By Anna Gorman, Kaiser Health News
In an effort to reduce California’s backlog of health and safety complaints at nursing homes, Los Angeles County public health officials told its inspectors to close cases without fully investigating them, according to internal documents and interviews.
The effort known as the “Complaint Workload Clean Up Project” has been going on since at least the summer of 2012, according to internal memoranda sent by email to managers and inspectors by county Department of Public Health supervisors.
Nearly one-third of the 1,286 nursing homes in the state are in L.A. County.
State and federal officials, who contract with Los Angeles County to inspect nursing homes on their behalf, said they are now investigating the matter. Contacted by a reporter, the California Department of Public Health issued a statement Sunday saying it did not approve the practice and has ordered Los Angeles County officials to “immediately discontinue” it. The county’s approach conflicts with the policies and protocols of the California Department of Public Health, spokesman Anita Gore said in the statement.
The federal Centers for Medicare & Medicaid Services is conducting a separate inquiry. “CMS recently was made aware of allegations concerning the quality and integrity of nursing-home inspections in Los Angeles County, and we are looking into those allegations,” spokesman Jack Cheevers said last week.
According to the confidential documents, L.A. County public health supervisors, including division chief Ernest Poolean, told inspectors to administratively close complaints submitted anonymously as “No Action Necessary.”
They instructed inspectors to close other cases by examining previous reports about the facility instead of thoroughly investigating the complaint at hand. If two other inspections done around the same time did not reveal problems similar to the new allegation, the complaint was to be determined “unsubstantiated.”
The internal documents said, however, that inspectors were to fully investigate complaints that were high-profile, were part of a lawsuit or involved alleged abuse or neglect.
The documents do not specify what types of investigations might have been cut short. Nursing home inspectors respond to a variety of complaints such as insufficient staffing, staff misconduct and unsafe conditions. Specifically, problems may include patients getting bed sores or being given unnecessary medications.
Poolean, chief of the health facilities inspection division for L.A. County Department of Public Health, said the county’s actions were the result of a state push to close cases.
All of the complaint investigations were started but some were not completed or written up, he said. The cases “may have sat on a desk for a long time,” he said. Poolean blamed a shortage of inspectors, saying he had trouble recruiting and retaining staff.
Elder care advocates said the approach was unacceptable, noting that the county has a legal responsibility to thoroughly investigate complaints about nursing homes.
“Abuse and neglect cases are not the only cases that lead to harm or death,” said Molly Davies, coordinator of the WISE & Healthy Aging Long-Term Care Ombudsman Program for L.A. County, whose position is partially funded by the state and federal governments. “There are other egregious types of complaints.”
Statewide, public health officials have said there are more than 9,000 open cases dating as far back as 2001 and that they are addressing the backlog. Gore, the spokeswoman, said the department takes its responsibility for protecting patients seriously. Like the county, state officials blamed the backlog on shortages of qualified inspectors.
At a recent legislative hearing on the issue, however, they assured legislators that all complaints are investigated. That process includes collecting data, reviewing records and doing observations, officials said last week. Following an investigation, public health officials write reports identifying any problems and may issue citations and fines and refer cases to law enforcement.
Under state law, an investigation must be initiated within 10 days – or 24 hours if the allegation involves the imminent threat of death or serious harm. Advocates said that it’s critical the investigations occur promptly because staff turnover at nursing homes is high, memories fade and residents may move or even pass away.
Last month, Democratic Assemblywoman Mariko Yamada of Davis, who chairs the aging and long-term care committee, proposed legislation that would require the state to complete investigations within 40 days. She also requested an audit of the state public health department’s investigative process.
In October, Sacramento-based Foundation Aiding The Elderly filed a lawsuit against the state alleging that complaints were not investigated in a timely manner. The suit alleged violations of state law “continue unabated at nursing homes and other long-term health care facilities, exposing the residents to unnecessary health risks.”
State officials acknowledge that the delays have affected investigations statewide but contend that Los Angeles County, the only jurisdiction in which county health officials are empowered to do inspections on behalf of the state, is anomalous in its approach.
The Los Angeles County long-term care ombudsman filed a complaint in July 2012 for Jeanne Callan, whose 89-year-old mother died after a series of falls at a Canoga Park nursing home. Her mother had a history of falls and the center should have known that and taken better precautions, Callan said. Callan said she didn’t get an official response – that the case was unsubstantiated – for a year and a half.
“I always expected that somehow, somebody would be there … to help protect people,” she said. “That isn’t happening.”Related