Eureka Rehabilitation Center, one of the four skilled nursing facilities in Humboldt County owned by Brius Healthcare, was hit with eight fines yesterday at $20,000 each.
The facility, which was visited by state inspectors in December, has been dogged by allegations of understaffing and improper patient care. It was one of three facilities slated for closure last year as the Brius and its local administrative branch, Rockport Healthcare Services, negotiated for an increase in MediCal reimbursement rates with the region's distributor, Partnership Healthcare Services. Brius, a healthcare giant that has a virtual monopoly on skilled nursing care in Humboldt County, ended up closing only one of its facilities, Pacific Rehabilitation and Wellness Center.

The state's inspection seems to confirm that this facility was, despite the insistence of Brius representatives to the contrary, understaffed. The California Department of Public Health has not provided the Journal with a manifest of the incidents that led to the fines, but the incident codes associated with each penalty, as found on the website for the Centers for Medicare and Medicaid Services, reveal a pattern of poor patient care.

One $20,000 fine corresponds to a failure of the facility to provide the "necessary care for highest practicable well being," which means residents are not being cared for in accordance with a "comprehensive assessment and plan of care."

Another fine was levied due to the facility failing to meet federal guidelines for "sufficient staff to meet the needs of resident[s]." The facility was also found not to have "an appropriately functioning [Quality Assessment and Assurance] committee," according to the description of the violation code on the CMS website.

And Eureka Rehabilitation and Wellness Center was fined five separate times, at $20,000 each, under violation code F323, the statute that requires administrators "make sure that the nursing home area is free of dangers that cause accidents."

The son of a former patient at Eureka, David Brodsky, complained to the Journal last year that lack of adequate staff and an unsafe environment contributed to his mother's fall and her placement on hospice care in August 2016. He said he had spoke with the administration and lodged a complaint with the state, but the CDPH website says that none of the five fines for safety violations were associated with complaints, meaning that investigators may have independently found hazards at the facility unrelated to the complaints of Brodsky and others. The CDPH did substantiate five complaints at the facility in 2016 related to quality of patient care, violations of discharge and transfer rights and mental abuse.

Granada Rehabilitation and Wellness Center was also hit with state enforcement actions and has been asked to pay $4,000 for two separate incidents of failing to self-report abuse.

When the potential closures were first announced, the company blamed the high cost of bringing in registry nurses from out of the area for an alleged fiscal shortfall of $5 million. The company insisted that without a hike in reimbursements, it could not pay a competitive wage that would attract qualified staff in Humboldt County, where there is a shortage of nursing personnel. The company also blamed the region's marijuana industry for diverting staff away from its facilities.

On Sept. 8, Vincent Hambright, Rockport's CEO, told a group of worried seniors and their family members at Eureka Rehabilitation and Wellness Center that, should they have to leave the facility they had come to think of as home, the company would do  everything in its power to make them comfortable and see them properly accommodated. Advocates argued that the threat of closure was a venal power move by the company, one that would endanger the lives of hundreds of current and future patients who would have to travel hundreds of miles out of the area to find skilled nursing beds. Hambright insisted the company was suffering an unsustainable loss due to importing staff. When family members and patients insisted that the facility was understaffed despite this expense, citing conversations with overworked nursing assistants and problems with improper wound care, Hambright shot back that this was absolutely untrue.

But one former staff member at Eureka Rehabilitation and Wellness Center called its understaffing "a nightmare," and said patients were "covered in feces" and suffering falls, especially during the night. And the company's own financial records revealed that, collectively, the five Humboldt facilities sent close to $5 million back into the coffers of companies owned or associated with its owner, Los Angeles-based billionaire Shlomo Rechnitz.

According to research conducted by the National Union of Healthcare Workers, financial penalties do not seem to be a significant motivator for facilities to improve care. Many fines are whittled down to a smaller number in litigation or dismissed entirely. Medicaid covers the cost for skilled nursing facility chains to challenge fees in court, according to advocates, which creates a disincentive for the state to pursue litigation.

The NUHW's research revealed that in the past three years, the state dismissed $23,000 of the $60,000 in penalties levied against Brius holdings in Humboldt County. According to a report In 2014  the company that brought in $77 million in profits from its California facilities, according to a report filed with the California Attorney General's Office.