Law enforcement agencies rarely prosecute poorly performing nursing homes or their operators, but an investigation of a facility in Robinson may signal a change.
The Ronald Reagan Atrium I Nursing and Rehabilitation Center in Robinson has been cited repeatedly by the state health department for violations since its 1995 opening. The problems were magnified by the Oct. 26, 2001, death of Mabel Taylor, a resident with dementia whose body was found outside in a locked courtyard.
In the time since a coroner's investigation of Atrium became public, numerous families and former employees made further charges, leading to an expanded probe. U.S. Department of Health and Human Services investigators have subpoenaed thousands of Atrium's records, including those of 14 former patients.
If any charges are filed against Atrium or its administrator, Martha Bell, it would be the first time that local or federal prosecutors in Pittsburgh had targeted a nursing home in recent memory.
Generally, federal prosecutors pay little attention to nursing homes because of other priorities and because no clear federal statutes exist relating to negligence or abuse in such settings, said U.S. Attorney Mary Beth Buchanan.
Across the state, however, the U.S. attorney's office for Eastern Pennsylvania has become a national model for its activist role. Civil court filings against six homes there in recent years have resulted in more than $1.5 million in penalties from those facilities, far more than is typical in fines from the state and federal agencies that regulate the industry, said David Hoffman, assistant U.S. attorney.
The nursing homes were prosecuted for filing false claims for Medicare and Medicaid reimbursements on the basis that they provided services inadequate to justify the payments.
"Our hook is it's a financial offense," Hoffman said, because neglect cases are so hard to file and prove. "While the money is of some value to us, the more important thing is to ensure [substandard care] doesn't happen again."
Two of the problem homes that his office pursued subsequently closed. Hoffman is less worried about that than state health department officials, who say they are reluctant to force relocation of frail residents.
"You can't hold residents hostage to bad care," said Hoffman, who took a special interest in prosecuting nursing home cases because he formerly served as counsel for the Pennsylvania Department of Aging.
He has been to Pittsburgh and elsewhere to advise other federal prosecutors on making such civil actions work, but Buchanan said it is too early to say if her office will file similar cases here.
Pennsylvania makes abuse or neglect in nursing homes and other older-adult settings a criminal offense, but flagrant, specific incidents of abuse are typically the only ones that result in charges. Allegations of inferior care provided on a day-to-day basis seldom result in court action.
"It's difficult to prosecute a criminal case because of the standard of evidence being beyond reasonable doubt, and it's tough to get reliable witnesses" in a nursing home, said Don Grant, manager of protective services for Allegheny County Area Agency on Aging.
Protective services caseworkers are required to investigate allegations of neglect or abuse and turn over any substantiated findings of harm to police. It is more common for the nursing homes to agree to address problems internally, such as by dismissing problem employees, than for legal charges to be filed, Grant said.
Of 2,626 substantiated cases of neglect or abuse against older persons in 2000-01, 15.3 percent were in nursing homes. More than twice as many were in the person's own home.
Christopher Abruzzo, chief deputy Pennsylvania attorney general, said the attorney general's office gets more referrals of alleged neglect in personal care homes than in nursing homes. Personal care homes, for people without serious medical needs, are less closely regulated and more abundant.
Gary Rotstein can be reached at grotstein@post-gazette.com or 412-263-1255.
E-mail this story 
