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.
SunCityInsPhysical, BSN, RN
34 Posts
I'm having gruesome Flashbacks. Putting 2 and 2 together I'm having Visions of decubitous ulcers gone really bad. I put myself through nursing school days, working in nursing home 40 hr weekends.
Proud to say we had 104 yr old pt on bed rest for 6plus years and NO decubitous. We turned her and massaged her and changed diapers every 2 hours. NO EXCUSES. Charge nurse kept a check list of rotations/positions and made rounds.
As an OR nurse I've assisted plastic surgeons treating decubitous ulcers. The worst one was unassuming on skin surface of gluteus maximus but had marsupialized under the skin to the bone and down to the knee.
This patients grand daughter was being paid as a CNA to care for her at home.
The surgeon had me call the police and the caregiver as arrested for criminal neglect and abuse.
I would suspect that this is the tip of the iceberg for that facility and many others across the country.
My suggestion would be surprise inspections and hold those who own the facilities accountable for adequate staffing. The state is also to blame. We're all in this together.
Not sure what is being taught in nursing schools these days, especially the illegal schools. Florence is turning over in her grave.
I was taught to date, time and sign dressings. We were also taught to restock supplies for the next dressing change, leave the area cleaner than we found it. To work as a team and care for each other as we give our patients the care we would like to receive. To know and follow the law and good care practices medical, nursing, psych and spiritual. Now a days we need to add gender awareness and respect but I've always treated each with respect.
I'm retired now, but my thoughts and prayers are with those of you who are teaching the next generations. Also for those working in these severely understaffed conditions.