Dwana Bain: Journalist at Law

Officials launch probe of embattled nursing home Recent deaths, piles of complaints spur Health Services Dept. inquiry

As published in The Independent June 21, 2000

By Dwana Bain
Staff Reporter

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. 
For example:

 

• 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. 

Sun spreads
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. 

Employee anger
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. 

Corporate Response
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. 

Accusations continue to rise against SunBridge: More allegations of mistreatment against embattled Burlingame site

As published in The Independent June 14, 2000 Editor's Note: This article is the second in a series examining the care that residents claim they have endured at SunBridge Care and Rehabilitation in Burlingame. Following an article written about the site in March, the Independent has received numerous calls from other area residents alleging abuse and neglect. By Dwana Bain Staff Reporter A dead body -the second of her three roommates to die in a six-week period - was left in the bed next to her for hours, until the morning when another shift came on. That's just one of the numerous recent events that "Lucy" - an 83-year old custodial resident at SunBridge Care and Rehabilitation Burlingame - claims to have endured at the embattled nursing home. Inside the loud facility, amid the overwhelming smell of antiseptic, Lucy -- who asked that her real name not be used -- stays in her room with a portable toilet. She's lived here four years. She will live in a nursing home the rest of her life. One day, her son brought her a copy of an Independent article published in March, which described elder-abuse allegations against the facility. "It's all true," she told the Independent. "And there's more." Lucy is one of a number of people in the area who have alleged that the Trousdale Drive nursing home abuses and neglects its patients, including leaving incontinent patients in diapers for hours at a time, failing to brush patient's teeth and failing to protect patients from abuse by the nursing home's other residents. According to a friend of a SunBridge resident, staff members at the site have allegedly been meeting with family members and friends of residents, stating that whatever might be published about the nursing home is untrue. The director of SunBridge Burlingame told the Independent that he was not allowed to respond to the allegations, and declined even to listen to the latest list of complaints against the nursing home. Karen Gilliland, the company's corporate spokesperson, did not respond when first contacted in May regarding some of Lucy's allegations. Hard to prove If several recent claims against SunBridge are proved valid, they could add to the facility's already long list of citations, which include fines for verbal, physical and sexual abuse. Unfortunately, according to Pat McGinnis, Executive Director of California Advocates for Nursing Home Reform, proving abuse is a battle often lost. "Sixty-six percent of the complaints filed in this state are unsubstantiated. For all the thousands of complaints that are filed, that's ridiculous," McGinnis said. It's not that the claims are untrue, she clarified, they just cannot be easily proven. McGinnis said that in San Mateo County, the blame falls in part on the California Department of Health Services Licensing and Certification district office in Daly City. "It's not a good office. They're very far behind in even checking the complaints." Ken August, a spokesperson for the California Department of Health Services, disputes McGinnis' assertion. "There is a requirement that staff respond to complaints within a 48-hour time period," he said. "If the complaint is substantiated, there will be investigations, citations and fines, depending upon the nature of the problem and the severity." He pointed out that all citations and fines against facilities are evidence of the state taking action. Still, he acknowledges that some complaints can't be substantiated. He attributes this in part to fact that people can call anonymously, which means some complaints have no evidence. But he said he hopes that residents or family members do complain if they feel they have valid cause. "We recognize that we cannot be stationed in a facility 24 hours a day." If they see a problem, "We count on them to pick up the phone and call us." Patients in nursing homes are usually physically frail and often suffer from Alzheimer's disease, dementia or other mental impairments. Advocates say that even patients with solid mental faculties are often too shy to speak, because they may not have been raised in environments where they were encouraged to be assertive. And, when patients do complain, they often mix in less significant complaints -- such as a staff person being rude. This clouds the more serious issues, according to McGinnis. "We tell them to complain about the big stuff," she said. "Complain about the life-threatening stuff." But some friends and family members say that they tried first complaining to SunBridge Burlingame, but have made little progress in speaking to anyone affiliated with the site or it's parent company. A friend of one SunBridge resident who died recently told the Independent that she has been searching for answers as to what happened at the facility to lead to her friend's death, but she's been facing a wall of uncooperative staff who won't release any details. "The door's closed," she said. "And that tells you that there's something terrible behind that door." A tarnished image SunBridge Burlingame is owned by Sun Healthcare Group Inc., based in Albuquerque, New Mexico; a company with a tightly controlled public relations department. In news stories around the country, Sun Healthcare representatives have routinely issued only brief statements to the press regarding allegations against the group. The company does, however, post the results of a "stories of the year" contest on its website -- "Heartwarming and uplifting, interesting and diverse" stories about nursing home patients -- according to the website press release. The executive who orchestrated the contest is quoted as stating: "This contest gives [nursing home staff] an opportunity to tell stories the community may not hear otherwise." There are other stories that emerge from the company's nursing homes that have been less flattering. For example: June 1998: SunRise Care and Rehabilitation Burlingame - now known as SunBridge -- the California Department of Health Services issued a class-B citation for failure to protect a resident from sexual abuse. August1998: SunBridge Care and Rehabilitation Burlingame (formerly SunRise) was issued a CDHS class-AA citation and a $10,000 fine in association with a resident's death. August 1998: The families of four deceased residents at Fountainview Healthcare Center - a Sun-owned facility in Sacramento -- charged Sun Healthcare with willful misconduct, intentional infliction of emotional distress, elder abuse, negligence and one case of wrongful death. October 1998: In a case that made national headlines, a 24-year-old comatose woman gave birth after being raped at Town Manor, a Sun-owned facility in Lawrence, Massachusetts. While these incidents happened two years ago, SunBridge Burlingame has been cited within the last nine months, when a patient developed an infection and had a leg amputated, allegedly as a result of neglect. SunBridge may be in line for even more citations and possible financial penalties, especially if Lucy's charges are upheld. Lucy, who is in SunBridge due to a debilitating physical injury, but who is lucid, can only walk or stand with assistance and needs help to carry herself to the toilet. "They have a [nurse's] aid ... every time she comes in the room, she immediately tries to pick a fight ...When she came in to assist me she said "Oh you're not ready," Lucy explained, adding that she can wait only a few minutes from the time she calls for help. "I said 'Don't waste any time just get the commode to me.' Right in the middle of what she was doing she just stopped and turned around and left. She ran in and out. She wanted me to soil my bed. She wanted me to soil my clothes. She wanted me to go [to the bathroom] on the floor so she could put me in diapers ...Finally she got me on the commode, then she wouldn't come back." Lucy says she was left on the toilet for at least 20 minutes, during which time she desperately dialed her phone to the operators in each of the facility's four units to get help. When she reached employees, "They started laughing and hung up," she said. "This is entertainment for [the employees]. They think this is all funny and it gives them something to talk about." According to Lucy, as she sat waiting for help, another patient - who Lucy has alleged has attacked her before -- entered her room. "She grabbed me by the arm and shook me." "For [the staff] to allow another resident to come into my room and physically shake me, how can they do that?" asked Lucy, who called the police to report the alleged assault. "I told the police [officer] all this, she said 'You know what Lucy? We are limited. There is only so much we can do.'" She said the officer then told her to move to another nursing home. According to the Burlingame Police Department, no report or investigation resulted from the incident. The incident was noted in the police computer as "an ongoing problem between two residents." The officer who responded to that call was unavailable for comment. This isn't the first time Lucy has called the police. She said she once passed out and woke up on the floor in a pool of blood. She said she had to beg and threaten a nursing home employee dial 911. Three of Lucy's roommates have died since April. Her second roommate died about 8:45 p.m. on May 15, according to the patient's death certificate. Although nursing home staff realized around 10 p.m. that the woman had died, they left the corpse in the room with Lucy until morning. "They left her in here for hours after she expired ...It made me so nervous and so sick." The nursing assistant who found the body allegedly told Lucy that she didn't know how long the patient was there. "We left at 1 o'clock [a.m.]," she told Lucy. When the Independent visited Lucy at SunBridge in April, another of her roommates had died just a few days earlier. The woman's death certificate listed her official cause of death as urosepsis, a bacterial infection of the bloodstream that originated in the urinary tract. Lucy believes her roommate's infection set in because of the alleged neglect of nursing home staff she had witnessed. "They would get her up around 9 or 10 o' clock [a.m.]. She would sit there in her chair, in her stupor until 9 or 10 at night." Lucy said, alleging that the woman's diaper was only changed once every 12-14 hours. "She was slowly going downhill," Lucy said, "I even suggested then that they should do something." What they did, according to Lucy, was try to drug her. "They had an idea that since I'm alert I would talk to someone [about her roommate's death.]" Lucy said that a doctor she had never seen before entered her room and told her he was a neurologist. "I've never needed a neurologist," Lucy told the Independent, "I don't even know what they are." Nevertheless, the doctor prescribed medication for her. Lucy refused to take it, though she said employees tried to force her to. "They were holding out my breakfast, my water," she said. No one told her what the drug was or why it was prescribed, she said, but she looked at the name on the prescription once: Luvox, which according to "The Physician's Desk Reference," is typically prescribed for obsessive-compulsive disorder. It can have a sedative effect on patients. McGinnis said that in trying to force medication on Lucy, the nursing home violated both state and federal law. According to McGinnis, the outcome of a lawsuit CANHR filed against the California Department of Health Services resulted in a law that strictly controls physical or chemical restraints - such as sedative drugs -- on patients. McGinnis said the law states that in order for such restraints to be given, a facility must have "informed consent" from the resident or a resident's guardian. The patient or representative must be told what the restraint is, why it is given and what the effects are. According to Elizabeth Quijada, whose stepfather stayed at SunBridge recently, the nursing home did not ask anyone for permission when they allegedly gave her stepfather sedatives. Quijada believes that her stepfather suffered an adverse reaction to the medication. "He woke up and he was just going crazy and pulled the curtains down and was just really, really agitated ... he is the most gentle person I had ever met." After the incident, Quijada asked to see her stepfather's list of medications, and discovered the sedative among the list. "The doctor said, "Older patients do well with this," Quijada told the Independent. "She said, 'Well, we'll give him something else.' I said, 'you'll give him nothing!'" Lucy maintains that they have tried several times to make her take the Luvox, though she continues to refuse. "I cannot tolerate this abuse. It's too much," she said, "It's ruining my health." Lucy says that people tell her she should just move to another facility. But she said there's no guarantee another place would treat her better, and furthermore, that a victim shouldn't be the one to be punished. She said she feels an obligation to help other patients at SunBridge. "I want to correct it for everyone's sake. I feel if I can make someone else's life more livable, then I've done something worthwhile while I'm here in the nursing home."

---

Allegations abound against nursing home: SunBridge accused of further elder abuse

As published in The Independent June 7, 2000

This is the first in an ongoing investigative series examining the ill-treatment patients claim to have endured at the SunBridge Care and Rehabilitation facility in Burlingame. Following an article written about the site in March, the Independent has received numerous calls from both inside and outside the facility with similar complaints of abuse and neglect. After visiting the site, the newspaper decided to investigate the cases further.

By Dwana Bain
Staff Reporter

She's dubbed it "The bridge to hell."
After a serious back injury landed 77-year-old Joan Burton in the hospital, she was sent to a rehabilitation facility.
Though nearly blind, she recognized the building where she'd visited friends in the past -- SunBridge Care and Rehabilitation, on Trousdale Drive at El Camino Real in Burlingame.
"When I saw the sign I thought, 'Oh my God! I'd rather die than go in there!'" she said.

Two months after an article about the nursing home first appeared in the Independent -- in which the daughter of a resident alleged elder abuse -- SunBridge is facing further complaints from Burton, as well as a current resident and family members and friends of former residents. Recent allegations include inadequate and poorly trained staff, neglect, and verbal and physical abuse.

"The things that happened to me were unbelievable," said Burton, who contacted the Independent last month after reading the first story about the nursing home. Burton alleges that during her 13-day stay at SunBridge, she developed a hematoma -- a blood clot caused by a broken blood vessel -- where she was recklessly stabbed by a needle used for an insulin shot. She said she had a bedpan spilled on her. She was allegedly forced to take medicine she was allergic to and then left lying in her own vomit for more than an hour while waiting for a nurse.

Because she complained, Burton alleges, she was called a "bitch" by the nursing home staff, and was later verbally abused by SunBridge's director, who called her a "goddamned liar" and a "senile old lady."
Sitting in her apartment, Burton seems far from senile or otherwise mentally impaired. She speaks clearly and coherently. Every time she tells her story, the details are the same.

Before entering SunBridge, Burton was already familiar with the nursing home, through several friends that had lived there. The facility -- which has also operated as Burlingame Nursing and Rehabilitation Center and as Care West -- has a long history of citations for neglect, abuse and patient rights violations. Since at least 1994, the number of complaints and deficiencies, violations issued by the federal government, against the nursing home has far exceeded the state and county average.

With 260 patients, the nursing home is large compared to others. However, Louis Nuyens, who gathers nursing home statistics for California Advocates for Nursing Home Reform, stated that citations are not proportional to a facility's size. While several facilities in the county have received no citations in that time frame, the Burlingame facility under its various owners has been cited 10 times, with fines totaling more than $45,000.

Over the past several years, complaints to Department of Health Services have far exceeded the state average. For example, in 1998 there were 48 complaints against the facility, almost 10 times the state average for that year and more than three times what could normally be expected for a facility of its size, according to statistics from CANHR.

SunBridge's current owners -- Albuquerque New Mexico-based Sun Healthcare Group - has racked up several lawsuits and substantial fines in California and throughout the country.

Through written statements, the company continues to deny wrongdoing. Karen Gilliland, Sun Healthcare's official corporate spokesperson did not respond to the latest allegations against the Burlingame facility, but a representative from the SunBridge Burlingame issued a statement denying the allegations.
But Burton, traumatized by her experience, filed numerous complaints with her HMO, Kaiser Permanente, which sends many patients to SunBridge. She also filed a complaint with California Department of Health Services Licensing and Certification.

According to Burton, most of the nursing home's patients are unable to speak for themselves. "I was the only one on my floor who was clear and lucid," she said. For this reason, Burton said, she will continue campaigning to ensure that others are not mistreated. She said she was particularly disturbed by staff members' treatment of mentally impaired patients. She allegedly witnessed employees pinch these patients, pull their hair and mimic them.
"Lucy" a custodial patient at SunBridge who asked that her real name not be used, said she has also seen employees mimicking patients "Anything that [the mentally impaired] people do that [staff] think is funny, they just burst out laughing," Lucy said.

Burton also voiced her complaints to Katrina Angeli, a continuing care leader with Kaiser in San Francisco. Angeli oversees nursing home care for Kaiser patients in the San Francisco and San Mateo areas. Kaiser has contracts with several area nursing homes, including SunBridge. According to Angeli, about 17 percent of SunBridge's population are patients sent by Kaiser.

Along with complaints of her treatment overall, Burton, a diabetic, told Angeli that was fed a non-diabetic diet, which caused her blood sugar levels to fluctuate significantly.
Feeding a patient the wrong diet is grounds for a citation, according to Pat McGinnis, the executive director and founder of California Advocates for Nursing Home Reform.

In an interview, Angeli told the Independent that specifics of the investigation into Burton's claims are confidential, but that the case is not closed. "We will continue to follow up until we're satisfied that everything that she talked about has been resolved appropriately."
But McGinnis said she doubts Kaiser has done much, despite its rhetoric about caring for patients.
"It doesn't matter what the administrators say because actions speak louder than words."

In accordance with Kaiser's grievance process, Sally Burke Wingard, manager of long-term care for Kaiser San Francisco sent Burton written confirmation of her complaints. The April 21 letter acknowledged several specific complaints - including the facility's alleged dirty restrooms and the bedsores Burton allegedly received. The letter stated that Kaiser would conduct an appropriate follow up.

The HMO's grievance process dictates that it will either address the complaints within 30 days or notify patients of more time needed. At press time - several weeks past the 30-day deadline - Burton said she'd heard nothing from Kaiser.

Burton isn't the only person to have complained about the nursing home. San Bruno resident Walter O'Toole said he was extremely upset with the treatment his friend Don -- who is now deceased -- received at the facility. Don, a former teacher, was dying of cancer. "He was in pain very much," said O'Toole. But he alleges that employees refused to give him pain medication. "He's in pain, can't you give him a shot?" O'Toole recalls telling an employee. "They said, 'No we'll go look at him' ...I sat there about an hour and they never came in."

O'Toole had other complaints. For example, he said when he helped Don to the restroom, the toilet was filthy, a claim also asserted by Burton and the daughter of a current resident.
Further, O'Toole alleges that the employees neglected and mistreated many of the residents. "I saw people tied in their chairs," O'Toole said.
"I noticed there was a lack of attention toward the people there. You can hear people moaning and groaning."
"The people weren't helping," O'Toole said. "It seemed to me either they were understaffed or they didn't have enough people."

A giant in the industry
SunBridge is no small player in the nursing home industry. Its parent company, Albuquerque New Mexico-based Sun Healthcare Group Inc. is a dominating force - one of the largest nursing home chains in the country -- owning 369 such facilities in the United States and155 facilities in Europe. Many of the nursing homes have been acquired by Sun Healthcare in the past few years, including the Burlingame site. The homes operate under a number of different names, including SunRise, SunDance, SunBridge. In the past few years, Sun Healthcare-owned facilities have racked up a series of citations, complaints and lawsuits against its facilities. According to the Health Care Workers Union Local 250, in 1998, government health officials cited Sun for nearly 1,000 deficiencies in its California nursing homes alone. Its Northern California facilities received 20 percent more deficiencies than did the average California nursing home that year.

Prohibited from speaking
The company has a tightly controlled public relations department. The company's corporate headquarters in New Mexico speaks for all United States facilities. The administrator who allegedly verbally abused Burton has in the past refused to answer allegations against the Burlingame facility, stating that he was not allowed to speak to the media. He was not available for comment on the remarks he made. His assistant - an executive director who requested her name not be published reiterated that employees are prohibited from communicating with the press.
However, she issued the following written statement: "We take all allegations of abuse and neglect very seriously. We have policies in place for employees to follow if allegations of abuse or neglect arise. We expect 100 percent compliance from our employees with regards to these policies. We have no record of any allegations of abuse or neglect being filed by this resident [Burton] while she was in our care. If a resident or their family member has a concern about the care provided in our facility, they can raise this concern with any member of our management team."
In addition, the statement said, there are other mechanisms in place to ensure that residents and family members are able to voice their concerns. These include: a customer response phone number posted in the lobby which connects to corporate headquarters; biannual surveys of residents and their responsible parties; and monthly family and resident council meetings.

In spite of SunBridge's assertion that she did not complain while she was a patient, Burton maintains that she did complain, to the very person who made that assertion.

State Citations 1996-1999

Citations are issued by the Department of Heath Services (DHS) during the annual certification visit, complaintinvestigations or special incident investigations for violations of state or federal law. While many facilities within the county have few or no citations, the Burlingame facility on Trousdale Drive has had several, including those issued below. Sun Healthcare Group Inc. purchased the nursing home in 1998.

1999 - A resident developed a severely infected wound on his ankle but staff noted it for the first time on the day the resident was admitted to an acute care hospital where his leg was amputated.. Cited for failure to continually assess resident's skin condition or to treat the infection. Fine $10,000
1998 -- A 91-year-old resident began eating only half of her meals, lost 10 percent of her weight in 16 days and became unresponsive. She was sent to emergency hospital where she died a day later from shock attributable to dehydration, sepsis, and urinary tract infection. Cited for failure to properly assess a resident's change in condition. Fine $20,000
1998 -- A male housekeeper licked and sucked a resident's breast. Resident reported incident to nurse but nurse did not inform supervisors or administrators. Cited for failure to keep residents free from mental and physical abuse. Fine $500
1996 -- A resident was given incorrect dosages of medication and was not monitored for toxicity. When infection occurred, staff did not notify physician that antibiotic was ineffective. Resident developed allergic rash and staff did not provide further treatment for infection. Resident died six weeks after admission to facility. Fine: $600
1996 -- One resident's abusive daughters threatened and intimidated her and other residents with yelling, verbal abuse and physical threats. Cited for failure to protect residents from verbal abuse. Fine $600
1996 -- A resident with a history of wandering and taking food from other residents was restrained by tying her wheelchair to her bed. Cited for violation of patient's rights. Fine $400
1996 -- A resident developed a serious bed sore within a month of admittance to the facility which required surgical closure. Cited for failure to provide required preventive care. Fine: $800

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Belinda's Story

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Before Prop 8: A Profile Of Domestic Partners

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Hillsborough Murder

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Betty Carlson: Victims Advocate

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Donna Anderson: Mind Of A Murderer

Download Anderson-Competence-p.1.pdf

Download Anderson-Competence2.pdf

Anderson Recounts the Moments Before her Son's Death
 

As published in The Independent May 7,2002

By Dwana Simone Bain
Independent Newspapers

REDWOOD CITY - If she could go back in time, she wouldn't have killed him. Instead, she would have taken him away to "London or Mexico." Or Canada. "Canada was right there ... that was pretty stupid," Donna Anderson said.
But at the time she repeatedly stabbed her 13-year-old son Stephen with a kitchen knife, Anderson felt it her only choice.
"I didn't want to kill my son, believe me. Both of us have died," Anderson said. "This is a nightmare. I loved my son."

In a May 2 jailhouse interview, a pensive Anderson spoke for almost an hour about the life she's led and the mistakes she made. She spoke of her estrangement with her family. And she spoke of the day she killed her only son and stabbed his father as the man tried to restrain her. "I feel horrible about how I ran my life, because I blew it," Anderson said. But the murder was not when she blew it, she believes. Anderson insists she murdered Stephen in an effort to protect him from a tragic future of pornography and child prostitution. "To have to pick between death and death for your children is horrible," she said.

The 49-year-old doctor is now being evaluated for her competency. Already seen by two court-appointed psychiatrists, the court will rule Friday whether it is necessary to appoint a third as tiebreaker. Anderson -- who has never admitted to being psychologically ill -- offered her own opinion on her state of mind. "I'm extremely regretful and heartbroken," she said. Heartbroken over her "real crime" -- moving to Minnesota in 1999. "I'll live with the heartbreak of that [decision] forever."

Sometimes, Anderson dreams about the pain her son must have felt as he died in his grandparents' Burlingame home. "I've felt it [the pain] actually." The pain takes Anderson's mind back to three years ago, and her move to Minnesota -- a move Anderson believes began the chain of events that led to the murder. With a good job prospect, Anderson said she asked her mother and brother for "permission" to move back to her home state. The family gave "glowing reports" about the twin cities area, she said. With a biracial child, Anderson was concerned that Minnesota was racist -- a suggestion she says her brother "categorically denied." But Anderson found herself disappointed in Minnesota. "It was a fundamental mistake to believe what they said about their world," she said.

She realized her relationship with her family wouldn't be as close as she'd envisioned. Her mother -- who'd visited her for weeks in California - stopped visiting overnight, Anderson said. Her brother planned a fishing trip for the boys and men in the family and "he didn't invite Stephen," Anderson remembers. Anderson found her family's behavior "traumatic." She said, "It was quite surprising ... their lack of human interest." Anderson now believes her family had a "dark side" and that her move to Minnesota brought it out in them. She has alleged in court that her mother and brother were involved in criminal activity. Anderson cited information she feels supports her allegations. She can't recall any incident of her mother abusing her. However, Anderson claims her lack of memory of her early childhood and her developmental delays in speaking are "objective" indications of such abuse.

Her mother "doesn't have a nice thing to say" about being pregnant with her, Anderson claims. Her mother never taught her about make-up or boys. "That's weird," she said. "I just wrote that off as being conservative." But Anderson now believes her mother's behavior was a way to cover up things about the family. "With how she's behaved in these last eight weeks, it's very clear that she has other priorities in life, and they're not me," she said. The last time she saw her mother was April 24, at a visit in jail. Anderson told her mother, "I know you miss Stephen, and I'm sorry." Her mother expressed "no regret, no remorse, no sadness," Anderson said. "Her face was just like ice." The elderly woman then asked her daughter to sign papers that would sign her financial interests away, Anderson alleges. "I said 'goodbye mom' and I walked out of the visit." Anderson said the visit was one of the few contacts with her family since the Feb. 24 murder.

As she awaits further word on her fate, Anderson is once again in the medical ward at Maguire Correctional Facility, where she had earlier been placed while on a hunger strike. Anderson is now eating, but Sheriff's Office spokesperson Bronwyn Hogan said the move is precautionary, "just to verify that her health is acceptable up to standard," Hogan said. Anderson claims she was placed in medical via her request -- she had originally asked for solitary confinement so she could begin the process of letting her old life die. "I really appreciate the wonderful life Stephen and I had," she said. Americans once had a legal and social support system "that really made the American dream possible. I really benefited from that. And my son -- although his life was short -- also benefited greatly from that. I was dedicated to passing that American dream on to him." Times have changed, according to Anderson. "Our legal and social support system isn't there anymore."

Anderson said she felt she had no place to turn. For women who think their children are being abused there is little protection under the law, she said. "The court system is making it very easy for everybody [accused of crime] to hide." Anderson denies any notion that she's incompetent or that she killed her son out of insanity, though it has been suggested many times. Anderson claims Superior Court Judge Judith Whitmer admitted as much during a closed hearing April 29. Anderson said the judge told her, "It's obvious that you're insane because your crime is insane." Anderson believes such circular reasoning is faulty. "If you look at what happened to decide what's possible, you'll always perpetuate the status quo," she said. Her crime is "an extreme case" of a mother kidnapping her son to protect him, according to Anderson. "I don't want any other mothers to be in this same situation," she said.

Anderson alleges that authorities never took her fears seriously, instead telling her, "We can't help you. Nobody did anything wrong." As she was fleeing Minnesota the week before her son's death, Anderson said she went to the FBI in Denver on Feb. 21 to tell them of the changes in her life insurance policy -- changes she claims were evidence of a crime by her family. She said the FBI told her, "We're not interested in your family right now." At that time, Anderson said, she was still unclear about the child pornography ring she is now convinced existed. "I thought they just wanted to kill us ... we were both going to be disappeared."

Anderson had brought Stephen to California several days earlier to live with his aunt and uncle in Mountain View. She thought the move could protect the boy. Though police have never released any information substantiating her claims that her she and her son were in danger, Anderson continues to assert differently. Shortly before the murder, Anderson says she had a horrific premonition of Stephen's future: He would be addicted to drugs, prostituted and put on the Internet for child pornography. "That morning that I killed him, my ex-husband told me I was right." Anderson said. But Frank Burns didn't actually tell her so, Anderson admitted. As the divorced couple discussed Stephen's future, Anderson explained her premonition to Stephen's father. "He said, 'I have the bus tickets back to Minnesota,'" Anderson remembered. Anderson interpreted that to mean her fears were confirmed.

Anderson returned to California Feb. 23. She arrived at the Burns home Sunday morning after spending the night in a local hotel. The Burns family wasn't expecting her that morning, Anderson admits. After the family's conversation that morning, the members dispersed. "They left us alone," Anderson remembers. In a back room, Anderson sat beside Stephen as he talked on the phone "being distracted." "I was sitting there looking at him. My whole thought process was 'Am I brave enough or not? Can I let him be tortured or can I do such a horrible thing?'" Anderson said she felt she couldn't wait. "This was the moment of decision."

She stabbed Stephen repeatedly all over his body, primarily in his chest and torso. "He was conscious for about 10 seconds" Anderson said. "He said 'mom.' And I said Stephen, I love you very, very much."

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