The governor wants to know why it took so long for health-care problems at a Providence nursing home to be addressed; he calls for an internal investigation of regulators, and he outlines new oversight legislation.

07:45 AM EDT on Wednesday, August 25, 2004

BY JENNIFER LEVITZ
Journal Staff Writer

PROVIDENCE -- Governor Carcieri yesterday said he would introduce legislation in the General Assembly to overhaul the system that regulates the state's 101 nursing homes.

He called for an internal investigation into Health Department regulators who repeatedly gave a Providence nursing home chances to meet standards even while patients were in harm's way.

Carcieri said "The Nursing Home Patient Safety Act" would give the state power to investigate the finances of private nursing homes, to act more quickly against poor facilities, and to intervene in deficient homes by appointing monitors to see that patients are being treated properly.

Carcieri's announcement came one day after a two-part Providence Journal story detailing flaws in the state's regulatory system, and telling the plight of Germaine Morsilli, an 87-year-old former resident of Hillside Health Center. Health inspectors documented her decline from November to February, from a Stage 2 to Stage 4 bedsore, before finally moving her.

Journal photo / Glenn Osmundson Governor Carcieri listens as Dr. Patricia Nolan, director of the Department of Health, answers a question at a news conference yesterday in the governor's office.

"Stories about the treatment of patients at Hillside have touched a nerve in all of us," Carcieri said at a news conference at which he was joined by Dr. Patricia A. Nolan, director of Rhode Island's Health Department.

He said the "thing that concerns me most about this circumstance right now is the question of what took so long?"

"I have spoken to Dr. Nolan to reiterate that the Department of Health and all of state government should always err on the side of protecting the safety and well-being of residents," Carcieri said.

Hillside Health Center on Providence's East Side closed in June, after a history of financial and health-care problems, forcing some 80 residents to move to other nursing homes. The owner, Antonio L. Giordano, was known as one of the delinquent borrowers behind Rhode Island's credit union collapse of 1991, and was part-owner of another nursing home that had care problems.

The Health Department documented serious flaws in the care at Hillside in the fall of 2002 and threatened fines. Yet after owners filed a "plan of correction," the threat was rescinded.

The next fall, during an annual sampling of 25 residents, inspectors first saw Germaine Morsilli. The Pawtucket woman, a former factory worker and a great-grandmother, was one of several Hillside residents with bedsores, which happen when people stay in one spot so long that their skin breaks down.

The Health Department notified Hillside that it would be fined, possibly lose Medicaid, and it froze admissions by December when a follow-up revealed conditions were worse.

But the department continued to allow Hillside to care for residents, including Morsilli.

The inspectors noted during a visit to Hillside on Feb. 13 that the Stage 2 bedsore they saw on Morsilli in November was by then a Stage 4, into her tissue and muscle and oozing blood. At Stage 4, infection can set in and a person can die. The department allowed Hillside to move Morsilli to a new unit and care for her for two more weeks before finding her dressing soaked with feces and ordering her moved.

Hillside's owner put the nursing home into receivership in March and it closed in June, unable to recover from financial problems. Hillside left owing $82,000 in unpaid fines for poor care.

Carcieri said that the proposal he unveiled yesterday had been in the works for sometime, but that the recent stories in The Journal had brought to light the "urgency to move forward."

"Oh, it's heartbreaking to see somebody, you know, their health deteriorating from bedsores because they're laying there totally immobile or laying there in either urine or feces or whatever," he said. "I mean, that just should not be happening."

Carcieri's proposed Nursing Home Patient Safety Act would for the first time grant the Department of Health and the Department of Human Services authority to investigate the financial condition of a nursing home.

It would increase the accountability of nursing home owners by requiring them to have more transparent corporate structures. Hillside Health Center was divided into at least two corporations.

The act would grant the Department of Health increased authority to act more quickly against a deficient nursing home, he said.

It would enable the Health Department to appoint a monitor, "someone on site with the authority to monitor patients' care . . . and stay on top of that."

Carcieri said the closure of Hillside also illustrates the need for more resources at the Health Department.

He said he would seek additional personnel and funds from the General Assembly in the 2005 and 2006 budgets, though he didn't say where that money would come from.

Carcieri said he was immediately installing new technology to ensure the tracking of complaints from nursing home residents and their families.

He said the measures "will provide the department with the tools and resources it needs to aggressively oversee the safety of residents."

Nolan was appointed in 1995 by former Gov. Lincoln C. Almond, and works on a five-year contract. She is in her fourth year of her second contract, and earns about $140,000 per year. She oversees 493 employees in five divisions, including the regulation of health facilities.

While she has been praised on some public-health issues, such as childhood lead poisoning, her department has recently been criticized for its slow response to crisis.

In July, a consultant brought in by Carcieri to study Rhode Island's response to The Station fire was sharply critical of the medical examiner's office, which is under Nolan.

While the chief state medical examiner, Dr. Elizabeth A. Laposata, learned of the rising body count in the hours after what proved to be the nation's fourth-deadliest nightclub fire, she provided one investigator to work at the scene. The response left the medical examiner's office with an incomplete record of where many of the 96 bodies were found, possibly hurting the criminal investigations. The report noted that Nolan was never notified on the night of the fire.

Yesterday, asked whether he was concerned about Nolan's performance, Carcieri declined to criticize her and said he was looking into both the handling of the fire and the nursing home.

Yesterday at the news conference, Nolan spoke about Germaine Morsilli.

Nolan said that the Health Department's close monitoring of Hillside last fall did improve care for some patients there. But, "the lady described in the story is one of a number of residents in this facility . . . she is one of the residents that for reasons we do not understand, they could not manage to care for."

She said later, "in retrospect, I think many members of the survey team feel that for whatever reason, the facility was unable to care for this individual and it's unfortunate that we didn't move her earlier. On the other hand, the assessment that the facility had the capacity to care for her is documented in our survey. Why they wouldn't care for this particular individual, I do not know."

Carcieri said: "I agree with Dr. Nolan that we shouldn't have taken so long."

He said there is a "question of whether we were tilting too heavily toward supporting the facility question versus making sure that person was getting the kind of care that she deserved."

Yesterday, Lt. Gov. Charles J. Fogarty also released recommendations -- already in the works -- for stronger legislation and said that the Health Department should start notifying families immediately when their relatives are being monitored by the state. That does not happen now.

Asked after yesterday's news conference about how soon regulations could really change, Carcieri said he realized that legislation in Rhode Island can take a while. Such a measure would likely be opposed by the nursing home industry.

Two nursing home representatives at the news conference yesterday said they opposed more legislation, that it would not prevent another Hillside from occurring because Hillside was doomed by a poor operator, not lax regulations.

DIGITAL EXTRA: Recap the special Sunday Journal investigative report on nursing homes, titled "Resident #1," with photos and related stories, at:

http://projo.com/extra/2004/nursinghomes/