People v. Casa Blanca Convalescent Homes, Inc.

• Decision Date: 23 August 1984
• Citation: 159 Cal.App.3d 509,206 Cal.Rptr. 164,53 A.L.R.3d 661
• Court: California Court of Appeals
• Parties: , 53 A.L.R.4th 661 The PEOPLE, Plaintiff and Respondent, v. CASA BLANCA CONVALESCENT HOMES, INC., Defendant and Appellant. D000551. Civ. 26915.

Page 164

206 Cal.Rptr. 164

159 Cal.App.3d 509, 53 A.L.R.4th 661

The PEOPLE, Plaintiff and Respondent, v. CASA BLANCA CONVALESCENT HOMES, INC., Defendant and Appellant.

D000551.

Civ. 26915.

Court of Appeal, Fourth District, Division 1, California.

Aug. 23, 1984.

Weissburg and Aronson, Inc., Peter Aronson, Jay N. Hartz and James R. Kalyvas, Los Angeles, for defendant and appellant.

Edwin L. Miller, Jr., Dist. Atty., and William D. Holman, Deputy Dist. Atty., for plaintiff and respondent.

STANIFORTH, Associate Justice.

The People by this action sought civil penalties and injunctive relief (Bus. & Prof.Code, §§ 17200, 17536) ¹ against defendant Casa Blanca Convalescent Homes, Inc. (Casa Blanca). The People charged Casa Blanca with multiple unlawful and unfair acts, ranging from failure to provide adequate nursing care so as to prevent decubitus ulcers (bedsores) to failure to serve adequate diets and keep the nursing facilities free from flies and pests, etc. After a court trial the judge imposed judgment upon Casa Blanca for $167,500 in penalties ² and appropriate injunctive relief.

In its memorandum of intended ruling, the trial court described each type of act found to be a violation and listed exactly how many of each type of act or condition it found in Casa Blanca's facilities.

FACTS ³

Casa Blanca Convalescent Homes, Inc., is a State of California licensed operator of nine nursing homes in San Diego County. Each of these facilities has been licensed and is responsible under the law for compliance with provisions of long-term care under the Health, Safety and Security Act of 1973 (Health & Saf.Code, § 1417 et seq.) and the regulations contained in titles 17 and 22 of the California Administrative Code.

Since 1974 Casa Blanca in its nine nursing facilities has on numerous occasions (by its actual admissions) allowed or caused incidents to occur and conditions to exist which violated nursing home regulations established by the State of California. The following is a partial listing of some of the acts and/or conditions found to exist in the Casa Blanca facilities:

PATIENT LEOLA DOBBS

Dobbs was a neurologically deprived patient discharged from Tri-City Hospital on July 16, 1976, and on that day was admitted to Casa Blanca facility Hilltop Convalescent Center (Hilltop). She was particularly susceptible to bedsores. On September 13, 1976, Dobbs returned to Tri-City Hospital. Her condition had deteriorated; she was stuperous, unresponsive, semicomatose with huge bedsores on her hips. In addition, she had constrictures and was dehydrated to the point where she lay in a fetal position. These facts warranted the conclusion she received poor nursing care while at Hilltop. Careful nursing care would have prevented her constrictures, bedsores and dehydration.

Dobbs' Casa Blanca medical record revealed, while she had an in-dwelling catheter, there were at least 70 instances where no record was kept of her intake and output of fluids. Such records are required by title 22, California Administrative Code section 72315, subdivision (j)(2). The purpose for maintaining a record of a patient's intake and output is to aid in the prevention of dehydration.

Dobbs was also prone to decubitus ulcers, yet her medical records indicate the turning schedule, an aid in the prevention of bedsores, maintained for her was inadequate. The nurse's aide's notes in some instances note "turned q 2 hrs." This record fails to tell how and when Dobbs was turned. A patient on a turning schedule, such as Dobbs, should be turned every two hours. Dobbs' medical record demonstrates the deficiencies (by shifts).

7 a.m. to 3 p.m.: 9 instances without document of turning at all.

25 instances of "q 2 hrs."

18 instances of the patient being turned but no entry noting the position.

3 p.m. to 11 p.m.: 5 instances of no turning documentation at all.

6 instances of "q 2 hrs."

31 instances of turning without reference to position with intervals of greater than 2 hours.

11 p.m. to 7 a.m.: 7 instances of no documentation.

30 instances of "q 2 hrs."

17 instances where the interval was greate than 2 hours.

When Dobbs was retransferred to Tri-City Hospital from Hilltop, she was accompanied by an interfacility transfer sheet which became part of the Tri-City Hospital medical record. The purpose of the transfer sheet was to communicate information about the patient to the receiving facility and provide for a continuity of treatment.

The sheet was filled out by the director of nurses at Hilltop. The description of Dobbs' condition on the transfer sheet was inaccurate. When Department of Health representatives later went to Hilltop to investigate the treatment of Dobbs, they examined her medical record and found a copy of the interfacility transfer sheet sent to Tri-City Hospital was missing. They asked the administrator or director of nurses where the copy of the interfacility transfer sheet was and were told that they would have to look for it. Following a two-hour search for the copy of the interfacility transfer sheet, one was produced. The sheet produced was not a copy of the one sent with Dobbs but was prepared at another time.

PATIENT OLIVE BLAHA

The medical record of patient Olive Blaha contains a physician's order indicating she is prone to decubitus ulcers. The record contained no turning sheet.

PATIENT GRACE HAWLEY

Grace Hawley's medical chart has an entry indicating the presence of a decubitus ulcer (July 23, 1976). No turning record was kept until August 8, 1976. Many of the entries in the record are internally contradictory. For example, the turning sheet reports on August 10, 1976, the patient was in bed on her right side between 10 a.m. and 12 p.m. The nurse's notes for the same period indicate Hawley was in a wheelchair during that time. The same contradiction is true of the entries on August 13, 1976.

PATIENT MARIE JOHNSON

The medical records of Marie Johnson report she is prone to decubitus ulcers. The records contain over 10 entries on the turnsheets beginning June 4, 1977, which indicate the patient was turned to the same side as the record says she had been turned two hours earlier. These entries on the turnsheets are generally found in the last line of a column on one page and at the top of the next page. The fact that these entries appear at the bottom of one page and continue on the top of the next page suggests the records were not filled out in chronological order, from top-to-bottom, as the patient was turned. Rather, they were completed later.

PATIENT BLANCHE HOLMES

Blanche Holmes' medical records contain a physician's order on December 8, 1977, to record her vital signs every four hours until they were normal. The patient's blood pressure was not recorded as ordered on 17 different occasions between December 8, 1977, and December 14, 1977.

PATIENT RUTH ANNE DAVIS

The patient record of Ruth Anne Davis contains no record of a measurement of her fluid intake and output between September 22, 1977, and December 10, 1977, despite the fact Davis had a Foley catheter inserted during that entire period.

PATIENT CHARLES FRANKENBERG

Charles Frankenberg was a patient at Hilltop from September 20, 1976, through December 10, 1976. His medical chart indicated he was prone to decubitus ulcers. A review of his record revealed he was in his wheelchair almost daily. The same chart also contained a number of entries which read for the same time period, "turned every 2 hours or turned x4."

PATIENT HARRIET CORBIN

On December 31, 1976, Harriet Corbin's physician ordered her blood pressure be taken twice a day. Her medical record indicates the facility failed to take her blood pressure as directed on at least 260 separate occasions between January 1, 1977, and June 30, 1977.

PATIENT GLADYS VOLCK

In July 1976 Gladys Volck was admitted to Hilltop. On August 20, 1976, a friend of Volck's found her in a stuporous condition tied up in a wheelchair, sitting in a pool of urine. Her tongue was hanging out of her mouth, her arms and legs were swollen and there were blisters on both heels "the size of baseballs." The friend ran out and called an ambulance to take Volck to an acute care facility. There she was treated by Dr. Stein who said her swelling had progressed to the point where it would have been obvious for several days. For this period, Casa Blanca's medical records regarding Volck contain no mention of her deteriorated condition.

Following Volck's transfer to the acute care hospital, Mr. McClaren, a field representative from the Social Security Administration, conducted an investigation into the quality of treatment Volck received at Hilltop. As part of this investigation, he interviewed Dr. Raymond Dann, the physician responsible for Volck's care while she was a patient at Hilltop. Mr. McClaren then told the Casa Blanca representative about his interview with Dr. Dann.

The director of nursing contacted Dr. Dann and asked him to write a letter, indicating the treatment given Volck by Casa Blanca was adequate. The first letter written by Dr. Dann possibly was not strong (self-serving) enough. In the fourth attempt to exculpate itself from any wrongdoing, the director of nursing prepared a letter using Dr. Dann's stationery. A handwritten rough draft of the letter was found in Volck's medical record at Hilltop.

Ms. Homewood, a questioned documents examiner from the San Diego Police Department, examined Volck's records. The examination of the medical chart revealed many of the entries regarding her diet had been filled out by one person, Casa Blanca's director of nursing, rather than the shift personnel who supposedly cared for Volck.

CREATION OF RECORDS AFTER THE FACT

Hilltop at one time employed an individual whose job it was to fill in blank spaces on a patient's medical record without regard for accuracy. One of her duties entailed altering her style of writing so the medical record would appear as if different individuals had...