Maryland health officials waited four months to begin investigating a complaint that a nursing home patient was so poorly cared for that his body was covered with sores and his hands and fingernails were caked with blood.

The case of the unnamed patient who had been in the nursing home for just under three weeks, was among several noted yesterday in a highly critical federal report on the way Maryland and other states have responded to complaints about poor care in nursing homes.

Members of the Special Committee on Aging yesterday also heard the tearful testimony of a former Baltimore resident who got virtually no response when she complained to Maryland health officials about the "negligent" care provided to her late grandmother in a Parkville nursing home. Gloria Cruz, who now lives in Delaware, said she was told by a Maryland official that we "deal with the live residents before we deal with the dead ones."

The report prepared for the committee by the U.S. General Accounting Office, cites Maryland and other states for not only failing to promptly investigate complaints, but also for understating the seriousness of complaints and setting up procedures that may limit and discourage the filing of complaints in the first place.

In the Baltimore area alone, federal auditors found that 101 pending complaints involving 56 area nursing homes had not even been assigned to an investigator. Those complaints, in some cases, were as much as nine months old.

Maryland officials do not dispute the findings, but say they have taken steps to address the problems. They also contend that federal rules have forced state inspectors to devote most of their time to other issues, such as closely policing and closing, if necessary, facilities with persistent problems.

The 22-page GAO report states that an ambulance attendant filed a complaint with the Maryland health department after transporting a patient from a nursing home to a hospital because of the patient's "unprecedented rapid decline."

The patient "had dried blood in his fingernails and on his hands sores all over his body smelled like feces and [was] unable to walk or take care of himself," the report states.

Although they ultimately determined that the nursing home had harmed the patient, state officials had put the complaint in a low priority category and had not begun the investigation until four months after it was filed.

Cruz testified that she complained to the state after her grandmother was released from a nursing home in extremely poor health. Laboratory tests later showed the patient had critically low levels of sodium. Cruz said her grandmother, Elsie Wagner, died on Oct. 16 of last year, a week after her release from the nursing home.

Cruz said she finally got a letter on Saturday from the state, acknowledging that her complaint -- now several months old -- was being investigated.

"I am pursuing this because I don't want my grandmother's death to be in vain," she testified. She added that she told state officials that if they looked into the complaints involving dead people, they might save lives.

In other findings specifically relating to Maryland, the GAO said a state official acknowledged that complaints were downgraded in severity due to manpower problems. Under state procedures the most serious complaints must be investigated within two days.

"A Maryland official acknowledged reducing the priority of some complaints because the state recognized that it could not meet shorter time frames because of insufficient staff," the report states.

The GAO auditors noted that during the one-year review period ending in June 1998, Maryland didn't rank a single complaint in the highest priority category. Nearly half of the 642 complaints were ranked at the lowest priority. As a result, they were not investigated until the next time the state made a regularly scheduled inspection.

Other complaints that Maryland officials classified in low-priority categories but which resulted in harm to patients include:

A patient who had to be hospitalized after an intravenous tube was improperly inserted and missed a vein.

A patient who suffered a broken jaw due to improper supervision was placed on intravenous feeding, eventually contracted pneumonia and had to be hospitalized.

Three patients in one facility who had sores, some exposing bone, due to improper care and nutrition. All three had to be hospitalized.

The state, according to the report, didn't investigate the first case until 139 days after the complaint had been filed, while the response time for the other cases ranged from 39 to 130 days.

Auditors also said Maryland's practice of urging residents to put complaints in writing may discourage future complaints. They said state officials gave conflicting information on whether or not complaints that were not in writing were ever investigated.

In addition to Maryland, GAO officials conducted reviews of complaint handling in Michigan and Washington. They also looked at state audits in 11 other states for comparison. The auditors also faulted the federal Health Care Financing Administration for failing to make complaint investigation a high priority and not providing states with proper guidance.

"Serious complaints alleging that nursing home residents are being harmed can remain uninvestigated for weeks or months," the report concludes. "Such delays can prolong situations in which residents may be subject to abuse, neglect resulting in serious care problems."

In a two-page written response to the audit, Carol Benner, director of the division of licensing and certification in the Maryland health department, blamed the delays on staff shortages and mixed signals from federal officials at HCFA.

Benner said a series of "seemingly well intentioned" initiatives by the Clinton Administration "had a direct and palpable impact on Maryland's survey activities." She said mandates from HCFA to focus enforcement on "problem" nursing homes coupled with a small staff forced the agency to assign fewer resources to responding to complaints.

"While we make every effort possible to prevent annual or complaint survey delays, we nonetheless recognize that delays inevitably occurred," Benner wrote in the response.

Benner said that her agency already had noted the delays and "began corrective action on several fronts" including the assignment of additional staffers. She said the changes were reducing both the backlog of complaints and the response time to new complaints.

Pub Date: 3/23/99