Four deaths tied to lapses in care at nursing home


Maryland health authorities have linked the deaths of four patients at the Seton Hill Manor nursing home to lapses in medical and nursing care and have ruled that the home may no longer admit new patients until it dramatically improves conditions.

State inspectors, who toured the facility from Jan. 22 through Feb. 4 and combed through patient records, reported that three tube-fed patients died after their diabetes was improperly managed.

Another patient, an elderly woman with Alzheimer's disease, died a day after becoming entangled in protective straps that were designed to keep her from hurting herself.

Besides banning admissions, the health department ruled that Seton Hill Manor will stop receiving Medicaid reimbursements on March 16. However, lawyers for the home plan to file an appeal -- an action that would keep the money flowing for another 120 days while the appeal is being heard. The admissions ban was effective Feb. 8.

The nursing home, at 501 W. Franklin St. in downtown Baltimore, received $7.5 million in Medicaid reimbursements last year -- making it one of the largest recipients of Medicaid money in the state's nursing home industry. Licensed for 360 beds, it is the size of some hospitals and ranks as the second-largest nursing home in Maryland.

Seton Hill won accolades in 1985 when it became one of the first nursing homes in the nation, and the first in Maryland, to accept AIDS patients. It now cares for 20 patients with acquired immune deficiency syndrome but plans to expand its AIDS service to accommodate as many as 50 within a month or two.

None of the criticisms leveled at Seton Hill Manor concerned the care of AIDS patients. But the state's acting health secretary, Nelson J. Sabatini, noted widespread problems in the care of jTC elderly patients and said in a letter that "a continued pattern of violations limit the facility's capacity to furnish an adequate level of care."

Lorraine Raffel, who owns the home, said she plans to correct the deficiencies within the next few weeks -- in time to satisfy inspectors when they return for another survey. She said she has hired a Philadelphia-based consulting firm to help solve its problems, and has hired new nursing managers to overhaul its delivery of care to patients.

Recently, she installed her son, Bruce Raffel, as administrator.

"I think that in nursing, we're seeing many sicker patients than we were ever seeing before," Mrs. Raffel said. "We have a lot of tube-fed insulin-dependent [diabetic] patients, and at some point it probably got away from us. We need to develop a whole new nursing concept."

Seton Hill's troubles did not emerge suddenly.

The home failed the last four annual inspections, according to Mr. Sabatini, but managed to stave off penalties by correcting its problems within a mandated timetable.

Then, after a troublesome inspection last November, Mr. Sabatini warned that he would take action against Seton Hill unless inspectors planning a return visit found substantial improvements. But when they returned last month, they uncovered a host of problems that occurred since the warning -- problems itemized later in a 62-page report that was made public yesterday. Of the three patients whose diabetes was mismanaged, two died after they received doses of insulin based on apparent misreadings of the patients' blood sugar levels, according to the inspectors.Inspectors also turned up the case of an 80-year-old woman, demented and self-destructive as a result of Alzheimer's disease, who became entangled in the straps of a protective vest that was designed to keep her from scratching her face or wiggling out of her chair and harming herself.

Records showed that on Dec. 20, she got twisted so tightly that it took two people to free her -- one to hold the strap away from the skin and another to cut it. She was sent to the hospital with a swollen, strap-burned leg -- and died the next day from a clot in her lung. Doctors attributed the clot to the obstruction of blood flow in her leg.

Yesterday, Mr. Sabatini said the findings were extremely serious but he believed Mrs. Raffel was taking the necessary steps to improve conditions there.

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