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Nursing home scandal shows need for regulatory reform

Updated:
OKLAHOMA CITY (AP) -- For years, Esther Houser has been suspicious of what she thought was ineffective enforcement of the rules that govern the standard of care at nursing homes regulated by the state Department of Health.

"We just knew that things weren't right," said Houser, the ombudsman for long-term care at the state Department of Human Services.

The arrest of a high-ranking Health Department official on a federal charge of taking a bribe from a nursing home operator seems to have vindicated Houser's suspicions.

Former Deputy Health Commissioner Brent Van Meter is accused of accepting a $1,000 bribe to help qualify a nursing home operator for federal funds.

Attorney General Drew Edmondson has said more arrests are likely.

"There certainly have been a lot of rumors over the past several years that there was corrupt activity going on in the inspection section," said former state Rep. Don McCorkell of Tulsa.

McCorkell's 1979 Nursing Home Reform Act established the structure for nursing home regulation and inspection as well as a standard of care for nursing home residents and patients rights.

"We had started hearing allegations that some of this was going on," McCorkell said. "If you create laws and the district attorney is corrupt, they don't get prosecuted. The same thing goes on the regulation side."

Edmondson, whose office's Medicaid Fraud Unit worked with the FBI in the probe, has said corruption within the Health Department could have compromised the quality of care in some nursing homes and created life-threatening conditions.

That possibility troubles Houser, who monitors the state's nursing home system and suggests ways to correct violations.

"The principal ones that are the hardest to take as an advocate for residents have been those that have resulted in physical harm or the death of the residents," she said.

In extreme cases, elderly or disabled nursing home residents have been left lying in their own waste, she said. Reports of residents suffering from chronic bed sores and other abuse are not uncommon.

In some cases, incapacitated residents get no help eating or getting a drink of water, creating filthy conditions that are also violations of state health regulations.

"When they're identified, they need to be acted upon," she said.

Protecting nursing home residents and improving the quality of their lives was the genesis of McCorkell's nursing home legislation, which was the first major measure he sponsored after being elected to the Oklahoma House in 1978. He served until 1996.

"Conditions were bad," McCorkell said. "We had circumstances where we had a large amount of cases where people had massive bedsores."

He said many nursing homes provided "horrendous care" and there were "a lot of problems in terms of patients' funds being abused," he said.

"It was an outrageous situation," McCorkell said. "We didn't have a patient bills of rights. We didn't have requirements for unannounced inspections."

The measure established a legislative framework for nursing home regulation that protected patients and provided for their care.

"It was a very, very difficult act to pass. There was tremendous resistance," McCorkell said. "Like every other industry, there are good players and bad players."

No one knows that better than Houser. Out of about 8,000 problems involving nursing homes that she deals with each year, 99 percent are resolved cooperatively between the ombudsman and nursing home facilities.

It's the 1 percent that refuse to satisfactorily resolved isputes and comply with nursing home regulations that require swift, strong enforcement action, she said

"You need to have very strict prosecution," McCorkell said.

Reacting to the nursing home crisis, the House has passed a measure requiring the Oklahoma Health Care Authority to certify nursing home inspectors and stiffening penalties for regulators who give advance warnings of inspections.

Houser said the Health Department is not the only state agency responsible for investigating unsafe and unsanitary conditions at nursing homes. Her agency already has authority under federal and state law to investigate complaints against nursing homes.

"Any way you can assure there will be checks and balances in the system is a good thing," she said.

The ombudsman's office has a 16-member staff located around the state at various area agencies on aging. The office also has a support network of 200 volunteers.

"We need more volunteers to provide in facility advocacy," she said.

Houser said her principal complaint about the Health Department's inspection practices is "failure of the enforcement system to adequately deter, to stop violations and to keep them from continuing."

She said inspectors do a good job of pinpointing problems, but that the penalties against violators are ineffective.

"We would like to see the folks at the Health Department supported and get inspectors' findings supported," Houser said.

McCorkell said the ombudsman's program should have legal standing to take action against nursing home violators when the Health Department doesn't.

"That's the one that has the institutional history of being on the side of patients," he said.

Houser said she believes the leadership team that has taken control of the Health Department and its nursing home inspection division will do their best to identify the agency's internal problems and turn things around.

"There's a lot of willingness on the staff to do the right thing," Houser said. "I want to see them get a chance to do it."
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