Caught in the Middle : Medi-Cal Rule Dispute Leaves 26 Patients in Fear of Eviction

Gary Krogh is as fragile as a glass Christmas ornament.

The victim of two strokes that left him paralyzed and barely able to speak, the 46-year-old label broker has become a prisoner of a frail, malfunctioning body.

Yet his wife, Pat, isn’t sure she will allow him to go to the hospital if he gets sick.

“I’m not saying I wouldn’t authorize it,” she said, standing near his bed at St. Joseph Medical Center Pavilion, a Burbank nursing facility where he has lived for the past year. “But I would say, ‘maybe we should hesitate.’ ”

The Kroghs are caught in an unusual medical dispute that could force his eviction if he leaves his bed for more than a week. He could even be evicted if he is treated for more than seven days at nearby St. Joseph Medical Center, which--like the Pavilion--is owned by the Roman Catholic order, Sisters of Providence.

26 Patients

The dispute, involving as many as 26 patients, arose in April after family members said they learned that Medi-Cal was preparing to transfer poor patients with long-term medical problems from expensive rooms at the Pavilion to nursing homes.

Medi-Cal insists that it was applying a requirement that state-funded medical care be provided at the lowest reasonable cost. The polished, spotlessly clean rooms at the Pavilion cost $150 a day per patient, more than twice the $60 rate for a bed in a conventional nursing home.

Though some of the patients were unable to understand what was happening, others decided to fight for their beds. They painted protest signs during recreational therapy.

In an effort to resolve the problem, Medi-Cal decided to allow the patients to remain at the Pavilion as long as they don’t vacate their beds for more than the seven-day period.

But that has only raised a new threat. The men and women rolling through the halls in their wheelchairs now see their own frail bodies as potential enemies.

An elderly female patient said that if she is taken to the hospital, “I just hope I die while I’m over there.”

In a possible breakthrough over the weekend, patients’ families said they received letters from Medi-Cal that stated that even if the seven-day period were exceeded, the patients could stay at the Pavilion so long as the medical center did not discharge them during their absence. It was not known whether the hospital would agree to those terms.

For her part, Pat Krogh is agonizing over what to do should her husband develop another case of pneumonia.

The patients’ attachment to the Pavilion can be readily seen in a tour of the fourth floor, where most of the affected patients have been living, some for as long as four years. Televisions hum with baseball games and soap operas, and efficient, smiling nurses move about bearing trays of food.

In fact, both the patients and Scott Seamons, the Pavilion’s administrator, say the Pavilion is the Cadillac of nursing facilities. Patients have been taken on excursions to a pizza restaurant, to Marina del Rey for boating trips and to Dodger games.

The patients and their families admit that their battle to stay on at the Pavilion is a commentary on American nursing homes.

“I have visited a half-dozen or more convalescent homes,” said Dorothy David, an 86-year-old patient. “You go to the door, the stench is terrible. People come to see me, and they can’t believe this place.”

‘Great Place’

“This is a great place,” said Emily Amarante, whose mother is a patient at the Pavilion. “It’s what every community should have.”

But what it isn’t, emphasized Seamons, is a nursing home. He said the Pavilion is for short-term nursing care. That is why the hospital receives so much money for each bed. “The majority of our patients come to us from an acute hospital and require a great deal of care,” he said.

The problems on the fourth floor “occurred because some had gotten better and stabilized and Medi-Cal allowed them to stay.”

It took a visit by a Department of Health Services nurse earlier this year to alert the state that some patients at the Pavilion did not need the facility’s special services because the critical period of their illnesses had passed. Preparations were made, according to Seamons, to transfer 14 patients. Another dozen might ultimately have been moved, he said.

Letters of Complaint

Then the families became active, scattering letters of complaint to everyone from Bob Hope to the Disney Foundation. Amarante said evicting the poor patients would be a callous economic decision. “If you can afford to pay, you can afford to stay,” she said.

Pat Krogh is the first to admit that her husband and the other patients are luckier than most of the poor and infirm, who wind up in nursing homes without the same amenities.

“I can see the point,” she said, when asked why her husband and the others should be so lucky. “But why should they be jockeyed around?”

Her husband’s illness has forced new responsibilities on Krogh, a sandy-haired woman who has become a spokeswoman for SEEP, or Stop Evictions of Elderly Patients.

She and her husband once owned their own business, which brokered envelope labels to hospitals from label-makers throughout the country; a four-bedroom house in Canoga Park and a share in a house at Lake Arrowhead. Then he had his first stroke on a cruise ship in the Bahamas last year. He was taken to Miami by jet and was recovering a few weeks later when he had a second stroke.

Sold House

Pat Krogh has since sold the house in Lake Arrowhead, fired the gardener and divided assets with her husband, according to Medi-Cal rules. She has also hastily learned her husband’s business. Now she is scraping by financially and he is broke.

But something went right, she said, when the Pavilion took in Gary. “We wanted him in this facility and God intervened.”

Darryl Nixon, administrator of the Los Angeles Medi-Cal field office, said the dispute at the Pavilion has become a bureaucratic mess. “The patients are caught between a rock and a hard place,” he said. “And we are caught because we’re relaxing our requirements” by letting them stay.

But the problem won’t go away. The families are focusing their attentions on Seamons, suggesting that the Pavilion should accept the lower nursing home payment rate for patients who return after violating the seven-day requirement.

Spokesmen for the patients say the suggestion has been turned down, prompting patient advocates to write a letter accusing those who made the decision of “pinching pennies” instead of meeting their “moral obligation to these patients.”

Seamons now says he is willing to look at the families’ recommendations. “We need to study that,” he said.

But he argued that such a solution “is a major policy question. We have a budget at that facility. Right now, we’re losing a significant amount of money.”

Another possible solution is to reduce services for the patients to cut bed costs, Seamons said.

“That would be a shame if they lowered their standards,” Pat Krogh said. “However, the patients would still want to stay because it’s their home.”

Seamons said the Pavilion has the same goal as the patients’ families: “to see that the patients who come to the Pavilion receive care and receive it in an appropriate manner.”

But he added that the patients on the fourth floor “have been fortunate to stay,” since the facility is not a nursing home.

“They want to stay,” said Seamons. “Of course they do, because it’s a Cadillac.”