The state issued no fines, nor did DHS bring in a temporary administrator to manage day-to-day operations, as the law allows.
The federal government never barred new admissions.
Lisa Wynn, who's in charge of enforcing standards at DHS, says inspectors who found the most serious violations remained at the home until the problems were fixed.
Big deal, says Steve Garcia, a California-based lawyer who says he's heard from one potential plaintiff and researched the home's inspection history. With such a shocking list of deficiencies, it should have been clear that the home couldn't be trusted to keep residents safe, he says.
"Why didn't licensing do something about it?" Garcia asks. "Why did they just allow them to continue to operate in a fashion that allows these things to happen?"
Homes that rely exclusively on Medicaid to make ends meet are asking for trouble, Garcia says, because reimbursements are so low. "You might as well start up the ambulances outside to ship them to the coroner's office," he says. Medicaid pays less than $120 a day; the average charge to a private insurer in the Phoenix area in 2002 was $162, according to a survey by MetLife.
Garcia adds the obvious: "If it's not enough money, don't take the people."
Esperanza Manor made the front page of the local paper last February when the home put 22 residents on a charter bus and threatened to dump them at a Maricopa County business office because the county hadn't paid its bills for residents sent there under the county's health plan. As the bus cruised through the city, the county cut a check for $186,000 and the residents were returned to Esperanza Manor.
The bus stunt prompted meetings between the governor's staff, the Department of Health Services and the Attorney General's Office, Lisa Wynn says, but the meetings led to nothing but a report to the state Board of Examiners of Nursing Care Institution Administrators and Assisted Living Managers for possible unprofessional conduct.
The board, which has the power to discipline nursing home administrators, has been embroiled in internal squabbling and had its funding taken away this year by the governor because of ineffectiveness. It took no action. "We went and investigated," Wynn says. "There was really nothing we could do."
Infinia, the Utah-based owner of Esperanza Manor, sold the nursing home to Dallas-based Centers for Long Term Care on April Fool's Day. The company replaced the home's administrator shortly after acquiring the facility, which is now called Mara Villa Care Center.
At least on the surface, Mara Villa is undergoing a face-lift. The walls are coated with fresh paint, linoleum on the floors is being replaced. A new administrator took over shortly after the home was sold. Other supervisors, including the home's social services director, have been replaced. The number of citations has plummeted. But serious problems remain, according to inspection reports.
In June, a resident who was supposed to be fed only puréed food choked to death on a banana, which wasn't on his prescribed diet. "It was a mistake," acknowledges Peggy Grunden, the home's administrator.
In May and June, a nurse four times failed to give a resident an antibiotic via a special IV line, and the resident's doctor wasn't told. Grunden says the incident prompted Mara Villa to stop accepting residents who require drugs administered through such IVs.
Grunden says she fired a nurse last spring who was overheard speaking with a resident who told her he had tried committing suicide several times.
"The next time you try, let me know and I'll show you how," the nurse told him, according to inspection records.
That incident, as well as others in which nursing assistants reported cases of the staff shoving, kneeing and slapping residents, showed that problems at Esperanza Manor were deeper than the state had known.
"We've had several allegations of abuse -- I'll be up-front about that," Grunden says. Although the law requires health-care workers to report abuse to the state, Grunden says some supervisors left over from the old regime demanded silence. "The certified nursing assistants were afraid they'd lose their jobs," Grunden says.
Neither the state nor the federal government has sanctioned the home's new owners for the most recent violations. None of the violations inspectors found since the home changed hands in April appeared on the federal government's Web site for consumers until New Times asked about the omissions. The day after the newspaper called the feds, the choking death appeared as a failure to "provide food in a way that meets each resident's needs."