Nursing homes sue state to overturn citations, fines
At a nursing home in Los Angeles last year, a nurse’s aide was giving a resident a bed bath when she noticed something moving around his feeding tube. When she looked closer, she saw maggots crawling from underneath the tube’s dressing.
Another nurse noted that the patient’s tube — inserted into his stomach to provide nutrition — “had not been cleaned” and “flies are always in the building.” There was no record of the feeding tube being cleaned for 23 days, a state inspector reported.
Already paralyzed from a stroke and suffering from COVID-19 pneumonia, the 65-year-old man contracted a serious infection and landed in the hospital.
The California Department of Public Health, which regulates nursing homes, investigated and in September 2020 fined the nursing home $60,000, concluding that the patient’s care at Longwood Manor Convalescent Hospital was so deficient that it could have killed him.
But the nursing home’s operator, Longwood Enterprises, Inc., has sued the state to overturn the fine, saying the alleged violations were not serious enough to merit the amount, according to a complaint filed in Los Angeles County Superior Court last December.
Over the past 18 months, Longwood Manor has sued the state four times in an effort to overturn fines and violations alleging poor care of its patients, according to court records.
The company’s lawsuits are among at least 433 appeals that nursing homes have filed against the state health department since 2016, according to a Calmatters analysis of enforcement actions. Nursing homes appealed more than 60% of the state citations involving a patient death and nearly half of the citations involving significant patient harm or threat of harm.
At Longwood Manor, in addition to the maggot case, the health department since 2017 has reported that a mentally-impaired woman was sexually abused by another patient, a resident repeatedly stabbed himself in
the neck and required a trip to the emergency room, and a patient choked on a medicine cup and spent nine days in intensive care. The nursing home has a one star rating, out of a possible five stars, from the federal government.
In court documents for the maggots case, Longwood Enterprises called the state’s $60,000 penalty “arbitrary, capricious and lacking in evidentiary support.” Elizabeth Tyler, the company’s attorney, said she was “not in a position to talk about the facts” in the case, and described the other
three incidents as unforeseeable. Tentative settlement agreements between the state and Longwood have been reached for three of the lawsuits, according to Los Angeles County Superior Court records.
The state health department settles many nursing home lawsuits, downgrading some of its most severe sanctions for deadly and dangerous incidents to less serious violations and lower fines, Calmatters’ analysis shows.
Between 2016 and 2020, the state downgraded and reduced fines of 14 of 45 citations involving the death of a resident after nursing homes sued, according to Calmatters’ analysis. Some of the facilities had chronically poor safety records. These “AA” citations carry fines of up to $100,000; two were slashed to $20,000.
State regulators also downgraded about 12% of “A” penalties — which involve actual or probable serious harm to patients — that nursing homes have taken to court since 2016. These violations carry fines of up to $20,000.
California is unusual in its requirement that nursing homes sue in civil courts to overturn citations and fines, due to a 1973 state law. Other states have state regulators or administrative judges handle appeals.
The California Department of Public Health declined to grant interviews or discuss its process or criteria for deciding when to downgrade citations and fines, and there are no public records on individual cases that explain their decisions. The department only provided an unsigned, emailed statement saying that its decisions are “based on the individual facts of the case” and information that emerges during appeals.
The state has downgraded more than 600, or almost a quarter, of the more than 3,000 citations issued to nursing facilities over the fire-year period for all violations, from the most serious ones involving deaths to records falsification, short staffing and data breaches, according to the health department’s statement.
A Nov. 19 court document indicates that a “settlement agreement is under final review” in Longwood Manor’s appeal of the state sanctions imposed for the patient who had a maggot-infested feeding tube. No additional information was included.
The maggots incident is a sign of a “systems breakdown, a violation of the right to quality care,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-term Care, an advocacy group.
Imagine, she said, “how that person and their family felt.”