The nursing home inspector noticed a resident at Hidden Lake Care Center in Raytown squirming uncomfortably in a wheelchair.
The resident, “severely cognitively impaired,” according to the inspection report filed later, had a pressure sore on the right hip that had been growing for months. It had blackened, drained blood and other fluids and, at one point, tested positive for E. coli, a germ found in feces.
The inspector then watched a nurse change the resident’s bandage. The unidentified nurse didn’t wash his or her hands or change gloves after cleaning the wound, instead re-dressing the resident with the same soiled gloves.
“The resident was crying out and grimacing during the wound care,” the inspector wrote in November 2015.
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Several more residents were struggling with painful, oozing bedsores, all of which should have been prevented, the inspector found. A few months later another resident almost died because staff failed to heed a doctor’s medication order.
Then the federal government put Hidden Lake Care Center on notice.
The U.S. Centers for Medicare and Medicaid Services in 2017 added Hidden Lake to a nationwide list of “special focus facilities” — troubled nursing homes that have to be inspected more frequently because of persistently poor state inspections.
Nineteen months later, Hidden Lake is still on the list, the only facility in the Kansas City area. It’s since been added to a national sub-list of 36 “facilities that have not improved.” Only three of those nursing homes have been on the list longer.
Experts say Hidden Lake could lose its Medicare and Medicaid reimbursements, a death blow for most nursing homes.
In the meantime, residents are in danger, said Kathy Greenlee, a former Kansas official who headed the federal nursing homes division under President Barack Obama.
“This is sort of ‘pay-close-attention time’ for someone who has a loved one there,” Greenlee said.
For some it’s too late.
At least nine medical malpractice and wrongful death lawsuits have been filed against Hidden Lake in the last five years, blaming the facility for deaths due to bed sores, preventable falls and general neglect.
Hidden Lake’s on-site administrator said she wasn’t authorized to talk to the media and referred questions to the facility’s parent company, MGM Healthcare in St. Louis.
Michael Winter, MGM Healthcare’s lawyer, said the company has poured millions of dollars into new equipment, training and personnel and hired consultants to help with things like nutrition.
“We’re doing everything we can to pass the survey and get off the special focus list,” Winter said Thursday.
Hidden Lake’s ownership extends well beyond St. Louis. One of the lawsuits accuses the owners of setting up a “corporate maze” of shell companies to avoid legal responsibility for poor care.
Navigating that maze leads to a group of owners based in New York. The group includes Benjamin Landa, who has come under scrutiny for running a chain of poor-performing nursing homes in that state and is now embroiled in a federal lawsuit that accuses him and others of an indentured servitude scam there involving 350 Filipino nurses.
MGM Healthcare, which is registered as Midwest Geriatric Management, manages nursing homes in Iowa, Ohio, Oklahoma and Wisconsin in addition to eight in Missouri, most of which are in the St. Louis area.
The dozens of homes are each registered under their own limited liability corporations. It’s a similar setup to one used by a New Jersey family for 15 nursing homes that the state of Kansas had to take over earlier this year because they were financially insolvent.
According to attorneys for John Shull, who’s suing Hidden Lake over the death of his father, Charles, it’s done for one reason: to keep the investors who actually own the nursing home from being held accountable.
“Defendants herein and currently unnamed have created a corporate maze for the express purpose of allowing those who actually make decisions regarding the care at Hidden Lake Care Center to avoid responsibility for the lack of care,” his suit says.
The suit names as a defendant Judah Bienstock, a resident of the St. Louis suburb of Chesterfield, who declined to comment through an attorney.
One of Landa’s attorneys, Seth Eisenberger, reached Wednesday at his office in Brooklyn, confirmed that Landa had a stake in Hidden Lake but said he was trying to divest it.
“Mr. Landa is a passive investor in the Hidden Lakes (sic) nursing home and has not participated in the management of the facility,” Eisenberger wrote in a followup email.
Landa is the founder of SentosaCare, a chain of dozens of nursing homes in New York. A story published by ProPublica in 2015 under the headline “How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm” documented the history of poor care, health violations and repeat fines at SentosaCare homes.
Landa and others sued the story’s authors for libel, but the suit was dismissed in February by New York state Supreme Court Justice Paul Wooten, who ruled that the parts of the story the plaintiffs took issue with were “substantially accurate” and the story was in the public interest.
Landa and others are now defending themselves against a federal class action lawsuit in New York brought by nurses who say they were recruited from the Philippines to work at several SentosaCare facilities, then weren’t paid what they were promised.
The nurses allegedly signed contracts that included $25,000 penalties if they quit the jobs before the contract was up. The class action suit says that violated human trafficking laws by making the nurses essentially indentured servants.
Eisenberger said that the suit is without merit and that Landa and the other defendants are trying to get it dismissed.
“The plaintiff and other nurses testified that Mr. Landa did not have any contact with (the) plaintiff,” Eisenberger said, “nor did Mr. Landa and the other defendants threaten (the) plaintiff or any other nurses.”
Winter said that whatever went on in New York, it had nothing to do with Hidden Lake.
“We follow all state and federal regulations,” Winter said. “All that does not exist at Hidden Lake. Never did, never will.”
As Landa fights lawsuits in New York, he’s so far largely avoided any exposure from the suits brought in Jackson County against Hidden Lake.
The plaintiffs include:
▪ Aleisa Rizo, who sued over the 2014 death of her father, Roger Simms. According to the suit, Simms was admitted to Hidden Lake in March 2013. On Jan. 7, 2014, he complained of respiratory distress, but the staff allegedly failed to adequately monitor his breathing. Early the next morning he was found lying across his scooter, unresponsive, and the suit says the staff didn’t try to resuscitate him even though he was a “full code” patient who had said he wanted all possible lifesaving measures to be taken. Simms, of Kansas City, was 69. The suit settled for an undisclosed sum in July 2016.
▪ Dixie and Melissa Laval, who sued over the 2013 death of their father, Calvin Laval of Raytown. According to the suit, Calvin Laval was admitted to Hidden Lake after getting treatment at Centerpoint Medical Center for a fall. After one day at the nursing home he suffered a fall that caused bleeding in his brain. He was rushed to St. Luke’s Hospital, but died two weeks later. The suit settled for $250,000 in 2017.
▪ Donald and Jack Wolfinbarger, who sued over the 2014 death of their mother, Leona Howard. According to the complaint, Howard “was in a frail, defenseless and dependent condition” when she was admitted to Hidden Lake in October 2014. She survived there for two months. “While a resident at Hidden Lake Care Center, Leona Howard suffered from the effects of unnecessary and preventable falls, pelvic fractures, severe neglect, severe dehydration, malnutrition, urinary tract infection, severe infection, severe pressure ulcers on her right heel and coccyx and sepsis,” the complaint says. Howard, from Independence, was 91. The parties dropped the suit following a $300,000 payment.
▪ Christopher White, who sued over the 2016 death of his sister, Sherilyn Sample. Sample, of Kansas City, was only 45 when she was admitted to Hidden Lake that June following surgery on both legs. The suit says she was wearing braces from her thighs to her ankles, and hospital staff had prescribed twice-daily injections with an anti-coagulent to prevent blood clots. The nursing home staff and medical director allegedly failed to give them to her, deciding she could take aspirin instead. On July 5, 2016, Sample “cried out for help and said that she could not breathe and was found to have noticeable sweat on her forehead and neck. An ambulance was called and she was transported to Centerpoint Medical Center.” She died within hours, allegedly because of blood clots that had traveled from her legs to her lungs. The suit is pending.
▪ The estate of Lillian Spence of Kansas City, which sued over Spence’s August 2015 death at age 81. The suit says Hidden Lake “failed to properly monitor and treat Lillian Spence’s bed sores and/or pressure sores, which resulted in infection and further injury, necessitated surgery in May 2015, and ultimately led to her death.” The lawsuit is still pending.
Judy Chowing, who was in a wheelchair having a cigarette outside Hidden Lake on Wednesday, said she could believe that the facility had had some poor health inspections. But after living there for two years, she had no complaints personally.
“It’s better than where I’ve been in,” Chowing said.
Another resident, seated just inside the front door, said Hidden Lake was “better than being on the sidewalk” and he didn’t want it to close.
Yet that appears to be a real possibility.
A regional spokeswoman for Medicare said via email that Hidden Lake is still being reimbursed for Medicare and Medicaid “at this time” but didn’t address whether payments would be withheld in the future.
But according to Rebecca Helveston, a Louisiana attorney who specializes in health care and nursing homes, when a home has been on the special focus facility list for 18 to 24 months, the danger of losing the reimbursements becomes particularly acute, especially if it’s not showing improvement.
Greenlee said just being on the list at all means it’s a possibility, though one the feds usually try to avoid.
Missouri state regulators, who can pull a nursing home’s operating license, said they have mandated extra training for Hidden Lake’s staff and met with administrators there recently to ensure they’re correcting outstanding problems.
Winter said he’s confident the facility has improved, but acknowledged that losing Medicare and Medicaid certification would be devastating.
“Of course that’s a concern,” Winter said, “but we’re hopeful with all the resources we’ve put in there, we will pass (inspection).”
Reports from Hidden Lake’s most recent inspections, in March and October, suggest problems persist.
Some residents told inspectors they were getting only one or two showers a month. Nearly all said the food is inadequate, often cold and frequently runs out.
The facility was still understaffed, with each of the approximately 70 residents receiving an average of just 16 minutes of care per day from registered nurses. The average in Missouri is 28 minutes a day, and the average nationwide is 41 minutes a day.
Its long-term residents suffer more than twice as many urinary tract infections and almost three times more pressure ulcers than the national average.
“If that’s a repeat problem, that’s a really serious issue for the residents,” Greenlee said of the pressure sores. “This is sort of a known risk with people who have high levels of care needs. Bedsores is not a surprise issue for a nursing home and they can be difficult, but it is really about having enough staffing in place.”
Greenlee said the feds’ options are limited for forcing better care, other than pulling Medicare and Medicaid payments entirely.
Hidden Lake is already being docked almost 2 percent of Medicare reimbursements because of high hospital re-admissions, according to a Kaiser Health News database, and it’s been fined following poor inspections on three occasions since 2015, for a total of about $33,000.
Greenlee said one thing she had done when she was in the federal government was order nursing homes to hire an outside consultant to run the place, if it became clear that the owners couldn’t do it properly.
That was perhaps the final step before pulling Medicare and Medicaid reimbursements, which she viewed only as a last resort.
“For me, the hardest part as a regulator was to decide when it is time to walk away and the facility has to close,” Greenlee said. “It is a real significant struggle for the federal government and the states because at that point you’re talking about closing the nursing home and moving the residents, which is really disruptive.”