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"Nursing facility assessed stiffest fine possible in patient’s death"

The Bakersfield Californian

BY EMILY HAGEDORN, Californian staff writer
Thursday, Jul 17 2008 5:08 PM

The state has slapped a Bakersfield skilled nursing facility with the stiffest fine possible after inadequate care killed a patient, it was announced Thursday.

Bakersfield Healthcare Center was fined $100,000 after failing to address adverse medication interactions that resulted in a patient’s death, according to the Department of Public Health.

The patient death occurred when the facility was run by Pleasant Care Corp., and the fine has been paid by that company, said Mary Sue Franklin, executive director of the facility.

LifeHouse Retirement Properties, based in Grand Rapids, now owns the facility.

"It’s not connected to the present owner in any way," Franklin said.

Pleasant Care filed for bankruptcy in 2007, and officials could not be reached for comment.

The resulting AA citation and fine is the most severe penalty and fine under state law and is reserved for skilled nursing facilities that directly cause a death, said Ken August, spokesman for the state Public Health Department.

According to a report filed with the state, the patient was admitted to the facility, at 730 34th St., in September 2006 and was prescribed Coumadin, a blood thinner, and Mobic, an anti-inflammatory drug.

The patient declined to take a blood test to detect drug interactions, and the staff failed to write new orders for tests, determine why the patient refused and update the patient’s care plan regarding the refusals, the filing says.

Fifteen days before the patient’s death, the facility’s pharmacist documented that taking the medicines together carries a risk of gastric ulcers and indicated that other medicines should be prescribed, the filing said. When the physician approached the patient about changing, the patient refused.

"However, no evidence was found that nursing staff reassessed the patient or offered risks versus benefits of changing the medication," the filing says.

On Oct. 19, 2006, the patient was taken to a hospital for low blood pressure and bloody stool.

The patient died 12 hours later.

"It is certain that the patient has essentially bled out through GI (gastrointestinal) tract and attempts at further resuscitation are futile," the emergency physician documented.

Franklin couldn’t comment on the whereabouts or current employment of employees involved in the incident.

The filing, signed by Franklin, says the facility agrees to closely monitor patients on Coumadin for any interactions. The staff will attend training on the medicine and how to care for patients who take it.

Preceding bankruptcy, Pleasant Care settled a $1.3 million lawsuit brought by former state Attorney General Bill Lockyer in 2006 as a result of allegations of elder abuse and negligent care. Pleasant Care facilities received more than 160 violations of state regulations over the previous five-year period.

While the incident happened in 2006, the complaint wasn’t filed with the state until July 2007, August said.

"It’s not unusual in a complicated case for the investigation to take a year," he said. "And a case like this must be thoroughly investigated to determine that this penalty is warranted."

Fifteen AA citations have been filed by the state this year, he said. This is the only citation of its kind in Kern County this year.