Sevierville nursing home faces stiff fines after survey

Cited for siderail beds that restrain patients, violate rules
Jun. 19, 2013 @ 03:31 PM

Fort Sanders Sevier Nursing Home has been cited for substandard quality of care because of two cases that inspectors say put residents at risk.

A June recertification survey by state health officials found two instances in which the nursing home placed residents in what inspectors termed "immediate jeopardy" because of the use of siderail beds. Regulations say such siderail beds put patients at risk and are considered to be restraints, and thus should not be used.

However, the nursing home had never been cited for those beds before, and within a matter of hours replaced all siderail beds in the facility, said Ellen Wilhoit, president and chief administrative officer of LeConte Medical Center, which owns and operates the nursing home. The nursing home had no warning the regulation was being enforced this year, and Wilhoit says other nursing homes inspected as recently as this year were not cited for siderail beds.

Even so, Fort Sanders Sevier Nursing Home faces federal fines of up to $10,000 a day from the time the bed issue was discovered on June 4 until the authorities review the facility's new plan of corrective action, which should be sent to the state by next week. That could be weeks or even a few months, meaning the nursing home could face a fine of several hundred thousand dollars. Until the issue is resolved the nursing home cannot admit new patients. Its Medicare provider agreement also is at risk.

Wilhoit received a certified letter about the findings dated June 12 signed by Karen Kirby, regional administrator of the East Tennessee Regional Office of the Tennessee Department of Health. The full 90-page report is in Wilhoit's possession, but she says until she formally accepts the report it apparently cannot be made public. She did discuss the report in detail during a Tuesday interview.

The state enforces the rules imposed by the Centers for Medicare and Medicaid Services, the federal agency that sets the standards for nursing homes and could pull the facility's Medicare certification.

"It would have been very nice to have had the information about enforcement of the policy," Wilhoit said. "Had I known ahead of time that full siderails were in violation, I would have contacted the corporate office immediately. We were not trying to avoid providing something for our residents."

Wilhoit said it seems to her that every year inspectors focus on a different aspect of nursing home operations.

"I don't know why," she said. "I do know that this year the focus is on siderail restraints. We will address that."

Wilhoit says she is not angry about the report or the possibly stiff fines, saying the goal is to make the residents safe and happy. She acknowledges the dangers of siderail beds, but notes they are in wide use and that locally there has not been an issue with them.

"This nursing home is one of the finest in the state," she said. "The staff is so caring. They are obviously called to care for the elderly."

According to Wilhoit, during the inspection, in looking over resident reports, state officials found that one patient had attempted to leave the bed several times but was stymied by the siderails. Another was found to have a leg draped over the siderail while trying to leave the bed. Those two reports led to the two cases of so-called immediate jeopardy.

Many nursing homes have found siderails, when raised, keep residents from leaving a bed who might not be steady on their feet or who don't need to be wandering without assistance. On the other hand, studies have shown the siderails can lead to injury or entrapment when residents try to climb over them, and there have been cases elsewhere when residents got stuck between rails.

When the inspectors called her attention to the siderails not being in compliance, she notified her superiors at Covenant Health in Knoxville, which owns LeConte Medical Center. They were able to find quarter-rail beds in storage. Those are beds that have rails at each corner of the bed, leaving a gap between so residents can leave easier and not feel restrained. In addition cushioned mats were placed beside the bed, and beds were lowered azs close to the floor as possible.

Wilhoit said the nursing home had never been told to replace siderail beds by any inspectors and had a plan in place to begin to replace the siderail beds a few at a time.

When the new quarter-rail beds were placed in the nursing home, the two rails at the feet were removed from most beds. Many residents use the rails near their head to help get out of bed or position themselves in the bed.

The fines of up to $10,000 a day are in addition to the $7,500 fine the state imposes for deficiencies. Wilhoit won't know the extent of the fines for some time, but she is aware of a nursing home in East Tennessee inspected around the same time as hers that was assessed a fine of $500,000. A similar fine against Fort Sanders Sevier Nursing Home would affect planned renovations to the facility under way and scheduled, Wilhoit said.

The families of residents have been notified of the inspection and the findings, Wlhoit said. She planned a meeting with them at the nursing home Tuesday evening.

Fort Sanders Sevier Nursing Home is licensed for 54 beds but has 41 patients — not because of the state's findings, but because of other factors, Wilhoit said. There is a waiting list of 150 or more people.