home is understaffed or has rapid employee turnover.

After a corporation took over one of the homes where O'Brien worked recently, the new administrator immediately cut staff.

One of the first moves was to reduce kitchen workers' weekly hours from 40 to 36, O'Brien said. Many quit. Some had worked there for years, knew the residents and often made special foods to encourage them to eat.

A stable crew of aides and nurses is vital, O'Brien said. They know who likes to sleep until 9 a.m., who prefers a bath in the morning and tea in the evening.

It takes strong, caring managers to build a strong, loyal staff, she said. But many corporations treat administrators like interchangeable parts. In many nursing homes around Tampa Bay, management stays for less than two years.
------------------------------------------
Everyone worries about the Medicare changes and nursing homes, she (Cheryl Harrell, a social worker) said. "We're praying it won't affect care. But we're afraid it will."
------------------------
A Tampa Tribune analysis of the latest inspections, up to April 1998, showed five of the six largest nursing home companies in Florida had a higher than average number of deficiencies when compared with all nursing homes in the state.

Total deficiencies for every 10 homes - - - Beverly Enterprises 106 - - All other homes 89

Deficiencies that caused "actual harm' for every 10 homes Each deficiency is graded to reflect its severity. Homes owned by five of the six largest companies, which are all publicly traded, had a higher than average number of deficiencies that caused "actual harm" to residents. - - - - Beverly Enterprises 8 - - All other homes 7

Regulation often fails residents
The Tampa Tribune November 15, 1998
VICKIE CHACHERE; ; of The Tampa Tribune;

Florida's nursing home regulation system is mired in weakness, much of which appears self-inflicted. The agency in charge pledges reform.
-------------------------------------
"The surveyors are much more aggressive and less forgiving or willing to listen to an excuse," said spokesman Ed Towey of the Florida Health Care Association. "The question is does that benefit the residents or not?"

Beverly Enterprises Inc., the nation's largest nursing home chain, has accused the AHCA of being arbitrary and inconsistent in its inspections of company facilities.

One in five of Beverly's 60 Florida homes have been cited for dangerous deficiencies. The company contends that's because the AHCA has targeted it.
-----------------
Beverly officials wouldn't identify specific incidents of surveyors overreacting in a recent inspection of a nursing home on Fletcher Avenue in Tampa. The nursing home has been given a conditional rating for a series of violations, including understaffing and neglected bedsores.

Beverly is appealing the rating.

Fines don't bite businesses hard;
The Tampa Tribune November 15, 1998
VICKIE CHACHERE

Financial pain is applied rarely to problem nursing homes. Government fines often are little, reduced or unimposed.

The AHCA recently declared victory with a $ 425,000 federal fine against Wellington Specialty Care and Rehabilitation in Tampa. The home was fined after the 1997 death of Mary Johann, who strangled when her head got caught between her mattress and a bed rail.

But the case is not over. Wellington's parent company, Beverly Enterprises Inc., is appealing to the U.S. Health and Human Services Department. A panel of lawyers will decide whether the fine should be paid, reduced or forgiven.

If the company loses on that front, it still can appeal through the civil court system, federal officials say.
-----------------------------
"A lot of people have a hard time accepting the fact that this is an industry also," he (John Grout, an Orlando attorney who represents nursing homes ) said. "The nursing homes have to make money. If they aren't going to make money, they aren't going to do it, and how are the elderly going to be cared for?

"A nursing home has a right to the same profit that somebody else receives."

Still, nursing home fines often don't cost the companies anything.
-----------------------------------
With few exceptions, homes simply can promise to fix problems to satisfy the state for a while. As long as they keep the promises, they won't get fined - no matter the violation.
------------------------------------------------
Not all companies appeal the fines, but most of the big chains do. Beverly homes appealed every fine or sought a settlement with regulators in the cases reviewed.

Homes that admit to wrongdoing and pay the fine get a 25 percent discount. But even when Beverly pays a fine, it stamps on its checks and all documents that it's not admitting any wrongdoing.

Beverly officials say they fight fines and refuse to admit offenses because they don't want private attorneys suing them to use that to sway juries.

"It would be interesting to see how much they spend on attorney's fees," Caufman (lawyer for state regulators) said. "If they spent some of their attorney fees on their homes and hired some staff, they'd be much better off."

2ND NURSING HOME IS SUED FOR NEGLECT
THE ORLANDO SENTINEL November 19, 1998

TAVARES - The family of an elderly woman has sued a Mount Dora nursing home, saying the facility neglected the woman so badly that she suffered painful bedsores that ultimately led to her death.

The suit, filed by the estate of Clara Jones in Lake Circuit Court, seeks more than $15,000 in damages from Mount Dora Health Care Center and its parent company, Beverly Health and Rehabilitation Services.

The nursing home declined to comment.
--------------------------------------
The suit also states that the home failed to keep complete medical records and did not develop an adequate plan to assess and meet Jones' needs. Changes in her condition were not monitored, and her family was not notified of any changes, the suit says.

The lawsuit also criticizes what it described as an inadequate number of staff members who weren't properly trained.

GOOD NURSING HOME CARE INCLUDES GOOD REGULATION
The Palm Beach Post November 25, 1998

The nursing home industry was once a collection of individual operators. After recent mergers and acquisitions, however, 10 publicly traded companies control 20 percent of the nation's 1.8 million nursing-home beds.

Florida's six largest nursing-home companies are traded on Wall Street. This creates the same kind of potential conflicts between the state's 676 homes and for their 71,000 residents as exist between managed-care companies and their patients.

How will the need for profit affect care?
---------------------------------
Several major companies have a presence in Palm Beach County and the Treasure Coast. Among them are Beverly Enterprises, Marriott, Genesis Health Ventures, Integrated Health Services and Manor Care, which just merged with Health Care & Retirement Corp.

How does ownership affect care? About 25 percent of Florida's homes fell below state standards during annual inspections between January 1997 and March 1998, the Tampa Tribune reported last week. Among four major chains - Beverly, Integrated, Vencor and Mariner Health Group Inc. - the failure rate was higher.

COMMENT:- The allegation that Beverly deliberately understaffed to increase profits is the same as that made against Sun Healthcare in a Qui Tam action in California and by several patients.

Civil suit filed for "wrongful death'
TELEGRAM & GAZETTE (WORCESTER, MA.) January 30, 1999

An 87-year-old patient at Hermitage Health and Rehabilitation Center died two years ago after an inexperienced nurse gave him an overdose of morphine and a doctor later ordered the nurse to stop administering an antidote, according to a wrongful death suit filed by the man's son.

The civil lawsuit, filed by James G. Clark of Worcester, alleges that the Nov. 21, 1996, death of his father, Frank D. Clark, resulted from negligence by licensed practical nurse Carmen VanHorne, Dr. Henry M. Weiman and Hermitage's parent company, which is listed as Beverly Health and Rehabilitation Services Inc. of Forth Smith, Ark.
----------------------
The suit, - - - - accuses Beverly and its management of trying to "increase profits at the expense of resident care by intentionally engaging in a pattern of understaffing their nursing care facilities throughout the United States, including their facility at Hermitage. "

A Beverly spokesman described the allegation as "unfounded and wholly inaccurate."

The suit alleges that VanHorne had only 2 1/2 weeks of experience as a licensed practical nurse when, on Nov. 20, 1996, she was placed in charge of about 62 residents, including Clark, in two of Hermitage's three units. State laws and regulations required Hermitage to assign a charge nurse around-the-clock to each of the three units, according to the suit.

The suit further charges that VanHorne voiced concern to her immediate supervisor that she was incapable of supervising two units, but that adequate steps were not taken to address her concerns.
-----------------------------
The suit alleges that VanHorne, who had never administered a narcotic by injection before, misinterpreted Weiman's order and gave Clark two vials of morphine sulfate, each containing 15 milligrams, from an emergency drug kit.
----------------------------
Regarding the suit's allegation that Beverly tried to increase profits by understaffing, Springer said, "At the end of the day, I think we will find that that allegation is unfounded and wholly inaccurate. "

Nursing homes seek fee limit
Sarasota Herald-Tribune March 21, 1999

Lawsuits alleging abuse, neglect and other maltreatment of residents cost Florida's nursing home industry an estimated $ 35 million a year. Now the industry is fighting back - not in court, but in the Legislature.

Nursing home operators want the state to restrict the fees paid to lawyers who file the lawsuits - fees that judges order the nursing homes to pay. The industry says its piece of the massive "tort reform" bills moving through the Legislature would not prevent nursing home residents from filing lawsuits, but would merely limit lawyers from collecting more than $ 50,000 in fees.
-----------------------------------
Both sides in the fight poured large sums of money into last year's legislative races, state campaign-finance records show.

The nursing home industry contributed $ 203,990 to legislative candidates and the state political parties, which support those candidates' campaigns. The biggest chunk of that money - $ 77,750 - came from Beverly Enterprises Inc., the largest nursing home company in the state. Another nursing home operator, Mariner Health Care Inc., gave $ 55,340, while the Florida Health Care Association contributed $ 51,250, and others donated $ 19,650.

THE SHAME OF OUR NURSING HOMES; nursing homes allegedly treat patients poorly
The Nation March 29, 1999

COMMENT:- There are a number of excellent reviews describing the corporatisation of health care and the adverse consequences for care of corporate business practices. I have quoted from excellent articles in the Florida series "Money or Mercy" on this page.

The article "THE SHAME OF OUR NURSING HOMES" is another excellent article. It should be read in its entiety. It uses Beverly to illustrate what is happening. I have put a full copy of this article into a separate web page. (click here to examine)

Florida Cites Resident 'Harm' in Denying Nursing Home
Medical Industry Today April 2, 1999

Florida state officials blocked a request by an established nursing home company to build a $7.3 million facility, citing a poor track record by the company's facilities in caring for its residents.

The officials said 40 of BEVERLY ENTERPRISES' (Fort Smith, AR) facilities in the state had been cited "for actually harming residents," according to a Tampa Bay Business Journal report. The history made the state skeptical of allowing a new home to be built in Hillsborough County.
-------------------------
Beverly said that half of the patient bed days would go to Medicaid patients, and also made other concessions in the attempt to win state approval. But in denying the request, state reviewers noted "quality of care issues" with Beverly Enterprises in citing the federal surveys that showed residents had been harmed.

HOW FAR THEY HAVE FALLEN ONCE SOUGHT AFTER, REHABILITATION THERAPISTS HIT BY CHANGES IN MEDICARE REIMBURSEMENT
Modern Healthcare April 12, 1999

Other long-term-care companies that have laid off up to 20% of their therapists include Atlanta-based Mariner Post-Acute Network, which cut 1,200 therapists; Fort Smith, Ark.-based Beverly Enterprises and Owings Mills, Md.-based Integrated Health Services, which eliminated 1,000 therapists each; and Kennett Square, Pa.-based Genesis Health Ventures, which cut 321 positions.

Attorney general investigating former nurse's aide
The Associated Press State & Local Wire July 24, 1999

A former nurse's aide is free on bond while the attorney general's office investigates allegations that he raped an elderly resident at Regional Nursing Center.

Christopher Sims, 46, of Bryant was arrested last month in the alleged attack on an 85-year-old resident at the nursing home.

He also has been named in Saline County Circuit Court lawsuits by relatives of two Regional Nursing Center residents. The suits, also filed against the nursing home, contend the home knew about assaults against the residents and did nothing to prevent them.
-----------------------------
Dan Springer, vice president of public relations for Beverly Enterprises of Fort Smith, which owns the nursing home, said he had not seen the lawsuits and could not comment on them.

A Bryant police report said the nursing director contacted criminal investigators June 7 about alleged abuses that occurred "on several occasions."

Carol Shockley, assistant director of the Office of Long Term Care, said her agency's investigation found that Regional Nursing Center provided substandard care to its patients and fined the institution $ 5,050 a day, beginning May 29.

She said a federal regulatory agency later looked at the case and increased the fine to $ 10,000 a day, bringing the total fines against the nursing home to more than $ 80,000.

NURSING CENTER CORRECTS VIOLATIONS
The Spokesman-Review (Spokane, WA) August 18, 1999

Pullman's Palouse Hills Nursing Center will now be allowed to admit new residents after correcting violations of state and federal care regulations.

The state Department of Social and Health Services barred the facility from accepting new residents after an inspection. State investigators found that the center was not in compliance with Medicare and Medicaid requirements.

The home had been deficient in its quality of care and prohibited from admitting new patients on March 12, according to a DSHS press release.

Palouse Hills Nursing Center is a 48-bed home serving Medicaid, Medicare and private-pay residents. It is owned and operated by Beverly Enterprises -Hospital Facilities Corp.

COMMENT:- Beverly's denies every accusation and challenges every penalty and restriction through the legal system to the highest level of appeal. Beverly exercises its right to be heard to the limits and beyond. It is conduct like this which renders understaffed and underfunded regulators ineffective. With all their staff and all their resources tied up in never ending confrontations over deficiencies in single facilities there is little opportunity for them to cope with the vast problems they face. They are worn down and soon compromise.

NURSING HOMES: BEVERLY SUES HEALTH OFFICIALS OVER CLOSING
Health Line September 7, 1999

The nation's largest nursing home chain, Beverly Enterprises Inc., has filed a lawsuit against HHS Secretary Donna Shalala and HCFA Director Nancy-Ann Min Deparle for "their roles in the removal of one of its nursing homes from (the) Medicare and Medicaid" programs, the Wall Street Journal reports.

Beverly's Brooksville, FL-based Spring Hill home was placed on a 23-day "fast track" to termination last year, after HCFA inspectors found "serious deficiencies posing an immediate threat to residents." The termination took effect in June 1998 and the company appealed the decision last October.

An administrative law judge ruled that the facility's problems did not place residents in immediate harm, but he only reduced Beverly's fines, rather than reinstating the nursing homes' participation in Medicare and Medicaid. The company now contends that placement on the "fast track" was unwarranted and calls the survey process invalid as its criteria were "too vague" (9/7).

Regulators Halt Admissions at Rock Hill, S.C., Assisted-Living Center
THE HERALD (ROCK HILL, SC) September 20, 1999

Beverly Healthcare's assisted-living center in Rock Hill will not admit new residents until state regulators agree it has fixed some "minor deficiencies" found during an August inspection.

The center, located on Herlong Avenue across from Piedmont Medical Center, volunteered for the temporary ban, said Denise Black, who's been executive director of the center for three months. The state did not require such an action, she said.

In August, the state Department of Health and Environmental Control found five problems "that were minor in nature" at the center, Black said.
-------------------------
Beverly submitted a "plan of correction" to DHEC, which accepted it. The state agency will perform a followup inspection to make sure Beverly is following through on its correction plan.

COMMENT:- The next article also reveals how the corporations appeal every closure up the system waging a costly and personel intensive war of attrition which government departments can ill afford.

Medicare target of nursing home suit
St. Petersburg Times September 20, 1999, Monday

The company that owns a Spring Hill facility says it was unjustly removed from the Medicare, Medicaid program.

A decision last year by federal health officials to revoke a Spring Hill nursing home's Medicare and Medicaid contracts has now landed the matter in a Washington, D.C., courtroom.

Beverly Enterprises Inc., a Fort Smith, Ark.-based nursing home company, filed a lawsuit against U.S. Health and Human Services Secretary Donna Shalala and the head of the Health Care Finance Administration (HCFA) alleging they improperly removed Beverly Health and Rehabilitation Center of Spring Hill from the agency's Medicare program. The lawsuit was filed in a Washington, D.C., federal court on Sept. 3.

HCFA, which operates Medicare and Medicaid programs, revoked the nursing home's Medicare status in June 1998 after state health officials found living conditions there that they thought put patient lives in "immediate jeopardy."

The company has consistently denied the allegations.

Beverly now is trying to overturn the agency's decision, which not only cost the company a $ 1,000 a day fine for 26 days, but has denied the company Medicare and Medicaid reimbursements for patients who lived in the facility during the suspension.
---------------------------------
The 120-bed nursing home opened in 1997 on Cortez Boulevard. Its advertisements promised the facility would "be the standard in health care against which other providers will be measured."

But when inspectors arrived, residents complained about unsanitary living conditions, and the auditors found that the facility did not keep adequate records on its patients. Even more troubling, one patient died of dehydration during the inspectors' visit, prompting them to take an even closer look at operations.
--------------------
State investigators returned to the nursing home May 27 and concluded that some of the most serious problems had not been corrected. On June 2, federal health officials pulled the contract allowing the nursing home to receive reimbursements for Medicare and Medicaid patients.

Beverly Enterprises contends in its lawsuit that federal officials were wrong to place the Spring Hill nursing home on "fast-track" status to lose its Medicare and Medicaid contract. Company officials thought they had more time to correct the nursing home's problems, according to the lawsuit.
--------------------------------
The government argued otherwise, but the judge found that some deficiencies cited by state auditors were invalid.
-----------------------------
The matter was then appealed to an appeals board. It declined to overturn HCFA's decision to fast-track the nursing home's case. The board said that HCFA has the right to terminate a facility from the Medicare program if it finds the facility isn't in substantial compliance with program requirements.

Exhausting all of its appeals, Beverly officials have now turned to the federal court system for help.

Executives confident in nursing home's care
St. Petersburg Times October 14, 1999, Thursday

A year after a moratorium on new patients was lifted, a corporate vice president says, "We're proud of the building. It's one of the nicest facilities we have."

SPRING HILL - In a bid to help restore community confidence, executives from Beverly Enterprises Inc. visited its nursing home here Wednesday to help dispel any lingering doubts about the quality of care at the sprawling yellow facility.

"We're proud of the building. It's one of the nicest (skilled nursing) facilities we have," said Dave Devereaux, senior vice president of operations at Beverly Enterprises.

In May 1998, a moratorium was placed on new admissions at Beverly Health and Rehabilitation Center on Cortez Boulevard after state investigators determined that residents there were in immediate jeopardy.
----------------------------
"This is unique. It's not every day you sue the (Health Care Financing Administration)," said Dan Springer, Beverly's vice president of public relations.

If the decision is overturned, Beverly won't have to pay $ 26,000 in penalties and will be reimbursed for the expenses of 22 patients who stayed in the facility after its federal funding was cut.

It's vindication the company wants, Springer said, not money.

We are confident in our position and feel betrayed by the system," he said. "This has less to do with money and more to do with the way the system needs to be fixed."
----------------------------
The sanctions last year against the Spring Hill facility are hardly the company's first.

The company owns Eastbrooke Health Care Center in Brooksville, which was the subject of a 1993 lawsuit for neglect of an 88-year-old man. A jury found in favor of the man's family and awarded $ 2.7-million.

More recently, the company closed Wellington Specialty Care and Rehab Center in Tampa after being fined a record $ 425,000 by the state. The case sprang from an incident in which a patient died when her head became stuck between the bed rails.

In July, the company announced it would take a second-quarter charge of up to $ 225-million to settle a U.S. Justice Department investigation into Medicare fraud charges. The settlement has not been finalized, but it could represent the largest financial penalty against a nursing home company.

Click Here for more about Beverly's response in this case

PROBLEMS PUT 5 CENTRAL FLORIDA NURSING HOMES ON WATCH LIST
THE ORLANDO SENTINEL October 11, 1999 Monday, METRO

Five nursing homes in Central Florida have been placed on a state watch list.

Lakeview Nursing Center Inc. of Sanford, Mariner Health of Melbourne, Oaks of Kissimmee, Plantation Gardens Rehabilitation and Nursing Center of Ocoee and Sunbelt Health Care and Subacute Center of Orlando were named in a quarterly report published by the Florida Agency for Health Care Administration, which oversees the nursing home industry.

The agency cited problems ranging from failure to provide fluids to keep patients hydrated to failure to prevent bed sores.

Click Here for the company's response attacking the inspection process.

Fort Smith nursing home leads state in profitability
Northwest Arkansas Business Journal October 18, 1999

Fifteen of the 50 most profitable nursing homes in Arkansas are owned by Beverly Enterprises Inc. of Fort Smith, the only Arkansas-based public company that owns nursing homes.

2 wrongful death suits filed against local nursing homes
St. Petersburg Times December 23, 1999, Thursday

In the second case, Michael White is suing Beverly Enterprises and Eastbrooke Health Care Center of Brooksville for the death of patient Susan Mattingly. According to the suit, the staff at Eastbrooke failed to prevent mental and physical abuse against Mattingly, failed to notify family members of changes in her health and failed to monitor and record her condition so that she could obtain adequate care.

NURSING HOME LAWSUITS ON THE RISE; FLORIDA RATE TOPS FIGURES NATIONWIDE, STUDY FINDS
Sun-Sentinel (Fort Lauderdale, FL) December 30, 1999

Homes in the state paid out 10 times more per bed for lawsuits and legal costs last year than they did in 1990, a study by a private actuarial firm showed. The rate, corrected to factor out Florida's large senior population, is skyrocketing far faster than in the rest of the nation.
--------------------------------------
Lawyers have won millions by showing graphic photos of bedsores and frail seniors, backed with inspection reports detailing violations uncorrected for months or years, suggesting a pattern of neglect. Juries find the emotionally charged cases hard to resist.

Although there are no studies to prove it, lawyers and advocates think the suits have led to improved conditions, especially at homes owned by corporations such as Beverly Enterprises, which are favorite targets.
----------------------------------
"When they get hit in the pocketbook, they may be forced to respond," said Charlene Harrington, a sociology and nursing professor at the University of California at San Francisco who has done research on the issue. "I don't think (the suits) have gone too far."

Last year, a $ 6.3 million award went to the family of Charles Barnes, a retired high school principal with dementia who died when he wandered away from Boca Rehabilitation Center, fell into a landscaping pond and drowned.

Since then, the family's attorney, Richard Schuler of West Palm Beach, said he has noticed more homes putting up fences, making residents wear electronic monitors and keeping better records.

"What nursing homes need to do instead of hide from litigation is pay their people more and provide better training," he said. Scared by the liability

Nursing Home Industry Critical of Proposed Corporate Compliance Program
Health Care Fraud Litigation Reporter January 2000

A recently released draft compliance program guidance from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services' has resulted in numerous objections from the nursing home industry, including claims that the program unfairly attacks nursing homes and will be too costly to implement. Draft OIG Compliance Program Guidance for Nursing Facilities, Federal Register , Oct. 29, 1999, P. 58459 (final comment period ended Nov. 29, 1999).
---------------------------
"The draft guidance stresses the importance of compliance with quality of care standards because nursing home residents are often the most vulnerable beneficiaries receiving care through Medicare and Medicaid," Inspector General June Gibbs Brown said.

The draft guidance targets five specific compliance risk areas for nursing facilities:

-- quality of care;
-- residents' rights;
-- billing and cost reporting;
-- employee screening;
-- kickbacks, inducements, and self-referrals.
----------------------------
Industry Concerns
In comments submitted to the OIG, representatives of nursing home facilities contend the draft guidance is duplicative of existing laws and regulations, and will be time-consuming and expensive to develop and implement, particularly for small facilities.

The American Health Care Association (AHCA), which represents more than 12,000 non-profit and for-profit nursing facilities, skilled nursing facilities, assisted living facilities, subacute providers, and intermediate care facilities for the retarded, objected to the scope of the draft guidance, particularly its focus on quality of care issues.

S.A. man sues to see town's records
The Charleston Gazette January 26, 2000, Wednesday

- A Kanawha County assisted-living facility is accused of allowing a patient to die of dehydration and malnutrition, according to a lawsuit filed Monday.

Robin L. Walker - administrator of the estate of Opal D. Baker - is seeking damages from Beverly Health Care Center of Glasgow and Beverly Enterprises Inc. of Fort Smith, Ark. The suit did not reveal Baker's relation to Walker, who lives in Chester, Hancock County.

COMMENT:- Beverly claimed payment for services to Medicare patients by nurses who were not providing that care. There are already concerns about staffing levels and these are based on the figures Beverly has previously provided! How much care did these people actually receive?

Beverly Pays $175 Mln for Medicare Fraud
Reuters Thursday February 3 4:32 PM ET

It stems from charges that 10 Beverly-California nursing homes improperly charged the Medicare program, which provides health care for the elderly, for the salaries of staff not fully engaged in caring for Medicare-covered patients.

Beverly-California ``fabricated nursing cost figures based on set formulas designed to maximize profits while avoiding detection by Medicare auditors,'' the government's sentencing memorandum said.

``The phony cost figures were backed by false documents, such as phony nurse sign-in sheets, that appeared to support Beverly's claims for payment,'' it said.

Quality push is costing residents, critics say
St. Petersburg Times February 07, 2000, Monday

An agency is cutting off facilities that don't pass inspection. But some say many problems are relatively minor compared with the human toll.
-------------------------
The industry, meanwhile, is fighting back. The Illinois Council on Long-Term Care has sued HHS and HCFA over inspection methods that nursing home trade groups call "fatally flawed." The case is now before the Supreme Court on a procedural question.

And Beverly Enterprises, the nation's largest nursing home chain, has alleged in a lawsuit that HHS made an "arbitrary" and "capricious" decision to suspend a Beverly facility in Brooksville from Medicare. The Medicare suspension led to an automatic cut-off of state Medicaid funds as well.

COMMENT:- Note the complaint that nursing homes can't get staff. I remind you that the problem of understaffing started when these corporations were "cutting the fat" to making the vast profits needed to fuel expansion. They antagonised the nurses unions by their aggression. Not surprisingly working conditions deteriorated and a vicious cycle was established. Nursing no longer has any personal reward. No one is prepared to bust their gut to give directors bigger bonuses and when nurses can't provide decent care then they are suffused with guilt and despair.

Son blames dad's death on Worcester nursing home
The Boston Herald February 17, 2000

Three years after his 87-year-old father was killed by a morphine overdose at a Worcester nursing home, Jim Clark will tell his sorrowful tale today at a Beacon Hill hearing examining the crisis in nursing home care.

"Nobody seems to care about the elderly," said Clark, who contends a lack of staffing led to the death of his father, Frank, at the Hermitage Health and Rehabilitation Center in December 1996.

The 10 a.m. hearing in the Gardner Auditorium at the State House will explore nursing home quality and staffing.

Many homes concede that they are seriously understaffed, saying they don't have enough money to pay nurses or other workers.

Ernie Corrigan, a spokesman for the Massachusetts Extended Care Federation, said the crisis has been exacerbated by the low Medicaid reimbursement rates.

"The issues of Medicaid reimbursement and staffing are inextricably linked," he said.

Nursing vacancies are up 46 percent and finding people to work as nurse's aides is becoming even more difficult, he added.

"People are choosing to work in fast food restaurants or retail stores rather than caring for frail people," he said.
---------------------------------
"We have to come to grips with the fact that nursing home care costs money," she said. "And the chief cost is labor."

The staffing crisis became fatal in Frank Clark's case. A Department of Public Health investigation ruled his death was due to an overdose, and the agency noted that the Hermitage was staffed with two nurses the night of the incident.
------------------------------
But Clark says she was "just a scapegoat. She was as much a victim as my father was."

In his report of an inquest into the death, Worcester Superior Court Judge Austin Philbin wrote that the nurse "lacked any supervision this evening and she lacked any evaluation as to clinical competency. She had never given an injection of morphine before."

According to Philbin's report, the nurse had only received her nursing certificate two weeks earlier and was made to cover two separate stations that night, even though she had protested to her supervisor that "I just started ... and I can't."

Three Hennepin County nursing homes to close; By law, the centers are responsible for finding place to move residents
Star Tribune (Minneapolis, MN) February 29, 2000, Tuesday

A Minnesota company told residents Monday that it will close three financially troubled Twin Cities-area nursing homes as soon as May 31.

Health Dimensions Inc. had said last week that three unnamed homes might close because they are antiquated and expensive to operate. The nonprofit company manages the homes for Beverly Enterprises, the country's largest chain of for-profit nursing homes. Beverly owns more than 500 homes nationally and about 30 in Minnesota.

Govt's False Claim Recoveries Rise
AP Online February 25, 2000

Beverly Enterprises Inc., the nation's largest operator of nursing homes, agreed to pay $170 million to settle allegations it defrauded Medicare by fabricating records to make it appear nurses were devoting much more time to Medicare patients than they actually did.

Industry Focus: Federal Government Cracks the Whip on Health Care Fraud
Preventing Business Fraud April 2000

The government determined that in 1992 Beverly began charging Medicare for the salaries of nurses caring for non-Medicare patients. Under the Medicare program, nurses' salaries are reimbursable costs; however, Medicare only reimburses for costs of caring for Medicare patients. If a nurse spends part of the workday caring for both Medicare and non-Medicare patients, Medicare only pays that portion of the salary attributable to caring for Medicare patients.

Instead of billing for the actual time spent on Medicare patients, ''Beverly fabricated nursing cost figures based on set formulas designed to maximize profits while avoiding detection by Medicare auditors,'' said the DOJ. ''The phony cost figures were backed by false documents, such as phony nurse sign-in sheets'' that appeared to support Beverly's claims for payment.

Patients' rights often pit families vs. nursing homes
The Arkansas Democrat-Gazette April 16, 2000, Sunday

MORRILTON -- Martha Deaver half expected trouble when she visited her mother at the Riverview Manor nursing home with two hired helpers one night last month. She found it: The nursing home called the police. Escorted out, Deaver protested, only to be booked for disturbing the peace and resisting arrest. Deaver said she was just trying to protect her mother. Riverview Manor said it was doing the same.
--------------------------
A petite woman in her mid-40s who moves and speaks surely, Deaver has long been at odds with Riverview Manor, owned by the nation's largest nursing-home operator, Fort Smith-based Beverly Enterprises Inc. The facility was home to Deaver's mother-in-law and to Helen Miller Steger, 80, Deaver's mother, who was incapacitated by a stroke and suffers from congestive heart failure and seizures.
--------------------------------------
"Ms. Deaver has in the past created a great deal of hardship for the facility and the staff," said Dan Springer, Beverly's spokesman. But state inspections support several of Deaver's most serious complaints:

Steger was hospitalized after receiving Rocephin, despite warnings in her medical file that she is allergic to the antibiotic. Deaver complained that her mother wasn't getting her Ritalin doses, but for 12 days the nursing home didn't investigate whether an employee was taking it. Deaver's mother-in-law mysteriously developed large purple bruises across her chest, but nursing-home officials reported them as small.

The inspectors documented other problems, too, in a 37-page report they issued on the home last November, prompted in large part by Deaver's frequent complaints. Springer said the flaws found by state surveyors were corrected. "People make mistakes," Springer said. "If there's a problem, we put our resources toward fixing it."
------------------------------
PROTECTING INTERESTS
Despite the history of acrimony, Riverview Manor didn't call police March 15 just because Deaver arrived. They called because one of the people she came with was Kenneth Davis.

A certified nurse's aide for 10 years, Davis, 43, worked until late February for Brookridge Life Care & Rehabilitation Center, another Beverly nursing home in Morrilton. On the side, Davis was a private "sitter," hired by Deaver and others to watch over their relatives in nursing homes, keeping them company and helping them sit, eat and rest.
--------------------------------------
"He was terminated for an offense that was clearly a violation of residents' rights," said Jerry Halley, a senior vice president at Beverly. "We did what we had to do to protect the patients." Beverly won't discuss why it asked Davis to quit, but Davis will. He said he was accused of a crime he didn't commit: verbally abusing a resident.
-------------------------------
By law, nursing homes must report abuse to the state, which examines the evidence and decides if the claim has merit. If it does have merit, the employee joins a list of those forbidden to work in Arkansas nursing homes. But Davis isn't on that list, which means either the allegation against him wasn't reported or it was never substantiated, state officials said.
----------------------------------
POLICY MATTERS
State nursing-home experts questioned Beverly's part in the report. If Davis was accused only of verbal abuse, and that accusation was either unreported or unsubstantiated, Riverview Manor's case for barring Davis is hard to defend, said Harvey, an elder law attorney who was responsible for helping families with nursing-home complaints until 1998.

RULING LIMITS FAMILIES' RIGHT TO SUE NURSING HOMES
The Palm Beach Post May 26, 2000, Friday, FINAL EDITION

An appeals court has watered down a state law protecting nursing home residents by ruling that if a resident dies after suing a nursing home for abuse, his lawsuit could die with him.
---------------------------
The ruling means that if a resident is raped, beaten, drugged or suffers other abuses at a nursing home and survives but dies of a different ailment, the family of that resident cannot sue under the 1984 law. The family would be forced to seek remedy under harder-to-apply negligence and wrongful death statutes.
---------------------------------
The 4th DCA case was brought by the wife of Gladstone Knowles, a 70-year-old Fort Lauderdale resident who entered the Washington Manor nursing home in March 1995 while he healed from hip replacement surgery.

For the next six weeks, Knowles was kept immobilized in a vest and sedated. His arms and legs became locked in a bent position - a condition his lawyers claim resulted from lack of motion. He developed sores that caused him great pain but was given no pain medication.

Within 67 days, Knowles was hospitalized because the sores had become infected. His condition was so bad that hospital staff was convinced he had been abused and called police to investigate.

After 26 days in the hospital, Knowles died of a heart attack.

"We can't prove what killed him, but we can prove he was chemically abused and illegally restrained and held in his bed for 24 days," said Jeffrey Fenster, the attorney for Knowles' wife. "The decision leaves the most frail and the weakest people totally defenseless against the large national nursing home giants."
-----------------------------
Lawyers for Beverly Enterprises, the nation's largest nursing home chain which owns Washington Manor, declined to comment on the case but said they were pleased with the ruling.

"The language in the statute was crystal clear," said Hugh Wood, whose Miami law firm represented Beverly in the case and has long argued that "Bill of Rights" cases should not be allowed to continue if a patient dies.

COMMENT:- The following case centred on the issue of understaffing. The massive punitive damages and the findings of the appeal judge speak for themselves.

Beverly Seeks Relief from $3 Million Punitive Damages Award in Gregory Case
Nursing Home Litigation Reporter July 27, 2000
CASE: Abuse and Neglect Litigation:Conservatorship of Gregory v. Beverly Enters.

Beverly Enterprises Inc. has filed a petition for review with the California Supreme Court arguing that an appellate court erroneously affirmed the jury instructions in an elder abuse case, and upheld an excessive punitive damages award.
--------------------------------
Background In June 1993, Gregory became a resident of Beverly Manor, a nursing home in Yreka, Calif. She had just suffered a severe stroke and, consequently, was partially paralyzed and semicomatose. She thrived under rehabilitative therapy and soon engaged in a number of activities. In January 1995, Gregory fell when a certified nursing assistant, Freida Pease, attempted to get her out of bed.
----------------------
A jury awarded Gregory $365,580 in compensatory damages and $94.7 million in punitive damages. Gregory subsequently accepted a reduction of compensation damages to $124,480 and a reduction of punitive damages to $3 million in lieu of a new trial.
----------------
The Court of Appeal Decision The appellate panel rejected Beverly's appeal of the verdict on all counts, including its claims of jury misconduct, prejudicial media coverage, and other evidentiary and instructional errors. It dismissed Beverly's argument that the jury instructions on the elder abuse claim were too vague and "allowed the jury to transform a simple negligence case involving Reba Gregory into a referendum on anything that happened to residents of Beverly Manor at any point in time."

The instructions did not mislead the jury, the panel held, and the lower court properly incorporated state and federal nursing home regulations as examples of the proper standard of care.

The court rejected Beverly's claim that the evidence was not sufficient to support the elder abuse verdict.

After reprimanding the defense for not fully setting forth the facts in their appellate briefs, the court found that the record amply indicated that it was not just a "simple slip and fall case," and that the home's administrators and the corporate defendants "were aware for nearly a year and a half before Gregory's injury that the facility was understaffed."

Likewise, the court upheld the finding that Beverly made fraudulent representations to Sandahl regarding the care it would give Gregory, again citing the evidence of understaffing.

The evidence showed that the facility tried to hide its problems with understaffing and "it was abundantly clear there was not enough staff to clean, move, feed, and dress patients during the busy morning shift," the court said.

The court also affirmed the punitive damages award and held that it was not excessive. The sizeable judgment was supported by the extensive evidence of chronic understaffing at the Beverly's facility, the court said. - - - - and the evidence showed that the residents suffered from "numerous indignities."
---------------------------------
Gregory further notes that the lawsuit was not based on CNA Pease's "momentary negligence, but were the direct result of Beverly's deliberate policies and practices that left Beverly Manor chronically understaffed and knowingly exposed patients to the danger of harm."

NURSING HOME OWNERS SETTLE LAWSUIT OVER CARE
The Stuart News/Port St. Lucie News (Stuart,FL) September 20, 2000
Gabriel Margasak of the News staff

STUART - The former owners of a Martin County nursing home settled a civil case Tuesday with a family that alleged their 91-year-old mother died as the result of her care at Salerno Bay Manor.

The settlement ended the suit against Beverly Enterprises-Florida, the company that formerly ran the facility. Company attorneys did not return repeated phone calls and the new owners of the home said they knew nothing about the case.

Madison McClellan, an attorney with Willie Gary's law firm in Stuart, represented the family. McClellan said the nursing home's former owners agreed to pay about $1 million to settle the case. McClellan declined to disclose other details of the settlement.

The family of Marjorie L. Elsebough filed the suit in 1998, alleging nursing home officials left their mother on the floor for five hours after she fell out of bed and broke her pelvis, McClellan said.

Elsebough later died at a hospital from internal bleeding that resulted in heart failure, McClellan said. McClellan said officials at the home were notified "she was known to be at high risk for falls," when Elsebough went to live at there in January 1997.

"They did nothing about it," he said.
----------------------------
It wasn't until her daughter came to visit the next day and found her mother in extreme pain that Elsebough was taken to the hospital, McClellan said. Doctors saw she had a broken pelvis and suspected internal bleeding and allegedly told the family "she didn't have a prayer."
------------------------------
The suit also included other allegations of inadequate care.

New rules guide senior care Rating system changes for nursing homes in Florida
The Florida Times-Union (Jacksonville, FL) October 11, 2000

Connie Bend said she felt terrible when the North Jacksonville nursing home she runs made Florida's most recent 'watch list' of homes with substandard inspections. 'It indicates something in our system broke down,' said Bend, administrator of Beverly Health & Rehab Center-Paradise Pines.

State complaint investigators in March found 9.5 percent of Paradise Pines' 167 residents developed bed sores. One man was hospitalized with a severe bed sore in March, and there was no evidence that staff had treated or even the sore until shortly before his hospitalization.

Paradise Pines has started paying a registered nurse to examine residents' skin during bath time and has disciplined one worker, Bend said. It now meets state and federal regulations.

Superior, Wis., Nursing Home Administrator Resigns
Duluth News-Tribune (Duluth) November 21, 2000, Tuesday

The administrator at a Superior nursing home that was cited recently for 22 federal health violations and nine state infractions has resigned.
---------------------
A September audit listed multiple violations of health and safety standards, ranging from less serious citations to severe infractions.

Among the violations: medication errors, incomplete medical records and two cases where regulators deemed that Beverly staff provided care that threatened the health and safety of patients.

Jeff Schueller, Beverly Enterprise's Wisconsin vice president of operations, told the News Tribune on Oct. 31, that the national nursing home chain is appealing all 31 citations.

The results of that appeal are expected sometime this week.

This is not the first time Benedict served as an administrator at a nursing home cited for numerous health violations.

In June 1993, Wisconsin surveyors cited the county-owned Middle River Health Facility, where Benedict was administrator, for 34 minor violations and five serious infractions.

The citations stalled the nursing home's sale for a month as staff worked to correct the problems.

Beverly Rehabilitation and Nautilus HPS Launch Program to Enhance Lives of Seniors Through Functional Independence
Business Wire November 21, 2000, Tuesday

Nation's rehabilitation, nursing home leader to roll out program nationally

Beverly Rehabilitation (NYSE: BEV) today announced a partnership with Nautilus Human Performance Systems (HPS) to provide strength training to elderly patients in select locations nationwide. Through a new program called "Freedom through Functionality," which is based on breakthrough new research, Beverly Nautilus will offer exercise programs designed to enhance functional independence and improve quality of life for seniors.

Home will lose funding Nov. 30; Emerald Oaks hopes to regain Medicare and Medicaid by Dec. 30.
Sarasota Herald-Tribune November 21, 2000

Emerald Oaks, a Sarasota nursing home, will receive no Medicare or Medicaid monies after Nov. 30 because it hasn't fully fixed the many violations state regulators have found there since May.

The federal Health Care Financing Administration had earlier notified officials at the home, 1507 S. Tuttle Ave., that it would deny payments for new admissions beginning Aug. 29 and would terminate its Medicare and Medicaid contracts on Oct. 30. Both federal programs, however, will continue payments through Nov. 30.

Meanwhile, the 120-bed home, which is owned by Beverly Enterprises Inc., the nation's largest nursing-home chain, is working to regain its access to Medicare and Medicaid by Dec. 30.
-----------------------------------
Group vice president Rich Mason, who oversees 19 West Florida company sites, said Beverly officials reapplied for both certifications last week. And today, in a conference call with an administrative law judge, the company will appeal the decision to end those payments.

"We are working on every front to make sure no patients have to move," Mason said Monday.
----------------------------------
Emerald Oaks' slow descent began on May 3, when the state Agency for Health Care Administration, or AHCA, investigated a complaint. Regulators gave the facility citations in three categories: neglect, dignity and standards of professional practices. They also levied a $ 10,000 fine, saying the instance of neglect posed immediate jeopardy to a patient.

On June 15, a follow-up visit yielded another citation. On Aug. 28, a second follow-up inspection was conducted in conjunction with an annual license and certification visit. Two of the former violations then were cited again; 19 more were noted.

A visit on Oct. 25 for final consideration before severing the contracts found one uncorrected problem and a repeat of neglect.
-------------------------------
Beverly, which has 562 sites nationwide, including 60 in Florida, has its detractors.

Kenneth Connor is an attorney for Wilkes & McHugh of Tampa, a firm that serves on the governor's task force for long-term care reform. He said Beverly repeatedly violates the rights of nursing home patients.

"Beverly is one of the most chronic offenders with some of the most egregious violations," he said, referring to its $ 175 million settlement earlier this year for overcharging Medicare.

"There is a constant tension between caregivers trying to provide care, and corporate types trying to rein in expenditures," Connor said.

Title and Source of article unknown -- from California
By Carolyn McMillan

As the waves crashed along Tajiguas Beach on a recent morning, Mary Hochman walked out onto the sand, took out a .38-caliber revolver and shot herself in the heart.
-----------------------
The 52-year-old night nurse at a local convalescent home was broke and was broken-hearted after months of bitter dispute with her employer. It all began when she tried to report that a nurse's aide hit an 81-year-old man who suffers from dementia.

She said she was told to cover up the information, a charge she detailed in a sworn declaration and a detailed journal she left behind.

"If a nurse cannot protect her patients I do not want to be a nurse. This has taken all hope away from me. I cannot continue to watch my husband and my daughter suffer because I was a whistle-blower," Hochman said in the final paragraph of the hand-written suicide note she left in her car.
---------------------------
Hochman had worked at Beverly La Cumbre Convalescent Hospital in Santa Barbara for eight years and had received glowing annual reviews. But when Hochman told state regulators in March about the beating allegation, infuriating her supervisors, Hochman claimed she was verbally reprimanded and she never returned to work.

Her death, the note and the journal have sparked a state Department of Justice investigation into a facility that public records show has widespread problems, and focused attention on the health care practices of her former employer the largest nursing home in Santa Barbara County.

"IT'S BAD'
State officials have found Beverly La Cumbre, at 3880 Via Lucero, responsible for at least 23 cases of abuse, neglect and financial exploitation of residents over the last 20 months by far the most complaints of any convalescent hospital in the county according to public records maintained by the Long Term Care Ombudsman Services of Santa Barbara.
------------------------------
Beth Badrak, an investigator with the ombudsman's office, says the complaints against Beverly La Cumbre point to a serious problem in care. "It's bad," said Badrak as her eyes conveyed a sense of urgency. "I'm getting two abuse cases a week. These abuse cases are supposed to be few and far between. It is not the norm for these facilities."

There have been 99 total violations against the facility this year, according to records from the ombudsman's office. Badrak investigates complaints from the facility, residents, family members, or whoever brings the matter to the attention of her office. She believes that Mary was an excellent nurse and did the right thing in reporting the abuse. "I knew that she was very caring," Badrak said. "She was extremely patient, and the residents and the staff just loved her."
-------------------------------
MANY REASONS FOR CITATIONS

The state Department of Health Service, which also investigates

complaints and can issue citations, has either cited or found deficiencies at Beverly La Cumbre 11 times since January 1998, a period of time covering the two most recent inspections for which documents were available. The citations were for many reasons, one of which was the abuse case that led to Hochman's suicide.
------------------------------------
Doris Sleeth said the aide verbally abused her while bathing her, yelling at her to not get mad at him for taking so long to attend to her. "He had me in the bed with nothing on and he was getting rough," Doris Sleeth said. "He turned to Paul and said, 'You make her apologize or I'm leaving!' "Oh, I said, 'I'm so sorry.' I would have said anything."

Her husband felt powerless to do anything. "He was a quarter my age and twice my size," Paul Sleeth said. "At least he's been fired and he's gone now." The family members of other residents say abuse and neglect is rampant
-------------------------------
An employee says that when she tried to report the case to an administrator, she was met with indifference. "Instead of calling in a nurse specializing in wound care, there was a total lack of concern," said the former employee, who asked not to be identified because she is trying to find a new job. "I even got a response

that somehow maggots were a good thing. That they were used as alternative therapy for some infections." When Simmons was taken to Santa Barbara Cottage Hospital, doctors determined that her foot had developed serious gangrene.
-------------------------------
A team of attorneys is planning to file two separate lawsuits

against Beverly La Cumbre, one on behalf of more than a dozen patients and their families and the other on behalf of at least two former employees who say that, like Hochman, they were fired or punished for blowing the whistle on abuse and neglect at the facility. "There seems to be a pattern of disrespect for state regulations, their own internal policies and the patients," said attorney Brenton Horner, one of the three lawyers preparing the cases. "It's profit over care."
---------------------------------
COVERUP ALLEGED

Mary Hochman's Aug. 31 suicide not only triggered the investigation by the Department of Justice, it also heightened the attention focused on the facility from planned lawsuits, as well as scrutiny by the Long Term Care Ombudsman. In her suicide note, Hochman described the pain she had endured after "blowing the whistle" on coverups at Beverly La Cumbre. She claimed to have lost her friends at work, her seniority and ability to pay her bills. She feared that she could lose her nursing license.
--------------------------------
"Since I became a whistleblower my entire life has been ruined. I tried to do the right thing to protect my patients. I have no job. I cannot pay my bills. I have no faith in nursing. If a nurse reports wrongdoing to the State her life will be ruined like mine.

She will lose her patients, her friends at work, her seniority. Medical records can be changed by administrators and no one will do anything. [Nurse's name]'s nurses notes were replaced by a nurse who was not even in the building on the stated date. [Another nurse's name]'s notes were destroyed. Is there anyone out there who understands how important it is that nurses be able to report wrongdoing. And these nurses must be protected when they report to the State. If a nurse cannot protect her patients I do not want to be a nurse. This has taken all hope away from me. I cannot continue to watch my husband and my daughter suffer because I was a whistleblower."

Nursing home crisis escalating; Families decry conditions; industry fights to improve
The Dallas Morning News December 3, 2000, Sunday THIRD EDITION

Carolyn Mitschke says she's glad that Texas and federal officials are working to end neglect and abuse in the state's nursing homes. But she's not cheering yet.

Ms. Mitschke moved her mother to six North Texas nursing homes in five years beginning in 1994. She sued and won judgments against two facilities, filed dozens of complaints, fought at every turn - often unsuccessfully - to protect her mother from harm.

"If the state had done enough, my mother wouldn't have gone through what she did," said Ms. Mitschke of Cedar Hill. "My mother had bedsores down to her bones - that's not enough of a change. There is no way it's enough."

Despite a campaign of intense scrutiny and stronger regulation of the nursing-home industry, workers, regulators and residents' families say horror stories still are unfolding in Texas nursing homes, which care for an estimated 94,000 people.

The industry "is in turmoil," said Jim Lehrman, Texas Department of Human Services deputy commissioner for long-term care. "It is undergoing an incredible amount of stress that I'm told they've never experienced before."
-------------------------------
* More than half of Texas nursing homes were found, in state inspections over the last 2 1/2 years, to have harmed residents through abuse or neglect, or placed their lives or health in jeopardy. An Oct. 31 report by the minority staff of the U.S. House Committee on Government Reform showed that only 16 percent of Texas nursing homes were in full or substantial compliance with federal regulations, based on recent inspections.

* Complaints to nursing home ombudsmen increased by about 67 percent in the last two years; about 86 percent of the complaints were substantiated by state surveyors, according to the Texas Department on Aging, which runs the ombudsman program.
-----------------------------
She sued the last two homes; both settled out of court. The owners of Holiday Hills - Pennsylvania-based 22 Texas Services Corp. and Arkansas-based Beverly Enterprises - declined to comment.
----------------------------------
According to the 1998 Texas Medicaid Cost Report - the latest available - daily per-patient spending by for-profit homes on direct care and food trailed that of their nonprofit counterparts. Nonprofits, on average, spend almost twice as much on employee benefits and have 28 percent lower staff turnover.

Mr. Longo said tax breaks and charitable endowments for nonprofits help explain those differences.

Mr. Latimer, president of the nonprofit nursing home group, said nonprofits, many of which are run by religious groups, foster "an attitude in the employees that you do what you have to do to take care of the residents."

COMMENT:- Australians will be familiar with the Riverside case in Victoria, which caused such an outcry. Here is a similar one in the USA.

Chemical burns bring nursing home inquiry Bathing episode put 2 of 10 in hospital, officials say
The Arkansas Democrat-Gazette December 08, 2000, Friday

A state agency has opened an investigation into a Little Rock nursing home after 10 residents were sponge-bathed in a mixture apparently containing floor cleaner and subsequently treated for chemical burns, officials said.

Two residents were hospitalized and eight were treated last week at the nursing home, Beverly Healthcare Williamsburg at 6301 Lee Ave., said Joe Quinn, spokesman for the state Department of Human Services, whose regulatory arm, the Office of Long Term Care, is coordinating the investigation.
--------------------------
State audits of the nursing home earlier this year found several problems, leading regulators to impose fines.

A June 16 survey cited the nursing home for failing to comply with certain federal nursing home standards. According to state records, the nursing home failed to:

• perform criminal background checks on 14 of 20 employees whose files were randomly chosen for verification;
• update written plans that detail residents' needs;
• make sure the residents' environment remains hazard-free;
• supervise residents to prevent accidents;
• and provide residents proper nutrition.

------------------------------
State officials closed another Beverly nursing home, Beverly Health and Rehabilitation Center in Jacksonville, in late 1998. It marked the first time in state history that regulators had closed a nursing home. The state took the action after two years of substandard inspection results and the deaths of two residents.

Howard Holderfield, 58, died after an unlicensed and untrained Beverly nurse punctured his stomach lining when she tried to reinsert a surgically implanted feeding tube, according to state records. A second resident, Jewell Elizabeth Forester, 80, died in 1997 after she was apparently given an overdose of digoxin, a cardiac drug, the state records say.

Family files wrongful-death suit against Neosho nursing home
The Joplin Globe (Online Edition WEDNESDAY, DECEMBER 27, 2000
By Wally Kennedy - - Globe Staff Writer

NEOSHO, Mo. - Using a walker, Rex Riggs pulled himself through the doors of Beverly Health Care of Neosho on Sept. 3, 1999.

Six weeks later, the 57-year-old disabled veteran was dead.

Members of Riggs' family say they want to hold the nursing home accountable. They have filed a wrongful-death suit in Newton County Circuit Court, alleging that negligence killed him.
-----------------------------------------
The suit claims employees of the nursing home "breached their duty and were guilty of negligence and carelessness by failing to measure up to the requisite standard of due care."

Tim Dollar, a Kansas City lawyer who filed the suit on behalf of Riggs' mother, said the nursing home failed to consistently monitor Riggs' condition, failed to properly insert a Foley catheter, failed to accurately report to a physician changes in Riggs' condition, and failed to transfer Riggs in time to a hospital that could provide him with adequate care.
---------------------------
Amy Knapp, spokeswoman for Beverly Enterprises in Fort Smith, Ark., said: "Because it's pending litigation, it would be inappropriate to comment.
--------------------------------
Dollar said the family faced a choice. It could make public its case against the nursing home or choose to protect the privacy of the family member.

"I think it is fair to say that family members had to weigh this in the balance," Dollar said. "They chose to make this public and hopefully change what's going on."

Daughter sues nursing home where father bathed with floor cleaner
The Associated Press State & Local Wire January 11, 2001

The daughter of a man who was given a sponge bath with floor cleaner at a nursing home has sued the operator of the home.
-----------------------------------
Bruce, 75, was one of 11 residents who were chemically burned Dec. 1 after spray bottles of pink floor cleaner and skin soap were somehow mixed up at the nursing home, according to state records. Bruce and one other resident were hospitalized.
---------------------------------------------
The state Office of Long Term Care completed a survey Dec. 12 and found several deficiences related to the baths. Investigators interviewed several burned residents who said they experienced a "stinging pain" when sprayed with the mixture. The office fined the home and ordered it closed by Feb. 12 if problems were not corrected.

But Beverly plans to close the home and move the residents by March. Springer said the home was old and the company decided it was in the best interests of the residents to close the home.

The state closed a Beverly nursing home in 1998, the Beverly Health and Rehabilitation Center in Jacksonville. The deaths of two residents and two years of violations uncovered in inspections prompted the closing.

Medicaid resumes payments to home
Sarasota Herald-Tribune December 13, 2000

Sarasota nursing home Emerald Oaks has been cleared of state violations and later this month will resume getting Medicaid payments that were suspended Dec. 1.

Continuation of its Medicare payments, however, hinges on the results of an inspection to be conducted by the state Agency for Health Care Administration on behalf of the federal Health Care Financing Administration.

The 120-bed home, 1507 S. Tuttle Ave., stopped getting funds from both programs because of a string of violations that began in May. Its parent company, Beverly Enterprises Inc., has since been picking up the tab for 51 residents there who are covered under both programs. The company has reapplied for certification.

Emerald Oaks successfully passed the last state inspection conducted Nov. 21 and 22, making it eligible for Medicaid on Dec. 22.
------------------------------------
Meanwhile, Beverly officials will challenge an October inspection that resulted in citations involving three residents. One was injured after falling repeatedly and was at risk of getting medication at the wrong time. Another was left lying in bodily waste for more than two hours, and a third cut her head in a fall and didn't receive proper medical attention.

 COMMENT:- AND IT GOES ON INTO 20001

State investigators seize Beverly La Cumbre records ::: Nursing home faces abuse, fraud allegations
NEWS-PRESS STAFF WRITER 1/24/01
OSHUA MOLINA

Special agents from the state Department of Justice seized hundreds of documents and electronic files from Beverly La Cumbre on Tuesday, searching for evidence of criminal abuse, neglect and Medi-Cal fraud at the embattled convalescent hospital.
----------------------------------
The hospital remains focused on providing quality care for its residents, Springer said.
-----------------------------
Two of the harshest examples of abuse in 2000 that the facility was cited for involve certified nursing assistants: In one case, an assistant repeatedly punched a disabled 81-year-old man in the arm, leaving a bruise the size of a baseball; in the other, an elderly man was physically abused and inappropriately touched over a two-week period.

The newspaper also reported the story of 102-year-old Beverly La Cumbre resident, Laura Simmons, who died on July 30. She had been rushed to Santa Barbara Cottage hospital with infected bed sores, some covered with maggots. Doctors there determined that her foot had developed gangrene.
--------------------------
A subsequent investigation into Public records maintained by Health Services revealed that Beverly has had widespread problems in recent months. Last week, Beverly was cited and fined for being understaffed and falling below the state minimum staffing levels.

Beverly was cited for the same reason in 2000; it also was cited for abuse and neglect and poor patient care in 2000, according to Health Services.

Eight civil lawsuits -- with allegations ranging from abuse and neglect to wrongful employee termination -- have been filed against the nursing home since September.

Suit says Beverly negligent
ARKANSAS DEMOCRAT-GAZETTE March 2, 2001
TRACI SHURLEY

The daughter of a woman who died in a Jacksonville nursing home in 1998 is suing Beverly Enterprises, claiming the company's negligence caused her mother's death.

Shirley Shultz filed the lawsuit Tuesday in Pulaski County Circuit Court on behalf of the estate of her mother, Dorothy Beatrice Hamilton. Beverly Enterprises, Beverly Healthcare and Rehabilitation-Jacksonville and Beverly's Williamsburg Retirement Inn are named as defendants. The case was assigned to Circuit Judge Willard Proctor Jr.
---------------------------------------
Shultz's filing says that Hamilton, who suffered from chronic obstructive pulmonary disease, had been known to remove the tracheotomy tube that led to her ventilator machine. However, the lawsuit says, the staff at Williamsburg failed to inform the Jacksonville staff of this risk.

Hamilton was found dead with her legs over the side of her bed and her breathing tubes removed, the lawsuit says. Shultz also alleges that the ventilator alarm had been turned off or disconnected.

Shultz's attorneys, Michael Crockett and Keith Grayson, contend in the lawsuit that Beverly Enterprises, because of its business practices, should be held responsible for the death.

The attorneys wrote that Beverly "made a corporate decision to maximize their profits by inadequately and improperly staffing and supervising the facility at the expense of the residents, including Dorothy Hamilton.
------------------------------------
The company's Jacksonville facility, named in Shultz's lawsuit, was closed by the state in late 1998. Beverly officials have said they plan to close the aging Williamsburg facility this month.

A separate lawsuit against Beverly was filed in January by the family of a 75-year-old man who was chemically burned Dec. 1 while staying in the Beverly's Williamsburg facility in Little Rock. According to state records, 11 residents there were burned after spray bottles of floor cleaner and skin soap were mixed up at the 6301 Lee Ave. home.

COMMENT:- Bank's has indicated that he sees future profits as coming from a system of franchised hospitals given incentives to reduce costs -- ie staffing. This is a system already characterised by poor care due to understaffing. What can we expect?

Longtime chief of largest nursing-home chain leaving post
The Associated Press State & Local Wire January 17, 2001

The longtime chief executive officer of the nation's largest nursing-home chain, Beverly Enterprises, is leaving his post.

David R. Banks, who turns 64 next month, will continue as board chairman of the company until the end of the year after 30 years with the company, 12 as its CEO.

William R. Floyd, 56, who joined the company 10 months ago, will take over as CEO on Feb. 10.
-------------------------------
"David made it clear he was grooming Mr. Floyd in potentially succeeding him in the CEO role," said Dan Springer, a spokesman for Beverly. "He is the one who recommended Mr. Floyd and is fully in support of the board's appointment."

William R. Floyd Appointed CEO of Beverly Enterprises; David R. Banks Continues as Chairman
Business Wire January 16, 2001, Tuesday

Most recently, Floyd was Chief Executive Officer of Choice Hotels International, the second-largest hotel franchiser in the world. He earned B.A. and M.B.A. degrees from the University of Pennsylvania and its Wharton School of Business.

Nursing homes forge new way; Florida measure would cap awards, increase staffing and boost Medicaid
Modern Healthcare May 14, 2001, Monday
Vince Galloro

Florida's nursing home industry would get some relief from the resident-liability lawsuits that it claims are putting nursing homes across the state perilously close to bankruptcy under a bill approved earlier this month by the Republican-dominated state Legislature.
------------------------------
For national chains, which claim to have been a particular target of aggressive plaintiffs' lawyers, the relief may have come too late. Citing liability concerns, Extendicare Health Services, Milwaukee, and National HealthCare Corp. , Murfreesboro, Tenn., have exited the state (See story below).

Beverly Enterprises, Fort Smith, Ark., is looking to sell its 53 Florida facilities as well, and the company last week announced an $86 million charge to write down the value of the facilities. The charge led to a first-quarter loss of $52.3 million, or 50 cents per share, compared with a profit of $6.3 million, or 6 cents per share, in the year-ago period. A $21.6 million charge for restructuring also hit the company's earnings. Revenue was up 2% to $659.9 million. Beverly said it is in discussions with a potential buyer of all the facilities and has talked with other parties interested in buying the Florida operations.

Comment:- Note that Beverly's home base is Arkansas and that it has had considerable political influence here. Beverly's long term track record for care is not good. If the current reorganisation follows past practices this means reducing costs further.

State and Beverly Enterprises complete two-year pact
The Associated Press State & Local Wire May 22, 2001

Beverly Enterprises Inc. said Monday it will keep procedures in place that were instituted during the past two years after the nursing home giant signed an agreement with a state agency to improve care.
-----------------------------
The pact called for Beverly to tie employee bonus pay to quality of care and for the company to work to hire more permanent staff rather than temporary workers. Under the agreement, Beverly was also obligated to enhance its system for reporting problems at homes and improve patient care and satisfaction.

The agreement came after the state closed a Beverly-owned home in Jacksonville.
--------------------------------
Knickrehm (Arkansas regulator) said the nature of the March 1999 agreement was unusual.

"This has been a unique effort to allow a nursing home company to set a higher standard for itself. We are pleased with the outcome of this two-year effort," Knickrehm said.
----------------------------------
The state closed the Beverly Health and Rehabilitation Center in Jacksonville in 1998 after two residents died and inspections revealed two years of violations.

Bringing Discipline (and Scorecards) to Nursing Homes
New York Times July 7, 2002

Before he can declare victory, however, Mr. Floyd faces many challenges, most recently a criminal investigation by the state of California into 46 citations for inadequate patient care at 20 facilities. While the incidents took place from 1998 to 2001, they are a stark reminder of Beverly's frequent run-ins with regulators over how it treats its residents and the prevailing image of a nursing home as a place where no one wants to be.

Last year, for example, a Beverly home in Santa Barbara, Calif., that accounted for 25 of the 46 citations, was fined by the state health department for failing "to properly care for a resident who was fed through a stomach tube, resulting in severe infection and his death." That nursing home, which is also the subject of several private lawsuits, is part of the state's inquiry.

Beverly sold that home last year and is in discussions with regulators about the citations. A settlement could be reached as soon as this month, most likely including a substantial fine. The company also expects to be asked to plead guilty to a criminal charge, but has made no decision on that.
------------------------------------
But improving the quality of care remains the main challenge. Some consumer advocates say Beverly still provides poor care at many of its sites. "I haven't seen a difference," said Patricia L. McGinnis, the executive director of the California Advocates for Nursing Home Reform, a nonprofit group.To focus attention on quality issues, Mr. Floyd has linked compensation directly to quality improvements. Sixty percent of the bonus for a local manager depends on quality factors, like whether regulators find fault with care during their yearly reviews and how many residents are being restrained or heavily medicated. Even 20 percent of the bonus for corporate executives is tied to better quality.
---------------------------
"The real issue is changing the culture," said Mr. Floyd, adding that such changes usually take a couple of years. "I'm seeing a momentum being established."

THE BOTTOM LINE OF CARING: National chains earn poor inspection reports
The Atlanta Journal and Constitution July 28, 2002

At a Jonesboro home run by Beverly Enterprises, state inspectors in May found a woman with numerous bedsores lying in linens soaked with urine and feces that had contaminated her wound dressings. The home's staff did not immediately change the woman, even after an inspector pointed out the problem. Beverly homes were cited 78 times for harm to residents in the last four years.
---------------------------
The Jonesboro home operated by Beverly Enterprises reported one of the higher operating margins in Georgia in fiscal 2001. But inspection records show the home has one of the worst records in the state when it comes to harming its own residents.

Beverly Reaches Agreement With California Officials
Business Wire August 2, 2002 12:00am

Investigations by State Attorney General William Lockyer and the County of Santa Barbara District Attorney Thomas Sneddon had focused primarily on two incidents that occurred at the La Cumbre Convalescent Hospital in Santa Barbara in July 2000 and in July 2001.

Under terms of the settlement, a subsidiary, Beverly Enterprises-California, Inc., has entered a plea of nolo contendere in Santa Barbara County Court to two felony charges under California's Elder Abuse statute. The settlement also provides that Beverly Enterprises-California, Inc. will:

• Pay a civil monetary penalty to the Attorney General and District Attorney totaling $2 million, payable in four quarterly installments of $500,000 beginning in the third quarter of 2002;
• Pay a fine of $54,000 relating to the nolo contendere plea;
• Reimburse the Attorney General and District Attorney for the costs of their investigations, which total $533,000;
• Enter into a "Permanent Injunction and Final Judgement" (consent decree) - along with Beverly Enterprises, Inc., Beverly Health and Rehabilitation Services and Beverly Healthcare-California, Inc. - ensuring that California nursing facilities owned and operated by Beverly Enterprises, Inc.'s operating subsidiaries comply with all applicable laws and regulations - and to continue their existing training and education programs.

"We accept responsibility for the two unfortunate incidents that occurred at the La Cumbre nursing home, but we firmly believe that those incidents did not constitute criminal behavior on the part of any of our operating units or our employees," said William R. Floyd, Beverly Chairman and Chief Executive Officer.
------------------------
As for the La Cumbre facility, Beverly sold the home to another long-term care provider last October.

see under fraud for more about this hospital

Plea Ends Nursing Home Abuse Probe Health: Firm that runs 60 facilities in state pleads no contest in case involving two deaths. It pledges improvements, is fined $2 million.
Los Angeles Times August 2, 2002

One of the nation's largest nursing home chains pleaded no contest Thursday to felony elder abuse charges stemming from the deaths of two people and promised to make wide-ranging improvements in the quality of care at 60 facilities statewide.
---------------------------------
The district attorney's office began its probe after the death of a 102-year-old woman, Laura Simmons, who suffered from infected bedsores at Beverly La Cumbre nursing home in Santa Barbara and had maggots in her foot. A year later, an 87-year-old patient at the same facility, William Marthai, died after a feeding tube was inserted into his abdomen, outside his stomach, leading to an infection, said Santa Barbara Assistant Dist. Atty. Tracy Grossman.

Among the leads investigators pursued was a journal left by a La Cumbre nurse, Mary Hochman, who had complained about conditions at the facility and later shot and killed herself, officials said.
----------------------------
The company has also settled lawsuits brought by both the Marthai and Simmons families. Details of the settlements were not available Thursday.
-----------------------------
Beverly also agreed to increase staff training to prevent neglect, bedsores and accidents and to treat patients with respect and dignity, according to a summary sheet provided by the attorney general's office. The chain pledged to have adequate staffing levels at facilities, and to develop quality review procedures at each facility that will make annual progress reports to the attorney general's office.
--------------------------------
It is unusual for nursing homes to be targeted in a criminal investigation, although state Atty. Gen. Bill Lockyer has pledged to pursue violations in such homes aggressively.

Elder Abuse Fine Called Ineffective
Los Angeles Times August 3, 2002

Care: Relatives of victims of nursing home neglect say $2-million penalty against chain's owner isn't enough to force industry reforms.
----------------------------------
Beverly Enterprises Inc. pleaded no contest Thursday to two felony elder abuse charges, and agreed to pay the civil penalties for a range of violations that allegedly led to bed sores, dehydration, malnutrition and improper medication among patients in the company's 60 facilities in California. The company did not admit wrongdoing in the civil case.

"It's a Band-Aid effect--$2 million is nothing to these people.
---------------------------
"Those places should be shut down. You can't just give them a slap on the wrist."
------------------------------
Sandra Michioku, a spokeswoman for the state attorney general's office, said Friday that the settlement also requires the company to provide authorities with an annual report detailing how it is complying with the court-ordered requirements, including more staffing and better training.

The company also will have a designated compliance officer at each of its facilities.
--------------------------------
In 1998, jurors in Siskiyou County awarded a record $95 million to a 66-year-old stroke victim whose hip and shoulder were broken when an aide at a Beverly facility, unable to find help, tried to move her from a bed to a chair.

That settlement was later reduced to about $3 million, said Prescott Cole, staff attorney with California Advocates for Nursing Home Reform.

Nation's nursing homes are quietly killing thousands
Post-Dispatch 10/12/2002

Rex Riggs was in stable condition when transferred to Beverly Healthcare nursing home in Neosho, Mo., according to Veterans Administration doctors. Six weeks later, the disabled Vietnam War veteran, 57, was hospitalized with gangrenous infections that led to the surgical removal of his scrotum, penis and lower abdomen. He died three days later. Federal investigators said bad nursing care caused his death.

SLU physician has cure for ailing nursing homes
ST. LOUIS DISPATCH October 17, 2002 07:45 PM

It began in 1992, when the new administrator of a nursing home in Maryland Heights approached SLU officials for help. National Health Care had just reopened the former Villa Capri Nursing Home.

The history was not good. State regulators had ordered Villa Capri closed, and prosecutors had sought felony neglect charges against several employees and the former owner, Beverly Enterprises. Beverly later sold the home and paid a $1 million settlement to avoid criminal prosecution. None of the employees were convicted.

Attorney General's office reaches $1.5 million settlement
Arkansas News Bureau March 5, 2003

Arkansas Attorney General Mike Beebe announced Tuesday that he has reached a $1.5 million settlement with Beverly Enterprises Inc., after an 18-month investigation found evidence of neglect at facilities operated by the Fort Smith nursing home giant.

Beebe said, during a news conference Tuesday at the state Capitol, that the Attorney General's Office found "evidence of neglect, injuries and failure to provide nursing care and treatment for vulnerable nursing home residents."
------------------------------
The complaints were about nursing homes throughout the state, and the most current one was dated mid-2001, he said. No criminal or civil findings were made against Beverly, Jackson said.
--------------------------------
Still, the settlement hardly caused a ripple on Wall Street, - - .

 

Beverly to settle 42 neglect cases : Fort Smith-based owner of nursing homes to pay $1.5 million
ARKANSAS DEMOCRAT-GAZETTE, March 5, 2003

Attorney General Mike Beebe announced Tuesday that Fort Smith-based Beverly Enterprises Inc. has agreed to pay $1.5 million to settle 42 cases of neglect in Arkansas nursing homes owned by the company.
----------------------------
Blair Jackson, a Beverly spokesman, said the attorney general’s office only investigated "a handful" of the 42 cases and that the company disagrees with Beebe’s findings.

"The resolution does not constitute an admission by Beverly of any wrongdoing,

Reinecke & Daily to pursue punitive damages against Beverly Enterprises Inc.
AP Newswires June 13, 2003

Reinecke & Daily announced today that one of the nation's largest private nursing home providers will be tried for punitive damages in an elder abuse lawsuit involving its Laguna Hills rehabilitation facility's treatment of a 79-year-old woman who was left outside in 100-degree sun for several hours. The suit claims that the woman, Margaret Petruccelli, was so severely burned that it necessitated the amputation of her left foot. She eventually died from complications due to the injuries.
----------------------------
"What makes Beverly Healthcare's neglect and warehousing of its residents particularly insidious is that its victims are the elderly, those too frail and ill to advocate for themselves. We look forward to holding Beverly fully accountable for the suffering they have caused by cutting resident care to increase profits," said the plaintiff's attorney, James Daily of Reinecke & Daily of Newport Beach, Calif.

Over the past few years, multimillion-dollar fines have been levied against Beverly Enterprises for Medicare fraud and bad business practices, including a 1999 settlement with the United States government for $175 million.
--------------------------------
According to California Department of Health Services records, this Beverly facility had been found deficient for inadequate resident supervision on two prior occasions. First on November 9, 1998 and then again, just months before Beverly lost Petruccelli, on March 12, 2000. Each time Beverly told state officials "the facility ensures that residents receive adequate supervision and assistance devices to prevent accidents/incidents." On May 24, 2001, following the incident, Beverly was found deficient a third time and submitted the same claim in response to state investigators.

 

MAIN WEB REFERENCE PAGES

• Beverly Enterprises in the Marketplace.
  Beverly's history and its financial transactions
• Care in Beverly Facilities.
  Allegations of understaffing and poor care - Inspection data.
• Beverly, Nurses and Unions.
  The bitter battle with the nursing unions - whistle blowing
• Beverly and Fraud.
  Beverly's fraud conviction - an interesting result
• Beverly's Denials and Explanations.
  Hoe Beverly understood the allegations and fraud
• David Banks and Corporate Culture.
  What sort of people are these?

ADDITIONAL PAGES

• THE SHAME OF OUR NURSING HOMES.
  An excellent 1999 review of the failure of aged care in the marketplace using Beverly as a case study - by Eric Bates in "the Nation". Its a must read. I have included the whole article.
• Beverly and Truthfulness.
  An interesting article which looks at contradictions in Beverly's statements.
• Beverly in Arkansas in the 1980's.
  The complex story of Beverly's involvement is a series of shady deals with the Clinton administration and with others whom Clinton brought to Washington. I have put two detailed 1994 press reviews on this page.
• Lobbying to Stop Litigation in Florida.
  There is a vast press on the bitter fight between citizens and their lawyers on the one hand and corporate chains on the other. Beverly was at the centre of this. I have put a review article from the Tampa Tribune here.

---

LINKS TO MAPS
Central Map ..... Initial Map ..... USA Map ..... Australian Map ..... International Map ..... Corporate Practices Map..... (to print)

---

Path
Home Page ..... US Corporate page ..... Aged Care ..... Beverly Overview

---

This page created Feb 2001, updated Mar 2001 by Michael Wynne
Last Update Aug. 2001 and Aug. 2003