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Nursing-home reports kept secret
By Mark Hollis
November 21, 2001
TALLAHASSEE -- State health regulators have collected thousands of secret reports of accidents, injuries and other problems in Florida nursing homes in the past six months, but fewer than 100 have led to on-site investigations.
A new state law aimed at improving quality of care for seniors urges nursing-home workers and their management to tell the state about unusual or harmful happenings in the facilities. These can range from patient falls with injuries, including death, to any condition that requires special medical attention.
Because of a separate and little-discussed bill that legislators approved this spring, at no time are nursing home "adverse-incident" reports made public, even in the most egregious cases.
State officials insist that every report is reviewed and taken seriously, but advocates for nursing-home patients are questioning why on-site investigations have been completed on only 99 of the 4,324 reports submitted to the state Agency for Health Care Administration since May.
Government watchdogs are also confounded over why every report is cloaked in complete secrecy. They argue that it is impossible to tell how carefully the state is responding to the reports unless some information about the documents is provided.
"There's already a crisis in public confidence of the nursing-home industry, and this sort of secrecy only fuels our suspicions," said Barbara Petersen, executive director of the First Amendment Foundation, a Tallahassee-based watchdog group.
Petersen said there's no legitimate reason why the state couldn't at least make the contents of the reports public while keeping the patients' identities private and protecting the people who file the reports.
"We can exempt the patient ID and any whistleblower who has come forward," Petersen said. "But to exempt the report itself, I think, is just bad public policy."
Barbara Hengstebeck, executive director of the Coalition to Protect America's Elders, an organization with ties to law firms that sue nursing homes, said the reporting system was enacted with nursing-home industry support to protect residents.
"There's a lot of things that go on in nursing homes that never get investigated," Hengstebeck said. Keeping the documents exempt from the state's public-records laws, she said, is a mistake.
"Not even the family can get the reports to see what it's all about," Hengstebeck said. "Where's the wisdom in that?"
As of mid-November, 4,324 reports of suspected adverse incidents were reported to the AHCA. Of those, 1,094 reports met the Legislature's definition of an adverse incident.
AHCA officials conducted investigations, which are called surveys, of nursing homes as a result of 163 of those reports. Ninety-nine surveys have been completed, with 16 leading to "unsatisfactory results" in which the nursing-home operator or a patient caregiver failed to give a resident proper treatment.
Pat Glynn, a spokesman for AHCA, said the program is working the way it is intended, although it is generating more reports than the state requires. Glynn insists that keeping the documents secret is valuable.
"We're getting overreporting," Glynn said. "But I don't think to err on the side of caution is a bad thing. . . . The idea is to encourage additional reporting without fear of reprisal."
Glynn and a spokesman for a nursing-home industry lobby group noted that low-wage nursing home workers with few job protections are likely to be in the best position to file the initial incident reports. Opening the records to public scrutiny, they argued, could dissuade some workers from reporting troubles in the facilities where they're employed.
"If you're going to ask nurses and staff to candidly assess [what happens to patients], and to focus on identifying problems, then you can't achieve that if you're not willing to give them protections," said Ed Towey, a spokesman for the Florida Health Care Association.
AHCA is required to submit an annual report to the Legislature about the so-called "risk-management" program for the state's 678 nursing homes. The report will supply the total number of adverse incidents by county, categories of incidents and type of staff involved, types and number of injuries by categories, types of liability claims filed based on adverse incidents, and disciplinary action taken against staff.
None of that information is currently available, Glynn said.
The adverse-incident reports are reviewed by just one person at AHCA, a full-time registered nurse. Glynn said in cases when the nurse needs additional medical advice, three other AHCA staff members, one of whom is a licensed health provider, can assist.
Glynn said the agency is confident the reviewer is not overburdened. "We're turning around the reviews of these adverse incidents consistently and quickly," he said.
Mark Hollis can be reached at mhollis@sun-sentinel.com
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Tallahassee Bureau