By Mary L. Crider

An investigation begun in October 2000 into possible felony elder abuse violations at a former Beverly Enterprises nursing home in Santa Barbara, Calif., now including a possible involuntary manslaughter charge, wended its way to corporate headquarters in Fort Smith on Wednesday.

Presented with a search warrant requested by the Santa Barbara County District Attorneyıs Office and signed by 12th Judicial District Judge Jim Marschewski, Beverly officials turned over requested documents to Santa Barbara Senior Criminal Investigator Laura J. Cleaves. Because the documents were provided on-site, the premises were not physically searched, Cleaves noted on the warrant "Return" form filed in the Sebastian County Circuit Clerkıs Office just before 4 p.m. Wednesday.

State agencies routinely ask for patient care records when they are trying to figure out what to do about allegations, and to obtain search warrants, investigators must allege violations of the criminal statutes, Beverly Senior Vice President for Corporate Communications and Investor Relations Jim Griffith said Thursday. Nothing comes of most of the investigations, and Beverly offered to turn over whatever records the state and the District Attorneyıs Office in Santa Barbara wanted, he said. "On the specific case they are looking at, we are convinced weıve done nothing wrong," Griffith said.

The sought documents include policy and procedure records for the Beverly La Cumbre facility, its staffing records, inservice education records and patient records for William Marthai, an 86-year-old resident who died July 5, two days after a Beverly La Cumbre licensed vocational nurse reinserted a gastrostomy tube (feeding tube), improperly placing it in Marthai's abdominal cavity. According to an affidavit also filed by Cleaves, the improper placement of the tube and the repeated failure of that nurse and other nursing staff to check for proper placement of the tube caused Marthai to develop peritonitis (a severe infection), which led to his death from septic shock despite emergency surgery July 5.

Cleaves stated that she learned of Marthai's death Dec. 4, after learning that the California Department of Health Services had investigated the incident and issued the facility an "AA" citation.

California long-term care facilities are required to report unusual incidents to the Department of Health Services within 48 hours, and that department can issue citations for failure to comply with regulations, Cleaves stated. Citations can range from "B" citations (actions or failure to take action that caused great bodily injury) to "AA" (the action or failure to act resulted in death). Citations may include fines or a suspended or revoked license, Cleaves stated.

"In California, we have an elder abuse reporting law. If it happens in the community, the report is made to the Adult Protective Services Agency or to local law enforcement. If it happens in a long-term care facility, it goes to the ombudsman or law enforcement."

"I should be getting those calls, and we do get a lot of those. We do an investigation, then notify law enforcement when appropriate. What happened is the licensing department didn't report it," said Kathy Badrak, executive director of the Santa Barbara County Office of Long-Term Care Ombudsman Services.

According to Cleaves, on July 20, La Cumbreıs administrator, accompanied by a Beverly Healthcare representative, told a Department of Health Services representative that Beverly Healthcare didn't consider the Marthai incident to be reportable under state regulations. The Department of Health Services representative indicated that it was, and on July 26, the administrator submitted a one-paragraph note to the department, stating that everything had been done properly but that it was better to report the incident "in light of recent unfavorable notoriety."

As to how Beverly addressed the situation, when the regulatory citation was issued, Beverly had to submit a plan of action to the state, Griffith said. The citation itself is being appealed, he said. Because it was a very difficult operating environment, on Nov. 1, Beverly Enterprises sold the facility to another operator, Griffith said. Helping Hands Community of Care took over the facility and renamed it Senior Living Concepts of Santa Barbara, Cleaves stated. Patient files were removed by Beverly corporate staff and transferred to the Fort Smith headquarters. Only the records of current La Cumbre residents were returned to the new owner, Cleaves stated. To protect confidential patient records when the company transfers or closes a facility, those records are shipped to a central storage facility in Fort Smith, Griffith said.

According to Santa Barbara News-Press accounts, the Santa Barbara District Attorneyıs Office initiated its investigation into elder abuse complaints at Beverly La Cumbre in October 2000, following the suicide of a 52-year-old night nurse who left a suicide note accusing the facility of ordering her to cover-up the abuse of an 81-year-old resident by a nurseıs aid. The nurse reportedly left behind a journal detailing her allegations.

According to Cleaves' affidavit, the investigation began after patients and their family members alleged the patients werenıt being cared for "in a manner prescribed by both law and regulation, resulting in injuries and even deaths of patients."

Of Santa Barbara Countyıs 26 nursing homes, the La Cumbre facility is the worst and has been for the past three or four years, Badrak said.

According to Medicareıs On-Line Survey Certification and Reporting data, the 189-bed facility had 29 health deficiencies at its last inspection in October 2000, two of which resulted in actual harm to a few patients. One involved treatment of bed sores and the other involved ensuring patients received needed help with grooming, hygiene and eating. According to Medicare, the average number of deficiencies for facilities in California was 11 (actual numbers ranged from zero to 54), and the average number nationwide was five.

Since the nurse's suicide, 10 lawsuits were filed by the Encino, Calif., law firm of Sternberg, Horner and Associates on behalf of various La Cumbre residents and their families. On Dec. 10, five of those suits were settled and confidentiality agreements signed. Afterward, the News-Press quoted attorney Brenton Horner saying that care, staffing and training improvements had been made and the wrongs addressed. A sixth case reportedly was settled in October, and another is set for trial in April.