State Officials, Patient Advocates Clash Over Caregiver Abuse Cases

By Rachael Bale

The Center For Investigative Reporting

Officials from the California Department of Public Health and long-term care advocates clashed today at an Assembly oversight hearing over regulators’ ability to process complaints of abuse against nursing assistants.

They couldn’t even agree on the number of abuse allegations that have yet to be investigated.

Evon Lenerd, a state health department official whose branch oversees investigations into caregiver abuse, said the state has a backlog of about 700 complaints that are more than a year old.

“What’s taking so long? It’s just the process,” Lenerd told lawmakers. “We are investigating every complaint we receive.”

But Patricia L. McGinnis, the executive director of California Advocates for Nursing Home Reform, said she had received private assurances from people within Lenerd’s professional certification branch that there were nearly 10,000. McGinnis said the department has been “extraordinarily unresponsive and has a long history of noncompliance.”

“Their pattern has been to do nothing and hope no one notices,” she testified.

Another witness at today’s hearing, the state ombudsman for long-term care, Joseph Rodrigues, said local ombudsmen have problems with their complaint referrals getting stuck on desks at the public health department and not having phone calls returned. Once, one was told to stop investigating a complaint even though allegations continued to come in from that particular facility.

The backlog is especially problematic, both officials and advocates testified, because as time goes on, substantiating allegations becomes more difficult as staff moves, evidence disappears and those who complain die.

The hearing, held by the Assembly Committee on Health and Committee on Aging and Long-Term Care, comes four months after The Center for Investigative Reporting found state health regulators had routinely conducted delayed and superficial investigations into complaints of abuse and neglect at the state’s long-term care facilities for the elderly and developmentally disabled.

At the hearing, Assemblyman Dr. Richard Pan, D-Sacramento, asked where the choke points of the investigative process were, saying his goal was to determine how the Legislature could assist the department.

Ron Chapman, the director of the Department of Public Health, did not provide specifics, though the committee and officials set a March deadline for a progress report on an improvement plan.

“There are significant process complexities that are involved here,” he said. Chapman testified that the department is looking to hire more staff members to help process complaints but that past staff hires haven’t helped the backlog significantly.

The CIR investigation focused on the role of public health department investigators within the Licensing and Certification division, which has oversight over the quality of care in residential facilities.

Over the past several years, the Department of Public Health has closed the vast majority of abuse and misconduct cases without action, CIR found. And the agency mostly has stopped referring cases to the California Department of Justice for prosecution and cut back on revoking licenses of nursing aides suspected of abuse.

In Southern California, abuse cases often are sent to Sacramento headquarters, where investigators rarely receive approval from supervisors to make site visits. During a mass dismissal of nearly 1,000 cases in 2009, many complaints were closed with a single phone call from the investigator, CIR learned.

When asked about this mass dismissal, Lenerd said that not every complaint warrants a site visit but that all 1,000 cases were investigated.

“At no time did we dismiss complaints with just one phone call. There were investigation steps used for every complaint allegation received,” she said. “As the cases got older, there (was) less evidence, less witnesses to interview. But we investigated every complaint allegation received.”

California law requires that the Department of Public Health perform on-site, in-person investigations.

Assemblywoman Mariko Yamada, D-Davis, requested a disposition of the 1,000 cases, which Chapman said he would provide.

In one case from 2008, which demonstrates the department’s slow investigative process, nursing aide Jason Joslin physically abused at least one patient at a facility in Riverside County. Although the public health department opened an investigation right away, it wasn’t until 2011 that the state took away his certification and decided to add him to a nationwide exclusion list.

But by then, Joslin had moved to Seattle, obtained a temporary nursing assistant license from Washington and was fully credentialed within months.

Another particularly egregious case involved the suspicious death of Elsie Fossum in 2006, who was then 95 and living at Claremont Place Assisted Living in Southern California. She was found severely injured on the floor of her bedroom. Several caregivers at the facility made it clear that they believed a nursing assistant had attacked Fossum. But the health department dismissed it as an accidental fall from her bed.

Because of the severity of her mouth injuries, Fossum died of dehydration a few weeks later.

The case was closed as unsubstantiated. The nursing assistant, who had in the past made disparaging comments about the elderly, quit soon after the incident and took a job at a nearby facility.

Seven years after Fossum’s death, the Los Angeles County Sheriff’s Department opened a criminal investigation, in part, following questions from reporters. The case remains unsolved, and the nursing assistant has not been charged with a crime.

The legislative hearing came about a week after a task force convened by the California Health and Human Services Agency, which oversees the Department of Public Health, released a report on the future of California’s developmental centers.

Essentially, the agency’s goal is for state-operated residential facilities to play a decreasing role in caring for the California’s developmentally disabled residents. As such, the task force’s report focuses on how to transition more residents from the state’s five board-and-care facilities into smaller, more specialized community programs.

In particular, it recommends establishing health resource centers where people who have transitioned to community homes would receive coordinated health services, ranging from mental health care to medication management to medical equipment and other services.

The report also recommends that the state operate smaller acute crisis facilities and crisis response teams, provide funding to regional facilities to expand care for those with enduring and advanced medical needs, and continue operating the Canyon Springs Community Facility and the Porterville Developmental Center’s Secure Treatment Program for those in the criminal justice system.

This story was edited by Robert Salladay and copy edited by Nikki Frick and Christine Lee.