By Amy Silverman
By Olivia LaVecchia
By Monica Alonzo and Stephen Lemons
By Chris Parker
By Michael Lacey
By Weston Phippen
Starting last year, the Arizona Department of Health Services began levying its own fines instead of relying solely on the federal government. The change came after a critical report from the state auditor general issued the month before Governor Janet Napolitano took office in January 2003. The auditor general pointed out that the state had never fined a nursing home and that inspectors weren't following up when homes self-reported problems to the state. The auditor general also said the department wasn't releasing enough information to the public about complaints and annual inspections.
In September, the state auditor general ruled that the problems had been fixed.
But the state still has a long way to go.
When they are levied, fines are small. For example, in October 2003, state regulators determined that Sun View Care Center in Youngtown had harmed residents by improperly using bed rails. Three residents had climbed over their rails and fell, all three within a month's time. Two suffered broken bones. According to the state report, the home kept using the same rails for one woman even after she fell twice. The third time, she fractured her hip.
The state could have levied a $500 fine for each resident who fell and increased it even more with a sanction for every night someone slept in a dangerous bed.
Instead, Sun View paid a $500 fine.
In theory, there should be plenty of information about nursing homes available to the public.
The attorney general maintains an elder-abuse registry that's supposed to include a report from any state agency that substantiates an allegation of abuse, which includes neglect that has resulted in injury.
The Bush administration has advocated a market-based approach to improving nursing homes. By posting information about inspection results on the Internet, consumers can make informed choices before putting loved ones in nursing homes.
The hope is that bad nursing homes will disappear because no one would place a relative in a home that provides poor care. The reality is, there's no place consumers can check to find all the information they need.
The Arizona Department of Health Services posts the dates and amounts of state fines against nursing homes on its Web site, but no information about violations that prompted the punishments. For that kind of detail, a consumer must refer to the federal government's Web site, which has no information about fines either from the state or federal government.
Even then, what shows up on the Internet can be a far cry from what actually happened. Take, for instance, a woman at Desert Cove Nursing Center in Chandler who developed gangrene in her right foot in early 2003. There was no mention of required weekly skin checks in the woman's record, nor had the home adequately addressed her risk for developing circulation problems in her foot. A dialysis center outside the home called paramedics when she complained of a headache, and was not as responsive as usual. By then, her toes were black, and doctors doubted whether they could be saved.
The state took no action, so nothing appears on the state's Web site. The federal government fined the home $1,500 and dutifully summarized the violation on its Web site for consumers.
Here's how the violation read: The home failed to "comply with program requirements between annual inspections; although it corrected these problems before the most recent inspection."
Unless you make a public records request, wait days or even weeks for a response and pay for the inspection report, that's all the information you'll get.
It's a problem easily solved: The state health department could post inspection reports on the Internet so the public would have a firsthand picture of what really goes on in nursing homes. At least three states, including Alabama, Iowa and Minnesota, post reports online. Industry insiders say they're all for it, but Arizona health officials plead poverty -- there's no money to post inspection reports on the Web, they say.
Theoretically, the public shouldn't have to rely on the department's Web site to find out what's going on in nursing homes.
Under Arizona law, any state agency that substantiates an allegation of abuse or neglect that has caused an injury must tell the Attorney General's Office and provide a written copy of its decision so that the information can be included in the state's elder-abuse registry. The registry is filled with complaints filed by lawyers who have sued nursing homes, but the state health department doesn't forward copies of inspection reports documenting harm to the Attorney General's Office for inclusion on the registry, which is easily accessible to the public.
The system is so big that it's become unwieldy. With at least four agencies that take complaints, the regulatory process can be confusing, for both nursing homes and consumers, says Linda Schoenbeck, director of utilization services for the Health Services Advisory Group, which has a federal contract to help nursing homes improve. She remembers a meeting a few years ago on nursing homes in the Governor's Office. "I was in this room with all these people, and I'm thinking, 'We're all taking care of the same patients, but we don't even know each other,'" she recalls.