$900000 for death at Kirkland adult-family home

June 08–For 22 days, caregivers at a Kirkland adult-family home guarded a secret.

An elderly woman at Houghton Lakeview suffered from pressure sores that had burrowed to the bone. No one called her family. No one alerted a doctor.

The state of Washington harbored a secret, too.

Investigators had cited Houghton Lakeview 33 times for inadequate care and substandard conditions. Two caregivers were convicted felons, barred from such work. Two others had forged nursing credentials. The public was never warned — nor were the residents in the home.

By the time the woman was rushed to the emergency room, it was too late. Jean Rudolph, 87, a retired nursing educator who had Alzheimer’s disease, died in 2008 from untreated pressure sores.

The state Department of Social and Health Services (DSHS) and the owner’s insurance company agreed to a $900,000 settlement this week with the Rudolph family.

This rare settlement reveals a state regulatory system torn between dual roles: booster of the industry as a way to control costs, as well as enforcer of its failings. With rising numbers of low-income seniors in need of long-term care, Washington and dozens of states are banking on these residential facilities as alternatives to more costly nursing homes.

The risk to the public, says attorney Tony Shapiro, who represented the Rudolph family, occurs when state agencies like DSHS form a "bunker mentality" and excuse violators to preserve existing adult homes.

Washington has 2,838 adult-family homes licensed to provide room and board for up to six vulnerable adults. Since April 2010, at least 446 homes have been cited for violations of health or safety standards, a recent Seattle Times analysis shows.

Recommendation overruled

In May 2007, a DSHS investigator tried to revoke the license of Houghton Lakeview after uncovering 11 flagrant violations, including caregivers with forged nursing credentials or felony convictions, and failure by staff to provide medications or report alleged abuse.

But DSHS supervisors overruled the recommendation and closed the case with a $200 fine.

James Rudolph, a son, said family members were kept in the dark about these problems.

In April 2008, Jean Rudolph, who had lived there for several years, developed multiple pressure sores on her back and elsewhere, according to DSHS records.

Caregivers failed to report or properly treat the festering wounds for 22 days, DSHS later concluded. Hobbled by Alzheimer’s disease, Rudolph had difficulty communicating or moving. At night, she would scream in pain, medical records show.

Bedsores are a common ailment in long-term-care facilities and are easily treatable. Experts say family members should routinely look for them when visiting loved ones. Rudolph family members said it never occurred to them to look underneath her clothing and beneath her bandages.

Eventually, a caregiver called James Rudolph, not 911, with a vague description of an emergency. He raced to the home, then rushed his mother to the hospital, but infection had already spread to vital organs. Jean Rudolph died in June 2008 at her son’s Bellevue home under hospice care.

In 2010, the caregiver who made that call, Effie Tutor, also known as Effie Dutton, 40, was sentenced to 31 months in prison for first-degree criminal mistreatment. Adult-home owner Patricia Goodwill, 62, was sentenced to a year in jail for second-degree criminal mistreatment.

DSHS settled the case for $650,000. Goodwill’s insurance company settled for $250,000, court records show.

Unqualified care

Jean Rudolph’s death was profiled in 2010 by The Seattle Times in an investigative series, "Seniors for Sale," which found that hundreds of seniors had been injured or died prematurely from substandard care inside adult homes, often at the hands of scantly trained caregivers.

The Times also found that scores of adult-home owners were dangerously unqualified to provide care to vulnerable adults.

Since then, the state has established more accountability and transparency. DSHS posts violations and sanctions on its public website. It notifies families and residents of these actions. Adult-home owners are required to post copies of violations in public view.

In addition, state officials toughened the training and requirements to become an owner of a licensed home. These changes have slowed the industry’s rapid growth, which, at its peak, tallied up to 400 new licenses a year.

By many accounts — police, prosecutors and community-health officials — the adult-home system has undertaken many improvements, though the sheer number of homes can make state enforcement spotty and inconsistent.

The Rudolph case has startling similarities to another DSHS settlement involving fatal pressure sores. In 2009, the agency paid $565,000 to the family of Nadra McSherry, 74, a retired teacher who languished nearly a month with untreated bedsores.

In that case, DSHS supervisors also ignored their own investigators’ pleas to shut down the Tacoma home, owned by Arlie Leno, which had amassed more than 135 serious violations since 1990. Leno’s home remains licensed.

In a legal brief for the Rudolph case, lawyer Shapiro cited Benjamin Franklin’s definition of insanity — doing the same thing over and over but expecting different results — to criticize the state’s misguided tendency to prop up adult homes as a way to save money.

"These deaths can be avoided if the state would just follow its own procedures," Shapiro said.

Michael J. Berens: 206-464-2288 or mberens@seattletimes.com



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