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By Michael Fagans / The Californian
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By Michael Fagans / The Californian
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By Henry A. Barrios / The Californian
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By JOHN COX and RACHEL COOK, Californian staff writers firstname.lastname@example.org, email@example.com
The case of a woman who died last week after being denied CPR at a Bakersfield independent living facility may spark changes in how such businesses are run and regulated, industry observers said Monday.
In a day that included the announcement of a police investigation into the incident, patient advocates and an industry spokesman emphasized that the nurse was not obligated to provide medical care to the woman, identified as 87-year-old Lorraine Bayless.
Glenwood Gardens part of giant US chain
Glenwood Gardens is part of a Tennessee-based company that says it is the “largest operator of senior living communities in the United States.”
The company, Brookdale Senior Living, reported $2.8 billion in total revenues in 2012, a 13 percent increase from the prior year, according to a report to the U.S. Securities and Exchange Commission. The company runs hundreds of “independent living, assisted living, and dementia-care communities and continuing care retirement centers,” according to its website.
It said it was the biggest US company of its type “as of December 31, 2012.... based on total capacity, with 647 communities in 36 states and the ability to serve approximately 66,700 residents.”
The company says it operates “communities that participate in federal and/or state health care reimbursement programs, including state Medicaid waiver programs for assisted living communities, (and) the Medicare skilled nursing facility benefit program.”
The report noted that “the cost and difficulty of complying with increasing and evolving regulation and enforcement could have an adverse effect on our business operations and profits” and that lawsuits could impact the company.
“The senior living and healthcare services businesses entails an inherent risk of liability, particularly given the demographics of our residents, including age and health, and the services we provide,” the report said.
“In recent years, we, as well as other participants in our industry, have been subject to an increasing number of claims and lawsuits alleging that our services have resulted in resident injury or other adverse effects.”
The company said it may continue to face the “threat of large jury verdicts” and that the business maintains liability insurance policies “with the coverage and deductibles we believe are adequate based on the nature and risks of our business, historical experience and industry standards.”
“We have formed a wholly-owned ‘captive’ insurance company for the purpose of insuring certain portions of our risk retention under our general and professional liability insurance programs. There can be no guarantee that we will not have any claims that exceed our policy limits in the future,” the report said.
A spokeswoman for Brookdale Senior Living did not return messages Monday.
— Rachel Cook
Nevertheless, the employee’s refusal to do CPR herself or get someone else to do it, as requested by a fire dispatcher, prompted a wave of puzzlement and outrage across the United States.
Excerpts from the intense audiotape of the 911 call continued to be played over and over again by radio and television outlets across the country, reflecting deep public interest in the incident.
Bayless was a resident of Glenwood Gardens’ independent living facility — not its assisted living facility or its skilled nursing facility, both of which are licensed medical facilities on the same campus along Calloway Drive.
Nursing home patient advocate Pat McGinnis said the situation highlights a “gap of oversight” that will almost certainly be taken up soon by the state Legislature.
“There’s a lot of discussion of, if this is legal, should it be?” said McGinnis, executive director of California Advocates for Nursing Home Reform.
But government intervention may not be necessary, trade group spokesman Jamison Gosselin said.
“This opportunity allows us to take a look at the issue of CPR and see if there are any standards or best practices or changes that could potentially need to be made in retirement living or in long-term care environments,” said Gosselin, spokesman for the Virginia-based Assisted Living Federation of America.
Police investigation, local inquiry
Bakersfield police confirmed Monday that they have opened an investigation into possible criminal misconduct by Glenwood employees.
Sgt. Jason Matson said the department’s initial findings were that no employees of Glenwood Gardens had done anything wrong. But he added that there were “several different angles” to look into before the case could be closed.
“We want to investigate this thoroughly and see where the facts take us,” he said.
Kern County’s Aging and Adult Services Department is also gathering information to determine whether elder abuse took place in Bayless’ case, Director Lito Morillo said.
“Once we determine which direction to go, we will take the action necessary,” he said, adding that the agency typically focuses on preventing elder abuse in various settings.
Authorities provided new details on the case Monday, including confirmation by the Bakersfield Fire Department that no “do not resuscitate” order was in the paperwork for Bayless that the fire department received from the facility.
The incident report shows the department was alerted at 11:07 a.m. Feb. 26 and arrived at the facility by 11:13 a.m.
“E15 was dispatched to a medical aid for a patient in apparent cardiac arrest,” the document’s narrative says. “While enroute, E15 was contacted by ECC via radio and advised the facility was refusing to initiate CPR. E15 arrived on scene simultaneously with Hall Ambulance.
“E15 personnel proceeded to the dining room and found a female patient to be pulseless, non breathing and lying supine on the floor. Co15 made contact with the facility LVN and received the patient’s paperwork. No DNR was present.”
Fire personnel were advised to immediately initiate CPR, the report continues. Hall Ambulance personnel arrived and took over primary care of the patient.
“E15 personnel assisted Hall Ambulance with CPR and the packaging of the patient,” the report said.
Bayless was taken to Mercy Southwest Hospital, where she later died.
The fire department has also released recordings of the seven-minute 911 call that depict a dispatcher pleading with a nurse who was employed by the facility to administer CPR to Bayless. The nurse refused.
"Is there anybody there that's willing to help this lady and not let her die?" the dispatcher asked.
"Um, not at this time,” the nurse responded.
The nurse said she could not have one of the other residents perform CPR. Toward the end of the call the dispatcher begged the employee to find someone, anyone else who could help.
"Is there a gardener or any staff, anybody that doesn't work for you anywhere? Can we flag someone down in the street and get them to help this lady?" the dispatcher asked. "Can we flag a stranger down? I bet a stranger will help her. I'm pretty good at talking 'em into it, if you can flag a stranger down I will help, I will help tell them how to help her."
Bakersfield Fire Department Battalion Chief Anthony Galagaza identified the dispatcher who handled the call as Tracey Halvorson. Galagaza, who is also the fire department’s public information officer, said Halvorson has declined to be interviewed.
“She was conducting the call according to protocol,” Galagaza said.
Galagaza said dispatchers follow a card system with a chart that instructs them what steps to take depending on the incident.
Kern County Emergency Medical Services declined to comment on the case.
“We're not going to comment right now, because we don't know the whole story,” said Kim Rodriguez, spokeswoman for the Kern County Department of Public Health Services.
Rodriguez said no complaints have been filed with the department about the case, but that the department needs to remain unbiased should an investigation be opened.
The case has raised questions about the role of nurses in independent living facilities, with some wondering why Glenwood staff did not perform CPR on Bayless.
Russ Heimerich, spokesman for the California Board of Registered Nursing, said the question of responsibility depends on whether the woman on the 911 call is indeed a licensed nurse working in the capacity of a nurse.
“I wish there was a black and white answer,” Heimerich said.
Circumstances that could allow a medical professional to forgo performing CPR include cases in which life-saving resuscitation could expose the care provider to harm — or when there’s a “do not resuscitate” order on file.
But generally, “a nurse in that situation must perform CPR” or provide other appropriate medical care, Heimerich said.
The requirement to render aid is less clear in cases in which a trained nurse is hired to function in a different capacity. A nurse or other medical professional working as an administrator, for example, may not be held to the same standard, professionally, he said.
But Heimerich acknowledged there are professional standards, and then there are human ethics, the need to simply do the right thing.
Why not hand the phone to someone willing to do it?, Heimerich asked.
“We really just need to take a look and see what the hell is going on,” he said.
It remained unclear Monday what kind of nursing credential the woman had, such as whether she is a registered nurse, licensed vocational nurse or certified nursing assistant.
Glenwood Garcens issued a statement Monday that the employee heard in the 911 call was not acting as a nurse at the time but as the facility’s director of resident services.
Kern County’s long-term care ombudsman, Nona Tolentino, said people trying to choose a retirement home for their family member could easily get the impression that all residents of Glenwood Gardens get the same care — which she said is not the case.
“This is why I encourage people to be savvy consumers in looking for” a long-term care facility, Tolentino said, adding that she was “appalled” that no one would provide CPR to Bayless.
Glenwood’s independent living facility, like all such businesses in California, are not licensed; they operate like apartments with special amenities such as laundry and meal services.
This would change if the state approves the company’s plan to turn the Calloway Drive complex into a continuing care retirement community.
These centers combine the services of a skilled nursing facility with those of an assisted living facility and an independent living facility. They typically command higher prices than offering such services independently.
State records show Glenwood Gardens’ application is pending. A spokesman for the state Department of Social Services was unable to determine when the application was filed, when a decision on the proposal is expected, or whether Bayless’ death could affect the application.
Bayless’ daughter, Pam Bradford, told The Californian Monday that she wanted the attention surrounding her mother’s death to dissipate.
“I just wish you would let the story die and you would let us be in peace,” Bradford said.
— Californian staff writer Steven Mayer contributed to this report.