Poplar Living Center

The Poplar Living Center, pictured Friday in Casper, recently settled a lawsuit alleging its staff injured a resident. 

Jenna VonHofe, Star-Tribune

A Casper nursing home that’s been repeatedly accused of negligence and poor care settled a lawsuit last month in federal court alleging its staff injured a resident — the latest settlement in a string of legal disputes amid closer governmental oversight due to repeated deficiencies found during health inspections.

The suit alleged that a Poplar Living Center van driven by one of the nursing home’s employees hit a blind resident standing near the curb waiting for a ride in March 2014. The resident, Gilbert Arellano, was knocked to the ground, according to the suit. Since the incident, Arellano has had pain and numbness in his right arm, the suit says.

Ian Sandefer, one of Arellano’s attorneys, said he could not disclose the amount of the settlement reached on Nov. 1 because of a confidentiality agreement. He declined to give any further comment, citing the agreement. The case was officially dismissed Tuesday from the U.S. District Court for the District of Wyoming.

The nursing home’s settlement was the most recent conclusion to six wrongful death or personal injury lawsuits filed against it in the last six years. Repeated inspections by the Centers for Medicare and Medicaid Services also detail a pattern of understaffing, improper care and unsafe building conditions. The federal agency rates the nursing home as “below average” and has classified it as a facility that needs close monitoring because of a “history of persistent poor quality of care.” It is the only nursing home in Casper with that classification.

Dave Clarke, one of Poplar Living Center’s attorneys, said the nursing home declined to comment on the settlement in Arellano’s case. In response to questions about the facility’s history of lawsuits and the observations recorded in federal inspections, Poplar Living Center released a statement Friday saying the company “continues to seek opportunities to improve the care and services we provide for those individuals we have to privilege to serve every day. We appreciate the efforts our staff have made to provide quality care and quality of life for our residents.”

Poplar Living Center did not answer more specific questions or provide further comment about the facility’s staffing practices, its policies regarding resident care, allegations made in the six lawsuits and deficiencies cited in the federal inspection reports.

The nursing home did not have someone stand with Arellano while he waited for his ride on the handicap ramp and the man was unable to avoid the danger himself because he is legally blind, the suit says. The suit alleges the facility failed to meet the legal standard of care because it is understaffed, did not accompany Arellano to the curb and allowed an employee to “negligently operate” a company van.

The company “ignored the state and federal laws designed to protect patients of skilled nursing facilities,” the suit states.

The suit also alleges that SavaSeniorCare, the company that owns the Casper nursing home, kept staff numbers low and didn’t adequately train employees to save money, thus endangering the residents. That allegation is repeated across many of the other lawsuits. The Centers for Medicare and Medicaid Services also cited Poplar Living Center for understaffing the facility.

According to its website, SavaSeniorCare operates more than 230 nursing homes across the country, including two more in Wyoming: Cheyenne Healthcare Center and the Sheridan Manor.

Federal inspections identify repeated problems

Inspection records of Poplar Living Center by the Centers for Medicare and Medicaid Services show a pattern of the for-profit Casper nursing home failing to employ enough staff to keep residents safe, take care of residents who showed signs of depression and investigate complaints of neglect. The federal agency also repeatedly noted damage to the building, including rusted air vents, leaking ceilings and large cracks in the walls.

The centers, which inspect facilities that receive federal funds from its programs, have cited 90 deficiencies at Poplar Living Center since January 2014 and suspended payment of federal dollars twice, according to a database created by ProPublica, a nonprofit dedicated to investigative journalism. In approximately the same period, the database found that the federal agency has cited two other Casper nursing homes, Shepherd of the Valley Healthcare Center and Life Care Center of Casper, for deficiencies 60 times and 34 times, respectively. Neither has had funds withheld.

The Centers for Medicare and Medicaid Services has inspected Poplar Living Center at least 10 times between January 2014 and January 2016. The facility has also failed since at least January 2014 to correct citations from previous inspections, according to the reports.

Improper wound care is repeatedly cited in the reports. One resident arrived at the facility in January 2015 without any wounds but developed open sores on her buttocks and legs in March. She was not admitted to the hospital to see a physician until she had “deep tissue injury” and widespread swelling, which later worsened, according to a report.

Another resident reported increased pain and numbness in the legs but didn’t see a doctor until two days later. The medications prescribed by the doctor did not help the pain and the resident demanded to see a physician. The doctor ordered that she be transferred to a Denver hospital by air transport. Doctors there found that two of her vertebrae were disintegrating due to infection, according to a January 2016 inspection report.

The reports repeatedly note that the nursing home fails to adequately record, investigate and resolve complaints about living conditions.

Facility staff acknowledged in an interview during the January 2016 inspection that “allegations of abuse and neglect had not been well-assigned, had not been reported, and may not have been adequately investigated.”

Inspectors wrote in a March 4, 2015, report that the facility “failed to provide adequate ventilation” and that the entire building “had a noticeable odor of urine and stool.”

Two aides told inspectors that they sometimes have to use hand towels to dry residents after a shower because the facility runs out of bath towels, according to the reports.

The nursing home administrator told inspectors in January, “I’m nowhere near where I want to be in terms of staffing,” according to the agency’s Jan. 15 report.

According to a report from March 2015, there were nights where only one nurse and one nurse’s assistant were in the building to care for more than 100 residents — many of whom require assistance to use the bathroom and navigate other simple tasks.

Residents who needed help using the bathroom reported they often waited long periods of time — sometimes up to eight hours — before they were taken to the restroom. One resident wandered the halls of the facility just after 8 p.m. March 29, 2015, with urine-soaked pants for at least 25 minutes before being helped.

Residents also told inspectors that the food served was inedible. A district manager who sampled a meal of steak and noodles also said the food was “not palatable,” according to the reports.

A history of lawsuits

Families of previous residents have sued Poplar Living Center at least six times in the past six years alleging that negligence led to the death and serious injury of their loved ones. The nursing home settled four of those suits for undisclosed amounts and one is still ongoing. A jury found the company negligent in one suit, though it declined to award monetary damages.

A suit filed in May 2011 alleges that a resident developed serious bedsores after the staff failed to turn him while he laid in bed.

The man was admitted to the nursing home free of pressure sores, and staff documented that he was to be turned every two hours to prevent them. But records at the nursing home show that staff on multiple occasions waited up to 11 hours before turning him, the suit says. The man then developed pressure sores on his buttocks.

The sores eventually become so severe that they destroyed the sphincter muscles around his anus and made him incontinent, according to the suit.

Another suit filed days after the first alleges that a 79-year-old woman died of malnourishment while in the care of Poplar Living Center because the nursing home failed to provide additional nutrition when the woman began to eat very little. The woman lost 20 percent of her body weight during her two-month stay at the facility, according to the suit. Her death certificate listed malnutrition as the primary cause for her death. The wrongful death suit was settled in 2013.

A wrongful death action filed in 2011 — about two weeks after the first two suits — alleges that a woman, who was quadriplegic, died in 2008 while a staff member attempted to move her. The staff member sat the woman on the edge of the bed without restraint or support and then walked away. The woman then fell from the bed onto the floor. She died of her injuries nine days later, the suit says.

A jury later found that the nursing home company was negligent in the woman’s care but did not find that the damages should be paid to the woman’s estate.

A fourth suit, filed in June 2011, says a resident died after falling while riding in a company van and becoming brain-dead when nursing home staff failed to properly care for her.

A 73-year-old woman was admitted to the nursing home for rehabilitation in 2009 after she fell at home. When she was released from the Wyoming Medical Center on Oct. 8 of that year, she was able to move on her own, was fully cognizant and had no concussion symptoms, the suit states. The nursing home sent an assistant janitor to pick her up from the hospital and drive her to the facility, but the janitor failed to fully secure the woman’s wheelchair in the back of the van. The nursing home had certified the janitor to transport patients, but he had never done so before.

When the van pulled out, the woman’s wheelchair flipped backward, and the woman hit her head, the suit says. The janitor stopped the van, and hospital security guards helped him pick up the woman.

Two nurses assessed the woman when she arrived at the nursing home and admitted her. At about 6:30 p.m., a neurological assessment showed the woman’s mental abilities were deteriorating. She appeared drowsy, her blood pressure had risen and she did not spontaneously open her eyes. A few minutes later, a nursing assistant noted the woman had a large knot on her head and said she was in pain. When the nursing assistant returned shortly after, the woman was vomiting, could not stand and was covered in her own feces, the suit says.

The staff decided not to consult a physician, send the woman to the emergency room or perform another neurological assessment, the lawsuit alleges. Nobody recorded checking on the woman’s condition between about 7 and 11 p.m. When a nurse checked on the resident shortly after 11 p.m., she found the woman unresponsive and running a temperature. The nurse called 911, and an ambulance brought the woman to the Wyoming Medical Center. At about 1 a.m. the doctors found that the woman was brain-dead, and her family decided to remove her from life support. She died shortly afterward.

An autopsy found that the cause of her death was bleeding in her brain “most likely incurred during an accidental fall received while unrestrained in a wheelchair,” according to the suit.

The janitor who failed to secure her wheelchair pleaded guilty to criminal negligence in 2010 and was sentenced to probation, according to the suit. The nurse in charge of the woman that night was sanctioned by the Wyoming State Board of Nursing.

The wrongful death suit was settled in 2013 for an undisclosed amount, according to court records.

The most recent suit filed against Poplar Living Center in federal court alleges that it took nursing home staff more than a month to diagnose a resident’s leg pain as a broken femur and ankle. The suit, filed in December 2015, alleges that when the staff did contact the Wyoming Medical Center emergency room, the hospital staff noted in their records that it appeared the woman’s gown and bedding were soaked in urine and “had not been changed for what looked like days.”

The woman was hospitalized for four days, and the Wyoming Department of Family Services started an investigation into the case. The department later found that the nursing home had not acted negligently, the suit says. Litigation in the lawsuit continues.

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Star-Tribune reporter Elise Schmelzer covers criminal justice.

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