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State calls for fines of nursing home in patient's death

Posted August 11, 2010

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— State regulators have asked federal Medicaid officials to fine a Chapel Hill nursing home where a nurse has been charged with murder in the death of a patient.

The Nursing Home Licensure Section of the state Department of Health and Human Services recommended that the Centers for Medicare and Medicaid Services fine Britthaven of Chapel Hill $20,000 for violations over a two-day period in February.

Nine of the approximately 25 patients in the Alzheimer's unit at Britthaven tested positive in mid-February for opiates, a class of controlled substances often used for pain management, officials said. Six of them were hospitalized, and 84-year-old Rachel Holliday, died on Feb. 16.

An autopsy wasn't performed on Holliday, but a medical examiner who reviewed her records determined that she died because of pneumonia-related asphyxiation. The report listed "morphine toxicity" as a contributing factor to her death.

Officials have said Holliday and some of the other Alzheimer's patients who tested positive weren't supposed to be receiving any pain medication at Britthaven.

Angela Almore, 44, of 724 Berwick Valley Lane in Cary, was indicted in June on one count of second-degree murder and six counts of felony patient abuse. Almore worked as a registered nurse at Britthaven.

Prosecutors allege that Almore drugged the patients to make them more manageable.

Chapel Hill nursing home could face more fines Chapel Hill nursing home could face more fines

The Nursing Home Licensure Section conducted an extensive investigation of Britthaven, at 1716 Legion Road, and found the facility didn't ensure patients were protected from abuse, its services didn't meet professional standards, unnecessary drugs were prescribed and significant medication errors occurred.

DHHS asked that each of the violations carry a $2,500 fine, which spokesman Jim Jones said would amount to the maximum allowable penalty of $10,000 a day.

"CMS may find something else that they want to do," Jones said Wednesday. "We're looking at two days that we know of when residents were exposed to this risk. The facility took steps to fix this problem pretty quickly."

State Rep. Nelson Dollar, R-Wake, criticized the amount of the fine and said lawmakers need to look at beefing up penalties for patient neglect in nursing homes.

"Twenty thousand dollars for a senior citizen who has died seems awfully small," Dollar said.

Paul Mahoney, a spokesman for Britthaven, said in a statement Wednesday that patient health and safety remains the highest priority for the Kinston-based chain and noted that the Chapel Hill facility has already taken corrective actions.

Immediately after the patients were hospitalized in February, Britthaven tested all staff members of the Alzheimer's unit for drugs in February and placed them on paid leave. Officials also started 24-hour monitoring of patients in the unit.

"It is extremely disappointing to our staff and management that (Almore) allegedly chose to administer medications without a valid order in violation of the law, facility policies and our code of conduct," Mahoney said. "We hope that these criminal actions will not undo years of effort by the many conscientious employees who have followed all the rules and worked hard every day to give our residents the best care possible."


This story is closed for comments.

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  • gingerdogditchdog Aug 12, 2010

    This is same company with, not one, but 2 bids (out of 4) in Johnston County to provide a new 100 bed facility. I'm just sayin'.......

  • liskm Aug 11, 2010

    amyrn, I agree it does take a special person and special training to deal with the increasing dementia population. It however is not in place largely in these facilities. It is a separate entity, the best I can describe?

  • amyrn Aug 11, 2010

    Go in and visit your relatives frequently. And there are some very good facilities with Special Care Units for Alzheimer's and other dementia related disease processes. I think the nurse most likely "diverted" other residents' drugs to give to these if that is in fact what happened. It is what she is accused of. It takes a special person to work with dementia residents and they need more training than your regular CNA's or PCA's. The licensed people should also receive more training. There have been homes for people for many years, not just the last few. Some people do not have any relatives and some relatives just cannot afford to stay home and look after their loved ones. But, they should take the time to go and visit frequently and see what kind of care they are receiving. And don't just look at your own family member, look around. See if anyone else looks neglected or mistreated and if so, report it.

  • liskm Aug 11, 2010

    MrGup2, obviously you watched something happy like the Walton's TV show.
    Actually you can improve a loved ones care via a good facility, when it is beyond your skills at home. One just must be selective in where they choose and VISIT regularly and MONITOR that care.

  • TheDude abides... Aug 11, 2010

    Nursing homes shouldnt be. There was once a time when children of elderly parents welcomed them into their homes and took care of them...regardless of how long.
    This was WAAAY before husband and wife had to work until we were 65 so we could pay for that nice house and fancy car. Just dont have time for grandma with all those bills.

    Grandma got traded in for a more luxuroius and comfortable lifestyle.

  • gunsmoke1 Aug 11, 2010

    My unanswered question is where did this morphine come from if those patients were not prescribed it? Additionally my experience tells me that someone else knew working with this nurse what was happening? This state does a good job on putting information out there for families on how to select a facility and what to watch for when visiting, how to watch without interfering in care and how to discuss issues with their administration in a nonconfrontational way. When these things all come together good outcomes usually result. I do not believe that any corporation especially this one as large as it is would want this type of care for any of their residents. So it is not necessary to blame the whole company or all the staff of this facility. Fines are part of the penalty process however fines take away more funds for resident care and staff education. However it is what regulators are left with in most cases.

  • Weetie Aug 11, 2010

    And I thank God that my family was able to take turns staying with our Mother around the clock so she never had to be alone for the 9 days she lived there. It was sad enough that we had to put her in a home because she had to have 24 hour nursing care and her time (3 months) in the hospital had been exhausted. I couldn't imagine someone mistreating her...My prayers are with this family.

  • Adelinthe Aug 11, 2010

    What a shame!

    Thank God my dad wasn't subjected to such as this when he had to be institutionalized in PA for Alz.

    He was always neat, clean and appeared content with where he was, and he did not appear drowsy or over-drugged.

    Thank God.

    It's a very difficult thing leaving your loved ones who cannot communicate for themselves alone in a place like this. Very difficult!

    God bless.