Pa. halted anonymous nursing home complaints for 3 years, audit finds

Pennsylvania Department of Health Secretary Dr. Karen Murphy (left) and Auditor General Eugene DePasquale on Tuesday discussed the results of an audit of the state's nursing home system.
Photo by Brad Bumsted | Tribune-Review

HARRISBURG — The Pennsylvania Department of Health risked “residents' safety” by refusing to accept anonymous complaints against nursing homes for almost a three-year period, Auditor General Eugene DePasquale said Tuesday. 

Halting anonymous complaints violates federal policy and is “a decision that is absolutely breathtaking,” DePasquale said at a news conference. He said he suspects it was “an action intended to silence critics.” 

It occurred from 2012-14 under the former administration of Republican Gov. Tom Corbett.

Michael Wolf, who became acting state Secretary of Health in October 2012, was nominated by Corbett in April 2013 and confirmed by the Senate in May 2013. Now a vice president of a health care management company, Wolf could not be reached Tuesday for comment. 

DePasquale, the state's fiscal watchdog, said his auditors found no records indicating the rationale for the decision to stop accepting anonymous complaints. 

The audit covered January 2014 through October 2015, a total of 22 months, DePasquale's staff said. During that period, 4,062 complaints were filed against for-profit and nonprofit nursing homes. The complaints resulted in 47 sanctions, 32 of them monetary, according to DePasquale's office. 

Dr. Karen Murphy, the current agency secretary and Democratic Gov. Tom Wolf's appointee, said the department resumed accepting complaints from anonymous tipsters in 2015. Complaints increased 63 percent after the agency rescinded the policy of not accepting anonymous complaints, the audit said. 

Asked what percentage of anonymous complaints were validated, Murphy said about 10 percent. 

While the agency fully cooperated with the audit and many of the recommendations have been implemented, it still has “work to do” in assuring appropriate staffing levels, DePasquale said. 

The level of care provided to 80,000 Pennsylvanians in nursing homes is directly affected by staffing levels, Depasquale said, and the state health department did little to enforce a law requiring 2.7 hours of direct nursing care per day for each resident. 

In 7,325 instances of the agency completing a nursing home survey, it issued 13 citations — “an unbelievably low number,” DePasquale said. 

He cited examples of insufficient penalties, such as a resident with a history of wandering, who fell down a flight of stairs in a wheelchair. Staff responded immediately, but the patient later died in a hospital. The facility was cited for violations and fined $4,000. 

In another instance, after a complaint from a family member that a patient was “dirty, frail and unresponsive,” the person was found to be malnourished and dehydrated. The patient was receiving too much anti-psychotic medication, DePasquale said, and later died in a hospital. 

As a matter of policy, the names of the homes are not cited in the audit, DePasquale said. 

Murphy said citations issued to homes are publicly available on her agency's website. 

Pennsylvania's maximum civil monetary penalty is $500 per day. 

A comparison of selected states in the audit showed the maximum penalty is $100,000 in California, $10,000 in New York, $10,000 per day in Texas, and $25,000 in Illinois, which may be doubled. 

Russell McDaid, president and CEO of the Pennsylvania Health Care Association, an advocacy group for nursing homes and their residents, applauded Murphy for requesting the performance review audit from the auditor general, including ways the department can improve its enforcement. 

However, McDaid cautioned that “more stringent penalties do not alone improve care.” 

“It is important to note that when any sanction or penalty is considered, the most important goal is to identify the practice in question, take steps to correct the practice and ensure that any sanction does not jeopardize the facility's ability to improve resident care, comfort and safety,” he said. “Taking financial resources away from the bedside does not improve resident care.”

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Pa. halted anonymous nursing home complaints for 3 years, audit finds