Intense Effort Averted Closing of Veterans Home

Few politicians spend more time courting veterans than Gov. Gray Davis. Whether he’s talking about transportation or schools, Davis manages to work references to vets into virtually every speech.

So the Davis administration was alarmed earlier this year that state Department of Health Services inspectors might declare that the state-run nursing home for elderly and disabled veterans in Barstow was providing substandard care. Such a finding would result in a loss of state certification and several hundred thousand dollars in federal subsidy.

In the end, the veterans home received a passing grade on March 7.

How the Barstow home attained that certification offers a glimpse of how the administration avoided an embarrassment days before the March 7 election, when voters were considering a $50-million bond measure to build two additional state homes for veterans. And it reflects Davis’ tendency to micromanage and to drive his appointees hard.

Department of Health Services Director Diana Bonta visited the Barstow home twice to investigate care. One of Davis’ top aides, Vincent Harris, traveled to the desert town, too. The state hired a consultant to help manage the home. And in January, Davis told Tomas Alvarado, head of the Department of Veterans Affairs, to live in the home until it was brought up to health department code.

“I wanted the director to understand how important it was to me that we did our level best for veterans,” Davis said last week, “and doing the level best means that the homes we ask veterans to stay in pass state and federal standards.”

Alvarado said he never actually curled up in a bed there. But he spent long hours at the home for a 2 1/2-week period in February and called the turnaround a “success story.”

“We had our backs up against our wall,” Alvarado said. “The governor took a real direct interest. . . . He wasn’t going to be the governor of a state, with the number of veterans we have, that was negligent with our elderly veterans.”

The Barstow home has had problems from the start. It opened in 1996 with beds for 400 military veterans, including 180 in a nursing home--the focus of the governor’s attention. Since it opened, state health inspectors repeatedly have found serious problems in the quality of care, their reports show.

“The problems have been long-standing and systemic,” said Brenda Klutz, who heads the licensing and certification division of the state Department of Health Services.

The Department of Health Services levied fines against its fellow state agency, the Department of Veterans Affairs--a total of $66,000 in 1998 and 1999. A $25,000 fine was for the death of a 75-year-old man who died in a fall after having lost his footing at least 10 times before. A federal agency responsible for overseeing nursing home care fined the Barstow home $64,000 last year.

In an inspection last year, state health officials noted that ants were crawling on and biting one disabled vet. In other indications of neglect, vets suffered from bed sores, rapid weight loss and severe constipation. Some fell and hurt themselves because they weren’t watched closely enough. Others were too heavily restrained, inspection reports say.

The veterans department responded by sacking administrators at the home and issuing a statement in December predicting that the home would pass a subsequent inspection.

On that follow-up visit in January, however, inspectors found more problems. One man had two untreated bed sores, including a bleeding wound on his right heel.

“Even after the resident’s pressure sores were discussed with licensed staff, the facility did not implement a plan of care to address the . . . heel,” the report noted.

Inspectors witnessed a resident “choking and coughing in the dining room.”

“No staff intervened to see if the resident was all right or needed any assistance until this writer asked if anyone was going to help,” the report says.

The Department of Health Services gave the Department of Veterans Affairs one last chance to meet minimum standards and retain its certification, making a Feb. 15 visit.

Adding to the urgency, the federal Health Care Financing Administration, which oversees funding for such facilities, set a deadline of Feb. 23 for the Barstow home to meet minimum standards or lose its federal subsidy for the care of elderly vets, estimated at about $400,000.

The federal deadline was two weeks before the March 7 election, when Californians would vote on Proposition 16, a $50-million bond to construct two new veterans homes. Davis personally signed the ballot argument urging that voters approve Proposition 16. The governor said he believes voters, who routinely support measures authorizing spending on veterans, would have approved it regardless of the outcome of the inspection.

However, if the Barstow home had failed the February inspection, there likely would have been news reports, giving some voters pause.

“Realistically, the continued lack of adequate care [at Barstow] could very well have slowed the process of construction of new homes,” said Sen. Joe Dunn (D-Santa Ana), who carried the bill that resulted in Proposition 16. “The perception for the average citizen would be, ‘Why would we build new homes when we can’t manage the one we have?’ ”

As it was, the home’s problems attracted relatively little attention outside the desert. There was virtually no campaign for or against Proposition 16, and the measure won easily, opening the way for veterans’ homes to be built in Lancaster and Saticoy in Ventura County.

Health department officials say the governor’s office never pressured them to ensure that the home would win recertification. “We call them as we see them,” Bonta said.

Rather, Bonta said, the pressure was on Veterans Affairs. Alvarado ensconced himself in Barstow in February and sent daily progress reports for the governor’s office.

“It was very intense. Everybody worked extra hours,” said nurse Dara Sexton who has worked at the Barstow home for two years.

In February, the health department inspected and again found problems, mainly with a lack of documentation of patient care. In the first draft of the report, inspectors gave the home a D rating. Given its past problems, that would have resulted in a loss of the home’s certification. But Bonta and Klutz directed that inspectors return to the home and investigate further.

“It was a paperwork problem, not a problem with patient care,” Klutz said.

The final draft, dated March 7, was pared down to eight pages, from 14. Even in the final draft, the state could have given the Barstow home a D grade for the paperwork problems, Bonta and Klutz said. But the Department of Veterans Affairs retained a consultant--at a cost of $850,000--to help bring up standards at the facility.

“I told them they absolutely needed help,” Bonta said. “Without the consultant, in truth, they wouldn’t have made the progress they did.”

On March 10, the federal Health Care Financing Administration sent a letter informing Veterans Affairs that the federal government accepted the state’s final inspection, concluding, “The termination of your facility will not take effect.”

The Davis administration, meanwhile, is proposing significant spending increases for Veterans Affairs, a $340-million-a-year department. The governor is seeking legislative approval to hire almost 50 more people in Barstow.

Hoping to reduce staff turnover, the administration began paying nurses an extra $400 a month in January, and is pushing to increase retention pay to $1,000 extra a month starting in July. If the boost wins legislative approval, registered nurses at top scale would be paid $5,600 a month at Barstow, or $67,200 a year.