It is anything but clear what caused Human Services Commissioner-designee Anita Roberts to abruptly move 10 of the clients at Sea View Nursing home to: first, the emergency department at Schneider Regional Medical Center and then, after SRMC refused to take anymore after the first three were delivered by ambulance, to the Queen Louise Home for the Aged on Monday.
Roberts called a last minute news conference Tuesday to advise the press what she had done.
The first the hospital had any knowledge that Human Services intended to send these patients to the emergency department was a phone call Monday from Roberts and Attorney General Claude Walker, who claimed a letter from the U.S. Department of Housing and Urban Development said these patients had to be moved because Sea View was “uninhabitable.”
Roberts also inferred at the news conference that HUD had given her clear marching orders to take this drastic action.
She said her office received a letter Sept. 23 from U.S. Housing and Urban Development demanding that “immediate action” be taken to remove all the patients whose medical needs have already been assessed by local physicians.
However, the letter says no such thing.
While expressing concern for the well being of the clients, due to the facility’s dire financial straits, the only thing HUD asked Roberts to do “immediately” was file a plan for relocation of the residents.
At least one source, who asked to remain anonymous, said Roberts has not done that. Instead she moved 10 nursing home residents with no warning, medical records or medicine.
As the guarantor of Sea View’s mortgage, finances are HUD’s only purview in the ongoing battle to save what was once St. Thomas’s only facility funded by Centers for Medicare and Medicaid Services.
But their funding ended on July 31, when CMS pulled Sea View’s accreditation once and for all and the funds they were providing in support of several long-term care patients at Sea View dried up.
The items of concern listed in the HUD letter are all related to legal and financial issues, which could lead to insufficient nursing care but have not, according to at least one medical doctor who evaluated the three nursing home clients that were sent to Schneider’s emergency department.
However, sending “frail” people into an emergency room setting is downright dangerous, according to Dr. Clayton Wheatley, emergency department director. “Prolonged stays in the ER drastically increase the chances of mortality and also morbidity,” he said.
The three who arrived unceremoniously at Schneider remained in the ER for 48 hours.
Wheatley said the three patients he saw were in perfectly good shape. “Their skin was pristine,” he said, referring to the absence of bedsores or abrasions, which are common telltale signs of neglect in nursing home settings. He lauded the care the patients had been given by Sea View.
Only one patient suffered from any kind of chronic condition, which Wheatley said was urinary tract infection. None were in any kind of critical condition.
Chief Medical Officer Dr. Luis Amaro said the trip to the emergency room put a burden, not only on the nursing home clients, but also on the ER patients who had to be moved back in the line behind the more recent arrivals while the Sea View clients were evaluated as required by federal law.
“They arrived without medical records or medicine,” Amaro said.
Hospital Chief Executive Officer Bernard Wheatley said they only had their clothing.
After the arrival of the third patient on a day when Clayton Wheatley had seen twice the normal number of clients at the ER, he said he called Amaro and said he couldn’t accept any more of the people from Sea View.
After that, the other seven Sea View residents were sent to Queen Louise Home, a nursing facility under the Human Services umbrella. According to Amaro, who is the consulting physician for Queen Louise, the seven arrived the same way they had at SRMC, without medical records or medicine.
Bernard Wheatley and Amaro did get that warning call from Roberts and the attorney general before the patients’ arrival. But the call was misleading.
They were told the patients were critically ill and need to be moved, calling Sea View “uninhabitable.”
“We are an acute care facility,” Wheatley said. “None of them had an admittable condition.” But all of them required 24-hour care, something Schneider Regional Medical Center is not equipped to provide.
Both the CEO and Amaro directed Roberts to have the physician who deemed the 10 patients that Roberts intended to transport to SRMC critically ill to contact Amaro with exactly what the diagnosis was before sending them to SRMC.
Saying that she would, that was the last either of them heard from her, they said.
No returned phone calls, no return texts, nothing, Wheatley added.
That left the attorney general to be the intermediary, he said.
Walker’s interest in the matter would be the contractual agreements between HUD and Sea View, as he is neither a physician nor a Human Services employee.
Attorney Maria Hodge, who filed a suit in District Court in April on behalf of Sea View Nursing Home against the Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services to stop CMS from cutting off payments to the facility for the long-term patients and to prevent the residents from being relocated, said Thursday morning, “I strongly object to what took place, moving these patients without notice or consent.”
Hodge said she had seen the letter from HUD and that there was nothing in it that indicated the patients needed to be moved.
Specifically, what the HUD letter deemed their concerns included:
– Facility is unlicensed;
– Reports of severe cash flow issues that are impacting ability to operate facility;
– Biweekly concerns over funding of payroll and losing staff;
– Numerous vendors not being paid;
– Federal taxes and other liens on the property;
– Default of the HUD insured mortgage;
– Facility has no professional liability coverage;
– And no plan to resolve current issues.
In the end, HUD’s concerns are clearly financial. The short version is if Sea View defaults, HUD ends up with an 80-bed, failing nursing facility on St. Thomas.
No one knows better than Sea View’s owner, Dr. Alfred O. Heath, what the nursing home’s financial problems are. In fact, he met with Gov. Kenneth Mapp two weeks ago in what Heath called a “desperate” move to save the facility.
Heath said Thursday afternoon that one of the things he told the governor was that the V.I. Department of Human Services owes Sea View $944,000.
Mapp said an audit would be required in order to verify that and that he would have an audit done.
But an audit takes time and Sea View has run out of that. .
So the other thing Heath asked the governor to do was to cover the back loans to HUD and the staff and vendors, while a plan could be put in place to save the nursing facility, one of only two on St. Thomas, that even with both of them can’t meet the needs of the growing elderly population, according to Amaro.
Mapp promised to call members of the V.I. Legislature to ask them to appropriate – and hopefully allocate – funds to keep the facility running. Heath said he had heard from some of the senators that the governor had kept his promise.
When you remove the financial considerations that have been in free fall for various reasons – including bad debt – for some time, what is left is the human toll and the cost to families and people.
Heath said the patients were removed from Sea View at dinner time Monday as though they were “cattle” herded into ambulances, that in the first three cases were inexplicably sent from a 911 emergency call.
“Was something on fire,” Bernard Wheatley mused about the direct implication that there was some sort of critical factor to the abrupt Human Services “kidnaping” as one person called it.
Turns out, nothing was on fire. In fact, the three patients that were inexplicably yanked from their dinners Monday and sent by ambulance to the emergency room at SRMC are just as inexplicably safely back at Sea View.
Calls to Government House for clarification of Roberts’ actions were not returned.