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"State fines Modesto nursing home $100,000"

The Modesto Bee

Posted on Tue, Mar. 04, 2008

English Oaks also was fined in 2001 for not monitoring the feeding tube of a patient who got an infection and died. - Modesto Bee - Brian Ramsay

State health authorities have assessed a $100,000 fine against English Oaks Convalescent & Rehabilitation Hospital in Modesto in the death of a 91-year-old patient who choked on food.

The "AA citation" issued in February by the Department of Public Health is the most severe penalty under state health codes.

An autopsy determined that Ernest Costa Sr. died at the nursing home Feb. 17, 2007, from choking on part of a peach.

The citation charges that English Oaks failed to find out what was wrong with the patient while he was choking, did not provide emergency care and failed to use procedures such as the Heimlich maneuver to try to save Costa.

The state assessed the fine against English Oaks and its owner, GHC of Modesto LLC. The 180-bed facility at 2633 W. Rumble Road provides long-term and rehabilitative care to patients.

Deanna Hill, administrator for English Oaks, said Friday she needed to speak with the company's attorneys before commenting on the citation. She did not return phone messages Monday. A state official said the company is appealing the fine.

In 2001, the nursing home received a "AA" citation and was fined $60,000 for the death of a 74-year-old patient. State health officials said the facility failed to properly monitor the woman's feeding tube, resulting in an infection that appeared to lead to her death. On appeal, the citation was reduced to an "A" violation and the fine set at $50,000.

Costa, who suffered from congestive heart failure and kidney problems, spent just over a year at English Oaks before the incident occurred. He was from Stockton and lived with family members in Modesto before being admitted to English Oaks.

Costa had memory loss and required assistance with eating and other daily activities.

State authorities reviewed records at English Oaks while investigating the incident last year. Costa was on a diet of soft foods because of problems with chewing and, five days before his death, he told staff he did not want peaches with his meals, records show.

During breakfast Feb. 17, 2007, a nursing assistant called a nurse to the dining hall at 7:45 a.m. because Costa appeared to have trouble swallowing. The licensed vocational nurse found no food in his mouth and told staff to take him to his room and have him lie down.

A second LVN reported at 7:50 a.m. that Costa was alert when he was returned to his room in a wheelchair. He was trying to cough out something but said he was OK, records show.

Costa soon became unresponsive, however. A supervising registered nurse called to the room kept him upright in the wheelchair but couldn't see anything in his mouth. The staff called 911 and by 8:05 a.m. Costa had no pulse. The ambulance was canceled because Costa had a "do not resuscitate" order.

An autopsy determined the peach part was caught in Costa's oropharynx, a tube that runs from the esophagus to the base of the skull. The oropharynx facilitates speech and is an airway to the lungs.

According to investigators, a policy at English Oaks calls for using the Heimlich maneuver to remove an object from a choking patient. Their report concluded that facility staff "failed to recognize and did not respond in the standard manner to clear the patient's airway. A physician's order for 'Do Not Resuscitate' does not mean a facility should not attempt a Heimlich maneuver to prevent a choking death."

In January, Costa's sons and a daughter filed a lawsuit in Stanislaus County Superior Court, charging that English Oaks knew about his need for a special diet but failed to give him proper eating assistance and gave him inappropriate food. Costa suffered mental anguish and physical pain during the choking, culminating in his death, the lawsuit says.

Costa's family, among other complaints, is alleging elder abuse on the grounds that GHC of Modesto operates the facility to reap profits and intentionally underfunded and understaffed the facility to increase earnings.

The plaintiffs -- Darrell Costa, David Costa, Ethel "June" Cesmat and Ernest Costa Jr. -- are seeking an unspecified amount of general, special, punitive and exemplary damages. David Jamieson, a Modesto attorney representing the family, declined to comment on the case. No trial date has been set.

Attorneys for English Oaks responded in a court filing that the lawsuit lacks evidence to support the elder abuse charge.

State authorities required the nursing home to submit a plan for correcting the violations. According to the plan, English Oaks took immediate action to give training to staff on recognizing the signs of choking, performing the Heimlich maneuver, suctioning and administering oxygen.

Employees will be given monthly training in emergency care for a year. In addition, the facility reviewed the residents who were on soft diets and identified 10 who were at higher risk for choking so their diets could be changed.

Nurses on duty in the dining hall will observe residents' eating ability during every meal and report any difficulty to the director of nursing, the plan says.

English Oaks isn't the only facility in Stanislaus County to have received a "AA" citation. In 2005, the state ordered Turlock Nursing and Rehabilitation Center to pay a $90,000 fine for the death of a patient from a head injury. The 91-year-old woman died 20 days after striking her head on a floor while an employee tried to move her from a wheelchair into bed, the state reported.