PA Nursing Home at Risk
Posted by Kim on December 29th, 2005 / Print This Post
Laurel Crest’s license is at risk, and Cambria County officials are under state orders to correct deficiencies by March 15 or face a shutdown stemming from a fatal overdose.Also, the state is imposing a $10,000 fine for deficiencies that caused the Dec. 3 death of the patient from a morphine overdose.
County commissioners and nursing home administrators were grim-faced Tuesday as they announced the state Department of Health’s findings and the sanctions imposed at Laurel Crest.
“We are fully cooperating with the state,” said Administrator Christopher Dear.
A team of state investigators was at the county-owned nursing home for a week in mid-December, following a complaint about the death of Eleanor Lee Kinnan of Revloc, age 70. She had been a resident at Laurel Crest for nearly eight months.
Her son, Jeffrey Kinnan of Armagh, has accused the nursing home and county officials of low staff levels that he says led to the medicine mistake.
A licensed practical nurse who administered the morphine later realized the dosage was improper, said administrators at Laurel Crest Rehabilitation and Special Care Center.
That nurse has been suspended with pay pending an investigation. At Tuesday’s press conference, Dear declined to comment on any personnel situation, including staffing and the suspended nurse’s status.
President Commissioner P.J. Stevens said that, although the outcome of the state investigation is negative, “We wanted to get it out to the public as soon as possible.
“It is now incumbent upon the administration of Laurel Crest to follow through. Our confidence is not shaken,” he said.
In a letter to Laurel Crest dated Dec. 22, the state lists five categories of deficiencies.
The two most serious, and the ones the state invokes in assessing the $10,000 fine, fault Laurel Crest’s quality of care and its pharmacy services.
Specifically, the state says that a doctor’s orders were not followed, and a doctor was not properly notified of the overdose.
The patient was “medically compromised” with multiple diagnoses including end-stage renal disease and cardiac issues, the state report says.
On Dec. 2, the day before her death, Kinnan declined “aggressive care,” including dialysis and hospitalization. A 10-milligram dose of morphine was ordered to be given every hour, the report says.
Instead, 40 milligrams were given, the report says. A physician was notified and ordered a drug to counteract the morphine.
But as the patient declined throughout the night, with shallower and less-frequent breaths, the physician was not called a second time. At 7:49 a.m., Kinnan was pronounced dead, the report says.
The second serious state charge is that Laurel Crest “failed to ensure that medications were used properly.”
Specifically, the report says the morphine was in a bottle that was not labeled specifically for that patient and did not contain the physician’s order.
Other deficiencies cited involved administrative procedures, record-keeping and other technical issues stemming from Kinnan’s death.
Since it opened in 1977, Laurel Crest has been no stranger to tough times, having experienced some staggering financial losses and two criminal investigations into residents’ deaths.
Between the late 1980s and the late 1990s, the facility consistently was cited by the state.
For two years in the late 1980s, it was put on four consecutive six-month provisional licenses and faced closing because of serious deficiencies. The home was in such trouble that it lost its federal Medicare reimbursement for months on end, causing losses estimated at $39,000 per week.
In 2003, the former commissioners were on the verge of selling Laurel Crest to Conemaugh Health System, but the sale was aborted.
The 386-bed facility had a net profit of about $1.7 million in 2004 and there are plans to expand its special-care units in a $5.8 million renovation project.
That is being financed by funds gained from the state in exchange for Laurel Crest giving up 166 beds.
Because of the overdose investigation, the state can levy further penalties. If the county does not correct the deficiencies by March 15, Laurel Crest will be denied Medicare and Medicaid payments, the letter says.