By Francisco Alvarado, FloridaBulldog.org
Plaza Health Network, the embattled nursing home chain that six months ago agreed to pay $21.5 million to settle federal civil charges that it defrauded Medicare and Medicaid, has habitually violated state and federal healthcare regulations by providing inadequate, and at times negligent, care to residents at its facilities.
FloridaBulldog.org reviewed U.S. Department of Health and Human Services (HHS) and Florida Agency for Health Care Administration (AHCA) records since 2012 and found 191 documented deficiencies at nonprofit Plaza Health’s seven nursing homes in Miami-Dade County. During the same time period, Plaza Health was hit with $24,820 in state and federal penalties for violations at three of its nursing homes in North Miami, North Miami Beach and the Overtown neighborhood of Miami.
The deficiencies ranged from improperly inserting a catheter into a patient and allowing a patient’s wound to fester without a physician diagnosing the injury for nearly three weeks.
“What is really cause for alarm are the recurring problems,” said Brian Lee, an executive with the union that represents Plaza Health’s rank-and-file employees who is also executive director of Tallahassee-based Families For Better Care. “There is a repeated pattern of issues that fly under radar that cause real harm to the residents.”
Ronald Lowy, a Miami attorney who is Plaza Health’s board chairman, said the deficiencies are not outside the norm.
“I think the number of deficiencies against our buildings are much less than the industry standard,” Lowy said. “The key is when a deficiency is found, we make sure those things are corrected so they don’t happen again.”
Founded in 1954 as the Hebrew Homes for the Aged, Plaza Health Network was sued in Miami federal court in 2012 by whistleblower Steven Beaujon, the company’s ex-chief financial officer, Steven Beaujon. The case triggered a Justice Department probe of Beaujon’s claim that for 10 years Plaza Health had paid kickbacks to physicians who referred it patients, allowing the company to submit $130 million in false claims for physical therapy.
Beaujon alleged that prominent Miami Beach developer Russell Galbut, who served as Plaza Health’s chairman from the mid-Nineties until November 2014, knew about the scheme and encouraged the practice. In previous interviews with FloridaBulldog.org, however, Galbut denied any wrongdoing.
In June, Plaza agreed to pay Beaujon $4.5 million and the U.S. $17 million to end the whistleblower litigation. Through companies he owns, Galbut is Plaza Health’s landlord on one of its nursing homes.
A month after settling with the feds, Plaza Health hired former state representative Elaine Bloom as president and CEO.
While the Medicare probe was ongoing, inspection reports filed by federal and state regulators show Plaza Health was also running into trouble over patient care.
For instance, Medicare.gov’s current overall rating for Aventura Plaza Rehabilitation & Nursing Center, 1800 NE 168th Street, is “below average” and its health inspection rating is “much below average.” The property is also home to Plaza Health’s corporate headquarters.
State regulators at AHCA put Aventura Plaza on its watch list from May 20, 2013 to Nov. 20 of this year for “failing provide adequate and appropriate health care to its residents.” But that didn’t prevent further problems. During a Jan. 16, 2014 visit, AHCA inspectors observed that medical staff had botched the insertion of a Foley catheter into a female patient.
“This failure to properly secure the Foley catheter to the thigh resulted in excessive tugging and injury as evidenced by bleeding from the Foley insertion site,” says an administrative complaint filed against Plaza Health. “The resident’s adult brief had a moderate amount of old blood and fresh blood.”
AHCA’s board ordered Plaza Health to pay a $2,500 fine in June 2014.
HHS and AHCA records also show that investigators went to Aventura Plaza on May 19 after receiving a complaint regarding a mistreated patient. Upon interviewing the attending nurses, investigators determined a nurse failed to properly bandage a patient’s open wound when the person was admitted into the nursing home on April 9. An incident report also says that a physician did not inspect the injury until April 28. By then, the wound had developed necrosis.
Plaza Health’s director of nursing, who is not identified by name, later told inspectors “it was not normal” to allow 19 days to elapse before a physician diagnosed the patient’s injury, the report says.
14 STATE AND FEDERAL DEFICIENCIES SINCE JANUARY
In all, investigators flagged Aventura Plaza for 14 state and federal deficiencies since mid-January. According to HHS records, Aventura Plaza was ordered to pay a $1,885 fine on January 21, 2015 for three deficiencies, including failure to report possible physical abuse by a certified nursing assistant against a patient.
The average number of healthcare deficiencies in Florida nursing homes per year is 6.2 and the national average is 6.8, according to Medicare.gov.
Plaza Health’s Arch Plaza Rehabilitation & Nursing Center, located at 12505 NE 16th Ave in North Miami, has been slapped with 24 state and federal deficiencies since 2012 even though Medicare.gov rated it “above average” and gave it a health inspection rating of “average.”
On March 1, 2015, inspectors cited 98-bed Arch Plaza for failing to immediately report a hand injury to a female patient that was not described. The patient, however, had to be taken to a hospital for further evaluation and treatment. Under state and federal law, licensed nursing homes are required to file prompt reports about injuries to patients.
Federal inspectors cited Arch Plaza again two weeks later for failing to keep its pill crushers clean. “During a survey of the pill crushers on the first floor medication carts, med cart #1 and #2 were found to be dirty with build-up residue on the crushing surface and dust mixed with brown buildup of dirt and rust on the front of the pill crushers.”
Follow up reports by state and federal investigators say Plaza Health implemented measures in June to correct those deficiencies.
“Plaza Health’s facilities have considerably less deficiencies when compared to other nursing homes in Miami-Dade,” said board chairman Lowy.
Lowy also said he’s documented anecdotal evidence that Plaza Health does a good job taking care of its residents.
“My own father-in-law is currently a patient at Aventura Plaza,” Lowy said. “He is thrilled to be there. I show up at the buildings unannounced and don’t tell patients who I am. Most of their general complaints are not of any major nature. There is nothing negative about the standard of care.”
However, several Plaza Health employees interviewed for this story said the non-profit company would continue to experience the same problems due to inadequate staffing and low employee morale.
In October, the Service Employees International Union (SEIU), which represents Plaza Health’s 400 employees, launched a media campaign demanding the non-profit increase its minimum salary to $15 an hour. Marie Alcindor, a certified nursing assistant who has worked at Arch Plaza for 22 years, said she earns slightly less than $11.50 an hour.
“Caregiving work is extremely rewarding, but the trouble is that I can’t support my own family on the low pay,” Alcindor said. “It also affects those we care for day-in and day-out.”
Yolaine Joseph, a certified nursing assistant at Aventura Plaza said she’s been with Plaza Health since 1981, yet only makes $13.08 an hour. She never looked for another employer because Aventura Plaza is close to her home, which allowed her to have more time to take care of her children.
“I don’t want people younger than me to go through what I have experienced,” Joseph said. “I have given them half of my life and I am a good worker.”
Lowy said Plaza Health simply cannot afford to raise the minimum wage to $15. “Medicaid and Medicare are not going to agree to reimbursing us those rates,” he said. “The $15 flat rate is something this industry cannot support.”