State regulators knew two years ago that Hillside Health Center was struggling to pay for food and basic medical supplies. Yet it was a court receiver -- not the state Health Department -- that finally closed Hillside.

12:30 PM EDT on Monday, October 18, 2004

BY JENNIFER LEVITZ
Journal Staff Writer

The air conditioner busted in the summer, insects speckled the wall by the broken ice machine, and the seafood salad was unsafe, served at 52 degrees.

The orange juice was kept at 76 degrees.

Supply companies would not deliver bandages without cash up front. The dairy that brought the Lactaid cut the nursing home off altogether.

This was life at Hillside Health Center, the 165-bed Providence nursing home that went into state bankruptcy in March and closed in June.

Records at the state Health Department showed that Hillside had a pattern of residents with bedsores, and the worst inspection record of any nursing home in Rhode Island.

Recent interviews with families and employees, and a further review of the public records, show that Hillside was chronically short of money to provide quality care for its residents.

And health inspectors knew that Hillside was struggling to pay its suppliers and its employees.

Hillside's former administrator, James D. Janetakos, said in a recent interview that the Health Department inquired about the tenuous finances at Hillside in 2002 and again in 2003.

Around the fall of 2002, Janetakos said, a state nursing-home regulator called and said, 'Jim, we're just getting a lot of rumors that you're running out of food and running out of medical supplies. Show me you've got it coming in.' "

Journal photo / Bob Thayer

Sean Woods, Hillside's former human-resources director, says that near the end, 9 out of 10 checks bounced. "We did our best to keep residents healthy and safe," he says.

The state's ombudsman for the elderly had complained to the Health Department in July 2002 that Hillside's checks to employees were bouncing. Three months later, the Health Department's spot check of 20 residents found widespread flaws at Hillside, including that some residents were not getting all their medication. A worker said one man wasn't getting his seizure drug because the supply had been out for two months, according to inspection records. Diabetics said Hillside had stopped handing out the evening snacks they needed.

Janetakos said he provided the state a month's worth of invoices, which showed that food and medical-supply companies would deliver to Hillside only if they were paid cash up front. Hillside, he said, had already been cut off by other food vendors.

Robert J. Marshall, spokesman for the state Health Department, told The Journal last week that the department did not have a record or recollection of asking for those invoices in 2002.

He confirmed that regulators did ask Hillside about payments to food and medical suppliers in 2003.

He said that inquiry was likely prompted by a complaint that food and supplies were short.

"We found that minimally adequate supplies were available," he wrote in an e-mail to The Journal. "There may have been some brief period where supplies were short but this did not continue."

He said the Health Department also looked into the bounced paychecks.

"This inquiry," Marshall wrote, "determined the problem was that paychecks were distributed on Thursday but dated Friday and couldn't be cashed immediately. By Friday, there was enough funds in the account to permit the cashing of the checks."

In a recent interview, Janetakos said he wasn't given enough money, as the administrator, to pay bills.

Janetakos recalled: "I tried to pay the bills I needed to pay to stay open. I didn't worry about vendors who'd stopped service. The providers of nursing services, they wound up telling me they were going to sue us and some of them did."

Jayne Birch, a registered nurse for an Attleboro temporary staffing agency, worked at Hillside in the winter of 2002, into early 2003.

"We were frequently short of supplies, there were times when they were short of insulin syringes and dressing supplies. Sometimes they would be locked up and only one person would have access. If he wasn't there, you had to try to get someone else. Particularly on weekends, they were short. . . . You would have to go to different floors to search it out," she said.

She said the nursing home was frequently missing medicine and specifically remembers having to borrow a prescription drug from one patient's supply to give to another until she could get to the pharmacy. "You were forced into that situation," she said.

"Once I saw the condition, I didn't go back. I asked not to go back."

Hillside had promised to pay her agency on a payment plan but had fallen behind so the agency had pulled out its nurses. Another temp agency, Above the Clouds Staffing in Woonsocket, also refused to continue sending a nurse to Hillside, said Michael T. Sanders, president.

"It wasn't good at all," he said. "The nurse asked not to be sent there again."

WILLIAMETTA KERKULA, who worked as a nursing assistant on the morning shift, was supposed to wash the residents, but she was often out of Peri-wash, a gentle soap used for fragile skin, she said. She'd stick a cup under the dispenser in the bathroom. "I'd have to use the soap in the bathroom that we wash our hands with."

Gina Lebrun, another certified nursing assistant, said that in 2003, she saw the food "really dropping, I knew the place was going to close."

"If someone didn't like ham, there wasn't any substitute. Sometimes they just would not eat, or eat a snack or whatever we could find.

"You'd go to the kitchen and ask and they'd say, 'I'm sorry, we ran out.' "

Lebrun was making her rounds one night in June 2003, when she came upon a room with a "caution" sign on the door, warning anyone who entered to don a mask and gloves.

Lebrun worried about catching a virus and then passing it on to her daughter, who was getting chemotherapy for cancer. But, she recalled: "There were no masks. The nurse told me, 'well, go grab a towel and cover your face.' They didn't have gloves, and told me to go buy gloves at Brooks."

Janetakos, the administrator, said he controlled inventory at Hillside, but he disputes that he actually ran short on food or supplies.

He said the staff were told to stock their units before the kitchen closed for the night, at which time the refrigerator was padlocked.

"If we left it unlocked, everything -- milk, butter, eggs, sodas, those kinds of things -- people would just walk in and take it. We think they were taking it home."

At one point, he said, he took back most of the keys to the main medical-supply closet and put a padlock on that, too.

"We were running out of things too quickly, especially gloves. We started to limit that."

When Sean Woods, the former human-resources director, started working at Hillside in June 2003, the workers' paychecks were bouncing, so he made a deal with Citizens Bank to cover the payroll.

"For a time they did. We ran thousands in bounced fees -- $5,000 to $6,000 a month in bounced fees. We went through that until September [2003] when the bank said forget it."

"Given the financial state of Hillside, any check that went out of there had a 90-percent chance of bouncing," he said. "It was a madhouse, we did our best to keep residents healthy and safe."

BUT RESIDENTS like Louise Conaty, 92, knew something was wrong at Hillside.

She had worked in the restaurant at the Biltmore Hotel for 38 years. She never expected that when she needed to be served, she would have to beg for coffee creamer from her bed in a nursing home.

What's the story, she'd ask "the girls" at Hillside. No cream?

We're out, she was told. They didn't pay their bills.

How about a tea bag?

All out.

The pork chops are tough. Have you an alternative? A salad?

All out.

"I wondered," she recalled, " 'what's next, the lights?' "

That wasn't far-fetched. Hillside might have had a chandelier in the dining room, and fancy window treatments -- a renovation financed through a loan backed by the U.S. Department of Housing and Urban Development -- but everything was on the blink.

In the Alzheimer's unit, three floors up from Conaty, one air conditioner was jammed and awaiting a replacement part and the other air conditioner had been broken all that summer of 2003, which the Health Department had noted in a complaint investigation that August.

And in the main function room at Hillside, the air conditioner had been down for two years straight. Janetakos said sometimes he put out a fan, but he had to clear everyone out when the room hit 80 degrees.

The refrigerator was still breaking down, forcing the nursing home to shuffle around food to keep it cold.

Janetakos said he tried to get money to fix the elevators; one had been down since Hillside opened, which he knew was a fire hazard.

It didn't seem like the way to live, said Louise Conaty, who now lives in an assisted-living apartment in Johnston, "not after you've run a home and raised a family."

Conaty, who wears a glittery "L" charm around her neck, said she fared OK. She has a watchful family, and she is resilient, "fast-forward as they say."

But, eating "watered down" stew, and begging for cream for her coffee or a tea bag or an alternative to dried pork chops was "degrading."

"Don't forget, I did fine dining in the Biltmore during the war years," she said.

"It should not be that way, just because you get older," she said. "We weren't animals."

Across the hall at Hillside lived Mildred Bricault, 81, who collects angel figurines. She had worked in a Pawtucket factory making straps. In 2000, she lost her sister, her son, her husband and her left leg.

"We used to have our families bring in canned goods," she said, "so we could have some hot soup or different things. Soup and brown bread in a can. Mostly hot soup. Campbell's noodle soup."

Even by institutional standards, Hillside's food was awful, said Betty Franko, whose mother-in-law Anna Franko lived at Hillside. "Every day they'd have some kind of dried-up sandwich."

Franko, a pediatric nurse, said Hillside was out of basic things in the kitchen, "no straws, no cups, things like that. We brought in our own cups and own straws. Even like bedside bags patients put tissues in."

Jacqueline Wallace, also a registered nurse at a Providence clinic, stopped by Hillside every day to see both her mother-in-law, and her mother, who had dementia and imagined she saw bears outside her window.

"One night, there was a fight," Wallace recalled. "This woman wanted Kleenex for her husband. The staff said, we don't provide them. I thought, what the hell is going on here?"

Another time, Wallace said, there were no fresh gloves around that would fit an aide. The worker was told to wear a used pair. Wallace said she told her, "Don't do that, that's not safe."

Food portions shrank, Wallace said. A scoop of maraschino cherries with cottage cheese, for instance, passed for a fruit plate.

IN APRIL 2003, Hillside turned to Guida Milk and Ice Cream Co., of New Britain, Conn., to supply milk and other dairy products. The company that managed the nursing home's food-service operations ordered the food, and Hillside was supposed to pay.

That never happened, according to Phyllis Consalvo, credit manager at Guida, but Guida kept delivering -- twice a week.

"It's not our policy in this company to shut nursing homes off if we can help it," said Consalvo.

The dairy company appealed to nursing home owner Antonio L. Giordano's company, Hillside Health Center limited partnership, at 190 Broad St. in Providence.

John Montecalvo, the financial officer of the company, kept making promises to pay, she said. "He kept saying they were having tremendous cash-flow problems." Company executives have declined repeated requests for comment from The Journal.

By Sept. 20, 2003, Hillside's balance with Guida was $15,576.16. Guida told the home: pay cash for each delivery or Hillside would get no milk.

Hillside never bought again from Guida.

"We didn't want to do it," said Consalvo. "We wanted to work with these people."

Between Oct. 30 and Nov. 4, 2003, when the Health Department returned to Hillside for the annual inspection, 11 family members met with the inspection team and some complained about food, according to records from the Health Department. One of them, Gail Marcoux, said Hillside had inexplicably stopped passing out beverages and snacks. "My mother was always thirsty," she recalled.

By this time, the Health Department had for three years been citing Hillside for problems with food and nutrition. This visit was no different. In the third-floor dining room, a man ate breakfast wearing a leather tie, shoes with no socks, and an open johnny that exposed his backside.

"This food is cold," he said, according to inspection reports. "I cannot eat it. What should I do now, sit here with this cold food?"

Interviews with the kitchen staff "revealed that no heated pellets were being used," inspectors wrote. The pellet machine was broken.

Employee checks were bouncing over the holidays.

A worker told inspectors there wasn't enough bedsore dressing in stock to treat an ill resident.

By the year's end, the quality of life and care at Hillside had so deteriorated that the Health Department banned new admissions.

Health inspectors were in Hillside on Jan. 30 and met with 23 residents, according to inspection records. "The majority of the 23 residents attending complained of fluctuating food temperatures and cold soups."

THE HEALTH DEPARTMENT was asked last week what its role is in looking at the finances of a nursing home operation.

Marshall, the spokesman, answered in an e-mail: "Only as it has a direct impact or result on resident care."

Marshall said there is no framework or requirement for any nursing home to share financial information with the Health Department.

He said, "We can monitor for availability of supplies and staff."

State law does permit the Health Department, Marshall said, to petition the courts, through the attorney general, to take a nursing home away from an owner and put a receiver in charge.

In the case of Hillside, that did not happen.

Janetakos said he thought the showdown was coming on Feb. 19, when state officials were scheduled to meet with Hillside executives. Hillside was into the second month of the state ban on new residents, but 108 people were still living there.

Janetakos said that he, his nursing director, and John Montecalvo, the financial officer, were called to the Health Department that day.

Marshall, the Health Department spokesman, told The Journal last week that the Feb. 19 meeting was a "demand meeting" called by the Health Department.

"The purpose of the meeting was to make it clear with the owner and administrator that [the Health Department] was moving toward license revocation if there was not immediate and significant progress in bringing the facility into full compliance."

Those present included Health Department officials, the state's ombudsman for the elderly, and representatives from both the attorney general's office and the Rhode Island Department of Human Services.

John Young, an associate director at Human Services, said in a recent interview that it's not common for the two state departments -- human services and health -- to share information about nursing homes, although they both have oversight roles: the Health Department inspects, while Human Services dispenses state and federal Medicaid payments to the nursing homes. At Hillside, he said, the typical monthly Medicare payment was $400,000.

Young recalled that Hillside's owners had asked for and received advances on Medicaid payments four times since January 2003. It's an atypical request, Young said, and one that suggests that a nursing home's finances are fragile.

Young said that Hillside's most recent annual cost report to the Human Services Department had showed that the expenses were being met.

Janetakos said he explained at the meeting that he was doing the best he could with the money he had. He said Donald C. Williams, associate director of health services regulation, asked him whether he was getting enough money from the owner to run the nursing home.

Janetakos said he told Williams, "unless my back is against the wall, the answer is no."

He said he told Williams that when he called the owners to tell them he couldn't pay bills, the usual reply was "let's wait to see the income, what comes in tomorrow."

According to Marshall, Hillside's lawyer said the nursing home would be in compliance in several months. "Our staff responded that this was unacceptable. We would not permit this to continue due to patient care concerns," he wrote.

Janetakos said he left the meeting expecting that he would lose his license -- he eventually did, after Hillside closed -- and that the Health Department would close Hillside down the next day. But that didn't happen.

Thirteen days later, on March 3, the owner of Hillside put the nursing home into receivership in Superior Court, Providence, declaring that he couldn't pay his bills -- which would total $9 million in claims.

That day, state health inspectors visited Hillside and noted that the ice machine and the plate warmer were broken. The pureed potato salad was 70 degrees.

The court-appointed receiver, Providence lawyer Allan M. Shine, had taken over the business and hired a temporary administrator, Carol Mancini, to come in that day and run Hillside.

It was 6:30 p.m. when Mancini realized there wasn't enough food for the next day's breakfast.

With staff reports from Paul Edward Parker.

Jennifer Levitz can be reached at (401) 277-7931 and jlevitz [at] projo.com