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Nurse Sues Manor Care Alexandria

Collingwood nursing home cited for violating residents’ dignity, safety.

A nurse is suing Manor Care Alexandria nursing home on Collingwood Road for wrongful termination. The nurse says she was a whistleblower, alerting state officials to violations at the nursing home.

Manor Care says her case has “no merit.”

Kimberley Washbourne was fired on Oct. 17 last year, the day state health department inspectors arrived at the facility. The report that resulted from that inspection cites the nursing home for more than a dozen violations to residents’ safety and dignity. Among concerns, according to the report: leaving one woman’s toes unclipped for months, leaving infectious wounds untreated for days and purposefully ignoring a patient’s damaged feeding tubes until the patient had to visit the emergency room with dehydration.

The health department inspection turned up 15 violations of federal code for Medicare-certified facilities. Half that number would be “a lot,” even if they were only minor infractions, said Rita Schumacher, the director of the Northern Virginia Long-term Care Ombudsman, a federally mandated organization that advocates for nursing home residents. She said many of the 15 violations found by state inspectors are “definitely egregious.”

There are 11 nursing homes in Fairfax County, according to a Medicare Web site that evaluates nursing homes. On average, each home had 11 violations of federal or state health codes, although only five facilities had more than five violations. Manor Care Alexandria had 31 violations, at least nine more than any other.

Manor Care Alexandria officials referred requests for comment to a corporate spokesman, Julie Beckert. After being read a detailed list of the charges in the report and the lawsuit, Beckert issued a statement saying the company could not comment on specific allegations but that the Washbourne case had “no merit.” The “allegations do not diminish the quality of care that we have provided at the facility,” the statement reads in part. “It is always our goal to promote care for our residents which enhances their dignity, meets their interests, and promotes their highest practicable level of safety, physical, and emotional well-being.”

ACCORDING TO THE LAWSUIT, Washbourne, a registered nurse for 16 years, had been working at Manor Care Alexandria for three months before she was fired. Manor Care, which provides long-term care and rehabilitation for elderly patients, hired her to be a liaison between the nursing home’s clinical staff and its administration. Her job responsibilities included developing, updating and evaluating plans for treatment, medication and other care, according to court documents. According to the lawsuit, Manor Care “rejected or ignored” numerous verbal and written complaints from Washbourne about deficiencies in care she believed were endangering the lives of residents and patients.

In her suit, Washbourne’s complaints about the quality of care included a failure by Manor Care staff to isolate residents infected with necrotizing fasciitis, a potentially deadly, transmissible disease that causes the rapid onset of gangrene. The suit cites poor staff training and a lack of necessities for care including syringes and wound dressings. The suit describes patients being left in beds with soiled sheets, old wound dressings and no water. It accuses Manor Care employees of failing to treat patients with serious wounds and switching to “cheaper, less efficient medicines” without approval of a doctor.

IN RESPONSE to Washbourne’s allegations, investigators from the Health Department conducted a survey of Manor Care Alexandria from Oct. 17 to Oct. 25. They interviewed six patients and reviewed four files. The report from this investigation details multiple cases of violations.

In one case documented in the state report, a Manor Care nurse discovered a crack in a feeding tube inserted into the stomach of an incapacitated patient, but instead of reporting the damage, the nurse wrapped the tube in a towel. A nurse on the following shift found the patient soaked with feeding fluid. When the person with power of attorney for the patient requested that the tube be reinserted by the patient’s doctor, Manor Care officials refused the request, finally calling the police to remove the patient’s responsible party from the nursing home premises. The patient was taken to the emergency room and treated for dehydration and other illnesses resulting from a lack of food and water.

In another case from the report, investigators spoke to a woman they found lying on her back. She said she had been asking to have her fingernails and toenails trimmed for months and that she was embarrassed by her long nails. According to the report, she also told investigators, “My socks are dirty. I have asked to have a clean pair for a week and no one has done it. … I know I have to pay for them. I would just like to have clean socks. It makes you feel so bad.” Investigators observed a brown stain on one of the patient’s socks, which the patient said were from an ankle wound. When a nurse removed the socks, the investigators saw that some of the patients nails had grown so long they were curling around the toes.

Investigators found another patient who was supposed to be receiving oxygen, but the tube running from the condenser to a nasal inhaler had fallen from her nose to the floor. Over a period of one-and-a-half hours, investigators observed a nursing assistant and a nurse attend to the patient but ignore her dropped oxygen tube. They watched the patient go pale and begin to cough. Finally, they intervened, telling a nurse of the problem.

The report also accuses Manor Care of inadequate infection control and monitoring, failing to alert physicians and next of kin about medical problems, late medical assessments, ignoring complaints of pain and recording treatments in the care logs of patients who had left the facility. One record indicated that clinical staff waited four days to treat a patient with antibiotics after receiving a report that the patient had two infections in her big toe.

WASHBOURNE’S SUIT claims she was fired in “retaliation” for reporting “dangerous conditions” to the health department, a violation of state statutes that protect whistleblowers. Washbourne is suing Manor Care for $250,000 for loss of earnings and emotional distress, and for $2.5 million in damages.

In a written response to the suit, Manor Care’s lawyers deny they ignored Washbourne’s complaints about care. Describing her complaints as “erroneous questions,” they say Washbourne was fired for “legitimate non-discriminatory and non-retaliatory reasons.”

Connie Kane, the director of the Long Term Care Division at the Department of Health, said that if Manor Care is found to be non-compliant 180 days after the violations were reported, its Medicare certification could be rescinded. Schumacher of the Ombudsman office said that in a subsequent report, the health department found that five more violations had not been addressed. She said that if the situation with Manor Care Alexandria becomes too dire, Medicare could step in and take over management of the facility.

Schumacher advised people with friends or family in Manor Care Alexandria “to get together with other family members and form a family council and work with the facility on how they can resolve the problem. Work together in fixing the problem. That may take outside help from the Ombudsman, from state health, but look at it as you’re working for the same goal.”