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Nursing home back in compliance

Regulators approve Heartland's plan to improve conditions. The matters came up after a patient died.


© St. Petersburg Times, published June 21, 2000

ST. PETERSBURG -- Government officials say they are now satisfied with conditions at a St. Petersburg nursing home where regulators last week threatened to strip away Medicare and Medicaid rights, because they said a patient had died there after choking on food.

Although the nursing home and state and federal officials have agreed on a plan of corrective action, they still differ on what actually happened to the resident who died on May 31.

In a vigorous denial of the government's claims, Heartland officials say "there is not one shred of evidence to support" the statement that the resident suffered "a choking episode."

In fact, the resident's death certificate lists the immediate cause of death as "debility of age," the probable manner of death was "natural," and a complicating factor as "end-stage Parkinson's disease," according to Heartland's written response to the regulators.

Heartland also says the attending physician reported that the surveyor, or investigator, "never spoke (to) or interviewed him nor had she reviewed the resident's death certificate."

"It is unclear and concerning how the surveyor could have determined and diagnosed the resident as having an "airway obstruction' and "choking,' " Heartland's response states.

Federal officials had threatened to revoke the home's eligibility for Medicare and Medicaid reimbursement after the incident, but the federal government works in concert with state officials, who actually inspect the home.

In perhaps their most stinging criticism, state regulators said documents indicated that the staff waited 25 minutes to call 911 after the purported choking episode, as they tried to figure out whether the resident had a "do not resuscitate" order in place. The state also quoted a nurse who "revealed that there was an approximate time lapse of 10 to 12 minutes between the time she was initially called into the room and when she actually called 911."

But Heartland says that could not have occurred. Their statement says the resident was found "unresponsive" at 7:10 p.m., the same time cited by state officials. A Pinellas County EMS report provided to the Times by Heartland's corporate marketing office indicates the 911 call came five minutes later, and that paramedics arrived four minutes after that.

The home says it "was clearly operating within accepted standards of practice."

Heartland's response is contained in a document that summarizes the government's claims of deficiencies, and outlines the plan of corrective action.

Under the corrective plan, which does not mean that Heartland admits to any wrongdoing, the nursing home has: established a system identifying residents who do not wish to be revived by CPR; developed a system for easily identifying patients with special feeding needs; reviewed and revised its policies governing "advance directives"; and others. It was not clear from the report to what extent the home already has some of these procedures in place.

"This facility is now in full compliance, so that basically means that we have accepted their plan of corrective action, as well as the feds," said Pat Glynn, spokesman for the Agency for Health Care Administration.

However, the nursing home and the state are now poised to begin a dispute resolution process, in which the home will argue that the public record should be corrected to clear up what it says are mistakes in the state officials' account of the incident.

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