At a hearing in which Attorney General Patrick C. Lynch disclosed the probe, state officials seek to distance themselves from the public criticism of nursing-home oversight.

09:48 AM EST on Tuesday, November 30, 2004

BY JENNIFER LEVITZ
Journal Staff Writer

Journal photo / Connie Grosch

Sen. Elizabeth H. Roberts and Rep. Steven M. Costantino, who co-chair the Permanent Joint Committee on Health Care Oversight, confer before yesterday's hearing.

PROVIDENCE -- A statewide grand jury is investigating possible crimes at Hillside Health Center, the Providence nursing home that closed in June and has since become notorious for its conditions, Rhode Island's attorney general said last night.

Attorney General Patrick C. Lynch declined to comment specifically on when the probe began, but said the grand jury would likely review testimony and evidence about Medicaid fraud and patient abuse. The grand jury will decide whether Lynch's office has enough evidence to support indictments.

Lynch's comments about Hillside came during a hearing at the State House held by the Permanent Joint Committee on Health Care Oversight, a group of legislators who have pledged to identify and improve weaknesses in Rhode Island's nursing homes in the wake of Hillside's closure.

So far, much of the public scrutiny has landed on the Health Department. Following its policy of allowing underperforming nursing homes numerous chances to improve, the department documented from November 2003 to February the dangerous worsening of 87-year-old Germaine Morsilli's bedsore, and the inability of Hillside to care for her. A September internal investigation ordered by Governor Carcieri found that Morsilli was not the only resident who wasn't being properly cared for.

The 165-bed nursing home received millions in Medicaid payments, but was chronically broke. A worker told a Health Department inspector that the nursing home was out of bandages for Morsilli. Diabetics weren't getting snacks. Paychecks bounced. When owner Antonio L. Giordano put Hillside into state bankruptcy on March 3, he owed $9 million in debt to vendors and in taxes.

Told last night about the grand jury investigation into Hillside, Jaqueline Wallace, a Providence resident whose mother and mother-in-law had lived at the nursing home, said: "Oh, thank God."

Wallace, a nurse, has said in the past that a person could get in more trouble for fighting in downtown Providence than for neglecting someone old and frail. Last night, she repeated that sentiment.

"When you're in a nursing home, you're vulnerable and you should be protected as a citizen," she said. "My mother may not know what day it is, but she should be protected like any other citizen."

Last week, the attorney general's office filed felony patient neglect charges against a nurse for allegedly refusing to give an 85-year-old resident of Waterview Villa, in East Providence, her nitroglycerin as she complained of chest pains in July; the woman died that night. And in September, a nurse at Oakland Grove in Woonsocket was charged with felony neglect for allegedly ignoring a choking woman, and her two supervisors were charged with misdemeanor neglect for not reporting the incident to the state.

In general, indictments in nursing home complaints are uncommon in Rhode Island.

The attorney general's office regularly picks up complaints -- and abuse incidents reported by nursing homes -- from the Health Department. The Health Department reviews the reports for regulatory violations, while the attorney general's office looks for evidence of a crime.

Of the 1,196 complaints and incident reports reviewed by the attorney general's office in the last year, 83 became formal cases, Lynch said. Eight people were charged.

The hearing last night at the State House showed where most of the blame for nursing home tragedies is landing so far: on state officials.

Health Director Patricia A. Nolan disputed a recent report by Lt. Gov. Charles J. Fogarty's task force that was highly critical of the Health Department. In an eight-page letter distributed at the meeting, she said that, foremost, Hillside and its owners and workers were to blame for the bad care at the nursing home.

Nolan also pointed at Lynch.

She disputed Fogarty's claim that she could have averted the Hillside disaster by using a 16-year-old law to petition the attorney general's office to appoint a receiver to take over the nursing home.

Nolan pointed out that she had recently tried such action with a different nursing home, Mount Saint Francis, and that nothing had happened.

She wrote Lynch on Sept. 2, asking him to appoint a receiver for Mount Saint Francis. The Woonsocket nursing home is raising alarms because it's partly owned by Hillside's owner, Giordano. It has a financial deficit that Nolan says could lead to poor care. Lynch says he doesn't yet have enough evidence to assess the solvency of Mount Saint Francis, and that there is no evidence that there is poor care at Mount Saint Francis as there was at Hillside.

Lynch said he found Nolan's comparison between Mount Saint Francis and Hillside "grossly misleading," "outrageous" "pathetic," and a "disservice to the public."

Lynch said Hillside and Mount Saint Francis were "apples and oranges" in terms of conditions, and said Hillside had 20 deficiencies last fall while Mount Saint Francis's recent survey had few problems.

Referring to Nolan's letter, Rep. Al Gemma, D-Warwick, said, "There it goes . . . it's not my fault, it's his fault."

Gemma said, "I think we're all to blame."

After the meeting, Nolan and Lynch exchanged words. He noted that she had aired her comments about his office in a public letter copied to Carcieri and the joint committee, but not to him. She apologized. She also pointed out that he aired his views on talk radio.