'I went through hell': Patient, nurse share their stories in wake of lawsuit
Matt Drange/The Times-Standard
Posted: 12/27/2010 0132 AM PST
Editor's note: This is the first in a three-part series looking at the stories behind the class action lawsuit against Skilled Healthcare. In the end, the parties agreed to a settlement in which the company admitted no wrongdoing, and the court granted an injunction ordering its 22 California nursing homes to comply with minimum staffing levels as mandated by the state.
It was the longest civil trial in Humboldt County history.
National nursing home chain Skilled Healthcare stood accused of repeatedly failing to meet state staffing requirements at 22 of its California facilities -- including five in Humboldt County.
After more than 100 days in trial, a jury returned a $677 million verdict against the nursing home chain, pushing the company to the brink of bankruptcy and renewing a national debate over tort reform. The suit came to an end on Nov. 30 when the court finalized a settlement agreement worth $62.8 million, which includes the cost of complying with an injunction that requires the nursing homes to follow the law.
To the class of people covered by the lawsuit, it wasn't about money or stock prices. It was about having a voice.
The class includes patients like Diana Medal, a 71-year-old widow who found herself in what she described as a living hell after a late-night fall sent her to a local nursing home for several weeks.
Then there are the family members like Cindy Cool, who cried when she heard her father's
name as she took the witness stand during the trial, and nurses like Vali McGrath, who said she couldn't take chronic understaffing at the facilities anymore.
It was a living hell.
A little buzzer, not much bigger than a pencil, hung at the side of Diana Medal's bed at Granada Healthcare and Rehabilitation. She needed to use the bathroom, and pressed it to signal a red light outside her door and at the nurse's station down the hall.
Almost 20 minutes later, help arrived.
”I went through hell every night just trying to get a bedpan,” said Medal, who spent three weeks in the nursing home earlier this year. “If you don't hold it, well, there goes your dignity.”
Medal is one of 42,000 patients in a class action lawsuit against Skilled Healthcare, and her story is a recurring theme at facilities run by the national nursing home chain. With chronic understaffing, caregivers who worked at some of the nursing homes said they were forced to make decisions that, in many cases, left out the general well-being of their patients.
Medal gave her cash and credit cards to her oldest son when she checked into room 206A on Jan. 22. She kept $14, emergency money, she said, “In case I needed to get the heck out of there.”
Medal contemplated taking a cab home that night, but gave herself two weeks before she would ask her son to get her out. Between her roommate -- who spent most of her time crying and refused to close the paper-thin curtain between the two women -- and the man who tore down the hallway in an electric scooter followed by a nurse wearing socks and no shoes, Medal didn't sleep at all that first night.
”I just lay there feeling sorry for myself. Sometimes I felt like crying,” Medal said. “I remember thinking to myself that night, 'I just want to go home.'”
It wasn't that the nursing staff didn't care, Medal said, it's that they didn't have time.
A California statute requires nursing homes to maintain 3.2 nursing hours per patient per day, which is the number of hours nursing staff works on a given day divided by the total number of patients in the facility. With up to 87 patients at a time, Granada often relies on 10 certified nursing assistants, or CNAs, during the morning shift, eight in the afternoon and four at night, according to daily staffing reports.
It's almost never enough, Medal said, to take care of everyone.
Medal fractured her spine when she fell at her home. Her back is an exaggerated S-shape, and while she used to be 5 feet 7 inches tall, Medal now stands less than 5 feet tall. On the weekends, she would do her rehab exercises outside by herself. Normally done during the week, the exercises are designed to be done under staff supervision.
Medal said she risked injuring herself to leave Granada behind her.
”I was willing to do anything to get out of that place. I wanted out of there so badly,” Medal said, adding that if it weren't for the encouragement of the staff, she would still be at the facility. “The nurses were wonderful. They realized how hard I worked to get out of there.”
An attorney's heaven
Timothy Needham got up from his chair at the attorney's table and strode toward the back of the Humboldt County Courthouse. He leaned over, making sure his tie was out of the way, and kissed his wife on the cheek.
The lead plaintiff's attorney in a class action lawsuit against national nursing home chain Skilled Healthcare, Needham just won a $677 million award -- the largest jury verdict in the country this year. For a lawyer, it was as close to heaven as you could get.
A California statute requires that nursing homes maintain 3.2 nursing hours of “direct patient care” per day; a minimum level that, according to staffing reports, numerous Skilled Healthcare facilities failed to meet for days, sometimes for weeks at a time.
On July 6, a jury assessed the maximum amount of damages, amounting to $500 per patient per day the 22 nursing homes implicated in the suit were in violation of the law. With a class of some 42,000 patients and a suit spanning back to 2003, the numbers added up fast.
News of the verdict traveled even faster. The company's stock crashed more than 75 percent the day of the verdict, dropping from $6.22 a share to $1.52 on July 7.
Skilled Healthcare defense attorney Kippy Wroten said the verdict -- which the California Association of Health Facilities vehemently opposed -- was “annihilating” for the company, and that with the exception of a handful of days over the last six years the facilities complied with law.
”With respect to the court and to these judicial proceedings as a whole, we strongly disagree with the outcome of this legal matter,” Wroten said in an e-mail to the Times-Standard. “We remain confident that our facilities are well staffed and are extremely disappointed with this result.”
For Granada Healthcare and Rehabilitation, one of five Humboldt County nursing homes owned and operated by Skilled Healthcare, the damages totaled $30 million. With more than 14,500 employees and for-profit limited liability facilities in California, Iowa, Kansas, Missouri, Nevada, New Mexico and Texas, Skilled Healthcare was on the verge of bankruptcy.
Vali McGrath said she couldn't take it anymore.
It was almost time for breakfast at Eureka Healthcare and Rehabilitation, home to up to 99 patients and one of the largest nursing homes in Humboldt County. Mornings are the busiest time of day, so when somebody called in sick on June 16, McGrath was left with one other certified nursing assistant to care for a wing of 29 patients.
”I told the nurse on duty that if they didn't give me another person, I would walk out,” said McGrath, a CNA who worked at the nursing home for more than one year before she quit. “I felt it was the only choice I had.”
McGrath could have lost her license for leaving in the middle of her shift, but that didn't stop her from testifying in the lawsuit against Skilled Healthcare just weeks later.
For McGrath, the nursing home represented an opportunity. With an extensive training and certification program, the facility offered a job as a CNA after just eight weeks of training.
As the eyes and ears of the charge nurse on duty, CNAs administer showers, brush patients' teeth and get them ready for meals. It's the patients who don't get any visitors -- or might not be as determined as someone like Diana Medal -- who sit in urine-soaked clothes, don't receive showers and are left in bed unturned for hours at a time, McGrath said.
Some days she would work through her lunch break to keep up, and even then it wasn't enough.
”These people rely on you, and when you can't take care of them and give them the treatment they deserve ... it's heart-breaking,” said McGrath, a single mom with three kids. “You really can't care too much. I'm learning that.”
McGrath knew she wanted to be a nurse after taking care of her mother, who was diagnosed with emphysema and congestive heart failure. Nowadays, McGrath works for Visiting Angels, a national network of in-home care providers that sends nurses directly to patients' homes, like the 93-year-old deaf woman McGrath cares for.
Even though she lives at home, McGrath is often the woman's only visitor, something she said is not uncommon in both in-home providers and assisted living facilities, where some patients are dropped off by family members and seemingly forgotten.
”You look in her eyes and there is just so much life left in her,” McGrath said. “I just can't see how someone would want to throw her away like that.”
By the numbers:
Days a jury found facilities were below staffing levels:
Eureka Healthcare and Rehabilitation: 651 days
Granada Healthcare and Rehabilitation: 790 days
Pacific Healthcare and Rehabilitation: 453 days
Seaview Healthcare and Rehabilitation: 755 days
St. Luke Healthcare and Rehabilitation: 846 days