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In Questionable Health

Nursing homes: Many O.C. facilities cited repeatedly for neglect and endangering patients draw light punishments, records show. Critics blame lax laws, forgiving system.


COSTA MESA — When nursing home inspectors toured Port Bay Care Center last April, they saw elderly and ill residents lying helpless in fetid rooms, mismedicated, underfed, dehydrated and suffering a multitude of indignities. Later, poring over the home's medical records, they found devastating consequences of neglect.

In the previous three months, a resident had died of massive dehydration 45 minutes after being taken to a hospital emergency room. Another man found unconscious was hospitalized with acute dehydration, kidney failure, infection and pneumonia; he too died. A woman hospitalized with fever, pneumonia and a urinary tract infection also had died after the home failed to provide proper care.

By law, California regulators can declare a nursing home's conditions "an immediate jeopardy to residents." They can impose a $25,000 penalty for each death caused by a home's lack of care. They can go to court to have an outside manager appointed or have the home's license revoked. Medicare and Medi-Cal funds--amounting to as much as 70% of a home's income--can be cut off in 23 days.

But at Port Bay, inspectors did none of that.

Instead, they approved more Medicare beds, asked the administrator to prepare a plan of correction and gave the facility six months to improve conditions or lose funds.

"What we saw at the time we did not feel constituted immediate jeopardy," said Jacqueline Lincer, head of the district office of the state Department of Health Services. "Looking back, maybe we should have done more."

Last September, Port Bay fell by its own weight, declaring bankruptcy and closing its doors. Regulators say it was one of the worst homes in the state, although a dramatic exception in a county where the majority of 89 licensed nursing homes provide quality care.

But critics say that Port Bay stands as stark evidence that California's enforcement of nursing home standards, as well as lax laws, allow the most troubled homes to stay open despite providing care that is at best mediocre, and at worst deadly.

According to a Times review of inspection reports, lawsuits, medical records and death certificates from the past two years, Orange County nursing homes that repeatedly break the rules usually draw light punishments from a regulatory system that frequently pulls punches and permits lengthy appeals. For example:

* Fines are often sharply reduced or dropped. First-time fines for neglect are automatically waived under state law; other fines are cut 50% if paid within 15 days. Of the $141,000 assessed against Orange County homes in 1996, only a third was paid.

* Eighteen Orange County homes were cited for poor care last year. Half were threatened with a loss of Medicare funds, but only three had funds actually cut off.

* At those 18 cited homes, 12 questionable nursing home deaths were noted by regulators in the past two years. Only one resulted in the maximum $25,000 fine. Officials said the others did not warrant a high fine, or, as happened at Port Bay, that they did not have the resources to thoroughly investigate whether patient care was a contributing factor.


Eight days after inspectors left Port Bay last spring, Donna Joyce, 48, was admitted, recovering from cancer surgery. Within two weeks, she was dead after being hospitalized with dehydration and infection, according to medical and state records. The home was fined $1,000 for Joyce's dehydration.

"Families think it's God's will when their ailing relative dies in a place like this. Well, it's not God's will, it's negligence," said her sister, Denise Joyce, a licensed nurse.

Ronald Millett, Port Bay's administrator last April, told The Times he does not believe the facility caused the deaths inspectors noted there, but acknowledged that there were problems with infection control, dehydration prevention and other nursing services.

"I really honestly don't feel any of these patients died because of neglect," he said. "There are things we could have done to better monitor or assess their needs."

Millett has a new job now, as administrator at Harbor Health Care in Fullerton, Orange County's largest nursing home.


More than 7,500 people live in the county's 89 nursing homes, and they are much more difficult to care for than in years past, experts say. Many are older and sicker. Others are younger people who have been moved out of hospitals after receiving treatment as a result of AIDS, gunshot wounds or long-term illness. It costs $3,500 to $10,000 a month for private care, so the lifeblood of 85 of the county's homes is government subsidies. The other four accept only privately funded patients.

California's nursing home system, which receives more than $800 million a year from the federal Medicare program and $2 billion more from the state Medi-Cal program, has drawn so much criticism that the General Accounting Office is investigating whether flawed laws and lax enforcement have allowed dehydration, malnutrition, bedsores and falls to persist.

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