Virginia Nursing Home Faces Possible Medicare Termination

Aug 19, 2013

Recently a jury in Spotsylvania County awarded a family more than $1.4 million dollars in a negligence suit against a local nursing home. The facility has a history of safety violations.

Joseph Roberts Junior, a 47-year-old veteran, arrived at the Carriage Hill Nursing and Rehab Center in Fredericksburg, Virginia in May 2011. He had broken his hip and had a host of other medical conditions -- including numbness and paralysis on one side. He was taking pain killers for severe back trouble and was being treated for depression.

Roberts was a smoker, and that was significant, because Carriage Hill is a smoke-free facility. But he insisted on smoking anyway, and early one morning a Carriage Hill staff member took him outside in a wheel chair -- near a landscaped area -- to have a cigarette.

"And he was left outside, and they went back in to do their work, and when they came back he was on fire," said Charlotte Roberts, Joseph's wife.  Joseph has since died from an unrelated infection

Charlotte didn't witness the incident. She says she has pieced together the story from his recollections and testimony from others.

Joseph Roberts, Jr. Photo provided by Charlotte Roberts

She says Joseph ended up on the ground and tried to put the fire out.  "But he was rolling in mulch. So that caught him more on fire." she said.

Exactly how the fire started has been in dispute. Carriage Hill has cited Joseph's history of mental illness and suggested he may have lit his clothes on fire intentionally.

But attorney Charles Meltmar -- who represents the Roberts estate -- says Joseph testified the fire started by accident...

"So what he testified to in deposition was that he saw the fire coming up his left leg and he tried to put out, but because he had left arm contractures left wrist contractures he was unable to do it," said Meltmar.

Joseph was taken to the Medical College of Virginia in Richmond -- with second and third degree burns on his legs. Earlier this month a jury awarded his family nearly 1.3 million dollars plus $170,000 dollars in interest.

"He was someone who was suffering from mental impairment as well as physical impairment and the combination of the both of those illnesses meant that he either needed to be watched or evicted and they did neither," said Meltmar.

Carriage Hill administrators had agreed to an in-person interview but they canceled at the last minute, saying they were evaluating options for an appeal and decided a conversation would be premature.

In a written statement the facility said it respectfully disagrees with the jury's decision. "Our committed and qualified staff is always striving to improve" -- the statement reads -- "and will continue to focus on providing the highest level of care for our patients." It also notes an initiative to improve quality of care.

But Carriage Hill refused to discuss safety issues that continue to plague the facility. In January 2012 -- six months after the fire -- Carriage Hill was placed on a federal list of Special Focus Facilities. According to the Center for Medicare and Medicaid Services -- CMS -- these are nursing homes with a pattern of serious problems that have persisted over a long period of time.

Lorraine Ryan is a CMS spokesperson. She says within 18-24 months of being added to the list, facilities are expected to reach one of three outcomes...

"One is improvement and graduation. The second is termination from Medicare. The third option is an extension of time. And that s really for nursing homes that have shown really promising progress that would benefit from having additional time," said Ryan.

Carriage Hill has been on the Special Focus Facility list for 19 months, and according to CMS, it has not shown improvement.

CMS gives Carriage Hill one star out of five and calls its overall rating "well below average."

The most recent state health department inspection in June documented numerous violations. It cited a case in December in which a patient fell while trying to move from a wheelchair to the toilet --- sustaining a hip fracture that required surgery. The inspection quotes a Carriage Hill report attributing the fall to the failure of a certified nursing assistant. The CNA reportedly wheeled the patient to the bathroom and then left the patient alone.

In a written response to the report, Carriage Hill says all nursing staff will have more training on moving and assisting residents.

Joani Latimer is Virginia's long-term care Ombudsman. She says consumers should be concerned about safety records like Carriage Hill's.  "I think that its a concern for the whole community around that nursing home to be aware of that and to be a resource get involved in trying to help find out what the underlying problem is."

Latimer encourages families to look at records on the CMS website before choosing a nursing home or rehab facility -- and to reach out to local area agencies on aging. But she says often it's hard to make sense of reams of inspections, evaluations and quality measures.

"It can be pretty overwhelming even if they know where to find the information, how to really interpret it is another piece of it," she said.

Latimer encourages people to visit nursing homes, even several times, and talk with staff, patients and their families before making a decision about where to go.