The residents of Continental Nursing & Rehabilitation Center were hospitalized and recovered, but at least two used heroin again hours after they were returned to the facility, even though they were supposed to be on close watch, Illinois public health department inspectors allege. One of the two overdosed again.
The department also opened a new investigation into the facility after the Tribune requested information about a sixth drug overdose in September 2015.
In that case, a 56-year-old resident was found on the floor by his bed with five packets of white powder beside him, a Chicago police report said.
Illinois law requires nursing homes to notify the Department of Public Health of unusual events that put patients at risk, but state officials said they learned of that case only when the Tribune filed a query about it.
The federal Centers for Medicare & Medicaid Services, or CMS, has imposed civil monetary penalties totaling $76,000 for alleged violations in the February incident.
Continental is contesting an additional $25,000 fine from the state public health department, which says the facility failed to properly monitor and treat residents with drug addictions.
State officials and industry representatives said they could recall no similar cluster of patients overdosing on heroin inside an Illinois nursing facility.
"I have never heard of that. No question that's uncommon," said Terry Sullivan, executive director of the Illinois Alliance for Living, a professional association of facilities that treat patients with mental illness and substance abuse problems.
Continental, which has housed a mix of older residents and younger adults with mental illness, did not admit deficiencies when it outlined corrective actions it would take — plans that were accepted by CMS in April. "The facility has ceased admitting any residents with active substance use," its plan said.
In a brief interview with the Tribune, Continental part-owner Moishe Gubin said he was not aware of any heroin overdoses or other problems at the facility.
"If you are right," Gubin said, "it goes against what our mission has been."
"If you look at our company historically, we generally give good care," Gubin said. "It's not lack of resources or staff, or they cheaped out and didn't take care of people. You'll never hear about that with us."
Continental is part of a rapidly growing, South Bend, Ind.-based nursing home operation that includes more than 50 facilities in eight states, records show.
Their 13 northern Illinois facilities include one that earned a top, five-star rating for overall quality from CMS. Four others, including Continental, were given a one-star quality rating, the lowest possible, and police and public health inspection records have alleged unsanitary conditions and negligent care at Continental and some other northern Illinois homes.
Medicaid and Medicare last year paid those 13 facilities a total of roughly $150 million, and the facilities reported a combined 2015 profit of $6 million, according to cost reports filed with the state. Similar data was not available for a recently added 14th northern Illinois facility.
Outside Continental's gray and white building at 5336 N. Western Ave., a sign advertises "quality nursing services for the elderly."
But the 208-bed home — which last year earned $11 million from the taxpayer-financed Medicaid and Medicare programs — reported to the state in March that 108 of its residents were under age 65 last year, 129 had been diagnosed with mental illnesses and 29 had felony records.
Chicago police responded to 60 reports of alleged batteries at Continental from 2011 through 2015, a Tribune analysis of police data found.
Police also responded in 2014 when a 61-year-old patient broke his hips and collapsed a lung as he tried to escape the facility by rappelling from a 4th-floor window using six sheets tied together, records show.
Continental immediately notified the state of that event, but the paperwork fell through the cracks, state officials acknowledge, and authorities conducted no investigation at the time.
After the Tribune inquired about the case, the department dispatched an inspector who last month reported that the man was not properly supervised although he had been admitted for treatment of bipolar disorder, depression and alcohol abuse.
He had been drinking in the facility just before he tried to flee and had a blood-alcohol level of more than four times the legal limit when staff found him "on the ground moaning" with a broken glass bottle and a beer can beside him, according to the state's report.
Continental is contesting a pending civil malpractice lawsuit filed by the man's family.
On the day of the five heroin overdoses in February, staff at Continental suspected that residents were seeking drugs from a female visitor but did not intervene or report it, a state inspection report said.
A 33-year-old resident told inspectors the visitor was a relative of a resident and sold "white powder in a small zippered baggie." The 33-year-old snorted the powder and said: "I don't remember much after that until I woke up and saw the paramedics standing over me."
Another resident who also overdosed said he paid $25 for the heroin and assured the supplier that if the drugs were "good" he could triple her money "in three days at the facility," the state public health inspection report said.
Continental was cited for not monitoring residents who returned to the facility from the hospital.
A 46-year-old woman who told a social worker she "wants to get sober and not be an addict anymore" overdosed again her first day back. Another man nodded off during his interview with an inspector, and a fellow resident said that man "got high again this morning."
In addition to the overdose incidents, police were called to Continental in October 2015 when residents alerted staff to narcotics abuse inside the facility. Staff searched rooms and recovered paraphernalia for cooking and shooting drugs that they turned over to police, records show.
Across the country, at least two heroin overdose cases have emerged in nursing facilities since last year. In a La Porte, Ind., case that remains under police investigation, a 64-year-old woman was found dazed and bleeding from the nose after ingesting heroin at the Golden Living Center in August. And in November a southern Ohio man was charged with involuntary manslaughter after allegedly supplying his wife with a fatal dose of heroin inside a nursing facility.
"We're a drug-taking society, and it's only a matter of time before this gets into the nursing homes," said Dr. Harry Haroutunian, physician director at the Betty Ford Center in Rancho Mirage, Calif.
Continental administrator Jonathan Dixon declined to discuss heroin abuse at the facility but gave Tribune reporters a limited tour of the second floor, where the overdoses took place. He said he did not have permission from "corporate" to take reporters through other parts of the home.
Those second-floor rooms no longer house younger patients with psychiatric and substance abuse problems, Dixon said, only geriatric and post-operative residents. The rooms were freshly painted, and some beds had been removed to convert them from triple-occupancy to double-occupancy.
The complex ownership and management structures employed by Gubin and his longtime business partner Michael Blisko limit their involvement in day-to-day operations, according to Tribune interviews and testimony they gave in civil lawsuits.
The physical facilities housing Continental and other homes are owned by subsidiaries of the partners' real estate investment trust, called Strawberry Fields. Registered in the British Virgin Islands, Strawberry Fields recently raised $68 million on the Tel Aviv Stock Exchange to expand operations with a goal of growing by 50 percent a year, according to its public statements.
Each of the 13 homes in northern Illinois is operated by a separate company; those companies hire administrators to run the homes day to day. Gubin and Blisko own a combined 75 percent of the company operating Continental.
Continental and other facilities pay a separate consulting company solely owned by Gubin and Blisko to offer suggestions about management, nursing, billing and payroll practices.
The consulting company was initially called New York Boys Management, but that name caused "image trauma," Blisko testified in a civil court deposition last year. "People felt that it wasn't giving the professional identity, if you will, that it wasn't good for business," he said. The firm is now Infinity Healthcare Management, records show.
Continental paid Infinity $313,818 in consulting fees last year, while the 12 other northern Illinois facilities paid Infinity $4 million in all, state nursing-home cost reports show.
Facility administrators are in charge of their buildings and free to disregard Infinity's recommendations, Gubin told the Tribune. He said he does not read state public health inspection reports about his homes.
"The person who is the administrator is the one who is responsible day to day," Gubin told the Tribune.
Continental administrator Dixon later sent the Tribune an email saying: "We consistently strive to provide the highest quality of care, in a safe environment."
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Chicago nursing home fined after residents overdose on heroin
Of course visitors could have brought the drugs into the facility. Or perhaps staff. But still what happened here is an indication that the facility isn't monitoring its patients.
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