BY CATHERINE TSAI
The Cincinnati Enquirer
FORT THOMAS -- Awards like best nursing home in the state have been given to Highlands of Fort Thomas Health Care Center in the past, but in July the state Cabinet for Health Services added another item to the list: a type-A citation for an alleged violation.
The Cabinet's most serious type of citation was issued after Billy D. Horn, a patient, burned himself while smoking in the care center's courtyard July 18. Mr. Horn later died with burns on 65 percent of his body, and the facility was cited for failing to supervise him.
"We're going to fight it, and I think we have a very strong case," said Barry Bortz, CEO of Carespring Health Care Management Group, which manages Highlands of Fort Thomas and three other facilities. Mr. Bortz said the incident was an accident, not a result of negligence. He described Mr. Horn, a 49-year-old patient recovering from a stroke, as competent to smoke without supervision, even though his family disagrees.
"He was very recovered, very alert, very oriented," Mr. Bortz said. "This man was not demented."
An appeal hearing originally set for next week was pushed back to November to accommodate the nursing home's lawyers.
The victim's family has asked lawyers Steve Franzen and Joe Condit to investigate the incident. Mr. Franzen said the family was upset because a doctor had said Mr. Horn was not to be left alone while smoking.
"That was the whole reason he was in there," Mr. Franzen said. "The family was concerned about his smoking habits and their ability to control him."
Every day, Mr. Horn smoked three or four packs, Mr. Bortz said, most of which he thinks were delivered from outside and stored in Mr. Horn's private cabinet. Highlands of Fort Thomas is a smoke-free facility, but patients may smoke outside.
Mr. Bortz also disputed findings that the center violated its policy by improperly managing Mr. Horn's smoking supplies. Mr. Bortz said the policy applied only to cognitively impaired patients, whose smoking materials were to be kept at the nurses' station. As for violating instructions for Mr. Horn's care, Mr. Bortz said Mr. Horn's plan should have been updated to say he was permitted to smoke without supervision.
"It still makes you sick that somebody got hurt, but I don't think it was negligence," Mr. Bortz said. "It was an accident. We're just as upset as anybody else. Wouldn't you be, after 20 years of caring for people?"
The state has records of two deficiencies at Highlands of Fort Thomas since 1997 that required attention, one of which involved injuries to a resident.
A report from July 1997 states that a patient fell after workers placed her on a lift for a bath. In two separate falls, she hit her forehead and needed stitches. The report said she was not properly restrained and that two workers should have supervised her bath. The center did not deny or confirm the allegations in a written response to the state, but it submitted a plan to prevent recurrences.
Then six months ago, the department interviewed residents to find out whether call bells were answered in a timely manner. Residents said they sometimes waited 45 minutes for an answer, especially after meals. The center disputed the claims, saying one man did not remember later that he had been interviewed.
Even so, the center said it would designate an aide whose only responsibility during and right after meals was to answer call bells. The facility's "superior" rating was subsequently restored. Mr. Bortz said those were the facility's only deficiencies in five years. The center has one staff member for every 10 of its 140 patients, Mr. Bortz said.
"It's not a restrictive, jail-type environment," he said. Since Mr. Horn burned himself, the home has closed the outdoor courtyard from 11 p.m. to 8 a.m. Mr. Horn had been seen in the courtyard with his clothes on fire around 2:30 a.m. And now, all patients' smoking materials will be kept at the nurses' station, Mr. Bortz said.
Type-A citations can carry fines of up to $5,000 with requirements to get outside training for workers. Mr. Bortz said the citation and appeal process have affected the staff somewhat personally. "I don't know how to explain it," he said. "It's just so sad that you work so hard to provide good care and be a good member of the community, and you're fighting this huge battle of punishments. It's very emotional." Jane Prendergast contributed.
