Attorney General Bill Lockyer Announces Enforcement Agreement Requiring Higher Quality of Care Standards in Sun Nursing Homes

(SACRAMENTO) – Attorney General Bill Lockyer today announced he has reached an agreement with Sun Healthcare Group, Inc. (“Sun”) resolving claims that the nursing home operator violated numerous provisions of a 2001 permanent injunction that required the company to improve the quality of care at all 18 of its California facilities. Among other provisions, the new agreement will require Sun to implement dozens of new quality of care reforms, increase nurse staffing, hire an independent wound care nurse monitor, and pay $2.5 million in fines and costs.

“When we entrust a loved one’s care to nursing home providers, we expect them to follow the law and protect residents from harm,” Lockyer said. “Sun’s failure to comply with the previous injunction not only violated a court order, it also caused pain for residents and their families. By agreeing to be held to higher patient care standards, Sun is getting a second and final chance to deliver consistent good care to those who need it. I expect them to become an industry leader in service, not just profits.”

In October 2001, Lockyer successfully prosecuted Sun for felony elder abuse stemming from criminally negligent care of residents at a San Mateo County Sun facility during a 2000 Bay Area heat wave. In addition to the criminal conviction, Lockyer settled a civil enforcement action against Sun alleging numerous violations of state and federal quality of care statutes and regulations. That settlement resulted in the state’s first-ever permanent injunction against a national nursing-home chain and required Sun to comply with state and federal laws governing quality of care, increase its staff training and develop internal oversight/compliance mechanisms.

While Sun complied with some of the reforms required by the 2001 injunction, the number of substantiated complaints and citations against Sun facilities documented by the state Department of Health Services demonstrated too little improvement by the nursing home chain.

Sun failed to fully comply with the 2001 court order for improvements to care. Investigators from the Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse (BMFEA) conducted an independent investigation to assess Sun’s overall compliance with the terms of the 2001 permanent injunction and found extensive patient neglect.

The Attorney General’s investigation focused on eight of Sun’s California facilities - seven standard nursing homes and one behavioral health nursing home which cares for the mentally ill and developmentally disabled. The investigation included four surprise nursing home inspections and one video camera surveillance operation.

BMFEA investigators discovered serious, systemic problems at each of the standard nursing homes in two or more of the following categories: false records, inadequate pressure ulcer care, dehydration, malnutrition, weight loss and patient safety. At the behavioral health nursing home, investigators found that staff was untrained on reporting and investigation requirements, and provided inadequate responses to dangerous conduct by residents.

The investigation established that Sun’s quality of care problems stemmed from insufficient staffing, inadequate supervision and a lack of staff training. Under the terms of the new permanent injunction, Sun has agreed to a requirement to allocate hundreds of thousands of dollars annually to increase its registered nurse-to-patient ratio to the 2002 statewide average. The new injunction requires Sun to automatically pay monetary sanctions for any failure to comply with these new nurse-staffing requirements.

The company also must train all its nurses on pressure ulcer prevention, accuracy in medical record-keeping, and the prevention of accidents and injuries to patients. The Attorney General’s Office will be guaranteed greater access and inspection rights at Sun facilities, and the company must immediately notify the AG of any failure-of-care incident. Finally, Sun will pay for an independent wound care nurse monitor, selected by the Attorney General, who will report to the Attorney General and direct Sun’s improvements in wound care.

Pursuant to the terms of the new permanent injunction, failure to comply with any of these provisions can result in civil penalties of up to $6,000 per violation, other sanctions deemed appropriate by the court, and potential exclusion from receiving further funding from both the Medi-Cal and Medicare healthcare programs. The new permanent injunction was filed and approved today in San Diego Superior Court.

Sun currently operates 18 nursing homes in California and approximately 100 nursing homes in 13 states.