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Cynthia Wilms was admitted to The Willows Nursing & Rehabilitation Center in Sun Prairie on July 30, 2007, for what was supposed to be a short stint of rehabilitation following an elective hip replacement.

Instead, Wilms, 72, a wife, mother, grandmother and piano teacher, grew sicker and sicker as her surgical wound developed into what is normally a common and treatable staph infection. Nobody at the chronically understaffed nursing home - listed by the federal government that same year as one of the worst in the nation - called a doctor or took other important steps to stop it, her family says, even as drainage from the wound soaked her clothes and bedding so regularly that her husband, Phillip, took her stained underwear and slacks home every night to wash them. She died on September 13, 2007.

Earlier this month, the large corporation that runs The Willows agreed to settle a neglect and wrongful death suit filed by the family for $2.25 million plus an undisclosed amount for costs. Officials at Extendicare Health Services Inc., the Milwaukee-based for-profit chain that owns The Willows and 175 other nursing homes in the country, refused to comment on the specifics of the case beyond noting in a written statement that the settlement includes no admission of liability on its part. Rob Hanson, a vice president for the company, claims in the statement that the company has recently invested "significant resources" into the 57-bed facility to improve conditions there.

The settlement is one of the largest between a nursing home resident and nursing facility in Wisconsin.

But there is little joy or celebration in the Wilms family's home, where Phillip and his daughter, Susan Hogue, sat down at the kitchen table last week to tell their story. There is just a silent piano, memories, and the hope that some good can be wrested out of Cynthia's death. "Why I filed the lawsuit in the first place is that I want to be sure that people in nursing homes get better care than we did," Phillip says, fighting tears. Phillip, a former elementary school teacher and principal, had been married for 53 years to his high school sweetheart.

Problems with Cynthia's care started as soon as the van transferring her from St. Mary's Hospital, where she had undergone what appeared to be a smooth surgery a few days earlier, dropped her off at the nursing home, Phillip says.

The wheelchair sent out to collect her was too small, and lacked working brakes and a lock. The bed in her room was broken; it wouldn't go up or down. The bedside table didn't move, either; its wheels were clogged with dirt, hair and dust. Cynthia and the mattress were moved onto a new bed, but the mattress was too long for the new frame, making Cynthia feel like she was in a hammock. Cooking appliances in the occupational therapy room didn't work.

The room had no television, radio or phone. The only way bedridden patients could communicate with the world outside their rooms was by pressing the call button, which would turn on a light. But it routinely took staff an hour to respond to such pleas for help, Phillip recalls.

The couple chose the center because it had a reputation for providing good physical therapy. What they didn't know, until Cynthia became a statistic herself, is that in the two years before Cynthia's admission, the facility also had a record of nursing home violations resulting in serious harm to patient safety, and hundreds of thousands of dollars in fines. Two months after Cynthia's death, The Willows was listed by the federal government as one of the 54 worst nursing homes in the nation.

"It's a terrible place," Cynthia told her daughter, who called from Texas every day and spoke to her mom on Phillip's cell phone. But Cynthia figured she'd get out of there soon enough, better than new. She had suffered from painful arthritis for years. The couple loved to travel to visit their three children and six grandchildren and great-grandchildren; a new hip would make such trips easier.

At home, her parents were inseparable, Susan recalls. Her dad sang old songs while her mom played the piano; he made her a harpsichord from scratch. They played cards with neighbors every Friday.

At The Willows, Phillip visited faithfully every day, arriving around 8 and leaving at night the same time. According to his deposition in the case, when he arrived in the morning, she had not been bathed, fed or helped to the bathroom.

After she complained that it took too long to be helped to the bathroom, nursing staff put a catheter on her - a humiliating procedure Phillip charges was done only to make their job easier; a doctor later said it had not been necessary. The couple feared staff might retaliate in other ways if they made other requests or complaints. Still, as his wife's health deteriorated, Phillip recalls in the deposition, he complained several times about her care to the social worker at The Willows.

At first the wound - a 6-inch incision in her left side - appeared to be healing nicely. But on August 12, a few days after the staples were removed at a nearby Dean Clinic, nursing notes from Willows staff reported bloody brown and yellow discharge. The notes say a doctor would be notified the next morning: that call never happened. Cynthia started to complain of increasing pain.

Day by day, Wilms recalled in his deposition, the infection got worse. There was so much drainage, it soaked her clothes and sheets. "I had to take my wife's underpants, nightgown or whatever home every night and wash it, and then come back so that she had dry stuff to use in the morning," he says in the deposition.

According to the deposition, nurses regularly asked him to help re-tape dirty bandages without changing dressings or cleaning the wound. "When the wound broke open and was draining down over the wheelchair and onto the floor," he recalls in his deposition, "I tried to get the front desk to respond. Finally I had to go out and find the person that was on duty, which I assume was supposed to be a nurse, and she was not very well prepared for the job she was assigned ... ."

He describes how the staffer at first tried to put him off, and then said she couldn't find a scissors or supplies for dressings. When she finally arrived to help, he says, she put the equipment, including the dressing she would use to cover his wife's wound, right on the bathroom floor.

"It was a circus," he says now.

Matthew Boller, the family's attorney, says that if the case had gone to trial, he was prepared to argue that fault lay with the for-profit corporation running the home, not the overworked staff. "The nurses were not bad people," he says. They were simply trapped, like the Wilmses, by a corporation that "puts profits in front of people."

During Cynthia's stay, Boller says, the facility was under "terrific pressure" from Extendicare to keep costs down and profits up. Its corporate strategy, detailed in dozens of pages of legal documents, was to aggressively woo the most profitable patients - very high-needs patients like Cynthia, who came with the highest rates of Medicare payments - while keeping staffing levels low.

An aggressive marketing campaign aimed at capturing these lucrative patients was at full throttle when Cynthia was admitted to The Willows. A brochure describing the policy, called the Green Flag admission policy, or The 24/7 Extendicare Admission Policy, provided staff with a list of desirable diagnoses, including dialysis, wounds, HIV, rehabilitation, quadriplegics and colostomies. Especially coveted were patients recovering from hip surgeries, like Cynthia, Boller says.

The brochure with the capitalized heading "AUTOMATIC ADMISSIONS/ALWAYS YES IMMEDIATELY!" provided staff at The Willows with the steps and scripts needed for streamlined admission.

Boller claims financial records kept by the company prove that it planned to profit from these patients - the company sought to make them at least half of the patient load at The Willows -without providing adequate staffing to care for them. "They budgeted and planned to be understaffed during the days when my client needed somebody to pick up the goddamn phone and call a doctor," he says.

Out of the 29 days Cynthia was there, he says, the facility failed to meet even its own minimum monthly staffing goals 80 percent of the time. During some shifts, there were only a couple of aides on duty in the 57-bed facility, Boller says, and some of these aides put in 120- to 130-hour weeks. On several key dates, including the day that staff noted a doctor needed to be called, no RN showed up at all, a violation of federal law. "My client was there for 29 days," Boller says. "There was not one day that all the people who were scheduled showed up. You can't run a meat market in the grocery store if you don't know who's going to show up." In a nursing home with such high needs, he says, "it's asking for disaster."

Extendicare Vice President Hanson's statement accuses Boller, whose firm Boller & Vaughan typically works on a contingency basis, of seeking to profit from such patients as well. "We do not intend to debate through the media the general allegations made by an individual who is trying to personally gain from the misfortune of others. Mr. Boller's comments serve only to undermine the efforts of all caregivers who do a very difficult job on a daily basis with care and compassion."

Michael Libby, administrator of The Willows, claims in a separate written statement that he is "very proud" of his staff. "Significant resources have been invested to improve the care and services provided at our center, including a complete remodel of the center this past summer to enhance the living environment and provide additional services to our residents." Libby says in the statement.

The officials claim that the nursing home is now in compliance with all state and federal regulations.

In fact, a summary of inspections of The Willows between January 1 and May 21 of this year, on file with the Department of Health Services' Division of Quality Assurance, found around a dozen citations which the nursing home promised to correct. None of those citations, however, were deemed to be of the scope or severity that could harm patient safety, like those on record around the time of Cynthia's stay at the center.

During the last days of her monthlong stay at The Willows, Cynthia dreamed of escaping, according to her family. "I've got to get out of here," she would say. " I want to go home."

She got her wish, in a way. On August 27, Phillip drove her to their Sun Prairie ranch house surrounded by fruit trees, with her beloved piano and the harpsichord he had built by hand. He had built a ramp for her homecoming. She was only there for a visit; a physical therapist accompanied the couple to check out the home to be sure it was safe for Cynthia's eventual discharge. During the visit, though, Cynthia started shaking so badly, her husband had to rush her to the emergency room at St. Mary's.

Doctors there immediately realized her fever, chills and oozing wound were due to a serious infection and put her on antibiotics. By then her entire new hip was infected, and Cynthia underwent a second surgery to replace it with another artificial joint.

But it was too late. "There's nothing they can do for me," Cynthia whispered to her daughter, Susan, when she flew in from Texas.

Susan watched helplessly as her mother's body shut down. On Sept. 13, a granddaughter called Cynthia to say she loved her and that she was going to have another baby. Cynthia, unable to speak, squeezed Susan's hand. Shortly afterward, she died from a renal infection and other complications. "If they had just taken care of the infection, my mother would still be here," Susan says.

A few days after his wife died, Phillip went back to the nursing home. He wanted to return some therapy aids so that other patients could use them. And he wanted to speak to management. "I told the nursing home people I couldn't see why they expect to get paid and collect money for care they couldn't give," he recalls. "They tried to shut me up so nobody could hear. But I said my piece."

The lawsuit is also a way to say his piece, he says. So is talking to the media. Sometimes settlements in neglect and medical malpractice cases include confidentiality clauses that in effect muzzle family members and lawyers from speaking out about what happened in these cases, so the public never learns. But Boller says his client refused to sign such a clause, even though it meant negotiations stalled. The settlement was not reached until days before the case was scheduled to go on trial earlier this month.

What matters to the family, they say, isn't the money they won. It is the message behind it. "The biggest thing is letting people know that they have to be vigilant at any place they go for care. They can't rely on the people there," Hogue says. "If we can keep some other family from experiencing this huge tragedy, that could give us some sense of comfort."

The other day, Susan, in town to testify at the trial, sat down at her mother's piano and played the favorites her parents used to sing together - songs from the '40s and '50s like "A Bicycle Built for Two" and "Let Me Call You Sweetheart." Phillip hummed along, tears in his eyes. The house, he says, is too quiet now.

 

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