Where I Stand - Mike O'Callaghan: Vulnerable patients must be protected by the state

NEVADA GOVERNMENT agencies and nursing homes have been working to improve care for many years. There's no doubt that progress has been made here and in other states. Usually this progress has followed complaints by the relatives of nursing home patients or the revelation of gross violations.

Sometimes social problems have been identified and challenged by caring and alert lawmakers. A good example of this has been the work of Assemblywoman Barbara Buckley, D-Las Vegas, who came to the rescue of people suffering at the hands of moneymaking HMOs. Buckley's work resulted in patient protective laws that have been copied by caring lawmakers in other states and even Washington, D.C.

In June 1998, the Journal of the American Medical Association published a study revealing that elderly patients in nursing homes were not receiving needed relief from pain. The report was so shocking that this column was used to bring it to the attention of our readers. Dr. Giovanni Gambassi, a lead author of the study, made clear that "there is no acceptable excuse for not treating pain appropriately in terminally ill patients." Even the American Nursing Home Association admitted the study of 13,625 cancer patients in five states raised "legitimate issues that bear close scrutiny." It would be interesting to learn what corrective actions have been taken since the report was published in JAMA.

A month later, hearings in Washington were equally shocking because one of our nation's most progressive states provided much of the shock material. Some California nursing home patients have been allowed to go without food, water or proper medical care.

The Los Angeles Times newspaper told readers that a General Accounting Office report found that 122 nursing homes in California -- facilities with a total of 17,000 beds -- had been cited in the past two annual inspections for 'conditions causing actual harm or conditions that put residents in immediate jeopardy or caused death.' The repeated violations included 'problems with infection control, pressure sore treatment and bladder continence care,' according to the report, which was titled, 'California Nursing Homes, Care Problems Persist Despite Federal and State Oversight.'

Although California is credited with being able to identify these problems, the state has done little to correct them. The 122 offending nursing homes were often repeaters, but in 75 percent of the cases no penalty was given them. The report also suggests that some states are tougher regulators than others. In 1997, Arkansas, South Dakota, Utah and the District of Columbia found no substandard nursing homes. Nevada and Kansas flunked almost 15 percent of the nursing homes they inspected. Silver State officials are evidently doing their inspection jobs better than some states.

Like California, a recent case in Las Vegas demonstrates that Nevada also has failed to follow up with the strength necessary to encourage nursing home operators to correct bad practices. An editorial in the Sun as recently as Aug. 8 noted that "Despite state investigators uncovering new violations, the state Bureau of Licensure and Certification on July 29 recertified the Cheyenne Residential and Nursing Center to house Medicaid patients. The Sun's Art Nadler reported Wednesday that this is the fourth time since February that the center has been cited for violations by the state."

Nevada government administrators and lawmakers should now take an even closer look at the nursing homes in this state. The fastest-growing state in the nation has had more than one social problem grow faster than the means available to solve it. Although the present means of nursing home inspection is better than other states, is it still adequate? When was the last time the governor, lieutenant governor, attorney general, mayor, county commissioner or legislator made an unannounced visit to nursing homes?

Recent reports have gotten the attention of Californians where the L.A. Times newspaper noted, "The state has substantial authority to impose fines on violators. It could have more if the Wilson administration had not helped gut a state bill meant to toughen sanctions against nursing homes. That pending bill, by Assemblyman Martin Gallegos (D-Baldwin Park), would have increased the top fine the state could levy from the current $25,000 to $100,000. But after pressure from the Wilson administration, state legislators dropped the higher fines and in fact added a provision for a 35 percent reduction in fines to nursing homes that do not appeal their penalties."

The newspaper went on to support the state and federal promises for better enforcement and oversight. Then the editors added, "But more fundamental reform is needed; restoring the fines in the Gallegos bill, changing an outrageous state law that allows nursing homes to greatly inflate representations of the amount of care provided by registered nurses and licensed vocational nurses, and setting clear, minimum staffing levels so one nursing assistant isn't hand-feeding two dozen patients."

Anybody listening?

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