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:
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."
Neglect of a Vulnerable Adult is a felony in South Carolina and, upon conviction, carries a penalty of up to five years in prison.
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.
It could have been a:
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.
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"?
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:
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.
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?
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.
The facility is going to have to answer for some of this.
My other question is how long did the dressing not get done and was documented that it was done. Was it just one shift?
Documenting care as important as wound care, that you didn't provide is fraud. It's unethical. If staffing doesn't allow you do basic care, it still has to be done. The next shift should have done it or bump it up the chain and document that.
I'm not sure they should have been arrested, but they and the facility need to be held accountable.
vintagegal said:This is troublesome. Has it come to the point where you, as a healthcare worker, have to additionally prove you're completing tasks outside of the charting? Should we hire someone to follow us with video cameras ? What is this country coming to? I'm seriously frightened as a nurse working in these dangerous times. This is now the second mainstream account of a healthcare institution having workers arrested to cover their own behinds. If these nurses intentionally didn't change a dressing, it's because they thought they could get away with it essentially, most likely due to lack of management and leadership. The institution wants to forego all responsibility and throw the nurses under the bus instead of coming clean about their role in this nonsense. BON should be the authority here, not the police. We need more info on if this was truly intentional, oversight, or overworked staff. I wonder what their nurse to patient ratios are.... I also would like to know if anyone else had difficulty with this wound care or with this patient. Playing devils advocate maybe they felt like it was outside of their scope- who knows? We need more insight into what occurred. The BON could have been instrumental in finding these things out and escalated up to police if there was proven intent to harm/neglect/abuse.
Hold up, you think it's the facility's fault that these nurses didn't change those dressings?
KathrynRNBSN said:complaint 2.pdf The facility was cited (attached) Without actually doing the investigation, which would be extensive, it is difficult to say although I think it's a very slippery slope.
Thank you for the info
FiremedicMike said:Hold up, you think it's the facility's fault that these nurses didn't change those dressings?
Absolutely, they should be in charge of 1) who they are hiring and 2) what type of work is being done. Why was this problem not rooted out sooner ? You're just going to let two nurses neglect a patient and all you're going to do is take pictures and call the cops? What about keeping patients out of harms way? Where was the management and oversight of an RN?
Is it just my reading of this or does the issue with R1 center around whether he actually did or didn't refuse wound care (3 times total)?
Who knows what the truth is because while it is easy for a nurse to document something false (such as a refusal), it is also easy for a patient to claim they never refused when in fact they did. For example if a patient is indeed getting "a hole in [your] buttocks" 3 weeks later it's awful easy to believably claim they never would have refused care--because who would want a hole in their buttocks. No one. So "obviously" he wouldn't have refused. But he still could have indeed refused. Maybe he thinks that he was supposed to be asked 3 more times sometime later in the evening and then he would have been ready.
The bottom line is it doesn't seem like we know many facts.
vintagegal said:Absolutely, they should be in charge of 1) who they are hiring and 2) what type of work is being done. Why was this problem not rooted out sooner ? You're just going to let two nurses neglect a patient and all you're going to do is take pictures and call the cops? What about keeping patients out of harms way? Where was the management and oversight of an RN?
OK, just so I'm clear, you feel the nurses are responsible for their own actions as well, right?
Leighsalu said:Arrested for not changing dressings? Keep arresting nurses for this and you won't have any nurses left.
Don't suck at your job to the point that you're falsifying documentation and causing patient harm. If that scares away the types of nurses that would allow this to happen, I'd say win-win!
hppygr8ful said:When I was in nursing school I was taught to write with a sharpie my first name and date on my dressing change. I still do it twenty years later though many of my co-workers find the practice strange.
It may be "strange" but it can save your cookies! I put my initials and the date of change, whether a wound or a Fentanyl patch, as a matter of routine. Why not do it, for heaven's sake? It seems that nurses have to defend themselves from everything in the healthcare setting today - from violent and/or litigious patients to corrupt or uncaring management to incompetent co-workers. It takes only a second...and it could save a license.
NRSKarenRN, BSN, RN
10 Articles; 19,146 Posts
Attorney General getting involved with wound care not being provided by individual nurses is unusual as FACILITY is held responsible.
Facility inspection reports can be found at Medicare Compare website.
Magnolia Manor - Spartanburg 10/4/2022 Health inspection report notes Police had been called by Social Service director (don't understand why) due to resident complaint of not having wound care provided --a repeat issue. CMS investigation done revealed wound care not being done along with some LPNS documenting care as being provided when interviews conducted confirmed wound care was not provided to patient, and nurses admitted lying to administrator --- that's healthcare fraud, especially if care was billed for payment. Surmise this is why Attorney General office got involved.