A judge hears both sides in the River Oaks case, but a larger issue delays a decision.
By COLLEEN JENKINS
Published April 8, 2003
INVERNESS - The Department of Children and Families made its case Monday afternoon for why it removed 12 residents from the River Oaks Assisted Living facility in late March, and several of the residents' family members argued against the decision.
However, Circuit Judge Patricia Thomas did not rule, instead postponing a decision until Friday morning. The reason? The state's fight against River Oaks is being fought on several fronts. Thursday, the Agency for Health Care Administration will argue that Thomas should close the 81-bed facility completely for violating multiple state statutes.
So, to decide the fate of the 12 residents already removed from the facility before deciding the fate of the entire facility just didn't seem to make sense to the judge.
"We've kind of got the cart before the horse," Thomas said Monday.
She'll decide Friday at 9 a.m. whether DFC's Adult Protection Services had reason to remove the dozen patients on an emergency basis. In at least nine of the cases, the removal took place against family members' will.
The ruling will be based on testimony from the three-hour hearing Monday. DCF attorney Ralph McMurphy called seven witnesses to justify the agency's removal of the patients.
Most arguments were based on information gathered during investigations by DCF and AHCA officials. They focused on the facility's improper use of restraints, the isolation of patients in the memory-impaired unit and the higher level of care required by certain patients.
When Marion Platt, a registered nurse consultant for AHCA, visited the removed patients in their new rooms at the Crystal River Health and Rehabilitation Center, she felt they fit the qualifications for skilled nursing care facilities, she said.
"All of them appeared to be frail elderly," she said. "They were quite thin. They needed to be assisted really in a way that an assisted living facility would have a hard time providing for 24 hours."
Others echoed her findings. The law requires residents at assisted living facilities to be able to move from place to place with minimal assistance, AHCA registered nurse Patricia Parmerle said.
"That is what I was not seeing (at River Oaks)," she said. "They needed complete assistance."
DCF investigator Deborah Daniels recalled watching River Oaks staff put one patient in a "stander," a machine designed to help strengthen leg muscles by making a person stand up. No licensed physical therapist oversaw the therapy, she said, and the woman in the device was in obvious pain.
"She was crying and screaming out," Daniels said. "To my knowledge, there is no physical therapist on staff at the facility."
Some families have argued that the state agency did not have adequate findings to justify an emergency removal. A few families first learned about the removals March 28, the day they took place.
At the hearing, Gary Hollins of Jacksonville, said he found out two days after the removal that his mother, 82-year-old Genevieve Ciacci, had been taken to a nursing home.
Her bag of medication for dementia and Alzheimer's disease did not arrive at the nursing home until many hours after she was placed at the new facility, he said.
"I only desired the best care for my mother," he told Thomas. "I was not happy with the way she was removed."
He was not alone. Other family members described the wonderful care their loved ones had received at River Oaks. They said they'd placed their mothers and fathers at the assisted living facility because of its low patient to staff ratio and the close attention paid to each resident.
Instead of coming to a table to eat meals in a family setting, David Watson, a former Citrus County School Board member, said by phone that his mother Gladys Howard now eats alone in her bed. When he visited her Saturday, her bags of clothes still had not been unpacked, he said.
Judy Stauffer, supervisor of the adult protection services for DCF, stressed that the agency's decision had been "agonizing" to make. But, she said, concerns of inadequate care at River Oaks had been building for a long time. The agency stood by its action, she said.
"This is not taken at all lightly," she said. "It has to be based on fact. The evidence stacked up on the side that we had to remove those residents for their safety."
