09:33 AM EDT on Tuesday, August 24, 2004

Jennifer Levitz's Sunday Journal report on the lax state regulation of nursing homes was searing and astonishing.

I know from visiting relatives that numbers of administrators, nurses, and social workers are dedicated and even saintly. I also know that it is a tough business to run, with pressures to save money, and it can be frustrating. And occasional lapses in patient care or state oversight could be expected.

But Levitz's tour de force, focusing on the Hillside Health Center, where problems were serious and persistent prior to its entering receivership and shutting its doors, exposed a state Health Department whose approach to regulation is dangerously lenient. It is marked by empty threats, excessive patience, undue coziness with operators, and an understandable but misguided fear that putting dicey homes out of business would traumatize the elderly. Sure, you want, if reasonably practical, to straighten places out and spare seniors the need to move. But it is obvious that the Health Department allows homes to take undue advantage of this attitude.

Especially troubling were comments from Ray Rusin, the department's chief of facilities regulation. He said nursing home operators complain of overzealous inspections. Rusin said he must meet standards of care. "But I'm cognizant of the fact that if I royally piss off the industry, they are going to go around me to the legislature."

Rusin should do his job and not worry about an industry end run. And if the operators want to grouse to the General Assembly, as indeed they sometimes have done, so what? Such moves can lead to public debate.

It was outrageous to read of the difficulty experienced by average citizens -- say a daughter of a patient -- in forcing either the operators or the state to pay attention to maltreatment of their loved ones or even to obtain basic information about conditions in homes. Part of the problem is delay caused by a department that bends too far in cozying up to operators.

Also alarming was the hands-off picture that emerged of Dr. Patricia Nolan, the health director. Certainly in terms of public relations -- doing interviews, say, or testifying before legislative committees -- she always struck me as savvy. It was chilling to read Levitz's account of trying to talk with Nolan about a patient whose ordeal at Hillside was the centerpiece of the Sunday Journal package. Nolan seemed more interested in avoiding second-guessing her underlings than in responding to the facts of the situation. After Nolan said she didn't remember details of the case, Levitz offered her the paperwork; Nolan pushed it back across the table. When I read that, I felt as angry as I do when I see public officials slam doors in reporters' faces. I would have expected better from Nolan.

I will be curious now to see what kind of reaction -- in words and in deeds -- the Levitz package draws from Governor Carcieri and the department. I will be curious to see if any heads roll or if any changes are introduced in the way the department does business and relates to the public.

Many pols may jump on the situation to grab a quick headline. But I will be curious to see how many really immerse themselves in this area.

In the end, it is a matter of conscience for all of society.

Psalm 71 says: "Do not cast me off in old age; when my strength fails, do not foresake me!"

Leviticus says: "You shall rise before the aged and show deference to the old."

This couldn't be clearer.

M. Charles Bakst, The Journal's political columnist, can be reached by e-mail at mbakst [at] projo.com