March 9, 2016

Kay Lazar

A Wilmington nursing home where a worker accidentally dropped a resident who died two days later is being fined thousands of dollars by federal authorities for providing substandard care, according to a government report made public Tuesday.

Woodbriar Health Center faces an even more dire penalty if it does not swiftly fix significant problems: The facility could be cut off from the federal and state health programs that cover the bills of most of its patients, costing it hundreds of thousands of dollars.

An investigation by state authorities found a widespread breakdown in communications and care at Woodbriar, part of a chain of troubled nursing homes owned by Synergy Health Centers. Investigators concluded that three shifts of nurses learned that 83-year-old Mary Meuse broke her legs in the Christmas Day fall but failed for 24 hours to let her, or her family, know the results.

The results of the state probe were turned over to federal authorities. Helen Mulligan, spokeswoman for the Centers for Medicare & Medicaid Services, said federal regulators are still determining exactly how much Woodbriar will be fined. She said the penalty will range from $250 to $3,000 a day, with the calculation likely starting from Christmas Day, when Meuse was dropped from a mechanical lift. If the maximum penalties were imposed, Synergy would face fines approaching $100,000.

Meuse, who was taking blood thinning medication for heart problems, was bleeding internally from her injuries. She died Dec. 27.

“I still can’t fathom what went on,” said Meuse’s daughter, Brenda Murray, after reading the report.

Synergy, the New Jersey company that owns Woodbriar and 10 other Massachusetts nursing homes, has faced mounting citations for substandard care — medication errors, poor infection control, inadequate staff training — since buying its first Massachusetts facility in 2012. The citations concerning the Woodbriar death are among the most serious.

Synergy released a statement through a spokesman Tuesday that said the Christmas Day accident was “an anomaly, [but] it is nonetheless unacceptable.” The statement said Woodbriar launched an internal investigation, fired five employees, reviewed its systems, policies, and procedures, and re-educated staff.

“While the possibility of human error can never be eliminated in any health care setting,” the statement said, “Woodbriar remains a safe and caring skilled nursing facility that delivers high-quality care.”

An X-ray taken at the nursing home revealed within two hours after the accident that Meuse, who told staffers her knees hurt after the episode, had broken bones below both knees, according to the state investigation. But a nurse who read the X-ray report shortly afterward later told investigators, “there was a lot of writing on the report, and to the best of her recollection she thought no fractures were seen.”

A nurse on the night shift reviewed the X-rays, discovered the broken bones, and alerted the day nurse who earlier missed the finding. Upon learning of the injuries, the day nurse called a physician and left a message with his answering service.

The physician told investigators he called the nursing home, but “no one answered his call,” so he instructed his answering service to immediately transfer any call from the nursing home to his cellphone. No one ever called him back, he said.

A nursing supervisor wasn’t told about the broken bones until the next morning, which prompted the supervisor to seek an order to get Meuse to the hospital, the report said.

Meuse, who was hoping to visit family the day of the accident, had told staffers she didn’t want to be hospitalized on Christmas. But when staffers finally told her the next day that she had broken her legs, “she had a shocked look on her face” and agreed to be hospitalized, according to a nursing supervisor who spoke with state investigators.

‘While the possibility of human error can never be eliminated in any health care setting, Woodbriar remains a safe and caring skilled nursing facility that delivers high-quality care.’

Woodbriar Health Center statement

A 21-year-old nursing assistant who had been working at Woodbriar only a few months failed to get another nurse’s help when she used a mechanical lift to move Meuse from her bed to a wheelchair Christmas morning. Most mechanical lifts require at least two people for safe operation, according to the US Food and Drug Administration.

Meuse’s medical records indicated she suffered from multiple sclerosis and heart problems and needed “extensive assistance” from staff when a mechanical lift was used, according to the state’s investigation.

“Although [the nursing assistant] looked in a lot of resident rooms and common areas, she could not find anyone to assist her,” the report states. The nursing assistant “said this was not unusual and in the past when she had asked for help she was told staff ‘were too busy,’ or ‘wait a few minutes but then [they] never show up,’ ” according to the report.

The nursing assistant also told investigators that Woodbriar had been short-staffed and that all of the assistants on Christmas were caring for more patients than they were used to handling.

David Hoey, a North Reading attorney who has successfully sued other nursing homes and represents the Meuse family, said state investigators need to better scrutinize nursing home accidents.

“One day, I would like to see the [Department of Public Health] go into the root cause for the deficiency, like not trained staff, or not supervised staff, or not enough staff,” Hoey said. “This is the real reason why things like this happen.”

A health department spokesman said in a statement the agency on Tuesday received Synergy’s proposed plan of correction to address the problems found at Woodbriar and will decide on Wednesday whether to accept the proposals.

If the state accepts the proposed corrections, investigators will conduct a surprise follow-up visit to ensure the problems have been fixed. If investigators determine problems still exist, the state will recommend Woodbriar be terminated from the state and federal health insurance programs, Medicaid and Medicare, according to a Feb. 9 letter the department sent Woodbriar.

Medicaid and Medicare programs typically reimburse nursing homes for most of their costs, and termination from those programs would spell financial doom for a nursing home.

Link to article in bostonglobe.com.