South Carolina LPNs Arrested For Not Changing Wound Dressings

Nurse Beth, MSN

According to South Carolina Attorney General Alan Wilson's office, two LPNs at Magnolia Manor in South Carolina were accused of failing to tend to the injuries of two residents. They were arrested and charged with Neglect of a Vulnerable Adult on December 8, 2022.

"A joint investigation between the Spartanburg Police Department and the Medicaid Fraud Control Unit (SCMFCU) found that between September 9th and September 11th, 2022, the two nurses allegedly failed to provide appropriate care as per the medical orders.”

Five months later, still not much is known. Here's what we do know:

Both are from South Carolina-the two LPNs are Alyssa Morris, 22, of Cowpens, South Carolina, and Heather Gowan, 44, of Gaffney, in South Carolina
Heather Gowan has been licensed as an LPN since 2007, while Alyssa Morris has only been an LPN since February 2022.
The charges claim the nurses both intentionally failed to change wound dressings at the skilled nursing facility, which caused the wounds to "increase in size." This incident was reported to law enforcement by Magnolia Manor, who cooperated fully with investigators.
The Attorney General's Office plans to prosecute Morris and Gowan.

Neglect of a Vulnerable Adult in South Carolina

According to South Carolina law, a vulnerable adult is a person "eighteen years of age or older who has a physical or mental condition which substantially impairs the person from adequately providing for their care or protection. A resident of a facility is a vulnerable adult."

Consequences

Neglect of a Vulnerable Adult is a felony in South Carolina and, upon conviction, carries a penalty of up to five years in prison.

Who Turned Them In?

According to the news, the facility, Magnolia Manor, reported itself to law enforcement. It's fair to say that healthcare facilities do not turn themselves in; instead, someone files a complaint. So it's conceivable a complaint triggered the investigation.

It also seems that Magnolia did not turn themselves in so much as they turned in the two nurses. Interesting that Magnolia chose to involve law enforcement rather than the BON.

Who notified the authorities?

It could have been a:

Disgruntled or concerned coworker
Family members (of both families?)
Provider

It's doubtful that a provider would have filed a complaint to law enforcement as they would have instead complained to the administration. It's also likely the provider would not have been aware because they do not round frequently in skilled nursing facilities.

A family member may have noticed that the dressing on their loved one was not changed as ordered, but there were two patients. Maybe the families talked amongst themselves and reported.

Perhaps a coworker was concerned for the two patients.

Collecting Evidence

The dates are precise, September 9 and September 11. These are the dates the ordered care was not given. A significantly larger wound would not have been realized in 1-2 days, so were progressive photographs of the wounds taken as evidence?

What evidence shows that the dressings were not changed during that time? Photographs of an unchanged dressing? Taken by whom?

How does the state prove intention, as in "intentionally failed to change... wound dressings"?

Medicaid Fraud Control

Medicare or Medicaid fraud can take many forms, such as billing for services that were never actually provided, performing tests that are not necessary, and obtaining benefits without being eligible.

Other types of fraud include:

Billing for phantom patients
Double billing
Billing for non-covered goods or services
Billing for more expensive services than were performed
Kickbacks

The fact that it's a fraud investigation means it was probably documented but not done. It's possible that multiple wound dressings were billed for but never done. In that case, the facility would be cited.

Unanswered questions

Anyone who has worked in a hospital or licensed subacute knows the process. A complaint is filed, and there is an investigation. If deficiencies are found, the facility is cited and must then come up with a corrective plan of action. Why was the facility not cited, as is typical in such cases?

Possible scenario

There's a scenario where the nurses followed the existing culture at the skilled nursing facility and wrongly chose to document tasks not done.

Was documenting care not given common practice at this facility, or were these two LPNs outliers in terms of skipping care? If other nurses could do the ordered dressing changes, then why couldn't they?

Or conversely, if no one could routinely complete their work, why were these two targeted?

Assuming nurses Morris and Gowan documented fraudulently, were they dishonest and intentionally slacking or dishonest and overwhelmed? Did they document the dressings as done, intending to do them later?

Were nurses provided enough time and supplies to complete their assignments?

As of today, they both have active compact state licenses. They both face criminal charges, and they'll likely face BON sanctions.

This writer is looking forward to hearing and sharing more facts about the case.