Rights and the Infirm : Nursing Homes Often Violate Rules Protecting Patients, Study Contends

Larry Pierce says he couldn’t believe what was happening to him when he was forced kicking and screaming from his nursing home bed, shoved into a wheelchair, rolled down a hallway and put into the back of an open pickup truck at the rear door.

“I thought, ‘What are these guys going to do to me?’ It was like a bad dream,” recalls Pierce, who suffers seizures and has difficulty walking and talking.

Pierce, 44, was being evicted, officials from the nursing home say, because they had received no state Medi-Cal payments for his four months of care.

His eviction last year is an extreme example of how patients’ rights are routinely violated by nursing homes in Los Angeles County, according to Bet Tzedek Legal Services, a nonprofit law firm that represents poor, disabled and elderly people.

In a study to be released today of 65 randomly selected nursing homes, the firm says information in admission documents often is used to deceive patients about a raft of state and federal regulations governing such facilities.

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The survey also found that nursing home administrators frequently fail to advise patients that they cannot legally be evicted without the right to appeal, as was done in Pierce’s case.

“We get so many nursing home eviction cases it’s just shocking,” said Bet Tzedek public relations director Susan Lev. “They take them out and dump them.”

“It’s easy to say something is common without knowing if it’s an industry practice or not,” said Mark Waxman, attorney for the California Assn. of Health Facilities, a major nursing home organization. “From what I have seen and what the association has seen, violations of the law are not common.”

Some facility administrators, Waxman said, may simply be using outdated admission documents.

“It certainly does not mean that there has been some injury to a particular patient,” he said. “It may only mean that the facilities have not updated the agreement in the recent past since the requirements do change from time to time.”

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Common violations of state and federal laws uncovered in the survey included:

* Requiring patients to waive some facilities’ responsibility for safety.

* Informing relatives that visiting hours are restricted when in fact they can visit at any time.

* Requiring patients to waive the right to be readmitted after a hospital stay.

* Demanding waivers of the right in certain cases to refuse being transferred to a different room within the facility.

* Insisting that patients absolve facilities of responsibility for personal injury in certain circumstances.

* Requiring family members or friends to assume financial responsibility for bills before patients are admitted.

“These are business practices that obviously happen to many people and they are often done to people who are so tired and sick that they just don’t have the ability to fight back,” said Eric Carlson, a Bet Tzedek attorney.

Admission documents were collected without telling nursing home administrators that a survey was being conducted, according to Bet Tzedek officials.

The organization pointed to several examples of how the rules are violated.

In one case, Los Angeles resident Elmo Pratt says he helped fellow church member Mary Reed sign into a nursing home two years ago as a favor to the 83-year-old woman.

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Pratt says an administrator at Country Villa East Nursing Center on South Western Avenue asked him to sign a lengthy document to admit Reed to the facility.

“I wondered if there was any money involved, because I have a family of my own and I couldn’t afford to pay the bill,” recalled Pratt, 54, who is a pharmacist. Pratt only skimmed the document before he signed.

“She (the administrator) assured me they would go with Medi-Cal pay only,” he said. “She said, ‘Somebody has to sign this,’ and this has come back to haunt me.”

Medi-Cal did not pay and after Reed died, Pratt was billed by the nursing home for $4,400. Last February he was summoned to Small Claims Court where a judge ordered him to pay half that amount.

Pratt turned to Bet Tzedek and was advised to appeal the judge’s ruling on the grounds that it is against federal law for nursing homes to require friends or relatives to assume financial responsibility for patients’ bills as a condition for admission.

Joel Saltzburg, attorney for the nursing home, said facility officials plan to look into the Pratt case and have been working with Bet Tzedek to be sure its admission documents reflect the law.

“We believe our policies do not break the law,” he said. “We will investigate the (Pratt) matter and do whatever is necessary to correct it if we find we have done something wrong.”

The Bet Tzedek survey found that 63% of the documents required relatives or friends to assume financial responsibility prior to admission, in violation of the law.

The survey also found that 91% of the homes “claim the right to evict residents for improper reasons” and 72% failed to tell residents that they have a right to appeal an eviction.

Bet Tzedek officials note that under the law nursing homes can require a patient to leave only if the discharge is necessary for the welfare of the patient, the patient no longer needs care, the safety or health of others are endangered or for non-payment of bills.

The law also requires that in order to be evicted, a patient must be given written notice and informed of the right to appeal to state health officials and be furnished the phone number of a long-term care ombudsman.

Victor Arkin, head of health facility inspection for the county, said that nursing homes sometimes send unwanted patients home in taxis. But Arkin had never heard of a patient being hauled away in the bed of a pickup as was done with Pierce.

“I’ve seen cabs, but not trucks,” Arkin said.

In January, 1994, Pierce was sent from the Martin Luther King/Drew Medical Center to the Vermont Knolls Convalescent Hospital in Los Angeles after being treated for injuries suffered in a mugging.

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Medical records indicate that Pierce was unable to stand without assistance and suffered from alcohol syndrome seizures. Pierce had no money and officials at the nursing home, a facility on South Vermont Avenue, expected Medi-Cal to pay for his care.

When Medi-Cal denied payment, nursing home officials say they issued Pierce a 30-day notice of eviction on April 27, 1994.

Pierce says he got no such notice. According to county health inspectors, he was not told of his right to appeal nor was he given the phone number of an ombudsman,

Pierce, a former roommate, a nursing home official and medical records are in general agreement on how Pierce was evicted.

A May 31 entry in Pierce’s nursing home records says:

“Patient was told that his 30-day notice was up. He refused to leave the facility. Became very uncooperative. Would not get out of bed.”

Antonio Bethley, social worker at Vermont Knolls and activities director at the time of the incident, said in an interview that he and two other staff members evicted a struggling Pierce by picking him up, pushing him into a wheelchair and wheeling him to a pickup truck.

“He was putting up a little fight,” Bethley said. “He was trying to get under the bed . . . because he didn’t want to leave.”

Pierce says he was choked and his roommate said in an interview that Pierce was manhandled and dropped on the floor.

“They drug him out of the room,” recalled Morvest Pickens. “I saw him get dropped on the floor. He was telling them that he couldn’t walk.”

Bethley says that Pierce asked to be taken to King/Drew after he was put in the wheelchair, but Pierce insists that he did not know where he was being taken.

The next day, Pierce was sent to another nursing home where he contacted an ombudsman. Several months later he filed a complaint with county health inspectors.

Vermont Knolls was issued a notice of “deficiency” and promised to correct its procedures regarding evictions. No fine was levied.