Nursing home negligence

The stench of human waste hit her as she walked into her new job.

Denise Hubbard hadn't officially begun as nursing director at St. James Nursing Center in Detroit. But her phone rang on a Sunday, a day before her start date: Midnight shift nurses had left, and dayside was short-staffed.

Could she come in?

In a series of court documents, Hubbard described her first day -- Jan. 14, 2001 -- in graphic detail: sickly, malnourished residents; overworked staff, and equipment "completely plugged with hard, dried green mucous."

"Dried salt like tear stains" streaked the face of resident Shirley Jackson as she rocked in bed, struggling to breathe. Jackson's lips and tongue were dry and turning blue. At 68 pounds, bones protruded through her skin.

Jackson was hospitalized, Hubbard said, and died weeks later. The home paid $265,000 to settle a lawsuit filed by her sister. Earlier this month, owner Ciena Healthcare Management issued a statement saying that, despite setbacks, it is making "progress towards better and sustained compliance" with health regulations.

In 2003, Hubbard filed a whistleblower suit against Ciena, spawning a legal battle that ended with a court-ordered plan to improve care in the chain's 36 homes, mostly in Michigan. Ciena paid $1.25 million but admitted no wrongdoing.

More than 10 years after Jackson's death, the 150-bed Detroit nursing home remains one of the state's lowest performing, federal ratings show. So are two other Ciena homes, Omni Continuing Care in Detroit and Brittany Manor in Midland, even as Ciena also owns highly ranked homes.

The story of St. James, from its enduring problems to its continued operation, shows the glacial pace of nursing home reform in Michigan -- where a substandard home can linger for years, racking up violations, but staying open for business.

Rich homes, poor homes -- all with same owner

Ciena Healthcare Management, a nursing home chain with nearly three dozen Michigan facilities, is a study in extremes.

At its newest home, Regency at Waterford, the smell of fresh paint and new carpet lingers. There are private rooms and showers, wide-open meeting spaces, courtyards and an executive chef.

While the Waterford home glimmers, Ciena also owns two Detroit homes that are among the state's most poorly rated: Omni Continuing Care and St. James Nursing Center. Both have been cited again and again by state inspectors for serious lapses in patient care, as has Brittany Manor, a Ciena facility in Midland.

Although these homes are near the bottom in serious violations, they are not alone. More than three-quarters of Michigan homes received at least one serious violation in the last three years.

At Omni in 2009, a diabetic man died after he didn't eat dinner or a snack and was not given a supplement or insulin. A lab technician found his body, cold and stiff. Staff had trouble rousing a sleeping nurse as they called 911.

Inspectors also cited Omni for failing to report several incidents, including one in which a 60-year-old man died after pulling out a tube connected to his trachea.

At St. James, along seven-lane Gratiot Avenue, a resident with a history of confusion slipped outside in 48-degree weather for hours, dressed only in pajamas. Surveillance tapes showed that he passed two staff members in the parking lot -- one who said, "Good morning," she later recalled -- yet no one questioned him.

It wasn't until the man's girlfriend reported him missing two hours later that staff searched for him. He was located two blocks away, sitting on a porch.

In 2009, inspectors reviewing a death at St. James discovered that a nurse caring for a dying woman was actually an impostor. Deanna Smith-Eddington had worked there for nearly a month, dispensing medications and caring for residents.

St. James was cited for, among other things, failing to adequately screen Smith-Eddington's background.

Ciena told the Free Press that St. James reported the impostor nurse to the state. She remains in prison.

There were lower-level citations, too.

At St. James last year, an inspector watched for 20 minutes as one resident stood covered in her own waste, asking for help that never came. One staffer observed what was happening, picked up breakfast trays nearby and left.

Yet the Ciena chain of nursing homes also boasts facilities that have performed well on federal ratings, with few violations, including Christian Park Healthcare Center and Christian Park Village, both in Escanaba.

Ciena "is such a mixture of poor performing homes and lovely places which are well staffed and (have) state-of-the-art equipment," said Sarah Slocum, Michigan's Long Term Care Ombudsman, a state office.

The poorest-performing, she noted, are in some of the most troubled neighborhoods.

Slocum said her concerns are not limited to Ciena, but extend to any chain that has an extreme mix of affluent and poorly financed homes, yet is expanding. "If those resources are being spent on opening the new places, they're not being spent on the old, struggling places," she said.

Southfield-based Ciena now operates under a five-year, court-ordered federal agreement that requires tighter federal oversight. The order came after St. James nursing director Denise Hubbard quit her post in 2001 and filed a whistleblower's suit alleging residents lived in filth, missed meals and medications and, in at least two cases, were malnourished or severely dehydrated.