Nation's nursing homes quietly killing thousands

The Associated Press

ST. LOUIS -- Thousands of America's elderly mothers, fathers and grandparents are being killed each year in the nation's nursing homes -- frail victims of premature and preventable deaths, according to a newspaper report.

The St. Louis Post-Dispatch, in a series that began Sunday, reported that the quiet pandemic is rarely detected by government inspectors, investigated by law enforcers, appraised by medical examiners or prosecuted.

Most of the deaths are caused by fatal neglect traced to caregivers upon whom residents depend for food and liquid and for turning them in their beds to prevent life-threatening sores, say investigators and leading researchers in elderly care.

"Unlawful abuse and neglect is widespread, underreported, infrequently prosecuted and the cause of untold suffering, injury, illness and death," Marie-Therese Connolly, who heads the U.S. Department of Justice Nursing Home Initiative, said in a study published last month in the Journal of Health Care Law and Policy.

These are examples of the types of deaths Connolly describes:

--Donald Mallory lost 40 pounds in a 37-day stay in the former Claywest Nursing Home in St. Charles, Mo. Court records state that Mallory, 60, was dehydrated, malnourished and rife with infection from bedsores. Doctors who reviewed Mallory's medical records for a lawsuit said neglect caused his death.

--Rex Riggs was in stable condition when transferred to Beverly Healthcare nursing home in Neosho, a southwest Missouri community, according to Veterans Administration doctors. Six weeks later, the disabled Vietnam War veteran, 57, was hospitalized with gangrenous infections that led to the surgical removal of his scrotum, penis and lower abdomen. He died three days later, with federal investigators blaming bad nursing care.

No charges resulted from the two cases.

Government documents and court records reviewed by the Post-Dispatch show hundreds of similar deaths caused by neglect in nursing homes nationwide.

The latest national compilation of more than 500,000 nursing home deaths -- for 1999 -- lists starvation, dehydration or bedsores as the cause on 4,138 death certificates. The data, collected by the National Center on Health Statistics, include 138 such deaths in Missouri and 186 in Illinois.

Most of the deaths can be traced to an inadequate number of nurses and aides. The U.S. Department of Health and Human Services reported to Congress this year that nine of 10 nursing homes have staffing levels too low to provide adequate care.

Many workers are unwilling to accept poverty-level wages for unpleasant, demanding work that often requires mandatory overtime or double shifts. Corporate focus on the bottom line frequently requires managers to operate homes with skeleton staffing because the industry says it lacks enough government money to provide proper care.

The American Health Care Association, the lobbying group for most of the nation's nursing homes, says malnutrition, dehydration and bedsores "are common conditions associated with the frail elderly, especially at the end of life."

"AHCA states unequivocally that any incident of neglect or abuse is unacceptable, but drawing a link of patients passing away from these maladies as a result of alleged poor care is simply irresponsible," the trade group said in a statement.

Government studies in two states and the work of plaintiffs' legal teams begin to document the problem's magnitude.

In 1998, the General Accounting Office assigned three registered nurses and a physician to determine what actually killed 62 people who had died in California nursing homes. They were randomly selected from nursing homes that had multiple deaths, the GAO said.

The GAO investigation determined that 34 of the 62 had received "unacceptable care" and had died of dehydration, malnutrition or raging infections from uncontrolled bedsores.

A year later, Little Rock, Ark., coroner Mark Malcolm became troubled by complaints from nursing home workers, relatives and inspectors who believed poor care was killing nursing home residents.

Malcolm and his deputies reviewed about 100 questionable deaths that occurred from 1993 to 1999 and determined that more than 30 percent of the death certificates listed an incorrect cause of death.

"The families were being told by the nursing homes that their loved ones died of heart attacks, strokes and other natural causes, but what we actually found was that about a third were wrongful and preventable deaths, either caused by or exacerbated by dehydration, malnutrition, including choking, or from sepsis from bedsores," Malcolm said.

The finding was significant enough to get the Arkansas Legislature to immediately pass a law -- the only one in the nation -- requiring nursing homes to notify a coroner of every death. Regulators say the law has had a deterrent effect -- citations for life-threatening care issued against the nursing homes dropped after the law took effect.

A Post-Dispatch examination of hundreds of court cases nationwide found that the vast majority of death certificates for nursing home residents attributed the deaths to natural causes such as pneumonia, heart attack and -- in some cases -- "cessation of breathing," "heart stopped," "old age" or "body just quit."

"Some physicians go to amazing lengths to avoid admitting that by omission or commission, the nursing home killed these people," said Tim Dollar, whose law firm in Kansas City is Missouri's largest litigator of nursing home deaths.

The Post-Dispatch examined the death certificates and the physicians' evaluations of 55 nursing home residents in Missouri and Illinois who died in the past two years and whose relatives sued for neglect. In 42 of the cases, the newspaper found that the cause of death listed on the certificate differed from what physicians said the medical records actually showed. In 40 of these cases, the nursing homes involved agreed to a settlement with the family before trial or were found in civil proceedings to have committed neglect.

The Post-Dispatch interviewed about 700 professionals for its series -- nurses, researchers, physicians, patient advocates, death investigators, nursing home operators, prosecutors and federal, local and congressional investigators.

In their eyes, government regulators are losing the war -- and in some cases, not even fighting the battle -- of preventing negligent deaths of the elderly.

"It's homicide. Don't sugarcoat it," says Dr. Vincent Di Maio, the medical examiner for San Antonio. He has extensively researched negligent deaths in nursing homes.

A small but increasing number of prosecutors have brought homicide charges in nursing home death cases. They've targeted nurses and aides found to be responsible for the deadly care and nursing home operators and corporate officials who fail to employ enough nurses to prevent these deaths.