State report raises concerns about nursing home employee responsibilities

BRISTOL, Va. – Not every member of National Healthcare Bristol’s nursing home staff knew they were required by law to report patient abuse, according to an October state inspection report.

The Virginia Department of Health conducted an annual, unannounced inspection Oct. 6-8 and the results were recently made public. Inspectors wrote that many NHC Bristol staff members were unaware they are legally required to report patient abuse to local law enforcement or to state regulatory agencies.

Also, the DHS Report on NHC Healthcare alleges that the home administrator once failed to notify a patient’s representatives of a sexual abuse claim that had become part of an ongoing police investigation.

“I figured they were already aware of it since it was being investigated,” the unnamed administrator is quoted as saying to an inspector.
News that nursing home workers were cited as being unaware they had to report abuse shocked Virginia Long-Term Care Ombudsman Joani Latimer, a private agent contracted by the state as a nursing home patient advocate.

“That is truly appalling,” Latimer said. “It’s not a new requirement ... it’s been in place for quite a while.”

Most of the 140-page inspection report focuses on health care, and claims that:
* Not all patients are receiving prescribed medications;
* Facility doctors have failed to examine all patients on a regularly scheduled basis;
* Not all representatives have been notified when a patient faces a new health problem.

NHC has addressed and listed a plan of correction for the deficiencies cited in the report, said Connie Kane, director of the Division of Long-term Care, the branch of the state’s health department tasked with monitoring agencies receiving Medicare and Medicaid funding.

Inspectors returned to NHC Bristol earlier this week to make sure corrections have been made, Kane said. The results are not yet available, and it is not known whether fines will be levied, Kane said.

Just 16 pages from the October report deal with possible patient abuse and reporting requirements.

Inspectors wrote that they interviewed only members of a single night and day shift about the state’s mandated reporting law. It requires police, doctors, nurses and other medical staff to report to supervisors and regulatory agencies any suspected case of elder abuse.

Mandatory reporters who fail to make a report can be fined as much as $500 for the first failure and $1,000 for following failures.

According to the October report:
* Two of the 35 staff interviewed did not state that they would report abuse to their supervisor and follow the facility’s chain of command.
* Twenty-one of the 35 staff members interviewed were not aware they were required to report the allegation to the appropriate state agency.
* Two of 35 staff members interviewed were unable to answer what agency they would report suspected abuse to.
* Twenty-three of the 35 staff interviewed were unable to correctly identify themselves as a mandated reporter of abuse or could not define the term.

NHC spokesman Gerald Coggin, e-mailing the Bristol Herald Courier from the company’s headquarters in Murfreesboro, Tenn., wrote that it is nursing home policy to notify families, physicians and the appropriate authorities when abuse is suspected.

The results cited in the study, Coggin wrote, were a misunderstanding by staff over terminology.

“While the staff was instructed regarding this responsibility, not all of them were familiar with the term ‘Mandated Reporter,’ ” Coggin wrote.
Inspectors arrived at NHC little more than a month after accusations surfaced that a former nursing aide there sexually assaulted male and female patients for years.

On Jan. 27, former nursing aide James Wright will face trial on four charges of aggravated sexual battery, which police allege happened to four NHC patients between 2000 and 2007.

Once the police charges surfaced, former NHC workers told the Herald Courier that supervisors either ignored or threw away written reports of the abuse. The former workers also said they were afraid they would lose their jobs if they skipped the home’s chain of command and called state regulatory agencies.

The ongoing police investigation did not spur the state investigation, said Kane, director of the Division of Long-term Care.

But inspectors did have the investigation in mind when they arrived, Kane said.

The sexual abuse claim that the administrator reportedly failed to pass on might be connected to the Wright investigation, conducted jointly by Virginia’s Attorney General’s office and Department of Health Professions. According to the inspection report, the home administrator, when asked about the sexual assault allegations surrounding a particular patient, noted that it was being investigated by the Department of Health Professions.

“I don’t know how much I can say about this,” the administrator is quoted when asked by the inspector about the allegations.

Asked why the family was not notified, NHC spokesman Coggin wrote: “In this instance, the surveyor asked the Administrator in October 2009 about an incident of alleged abuse in 2007. The Administrator was not informed about the allegation until 2009. She was informed by authorities who were already investigating the matter. These authorities had already advised the patient’s family of the allegation.”

Though asked, Coggin would not name the administrator.

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