State Nursing Home Deaths Blamed on Bungles : Report: Advocacy group says misconduct or mistakes claimed 14 lives, one in Orange County. An industry spokeswoman said the allegations distort the care picture.

Fourteen residents of California nursing homes died last year because of mistakes or misconduct by the facilities, an advocacy group said Wednesday in a report that calls institutional care of the state’s elderly a tragic disgrace.

Another 379 patients were in “imminent danger” of death or serious harm as a result of violations by the homes in 1992, according to the report by the nonprofit California Advocates for Nursing Home Reform.

One of the 14 deaths occurred at an Orange County nursing home, the John Douglas French Center for Alzheimer’s Disease in Los Alamitos, which received a citation for a death caused by the “physical environment,” said Patricia McGinnis, executive director of the advocacy group.

Circumstances of the death were not available, McGinnis said. Officials at the nursing home were not available for comment Wednesday.

Two of the 10 nursing homes listed as most “deficient” in providing care are located in Orange County--the Sterling Health Care Center in Anaheim and Harbor Health Care in Fullerton. Officials at those homes did not return telephone calls from a reporter Wednesday.

Despite the death at the Los Alamitos home, Orange County facilities show a much better than average record for fines levied for serious offenses, which include putting patients at risk of injury or death.

Orange County’s 67 homes received just two such citations in 1992, the report showed. In Santa Clara County, which has about the same number of homes, there were 162 citations last year.

The advocacy group, however, discounts the small number of citations in Orange County, calling the region one of its most problematic sites. Lax enforcement by the state’s licensing office branch in Orange County may mask the actual extent of the violations in the county, McGinnis said.

“We picked out Orange County in particular in our report card to criticize for their enforcement,” she said. “There are too many places there to have so few things going on. . . . There seems to be something wrong.”

An official at the Orange County Council on Aging, which operates an ombudsman program for nursing home residents, agreed that the number of citations issued in Orange County is too low.

“We’ve taken issue with that, said Executive Director Pamala McGovern. “There are a lot of complaints that don’t become citations, and I don’t understand why.”

Paul H. Keller, who oversees state surveys of nursing home residents for most of Southern California, said officials will look into the Orange County citation statistics in coming months “because there seems to be a statistical anomaly there.”

In one case examined by the advocacy group, a resident of a Merced nursing home died by choking after being force-fed. In another incident at a Davis convalescent center, a patient was killed by “fecal impaction” caused by drugs that caused constipation. And in a third episode, a Riverside patient prone to falls died after tumbling from her wheelchair.

State fines for these violations ranged from $10,000 to $25,000 and have been contested by the homes. In hundreds of other incidents, patients were needlessly or excessively drugged, restrained in their beds for days and forced to lie in their own feces, charged the report, which was based on government inspection and citation records.

“People are suffering and losing their lives because this industry tolerates substandard care,” McGinnis said in releasing the study. “If these sorts of abuses were happening to animals, we would be outraged. Why don’t our elderly get more respect?”

An industry spokeswoman reacted hotly to the report, saying it “distorts” the picture of nursing home care, which she described as “quite good, overall.

“There are individual situations where residents and families are not pleased,” said Kathy Daigle of the California Assn. of Health Facilities, which represents 1,000 nursing homes. “But if there are legitimate problems, there is a rigorous enforcement system to deal with them.”

Daigle declined to discuss the 14 deaths, noting that many of those cases are in litigation, but said, “One death is too many in our opinion.”

In 1992, 162,103 state residents--about three-fourths of them women--spent time in a nursing home. Estimates show that one in four Californians will enter a nursing home at some point in their lives.

According to the study, a majority of California’s 1,228 rest homes fail to meet acceptable standards in certain categories of care and lag behind the national average in compliance with federal laws.

The report also faulted government’s enforcement approach. In 1992, it noted, the state issued 1,812 citations to nursing homes and assessed about $5.6 million in fines. But in keeping with the enforcement philosophy, many of the fines were forgiven once they were appealed or problems were corrected, so only $2.3 million was collected.

State regulators acknowledged the past enforcement trouble but said a new law that went into effect Jan. 1 has brought improvements. In the first five months of this year, the state has levied $1.3 million in fines and collected $550,000 of that total.

In one area--the use of drugs and physical restraints to control patients--the report found that California’s rest homes have made progress. In in 1992, 26% of all patients were restrained, down from 68% in 1990. Still, California lagged behind the rest of the nation in reducing the use of such restraints, federal data contained in the report show.