A Health Department official says a "high percentage" of complaints cannot be verified because there are no witnesses.

09:32 AM EDT on Monday, August 23, 2004

BY JENNIFER LEVITZ
Journal Staff Writer

Rhode Island's Department of Health gets hundreds of complaints about nursing homes every year.

Where do they go?

Betty Gordon says hers seemed to go almost nowhere. She contacted the Health Department about Hillside Health Center in February 2000, some four years before the Providence nursing home closed down because of documented poor care and financial troubles.

Gordon, a retired Classical High School English teacher, warned the department that Hillside's staff had apparently been cut.

Her mother, Maria Filippelli, immobile and incontinent from a stroke and broken hip, was being ignored and not taken to the bathroom, Gordon said.

Gordon says she spoke to Arthur A. Pullano, a principal surveyor in the facilities regulation division. He "kept asking me about meals," she says. Were meals getting served? Gordon says she told him she wasn't calling about meals, but about patient care.

Gordon says a few nights later, a health inspector was in Hillside's dining room, where there was an "overabundance of staff" passing out meals.

Pullano doesn't recall Gordon's call, he says, though he did receive complaints about staffing at Hillside.

He says that when family members call about the number of workers, he tells them that the Health Department has phased out minimum staffing requirements for nursing homes.

The department opposed two General Assembly bills in 1998 that would have reinstituted minimum staffing levels across the nursing home industry. The department said regulators could order more staffing if individual circumstances called for it.

The philosophy, Pullano says, is "outcome based": if work is getting done, the size of the staff is not an issue.

He says he tells callers: "Yeah? What's not getting done? What's not getting done? Tell me what's not getting done, so I can justify a visit."

The Health Department received about 600 nursing home complaints two years ago. For the last fiscal year, ending June 30, the department took in 1,036 complaints, according to Raymond Rusin, chief of facilities regulation.

He says he is not sure why there was an increase, though he says some of those complaints came from within nursing homes, which have gotten better about reporting themselves.

For serious complaints, an inspector is dispatched immediately, Pullano says.

Less serious complaints are put into a file and are investigated when the department visits nursing homes for the annual inspection, Pullano says.

Pullano says he now has about 100 active complaints.

Rusin says some 751 complaints were investigated last year, and a "high percentage" were never substantiated. He said it's hard to "second-guess" a situation, and to make a judgment in cases when there were no witnesses to an alleged mistreatment at a nursing home.

He says sometimes family members don't understand why a complaint can't be substantiated.

"Sometimes we'll investigate a complaint and say, 'Gee, the facility did everything they could do, there was no violation of regulations here.' The family members have a hard time understanding, they wonder 'Why didn't you punish that home?' "

"Sometimes we give the [nursing home] a deficiency, and that's the punishment. We tell them what is wrong, they tell us how they are going to fix it."

Gordon moved her mother out of Hillside on March 17, 2000, after finding her sobbing, in a urine-soaked bed, saying she had been ringing her bell since the night before.

She again complained to the Health Department on March 22, 2000, writing that personal care at Hillside had deteriorated due to a lack of staffing.

Gordon's complaint included another matter: a Hillside doctor had halted her mother's daily heart pills for no apparent reason.

The Health Department's Complaint Unit sent the complaint about the doctor to the department's Board of Medical Licensure and Discipline.

It took the licensure board three years to investigate.

In March 2003, three years after Gordon complained, the board sent the doctor a "letter of concern."

Of the approximately 1,000 complaints received by the licensure board each year, 300 are investigated.

About 10 or 15 cases result in a formal sanction.

In another 40 cases, the board doesn't sanction the professional, but sends a "letter of concern."

In the spring of 2003, Gordon's mother died of heart failure. Gordon started wondering whatever happened to the complaint she had made about Hillside. She wrote to the licensure board, and received a reply describing the board's findings.

According to an Aug. 1, 2003, letter to Betty Gordon from Derek J. Puleo, assistant administrative officer, the board had "noted that stopping Mrs. Filippelli's Digoxin entirely to determine if she could do without it, and then re-instituting it to determine if she would become symptomatic, did not meet the standard of care."

Puleo added: "In addition to poor communication, the Department's medical reviewer, the physician who acted as an expert consultant in this case, and the Board, also expressed concern over the poor documentation in the medical records" of the doctor.

Why the three-year delay in the investigation?

Dr. Robert S. Crausman, chief administrative officer for the board, says Gordon's complaint in 2000 came as "the board was between chief administrative officers."

Gordon's complaint was not as worrisome as other cases, he says, and "was sort of triaged to the bottom of the pile."

Gordon says, "What bothers me about the three-year wait was that this doctor was still treating other patients."

Jennifer Levitz can be reached at jlevitz [at] projo.com or 277-7931.