Wayne Karczewski quit his job as administrator of a chain-owned nursing home in Orlando to manage a smaller, family-run facility in Sanford because he was frustrated with a bureaucratic system that he thought put profit over the welfare of the residents. "Some of the big chains really aren't focused on the business they are in: taking care of people,'' said Karczewski, now administrator of Lakeview Nursing Center in Sanford. "But if you don't treat the human life appropriately, your bottom line is going to suffer even more when a sheriff shows up with a subpoena.''
Karczewski thinks staffing levels and quality of care suffer when administrators must pinch pennies.
Indeed, nursing homes that are short of staff or score poorly during inspections are far more likely to wind up as the target of lawsuits, according to a review of court and state inspection records by the Orlando Sentinel and South Florida Sun-Sentinel.
Central and South Florida nursing homes slapped by regulators for a high number of quality violations were sued three times as often as homes that had few violations.
Four of the 10 Orlando-area nursing homes cited most often for quality violations during the past four review periods ranked among the five most-sued facilities.
Halifax Convalescent Center in Daytona Beach, for example, ranked eighth with 48 inspection violations and first with 11 lawsuits. IHS of Central Florida at Orlando ranked sixth with 49 violations and second with nine suits.
"Without bad care, you don't have a rash of lawsuits," said Robert Brown of Freidin & Brown, a Miami law firm that specializes in suing nursing homes.
Still, nursing-home operators say many lawsuits are unjustified and the recent flood of litigation, which often results in six- and seven-figure payouts, is threatening their survival. Compounding the problem, nursing homes say, the legal awards are forcing many insurers to abandon the state, while the ones left behind charge skyrocketing rates.
To counter the financial assault, the industry wants the Legislature, in its session opening Tuesday, to restrict how much nursing-home residents or their families can win in court and how much lawyers can collect.
But even some state regulators acknowledge that nursing homes are partly to blame for the lawsuit debacle. They say they have been unable to persuade persistently troubled homes to comply with minimum quality standards.
Subpar homes have learned they can stay open by sprucing up for state inspections, then often backslide once the license is renewed, state inspectors said.
"Some facilities just can't seem to get it right, but they stay open," said Patricia Feeney, supervisor of nursing-home inspections in six South Florida counties. "Continual violations, continual turnover of staff, continual budget problems, low quality."
Consider Integrated Health Services of West Palm Beach. During the course of its past four inspections, the home was cited for 58 violations.
Marie Massey blames that record of citations for the 1998 death of her sister, Doris LaJeunesse, who went to Integrated for a few weeks of physical therapy after a stroke.
A nurse misread the order for her insulin shot. Instead of giving six units, she gave 64 units, according to a suit filed by Massey. LaJeunesse, 82, went into diabetic shock and deteriorated until she died five weeks later.
"She was suffering. She had pains. She just kept getting worse. They killed her," Massey said.
The home's attorney, Raul Romaguerav, agreed that the insulin overdose was a dangerous error, but he said it didn't kill LaJeunesse. She recovered enough to go to another nursing home, he said, and she likely died from complications of her stroke.
ISSUES DATE TO 1970S
The debate over nursing-home quality goes back to the 1970s, when a Miami grand jury documented widespread problems, from rats in beds to roaches in food, in the facilities.