Man dies after KCK nursing home stay left him with sepsis. It’s not the first complaint.

Healthcare Resort of KC accused of neglect after patient dies | The Kansas City Star

JUNE 25, 2023 6:00 AM

John Curtright of Kansas City, Kansas, could barely move.

A stroke contorted his right leg muscles into a shape that made walking near impossible. The former roving musician appeared frozen, unable to sit up straight. So, his only daughter, Amanda Cook, rushed him out of a rehabilitation facility in January 2022 to search for a place able to care for him long term.

The Healthcare Resort of Kansas City, a 70-bed nursing home on Parallel Parkway, claimed to have the resources to care for Curtright, alleged a Wyandotte County District Court lawsuit, which was filed last week on behalf of his daughter.

But three months into his stay, caretakers found Curtright unresponsive and rushed him to the hospital. Providence Medical Center doctors believed he was in an “altered mental state.” Curtright appeared severely malnourished. A wound left to fester on his right toe had turned into sepsis, court documents said.

He died about one week later at the age of 78.

An attorney for the family, Chris Schnieders, said nursing home staff had assured Cook on multiple phone calls and in-person visits that her father was healthy, aside from his contorted leg.

“There were no issues with any sort of wounds that were healing,” Schnieders said of Curtright’s condition entering the nursing home.

“[Cook] was told that everything was fine and there was nothing to be concerned about.”

She filed the wrongful death lawsuit against the nursing home on June 12, seeking $75,000 in damages for the alleged neglect of her father. Schnieders said they plan on increasing that amount by “much more” in court.

And Cook is not the only one with such complaints.

The nursing home has been embroiled in at least three other similar wrongful death cases filed in Wyandotte County since 2020. A company which owns the facility, Ensign Group Inc., also operates the Kansas City, Kansas, Riverbend Post Acute Rehabilitation on Freeman Avenue. The site became one of the largest COVID-19 outbreaks in Kansas in April 2020, leading to about 35 deaths including both patients and staff.

“This is a group that has facilities all over the country and many of them have the same kind of track record. We’d like to see that improved upon,” Schnieders said.

The Healthcare Resort of Kansas City and its owners did not respond to requests for comment Friday.

Cara Sloan, a spokeswoman for the Kansas Department for Aging and Disability, which warns the Centers for Medicare and Medicaid Services of under-performing facilities, declined to comment on the Kansas City, Kansas nursing home.

The nursing home performs well below the state and national average, according to surveys and inspection reports compiled by CMS.

In multiple cases, the nursing home failed to investigate patient falls that led to “major injury.” In another, staff failed to provide respiratory assistance to a patient struggling to breathe. A March 2023 inspection report revealed a patient suffering from sepsis and staff failing to alert the physician to the need for treatment.

Curtright lived most of his life in the Kansas City, Kansas area, according to an obituary written by family members. He was born on St. Patrick’s Day in 1944, and from that day on, he was “never far from his guitar.”

The musician studied Economics at Baker University in Baldwin City, Kansas and served as a dental technician for the Navy Reserves in the Vietnam War.

His only daughter Amanda Cook moved him from nursing home to nursing home around Kansas City, Kansas, as he grew older. After a serious stroke, Cook placed him in Providence Medical Center and Rehabilitation Facility on Nov. 28, 2021.

Less than two months into his stay, staff told Cook she would need to find him another treatment center. Her father, the former traveling guitarist, was practically immobile. His right leg muscles hardened, creating a contracture that froze his leg into place. He could not walk and required constant supervision.

A transferring care team at the Healthcare Resort of Kansas City told Cook they would make him comfortable and keep him as “functional as possible,” according to Cook’s attorney Chris Schnieders.

When he arrived on Jan. 26, 2022, Providence Medical Center staff told the nursing home Curtright needed certain medical provisions to keep wounds from occurring on his right leg.

Nursing staff noted a foam brace would help prevent the pressure sores from developing, but it is unclear whether one was ever provided, according to Schnieders. By March 7, a wound appeared on Curtright’s right toe, court documents said.

Two weeks later the sore became a deep crater, affecting the skin’s underlying tissue. The wound continued to fester for weeks. By April 11, his bone peeked out from under the ulcer.

When Cook called to check in, she heard her father complain of pain around his right foot. But nurses told her, “You have nothing to worry about,” Schnieders said.

“They were pretty careful to make sure everything was covered up so when [Cook] was there, there was absolutely no attention called to what was going on with his wounds,” he said.

The nursing home did not respond to questions from The Star regarding the daughter’s allegation.

On April 26, Curtright was discovered unconscious.

His confused mental state led doctors to determine he was suffering from sepsis and severe malnutrition. His white blood cell levels were “extremely high” and a mild odor emanated from his right toe, court documents said.

Doctors considered amputating his leg, but his condition was rapidly deteriorating. He was placed in a hospice on May 5 and died the same day.

“[The Healthcare Resort of Kansas City] frequently are allowing their patients to go into dire straits with their infections prior to doing anything like contacting a hospital,” Schnieders said of the nursing home.

“In our regard, John passed away because they didn’t get there on time.”

Since 2018, the federal government has fined the Healthcare Resort of Kansas City over $100,000 for failing to correct problems cited on inspections reports or allowing issues to lead to serious patient harm.

The largest single fine of $78,458 followed an Aug. 3, 2022 inspection where a patient with dementia was placed in “immediate jeopardy” after multiple falls and a lack of supervision led to her fracturing her shoulder, documents said.

While the nursing home has a documented history of concerns, it has yet to be flagged by the federal government. On the state level, Kansas can only flag two nursing homes at a time to be a part of the Special Focus Facility program program, which monitors problematic nursing homes every six months with state inspections, said Cara Sloan, a spokeswoman for the Kansas Department for Aging and Disability.

By the end of the program a nursing home will either “graduate” or have their Medicare and Medicaid programs terminated, which often leads to the facility shutting down, Schnieders said.

The facility sits on a list of ten other Kansas nursing homes at risk of being submitted to the CMS SFF program for quality issue violations.
Past inspections for the Healthcare Resort of Kansas City have exposed issues, documents said. The nursing home accumulated 49 citations detailing deficiencies around patient health and safety since 2018, which is high compared to other facilities across the state and nationwide.

An inspection report published Thursday discovered issues that ranged from a physician missing a patient’s urine analysis reports to a nurse failing to provide wound care.

Prior reports revealed staff struggled to communicate the needs of patients to physicians, leading to some patients missing treatments or not receiving aid for injuries developed at the facility. On a number of occasions, nursing staff were cited for failing to investigate patient falls, documents said.

Some of these issues appeared to stem from high staff turnover. According to CMS inspection reports, turnover among the total nursing staff is nearly 17% higher at the facility than the state average and 20% higher than the national average.

“It’s pretty clear this facility has a pretty dismal track record of caring for patients under infectious disease circumstances, and also under sepsis conditions,” Schnieders said.

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