01:00 AM EDT on Sunday, August 22, 2004

Three years after inspectors started documenting poor care at Hillside Health Center in Providence, and two months after the nursing home closed, the Health Department has revoked the license of the man who ran the day-to-day operations.

In a July 29 administrative order, the Health Department wrote that administrator James D. Janetakos "failed to address an ongoing unsafe level of patient care."

If Hillside couldn't care for its patients, the order stated, Janetakos "had a duty and moral responsibility to the patients to bring this matter to the attention of the owner of the facility and the Department of Health."

The order was signed by Bruce W. McIntyre, legal counsel to the Health Department's Board of Medical Licensure and Discipline.

Janetakos, 63, did not attend a hearing earlier that month, on July 20, about his nursing home administrator's license.

In a July 1 letter to Maureen A. Hobson, acting assistant director of health, Janetakos wrote that he wasn't going to defend his license because he has a modest retirement account and doesn't want to spent it on "what appears likely to be a futile effort to avoid being a scapegoat."

Janetakos, who received his Rhode Island nursing home license in 1997, after a career in hospital administration, said by phone on Aug. 6 that he plans to retire. His license had already expired in June and he had no plans to try to renew it. Now that his license has been revoked, he cannot reapply. Janetakos said he wants "to get out of the health-care field."

According to records on file with the Rhode Island Department of Human Services, Hillside paid Janetakos an annual salary of $74,000.

The July 29 order revoking Janetakos' license mentions problems that the Health Department knew about through inspections and complaints: bed sores, poor care of incontinent patients, and "persistent inadequate staffing." The order said "employees had difficulty cashing paychecks."

In his July 1 letter to the Health Department, Janetakos wrote that he had presented the owners with a plan to have a new management group come to the nursing home to "rebuild the nursing program, assess other areas of improvement, and provide additional nursing staff."

He said the owners had rejected the proposal.

The order revoking his license says that under Janetakos, nursing documents were shredded.

Janetakos, in the Aug. 6 phone call, said: "I have no idea about that."

The Health Department's Board of Examiners in Nursing Home Administration investigated complaints -- but took no action -- about Janetakos in 2001 and 2003. The eight-member discipline board must include three active nursing home administrators, one who is chairman of the board.

The chairman then was Robert Budway, at the time administrator at Cartie's Health Center, in Central Falls. Budway says nursing home administrators may be "ineffective for many reasons," including financial problems, or a turnover in staff.

"It's a tough industry," he says. "The industry has changed. The regulations we have today are nothing like what they used to be."

He added: "These [regulations] have grown and they have become complex. It's entirely possible that a facility may be giving good care but still end up with deficiencies."

By Jennifer Levitz