NEWS

Tennessee months behind investigating reports of patient abuse

Anita Wadhwani
USA TODAY NETWORK - Tennessee

The state is months behind in investigating reports of patient abuse in hospitals and nursing homes, falling far short of the 48-hour turnaround required to conduct on-site investigations in cases where the risk of "immediate jeopardy" is suspected, potentially leaving patients at risk, an audit by the Tennessee comptroller has found.

Various community agencies will partner for a free community health clinic at Hobgood Elementary on April 29.

Some investigations took up to 146 days to begin.

The board that bears the responsibility for oversight of abuse investigations — the Tennessee Board for Licensing Health Care Facilities — also takes far too long to place abusive health care workers on an online registry intended to prevent employers from hiring them to work with patients again. In one case, it took 10 months to place an individual on the state's abuse registry.

The comptroller's 24-page report outlines a series of serious problems in the oversight of hundreds of Tennessee's nursing homes, assisted living facilities, hospitals and 24-hour care facilities for people with intellectual disabilities.

And the board has allowed unlicensed staff to administer medications in assisted living facilities because its rules haven’t been clear on who is allowed to dispense them. Additionally, auditors found that fines are so low for breaking rules that some assisted care facilities "preferred to pay the fines ... instead of hiring higher paid licensed staff" to administer medication.

The audit also found the oversight board is not ensuring that nursing homes meet fire sprinkler regulations. Lawmakers strengthened those requirements after a devastating Nashville fire in 2003 claimed the lives of eight elderly women. Nashville fire officials, including a district chief whose 96-year-old mother perished in the fire, said at the time a fire sprinkler could have saved lives.

Many of the findings "jeopardize the safety and welfare of persons" in Tennessee’s licensed health care facilities.

The Tennessean sought comment from the Tennessee Department of Health, where the board is housed. A spokesman said the department could not speak for board members. The Tennessean could not reach individual board members for comment late Friday.

Tennessee’s ombudsman for long-term care did not respond to a request for comment by deadline.

The board consists of 18 members appointed by the governor. It regulates and licenses the state's 160 hospitals, 321 nursing homes, 291 assisted living facilities, 128 residential homes for the aged, 153 care facilities for people with intellectual disabilities, 39 psychiatric residential treatment centers and dozens of other centers that care for patients.

The Department of Health's Office of Health Care Facilities works for the board by monitoring health care facilities and investigating complaints. The office also maintains the Tennessee abuse registry. Employers are required by law to check the abuse registry before hiring health care workers to care for patients.

In the audit, health officials cited a large spike in the number of complaints for creating a backlog for existing staff to investigate. Since 2011, there has been a 50 percent increase in complaints filed against health care facilities. Between July 2014 and September 2015, there were 2,292 complaints. Of these, 792 still await investigations — 263 of them involving nursing homes.

In its written response to the audit, management for the Office of Health Care Facilities noted that it hasn't had adequate staff to conduct investigations.

The same inspectors, called surveyors, who are responsible for abuse investigations also are responsible for routine surveys of each facility to ensure they comply with health care rules. Those regular surveys are supposed to take place every 15 months. About 40 percent of the facilities examined by the comptroller's office were not inspected on time. Inspections on average took place every 17 months.

In its response to the audit, the Office of Health Care Facilities noted it had caught up with the backlog of annual health surveys in July. It also has filled six of 12 staff vacancies. Officials plan to roll out an electronic planning system to "enhance efficiency."

The Office of Health Care Facilities also is "in the process of promulgating regulations for the Registry of Persons Who Have Abused, Neglected, Misappropriated or Exploited the Property of Vulnerable Individuals" that will create new procedures for timely reporting to the abuse registry.

The Board for Licensing Health Care Facilities has formed a standing subcommittee to examine rules for who can administer medication, the written audit response noted.

There was no written response contained in the audit about the failure to ensure fire sprinkler rules are being followed.

Reach Anita Wadhwani at 615-259-8092 and on Twitter @AnitaWadhwani.