An elderly man living at a local nursing home had bedsores and overgrown nails when he was brought in to Howard County General Hospital late last week, prompting an emergency room nurse to report suspected physical neglect to police.
As a result of the police report, state officials say, they plan to investigate the care of Vernon Brown, 75, at the Lorien Nursing Home & Rehabilitation Center in Columbia's Hickory Ridge village.
But the hospital already has determined that the elderly man did not suffer from any maltreatment, said Victor Broccolino, the hospital's president and chief executive officer.
Lorien officials say Brown's condition did not indicate neglect or maltreatment, stressing that elderly nursing-home patients do not end up in the hospital until they reach acute stages of ill health.
But four hospital employees -- all of whom refused to give their names for fear of retaliation by the hospital -- said Brown, whose severe neurological illness prevents him from speaking, was in very poor condition when he was brought to the hospital.
"His fingernails were so long they were biting into his palms," said one employee. "His catheter was filthy, and the dressing [on his wounds] hadn't been changed in God knows when. There was something wrong there."
The case raises a controversial subject among those who provide health care for the elderly and infirm: What exactly constitutes neglect, abuse or maltreatment among patients who cannot care for themselves?
Experts say care givers face continual dilemmas as they try to determine which conditions are permissible as unavoidable symptoms of disease and which constitute neglect.
Some problems, such as bedsores and deteriorating limbs, are preventable only with almost constant turning and massaging of patients.
"This is a muddled gray area," said Dr. Leslie Morgan, a University of Maryland professor of sociology who specializes in issues of aging. "There is no line you can draw, really."
Added Anne Pecora, a law professor at the University of Baltimore who focuses on aging and the elderly: "It is extremely difficult to sort through these issues, especially if you don't have anyone in the family who is there every day. You have a patient that is not going to yell and scream and say, 'Come take care of me.' That's when these issues come up."
Dozens of variables affect on-the-spot assessments of convalescent patients' conditions, experts say.
Patients' health might be improving or declining.
Care givers might not have bathed or changed wound dressings often enough.
Patients might be belligerent and abusive toward health care providers, making maintenance -- such as trimming fingernails -- difficult.
In this case, even the doctor who first saw Brown as he entered the hospital emergency room -- Scott Maurer of Columbia -- said he is still struggling to sort out whether or not his patient had been maltreated.
"Mr. Brown had bedsores, but they were not grossly neglected," Maurer said. "The nails should have been trimmed, yes, but it didn't look to me like anybody had ignored him. This was far from a criminal matter.
"But it's important to note that a lot of the nurses seem to feel that there is a problem here," the doctor said. "There must be something behind this. I don't know."
Maurer added that because nurses see patients first, they often are more aware than doctors of the condition of incoming patients.
The Columbia Lorien nursing home -- part of a chain and one of the largest homes in Maryland -- has a good record with the state agency that oversees Maryland's 250 homes, according to state records and officials.
In the past 14 months, six complaints have been lodged against the home. Four were found to be unsubstantiated, and two investigations -- including Brown's -- are pending, said Carol Benner, director of the state's Licensing and Certification Administration, which regulates nursing homes and would look into the Brown situation.
"Basically, this is a good nursing home," said Benner, adding that the number of complaints against the home is in line with others in the state. The agency is obligated to investigate all complaints, including relatively minor ones.
Brown has lived at Lorien for at least eight years, according to officials there.
Maurer, who is supervising his care at the hospital, said he is bedridden with several long-term health problems. The thin, frail man cannot feed, clothe or bathe himself, and he can scarcely move.
Brown was brought to the hospital late Thursday or early Friday after Lorien employees suspected he had pneumonia, according Howard County police spokesman Steve Keller.
Speaking anonymously, the four hospital employees who saw Brown as he entered the hospital said it appeared his nails had not been trimmed in weeks, perhaps months.
Brown's bandages -- the type that should be changed daily -- were discolored and obviously very old, the hospital employees said. Brown also had multiple bedsores, at least one of which was infected, Maurer said.