Nursing homes facing new rules

Facilities soon must tell families if patients are harmed, suddenly decline

Agency action in lieu of law

December 18, 2003|By Walter F. Roche Jr. | Walter F. Roche Jr.,SUN STAFF

After four years of legislative battling, a state agency is moving ahead on its own with "common sense" regulations to ensure that relatives are informed when nursing home patients are adversely affected by substandard care or suffer sudden health setbacks.

The notification rules, spurred by the case of a woman who was fed to death in a Baltimore nursing home, are set to go into effect within the next month, according to Carol Benner, head of the Office of Health Care Quality in the state Department of Health and Mental Hygiene.

The rules, published recently in The Maryland Register, spell out the conditions under which notification will be mandatory. They include development of bedsores, the onset of aggressive or inappropriate behavior, accidents that may require a physician's intervention and heart attacks or strokes.

The new standards have the support of the nursing home industry and of those who pushed for a state law requiring reporting on relatives. Lobbyists for the nursing homes had opposed setting the reporting requirements by statute.

Benner said the notification rules will go into effect 10 days after they are published in final form, which is expected within a few weeks.

The mandatory reporting was spurred by the case of Bertha Small, an 89-year-old woman who died after staff at the Villa St. Michael Nursing and Retirement Center left a feeding tube running for hours, until the liquid nutrient exploded from her nose and mouth.

State inspectors, Benner and the state medical examiner later concluded that Small had been fed to death. The feeding tube was left running even as the woman was heard moaning in obvious pain and distress, a state report concluded.

David Baxter, Small's grandson, learned the truth about her death only after reading about it in The Sun. He appeared this year at a General Assembly hearing urging approval of a bill to force nursing homes to tell families about such incidents. The bill was defeated.

Baxter said this week that he is pleased the new rules were being put into effect but questioned why it took so long. "It's simple common sense, a common courtesy," he said, adding that he would prefer to see the requirement in a state law, which then could be changed only by an act of the General Assembly.

Baxter's family sued the nursing home. The case was settled, but the terms were not disclosed. After the incident, the nursing home was fined $7,500 by the state and filed a corrective action plan. State officials say the facility is now in compliance with state and federal regulations.

State Sen. George W. Della Jr., the Baltimore Democrat who has filed the mandatory reporting bill on behalf of the Maryland Nurses Association every year since 1999, said the regulation was "the right thing to do." While a state law might have more permanence, he said, "At this point, I'll take whatever I can get."

Rob Hendrickson, lobbyist for the nursing association, said he was pleased with the regulations but concerned that they do not spell out that the family be notified when a nursing home is cited for noncompliance. He also noted that the rule does not set a specific penalty.

Benner said her department will require nursing homes to notify relatives as part of a corrective action plan. Although the regulation does not set a specific penalty for violations, she said the agency, under existing rules, can impose fines of up to $10,000.

Mark Woodard of the Maryland Health Facilities Association, which represents nursing homes, said the regulation was "a reasonable step forward" that would address problems noted at legislative hearings.

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