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Nursing home pays $212,500

Crystal River Health and Rehabilitation Center paid the settlement in the overdose death of a 94-year-old patient.

By JIM ROSS, Times Staff Writer
© St. Petersburg Times
published May 26, 2002

CRYSTAL RIVER -- A Crystal River nursing home earlier this month paid $212,500 to settle a legal claim brought by the survivors of a woman who died while in the home's care.

Anna Kucharski, 94, became a resident at Crystal River Health and Rehabilitation

Center on Aug. 6, 2000, state records showed.

She died 18 days later, at least in part because health providers administered an overdose of medication, according to the records.

State inspectors later investigated and confirmed the overdose. They cited Crystal River for failing to provide services that "meet professional standards of quality."

The nursing home, in its written response, didn't challenge that finding or a related one involving another resident.

"Both of these instances occurred due to poor nursing practices by an agency and staff nurse," a Crystal River Health and Rehabilitation Center official wrote. "Neither nurse will be returning to this building."

Documents didn't indicate which nursing agency was involved, or which nurse from the nursing home, and an attorney who represents the home declined to elaborate.

"The facility appropriately notified the Agency for Health Care Administration of a potential medication error and an appropriate investigation was initiated by the company. We do not comment on employment issues," said Dale Sisco of the Tampa law firm of Bavol, Bush and Sisco.

Lawyers for the nursing home and Mrs. Kucharski's survivors settled the legal claim before a suit was even filed, court records show. A judge approved the settlement and distribution of the funds, minus legal fees and costs, to Mrs. Kucharski's heirs.

Mrs. Kucharski came to Crystal River Health, 136 NE 12th Ave., from a hospital, according to an inspection report that the state Agency for Health Care Administration prepared.

The report didn't say which hospital or why Mrs. Kucharski was there.

Her diagnoses upon entering Crystal River Health were dementia, degenerative joint disease, osteoarthritis and rhinitis (hay fever.) She was "alert and talkative but forgetful," the report said.

Physician orders called for her to receive Advil twice a day for joint pain and physical therapy.

Three days after Mrs. Kucharski arrived, the home's physical therapy department called her doctor to report that she was complaining of pain and was unable to participate in therapy, the report said.

The doctor (a name is not listed in the report) discontinued Advil and started a new drug regimen that, among other things, called for application of a Duragesic patch (25 milligrams) every 72 hours "with a caution to watch for sedation and/or hallucination," the report said.

Duragesic is a potent pain reliever.

State inspectors reviewed records and found health workers applied a patch on Aug. 10, 13, 16 and 19, the report said.

"The resident's chart does not document why, but another patch is documented as applied to the left chest" on Aug. 20, the report said.

There was no indication the nurse who applied the patch contacted the doctor to say an extra patch was being added, or that the patch applied the previous day was missing, the report said.

A review of nursing notes showed that, at 4 a.m. Aug. 20, Mrs. Kucharski was resting well, alert but confused and showed no signs of discomfort.

Some 13 hours later, however, the notes indicated shallow respirations and pale skin, the report said. Mrs. Kucharski responded to her name only by opening her eyes briefly.

The nurse didn't call the doctor until 6:30 p.m., even though home policy calls for immediate notification when a resident's status changes.

An ambulance took Mrs. Kucharski to Seven Rivers Community Hospital at 6:55 p.m., the report said. Paramedics reported they removed one patch from her chest during transport.

The Department of Children and Families, which investigates complaints of elder abuse, found during its investigation that the nurse in question discovered a second patch on Mrs. Kucharski's lower back after the first patch was applied Aug. 20.

The hospital admitted Mrs. Kucharski with a diagnosis of dehydration and Duragesic overdose, the report said. She was transferred to another long-term care facility, where she died Aug. 24.

Mrs. Kucharski died "as a result of injuries sustained in a nursing home," according to a legal document that her survivors filed recently.

One of Mrs. Kucharski's daughters, June Dunbar of Homosassa, is personal representative of her estate. The estate accepted the nursing home's settlement offer of $212,500, court records showed.

Of that amount, $70,833 went to the law firm of Catania & Catania and almost $3,000 more went toward fees associated with the case.

The rest goes to the beneficiaries: Dunbar and a sister who lives in California.

-- Jim Ross writes about medical issues in Citrus County. Reach him at 860-7302 or

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