A group of for-profit nursing homes -- including two in the central San Joaquin Valley -- have put elderly residents at risk and skirted state law by skimping on staff to make more money, lawyers contend in a class-action lawsuit.
In a trial unfolding in Humboldt County Superior Court, lawyers for nursing home residents say staffing problems have plagued homes operated by Skilled Healthcare Group Inc., the 10th-largest nursing home chain in the country. They hope to collect a multimillion-dollar judgment and improve care.
The nursing homes deny the allegations and say they have maintained adequate staffing levels and provided quality care.
Industry and advocates for nursing-home reform are watching the case closely. It's not the first class-action case nursing homes have faced for staffing problems, but the size of the case means it could have a far-ranging effect on how nursing homes are staffed.
The lawsuit names as defendants 22 nursing homes in California, the company that owns them, Skilled Healthcare Group Inc., and its subsidiary Skilled Healthcare LLC. Willow Creek Healthcare Center in Clovis and Valley Healthcare Center in Fresno are two of the defendants.
More than 32,000 nursing home residents are represented by the class action, lawyers for the plaintiffs say. A retired Fresno postal clerk who received care at Valley Healthcare is one of three named plaintiffs.
The case has been lengthy -- it was filed in 2006, and after four years of pretrial motions and hearings, the trial could be coming to a close this spring. This month, the plaintiffs rested their case and the defense began presenting testimony to jurors.
Millions of dollars could be at stake. In addition to seeking punitive damages, the plaintiffs are suing for statutory damages for each day the nursing homes are found out of compliance with staffing laws. The plaintiffs contend the California homes were under-staffed thousands of days over the six-year period -- 2003 to 2009 -- covered by the lawsuit. Penalties can be up to $500 per resident for each day the law was violated.
Lawyers for the nursing-home residents say they hope not only to win restitution for residents, but also to spur reforms in the industry. "We want to change the corporate culture of the for-profit nursing operators to have them start paying more attention to the nursing of the residents and less attention to shareholders," said Michael Crowley, lead trial counsel for the plaintiffs and a lawyer with the Janssen law firm in Eureka.
The defense declined to comment except in writing.
"The 22 facility defendants work hard every day to provide quality care to their residents, and vigorously dispute the plaintiffs' allegations, before and during the current trial," the defense said in the statement from attorney Kippy L. Wroten.
Chains are watching
Skilled Healthcare Group of Foothill Ranch was the nation's 10th-largest nursing home chain in 2009, based on the number of nursing beds, according to the trade journal Provider Magazine.
The outcome of the trial "will be of big interest to the chains," said Charlene Harrington, a professor of nursing and sociology at the University of California at San Francisco and a national expert on nursing-home staffing.
"I think it would definitely have an impact if [the nursing homes] lose," she said. Harrington testified as an expert witness for the plaintiffs.
At issue is whether the homes violated California Health and Safety Code law by not having enough staff to care for residents. California requires that nursing homes provide at least 3.2 nursing hours per resident per day, which includes care by registered nurses, licensed vocational nurses and certified nursing assistants.
The Humboldt County District Attorney's Office intervened in the he lawsuit, alleging the homes had an unfair advantage over others that complied with the staffing law, and therefore the group's homes are in violation of unfair competition laws.
Skilled Healthcare officials say there is no merit to the allegations.
In an e-mail statement, an attorney for the company said the firm does not believe a civil class action is the appropriate forum in which to address allegations of statutory and regulatory violations.
Company officials did not specifically answer the charge that their staffing levels broke the law, but they said they disagree with the plaintiffs' interpretations of staffing requirements, and their assertions that staffing requirements were "routinely violated." They contend no set staffing level defines quality. Staffing levels should be set by medical staff in each home to meet individual needs of patients, the company says.
The question of staffing
Understaffing is one of the primary causes of inadequate care and often unsafe conditions in skilled nursing homes, the plaintiffs argue. The three plaintiffs named in the lawsuit all had similar complaints that the nursing homes where they stayed were understaffed, Crowley said.
Two of the named plaintiffs were residents of nursing homes in Humboldt County. But one -- Walter Simon, 78, of Fresno -- was a resident at Valley Healthcare on Tulare Avenue.
Simon declined to talk about the care he received at Valley Healthcare for the four months he was there in 2007. "I'd rather not comment on it, because it might affect the case," he said.
The class-action lawsuit is not the only legal dispute to emerge amid concerns over the level of care at Willow Creek in Clovis.
In 2003, when Willow Creek was under ownership by Fountain View Inc. and Summit Care Corp., the nursing home was ordered to pay $2.4 million to the Fresno daughter of a stroke victim who sued over her mother's death. The daughter said her mother was left in her own waste for days at a time, resulting in infections and other health problems.
And in 2001, a jury awarded a $5.2 million judgment against Willow Creek in the death of a 65-year-old woman.
In 2009, a complaint was filed in Fresno County Superior Court for professional negligence in the death of an elderly resident.
The complaint, brought by Charles McCarley, said his mother, Jewel Sommars, was a resident of Willow Creek on Sept. 12, 2008. She was diagnosed with advanced Alzheimer's dementia, confined to a wheelchair and was totally dependent on others, the suit said.
Sommars was to be closely monitored, the complaint said, but on Sept. 12, she wheeled herself past the nursing station and lobby to the outside grounds and fell from her wheelchair. "She sustained serious injuries which subsequently resulted in her death on September 20, 2008," the complaint said.
McCarley could not be located to comment, but the law firm representing him said a confidential settlement had been reached and they would make no comment.
Melody Chatelle, a spokeswoman for Skilled Healthcare LLC, said the company had no comment on lawsuit settlements.
Skilled Healthcare provides administrative support to Willow Creek and Valley Healthcare.