Nursing Home Official Calls Fine ‘Improper’ : Company Will Appeal State’s $25,000 Penalty, Citation Issued After Patient Choked to Death

An official of a Santa Ana nursing facility said Wednesday that the home will appeal a $25,000 fine and citation issued by the state Department of Health for contributing to the death of a patient who choked on food, calling the penalty “improperly issued.”

The citation against the Bristol Care Center nursing home, 1092 Hemlock Way, was the most serious action the agency could take short of seeking immediate closure of the facility.

Richard L. Pruitt, executive director of the South Coast Care Corp. of Huntington Beach, which operates Bristol and five other nursing homes, said Wednesday the nonprofit company intends to appeal the citations and fines.

“I feel so strongly that we will win this one that we’ll take it to the (U.S.) Supreme Court,” Pruitt said.

‘We Did Not Act Improperly’

“The accusations that the department is making I don’t think are valid. We did not act improperly nor did we act incorrectly. I feel that our documentation on this patient was excellent.”

But a state official said employees of the home failed to follow proper procedures in treating the patient before his death.

“The man died of aspiration of food, choking,” Joan Dowling, administrator for the state Department of Health’s Southern California region, said Wednesday of the citation. “The patient choked. There were three nurses actually involved; they failed to assess the patients’ needs; they didn’t follow their procedures.”

The state Department of Health is “looking into other deaths (at Bristol Care Center); I won’t limit it to one or two,” Dowling added. “We’re looking into all kinds of complaints.”

Dowling said the beleaguered nursing home, which has been cited 14 times since January for lack of proper nursing care and health code violations, was not closed because “you can’t close them on one incident.”

“Everybody has due process of law,” she said. “They have to have a whole system problem, not an isolated incident.”

Danger to Patients

There would have to be “imminent danger” to patients to issue an immediate suspension order, Dowling added, and “we don’t feel there’s any patient there in imminent danger.” Pruitt said the citation was based on the May 11 death of James Franklin Cochran, a 41-year-old resident of the nursing home, whose death certificate states he died of cardiopulmonary arrest.

Dowling said Cochran suffered from Huntington’s chorea, a progressive hereditary disorder of the nervous system that is accompanied by increasing mental deterioration and is characterized by erratic jerking movements triggered by involuntary muscular contractions.

Bristol Care Center was cited by health inspectors for having cockroaches and failing to treat a patient’s bedsores following a recent series of surprise inspections.

The inspections, which have been conducted during off-hours in Orange, Riverside, Santa Clara and Fresno counties, are part of an experimental crackdown on nursing home abuses that will be expanded throughout California, state officials said.

Six health inspectors toured Bristol Care the morning of April 27 and reported that an elderly male patient suffering from bedsores was denied treatment for four days. They also cited the facility for having cockroaches, for the failure of its emergency generator to work properly and for failure to maintain hot water at a safe temperature. The nursing home was fined $37,000 and cited for seven violations.

Pruitt said the bedsore problem was not a failure to treat the patient but simply a failure to document the treatment in writing. He said the cockroaches surfaced when construction workers tore off old paneling during an extensive remodeling project at the 145-bed home.

On Wednesday, Pruitt said he is aware of the department’s investigation into only one other patient death at the home.

He defended Bristol Center as a “skilled nursing facility” and said the staff of 115 to 120 “acted appropriately” in both the Cochran case and the other death under investigation.

Says Staffing Is Stretched

“They have to care for people seven days a week, 24 hours a day,” he added, noting that the staffing is stretched. “But we more than meet the requirements of the law.” “They’re responsible for the care of that patient,” Dowling said. “They have to follow doctors’ orders. They’re supposed to . . . have a nurse on 24 hours a day who can perform cardiopulmonary resuscitation. They didn’t (perform CPR).”

“Our staff is trained in CPR,” Pruitt said. “They (health department officials) are talking about RNs and LVNs. To say they are supposed to know CPR is an off-the-wall comment to me. That’s like saying that a nurse has to have a license.”

“What they have cited is assessment. What it really gets into is a judgment call,” Pruitt said. “They’re second-guessing after the fact what the nurses did. The documentation is quite clear. And every indication is that they (the nurses) properly and appropriately dealt with that situation. . . . I feel very confident that when we get done with expert witnesses . . . that we were not at fault . . . in dealing with the patient.” Bristol Care’s citation Tuesday was the first issued in Southern California since the state Legislature adopted tougher standards and penalties March 6. Fines for citations such as the one against Bristol range from $5,000 to $25,000, health officials said.