As published in The Independent June 21, 2000
By Dwana Bain
After several reports in The Independent, and the deaths of three patients at SunBridge Care and Rehabilitation Burlingame during the one-day record-breaking heat wave last week, state health service investigators have finally turned their sights to the embattled Burlingame nursing home.
John Hinton, a supervisor at the California Department of Health Services Licensing and Certification in Daly City, said that state surveyors are now camped out at the nursing home, 042ng into allegations recently leveled against the facility, including the June 14 deaths.
Hinton said his investigators won't be packing up their inquiry anytime soon.
Three residents reportedly died at SunBridge from the effects of the record heat last Wednesday, but local SunBridge officials are denying any negligence contributing to those deaths.
"I have two residents who expired," said Brent Kahn, the administrator at SunBridge Burlingame. Kahn added that he doesn't believe the patients died from heatstroke and declined to comment further.
Later reports indicated that three residents at the home had died, though the nursing home will not confirm that figure.
Despite other widely published reports that autopsies would be performed on the deceased, the county coroner said that those reports are wrong and that no autopsies of the patients were planned, as of press time.
San Mateo County Chief Deputy Coroner Robert Foucrault said that a total of 11 deaths were reported to the coroner's office June 14 - when temperatures across the county broke the 100-degree mark - although it is uncertain if the others were heat related.
Foucrault also said that a death is not required to be reported to the coroner if a patient has been seen by a physician within 20 days.
Only one death was reported to the coroner from the nursing home, and, since the doctor had already signed the death certificate, the coroner did not take jurisdiction over the body.
SunBridge, parent corporation face nationwide allegations of neglect
Just hours before television crews and state investigators descended upon SunBridge Care and Rehabilitation, its parent company, Albuquerque-based Sun Healthcare, denied knowing of any recent complaints against its Burlingame nursing home.
But following a recent series of allegations against the nursing home - many of which have been raised in Independent stories - and three widely reported deaths at the nursing home June 15, the California Department of Health Services Licensing and Certification sent investigators Thursday to examine the complaints surrounding the troubled Trousdale Drive nursing home.
John Hinton, a supervisor at the California Department of Health Services Licensing and Certification, did not elaborate on the specific complaints the department is investigating, but did confirm that investigators have been on the premises.
In addition to complaints already raised in the series of Independent stories, a number of area residents have come forward to express their outrage and concern over the facility's alleged mistreatment of its patients.
- Ed Ray - who was sent to SunBridge in April to recover from a stroke -- claims that an employee repeatedly injured him when she dressed and undressed him by roughly pulling his clothing over the feeding tubes in his nose. He alleges he endured 24-hours-a-day noise at the nursing home, and that he had to wait 45 minutes for a nurse to respond each time he put on his call light.
- Victoria Ansley - whose mother died at a hospital after suffering a massive stroke at SunBridge - was told that her mother had quite likely suffered a stroke two weeks earlier that the nursing home employees failed to notice.
- Darlene Swedberg - whose father died in April after living five months at SunBridge - claims that her father developed a mouth infection because no one brushed his teeth. She further alleges that the dying man waited five days to see a doctor and that she had to beg employees to let her call an ambulance.
These are a just three of the several complaints leveled against SunBridge Burlingame, which also include an allegedly neglectful staff - some of whom speak so little English they cannot communicate with patients -- and an even more neglectful administration that ignores patient complaints.
Administrators at the nursing home repeatedly refuse to speak with the press, and a television camera crew was blocked from entering the facility Friday morning.
Unfortunately, the problems at the Burlingame site appear to be just one example of several such stories being played out in the nursing home chain's other facilities throughout the country.
The company with small roots grew into one of the most powerful chains in the nation. But in spite of its rapid expansion, troubles have plagued the company for a long time.
History of deficiencies
The Burlingame nursing home had already had problems for years, but showed little improvement when it was acquired by an industry giant, Sun Healthcare Group, Inc., in 1998. A December 1998 inspection - the last publicly released -- of the nursing home revealed that five of its 31 listed deficiencies were of a level that caused actual harm to patients.
Sun Healthcare - which began with nine nursing homes in 1989 -- is now one of the three largest nursing home chains in the country. In spite -- or perhaps because -- of the company's size, Sun Healthcare-owned facilities have consistently shown bad track records over a period of several years.
In August 1995, Consumer Reports magazines rated 43 nursing home chains nationwide.
Ratings were based on a company's level of critical deficiencies (violations), which are based on 69 federal standards relating directly to a resident's health or well-being, for example: Inadequate treatment for bed sores; misuse of physical restraints; unsanitary food practices; and medication errors.
The magazine reviewed the deficiencies cited for those critical standards, and created a deficiency index to calculate an overall score for each chain.
Consumer Reports scored the homes on a scale from 0 to 100, with 100 being best. Sun Healthcare's score was 29. Only nine of the 43 chains surveyed received a lower score. At the time, the company facilities were concentrated in Illinois, Texas, Massachusetts and Washington.
Regency Health Services -- a large nursing home chain in California -- received a score of 34 in the Consumer Reports 1995 ratings.
In 1997, the two corporations with poor scores merged. Sun Healthcare purchased Regency Health Services' 116 inpatient facilities for a reported $589 million, significantly expanding Sun Healthcare's presence in California.
It was a year of phenomenal growth for the company. In early 1997 it had acquired another long-term care chain, Retirement Care Associates, and invested $12 million in Alpha Healthcare, an Australian hospital company. Sun Healthcare also launched a long-term care software company, which Sun CEO Andrew Turner bragged would enhance their goal of becoming "a one-stop shop for the long-term care industry."
According to a 1997 CEO compensation survey by Jenks Subacute Business Report, Turner earned $6.5 million in salary and bonuses in 1997, a 763-percent increase of his salary from the prior year, the report claimed.
Fall from grace
The company's shining moment didn't last long. Just one year after the Regency acquisition, several of the Sun Healthcare facilities -- including two that had been only recently purchased by Sun -- were hit by a barrage of complaints, according to news articles and public records.
The company posted significant year-end losses in 1998.
Then, in April 1999, the company slashed 10,000 jobs from its then 88,000-person payroll.
Just one month later, an article in the Albuquerque Journal reported that a survey of 321 Sun Healthcare-owned nursing homes throughout the country indicated that 38.6 percent had been cited for at least one deficiency that placed residents in immediate jeopardy of injury or death. In California, five Sun Homes were named among the 26 on the state's focused enforcement list, which targets the worst two facilities in each of the state's districts. Homes on that list are not permitted to apply for more nursing-home licenses within California, according Leah Brooks, a spokesperson for the California Department of Health Services Licensing and Certification. At press time, Brooks could not confirm how many of Sun's homes remained on the list. In the fall of 1999, Sun Healthcare filed Chapter 11 bankruptcy, which officials attributed to "deep cuts in Medicare reimbursement."
However, Pat McGinnis and other representatives at California Advocates for Nursing Home Reform said that Sun's financial woes are a protest to the federal government now carefully monitoring payments and setting fixed limits homes receive for medical services.
The Balanced Budget Act of 1997 changed the way in which nursing homes are reimbursed for services. Nursing homes were once paid actual costs for treating patients. Under a change effective January 1999, they now are entitled to only a fixed amount per person.
Additionally, GAO - an investigative arm of congress - had accused that Sun Healthcare and other nursing homes had been receiving money for services not being performed.
The company's troubles continued while it underwent reorganization after filing bankruptcy.
For example, in December 1999, SunBridge Care and Rehabilitation in Exeter, New Hampshire, was fined $110,000 by the federal government as a penalty for taking 109 days to correct 30 deficiencies discovered by inspectors in August 1999.
According to an article in the Seattle Post-Intelligencer, as of April 2000, Sun had already transferred management of seven of its 24 nursing homes in the state of Washington other operators.
Experts have speculated that Sun Healthcare may be a victim of its own acquisitions. During the 1990s, the company had purchased more than 100 facilities that provided extra services, such as physical therapy. But the strategy backfired when the new reimbursement rules came into affect, because the government would not easily pay for some services. As of last September 1999, the company's debt exceeded $1.5 billion, according to published reports.
Patients aren't the only ones complaining about Sun Healthcare. According to a CNN report, in October of 1998, a union representative alleged that understaffing had most likely been a factor in the rape and subsequent pregnancy of a comatose patient.
According to an article in the Albuquerque Journal, a registered nurse sued a subsidiary, SunRise Healthcare Corp. in May of 1999, alleging that SunRise assigned employees more duties than they could finish during their shifts and then forced the workers to clock out, even if they worked several hours more.
In August 1999, a speech pathologist and a speech therapist filed lawsuits against Sun Healthcare, alleging that the company forced employees to work hours of unpaid overtime. SunDance - a Sun Healthcare-owned facility - allegedly used several tactics to avoid fully compensating employees, according to the lawsuit. For example it mis-classified its hourly paid speech and physical therapists as salaried employees, refusing to pay caregivers for their administrative duties. The plaintiffs' attorney was quoted as stating that there was a "clear pattern of wage and time abuse" from the top down at Sun Healthcare.
In the Bay Area, Sun Healthcare Group locked out 160 workers at nursing homes located in Pleasant Hill and Fremont in November 1999, according to the local chapter of SEIU, an organization that represents health care workers.
The workers had finished a two-day strike to protest the company's attempts to sharply reduce health insurance and benefits for future employees. Workers attempting to return to their jobs after the strike, were allegedly greeted by security guards who stopped them from entering the nursing homes.
During the strike, eight patients died at the Pleasant Hill and Fremont nursing homes.
Greg Johnston, communications manager for Sun Healthcare, stated that the company's goal is to provide the highest-quality of care to the residents.
"It is important that we hear directly from family members," he said, adding that the corporate headquarters' 800 number is posted in the lobby of each facility, and that families can call at any time. "I think that concerns should always be brought to the facility immediately," said Johnston. "It's nearly impossible to respond to complaints or concerns when we haven't heard from individuals. We certainly encourage patients to get in touch with us."
Johnston said that there are also comment forms available at the Burlingame site, so that friends or family members of residents can describe their concerns in writing.
However, Johnston said, that to Sun Healthcare's knowledge, no complaints or concerns about the Burlingame home had been voiced through those channels for at least six months.
But McGinnis, executive director of CANHR, believes that part of Sun Healthcare's problem is that its addresses all its issues from its corporate headquarters, far removed from where the problems are actually happening.
"When you have your headquarters out of the state they have no accountability to the community," she said.
Johnston, however, said he does not believe that the physical separation between the world headquarters and its subsidiaries significantly impacts a given nursing home. "We communicate with these people quite frequently," Johnston said of the nursing home administrators.
As to why individual directors may not speak to the media regarding complaints, "We don't have public relations professionals at the given facilities," Johnston said.
Johnston said that in January, a customer satisfaction survey regarding the Burlingame facility showed that 88 percent of those who responded say they would recommend facility to friend or family member. However, only 24 respondents answered the survey.
Complaints can and should be filed through the California Department of Health Services Licensing and Certification or through the county ombudsman, Johnston said, but he claimed that SunHealthcare had heard no such complaints about its Burlingame facility in recent months. Johnston said that the facility's last inspection was in March of this year, and that survey shows improvement since the 1998 survey. The Daly City Department of Health Services Licensing and Certification stated that though the survey had been completed, it had not yet been publicly released.