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Bay Minette veterans home faces 74 pages of deficiencies
State health officials considering taking licensure action

By Desiree Hunter
Associated Press Writer

MONTGOMERY — State health officials are considering taking licensure action against a Bay Minette veterans nursing home where two patients died after falling earlier this year.

Rick Harris, director of the department's Bureau of Health Provider Standards, said Wednesday that officials expect to decide this week what action to take on William F. Green State Veterans Home, cited for failing to take proper action after falls that led to deaths.

He said the most severe action would be to revoke the license of the 150-bed home. A lesser penalty would be probation with an agreement to correct problems.

August inspection

Harris' division issued a 74-page statement of deficiencies against the Bay Minette veterans home following an August inspection. The center has since filed a plan of correction and is disputing some of the department's findings.

Medical Director Tom Geary is reviewing the report and it could be modified as a result, Harris said.

The August report cited numerous problems at the home, most seriously that staff failed to follow proper procedures after two patients fell and later died.

Harris said it was too early to speculate on what action would be taken, but the "biggest concern is that the federal Department of Veterans Affairs identified fall issues last January and we identified some again in this survey."

The state report in August said nurses checked the vital signs only once on a patient who fell at noon on March 8 and they performed no neurological checks. The patient was found dead in his bed at 10:30 that night — 10 hours and 30 minutes after the unwitnessed fall.

Staff also failed to do neurological checks on a resident who fell on May 3 at 12:45 a.m. The patient's family wasn't notified until 2:15 a.m. and the doctor wasn't informed of the resident's fall and low oxygen level until 2:35 a.m. — and the resident died on the way to the hospital at 3:58 a.m.

State health department surveyors also reported instances of mental and verbal abuse, staff members taking too long to inform family members about their loved ones' conditions, water temperatures exceeding 110 degrees Fahrenheit and ant infestation in patient rooms.

Numerous falls

Numerous falls had been identified at the home in June 2006, resulting in the creation of a Facility Injury Prevention Program. The U.S. Department of Veterans Affairs did a full annual inspection in October 2006 and a focused survey on the prevention program in January.

That survey found that while there was a reduction in falls, the severity of injuries was still a concern because staff consistently failed to follow protocol by immediately notifying doctors and performing neurological checks on the fallen patients.

Other nursing homes

The Alabama Department of Veterans Affairs operates two other nursing homes in Alabama — the Floyd E. "Tut" Fann State Veterans Home in Huntsville and the Bill Nichols State Veterans Home in Alexander City. All three nursing homes are operated by Health Management Resources of Anderson, S.C., and have a capacity of 150 beds.

Calls to Health Management Resources were not immediately returned Wednesday.

W. Clyde Marsh, commissioner of the state Department of Veterans Affairs, said the South Carolina company is "questioning a couple of items" in the state report.

"Obviously we are monitoring this very closely," he said. "It's getting oversight and I would just say that all of our homes are providing good care to veterans. Anytime someone comes in and identifies some issues, those issues are addressed and corrected and I will expect the same in this case."

Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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