Hope I Die Before I Get Old

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• Penalties are light. The maximum fine is $500, although that can be ballooned in some cases -- say, a bedsore that goes untreated for several weeks -- if the state levies the penalty on a per-day basis. Other states have much bigger sticks. In Washington state, the maximum fine is $3,000; in California, it's $100,000.

• DHS doesn't report cases to the Attorney General's Office for listing on the state elder-abuse registry, as required by state law. The registry is supposed to serve as a quick way for the public to find out who's been giving substandard care.

Since the health department started issuing fines last year, the state, as of August, had fined a dozen Maricopa County nursing homes a total of $30,650. The biggest were levied against Plaza Del Rio in Peoria, which was hit with a $14,100 penalty for not getting a state license after an ownership change, and Freedom Plaza Care Center in Peoria, which paid $8,050, also for not getting a license after the home changed hands.

At least nine Maricopa County nursing homes haven't been punished at all after inspectors found patients had suffered real harm because of poor care. The cases include:

• In February 2003, the state found that Suncrest Healthcare Center in Phoenix near South 24th Street and East Southern Avenue hadn't given morphine to a woman before such simple tasks as taking a shower, as ordered by her physician. Her pain was obvious when the staff cleaned a bedsore: "During the hour-long treatment, the resident, who is non-verbal, occasionally widened her eyes and batted and waved her left hand in the air toward the nurse, clenched the side rail with her left hand, displayed facial grimacing, including tightly closed eyes, and her body was shaking." The state inspector who wrote this account found that the woman hadn't gotten any pre-treatment painkillers for at least two weeks. The state found a total of 15 violations, including a woman who went three days without a shower and a woman who sat naked from the waist up in a hallway for several hours, in full view of staff, visitors and other residents. Rooms and halls reeked of urine, and floors, walls and privacy curtains were stained with feces.

• In February 2003, the state found that the staff at Bryans Extended Care Center in Phoenix, which has since been acquired by a new owner, didn't change the bandage over a sore on a resident's heel for 11 days. The resident developed gangrene and had his leg amputated below the knee.

• In September 2003, investigators determined a resident fell out of bed at Phoenix Mountain Nursing Center in northeast Phoenix after the home used improper bed rails. The resident suffered a fractured hip.

• In September 2003, Heather Glen Care Center in Glendale was cited for failure to get dental care for a resident with loose and broken teeth. He cried out when his teeth were touched, and jerked away when a staff member approached with a toothbrush.

• In February of this year, the state found that Highland Manor Health and Rehab in Phoenix hadn't given enough water to a resident who suffered dehydration so serious he was sent to a hospital.

• In April, the state found that Life Care Center of Scottsdale hadn't properly treated or assessed pressure sores in four residents. The home also hadn't followed doctors' orders in tracking hydration in two residents, one of whom developed a urinary tract infection. And the home hadn't used the proper bed rails for a resident who fell out of bed and broke her hip.

In yet another case that resulted in no fines, Eugenia Zarembski fell and broke her right leg in the spring of 2003. Her doctor told the staffers at Plaza Del Rio, a Peoria nursing home, to keep a leg brace in place at all times. They took him literally.

Three weeks passed before anyone looked under the brace, even though the staff knew Zarembski was at high risk for developing pressure sores and was supposed to be checked weekly from head to foot. By the time a nurse found the sore on Zarembski's right calf, it had turned black. She had a cluster of less serious sores around her knee.

Three days after the sores were found, Zarembski's family took her out of Plaza Del Rio and sent her to a nursing home in Modesto, California, where the staff noted she was "dirty and unkempt." She smelled of old urine, according to admission notes written the same day she left Plaza Del Rio. Dirt was caked between her toes. "Teeth dirty, unbrushed," her new caretakers noted. Her right heel was black from another sore; her left heel was red and mushy.

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Bruce Rushton