Diagnosis: Eviction

An out-of-state company mismanaged its Mill Valley nursing home, then closed it down, casting dozens of elderly patients to the winds. Within months, 10 of them were dead.

On May 8, state officials ruled that the home would be barred from receiving Medicare and Medi-Cal payments starting May 28.

Less than a week later, Lenox Healthcare Inc. sent out letters to patients that read "Notice of Intent to Discharge." The company told its Medi-Cal patients that they had 30 days to vacate the premises.

After the eviction notices went out, bedlam ensued, family members of former patients recall.

"We received this notice saying their license was in suspense and giving us 30 days to move out. We found out that there were only six beds available in the entire county," says Agneta Lindman. "I asked James Hardee, the Lenox regional director, what will happen for people who can't find beds? He says, "We'll charge you as a private pay person."

Neither Lindman nor the other Medi-Cal patients could afford the $124 per day that the home charged private-pay patients. Medi-Cal reimbursed the facility at a rate of $94 a day. Family members and patients describe the resulting scene as resembling a refugee exodus.

The discharges were eventually halted by a court decree, but not before more than a dozen families, frightened by the eviction notices, immediately moved their loved ones elsewhere. Other patients who didn't have family or friends present were moved out by Lenox before the court injunction to halt the evictions took effect.

"It came unexpectedly. Nobody imagined that they wouldn't be able to do it," recalls David McGahey. "A panic broke loose. People started moving out like crazy."

Some 70 residents effectively stood to be evicted as a result of the order. Family members and health officials say orderlies scooped patients' belongings into plastic bags and boxes. Many were confused and frightened.

"There was this one woman who was a Holocaust survivor, and they put her things in a black plastic bag, and told her they were coming to take her away," recalls McGorty, the nursing-home ombudsman. "There were these three veterans who lived at Mill Valley, and they found each other and became close friends. They used to tell war stories together. Two of the vets were crying. They called an ambulance to take them away at night. At night! When they saw what was happening, the ambulance drivers refused to transport them. They knew that what they saw was wrong."

But the patients, their families, their neighbors and advocates, didn't give up without a fight. And they almost won.

Just as it seemed that Lenox was well on its way to getting rid of all the subsidized patients, a remarkable thing happened. Alerted by family members, Pat McGinnis of California Advocates for Nursing Home Reform recruited pro bono legal help from the powerful San Francisco law firm of Morrison & Foerster. The firm sued to stop Lenox from discharging the Medi-Cal patients. The legal battle was a fierce one, recalls California Advocates attorney Prescott Cole.

"With the money [Lenox] spent on legal fees, they could have brought the nursing home up to code several times over," he says.

Initially, the patients' attorneys prevailed, and a judge ordered Lenox to halt the evictions, though many of the Medi-Cal patients had already been removed.

But when it became apparent that it could not run the home as it wished, Lenox eventually decided to sell the home and allow it to close. This spring, a second round of notices was sent to all the home's remaining residents informing them that Lenox was getting out of Mill Valley.

As it fought Morrison & Foerster attorneys, Lenox also waged battle on another front. According to the "Mill Valley Healthcare Center" file at the California Department of Health and Human Services offices in Daly City, Lenox responded to the collection of state complaints -- an inch-thick sheaf depicting a facility essentially out of control with inadequate staff, missing medical records, and myriad failures to provide proper care -- by challenging inspectors' conclusions. Lenox submitted several watered-down "Plans of Correction" which were summarily rejected by state regulators. The state gave Lenox six months to fix things. The company failed to do so.

"They were given six months to make corrections, and they didn't do that," says Julia Abramson, whose father Larry was the last patient to leave the Mill Valley home. "I don't know why they didn't do it, unless they couldn't care less about their medical certification."

Finally, Lenox was forced by the state to hire a private consultant to manage the home while it looked for a competent buyer to run the facility. Residents and family members at first met this move with skepticism.

But it turned out to be a brief godsend. Under state pressure, Lenox hired Lynn Blair, a Pinole consultant who brought in a top-notch management staff and galvanized the remaining Mill Valley employees.

"That was a period when everything went exceedingly well," recalls Holland Gray, whose partner, Larry Abramson, was a patient at Mill Valley. "They weren't conscientious about anybody's eating until Blair and company came in. They used to put the tray in front of Larry in the room, and if he didn't eat it, they would say he didn't like it. Blair and company started having everybody who could, eat in the dining room. They would write down [the] percentage of food that was being eaten, and knew ... if he needed help eating."

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