Coroner to 'Spot Check' Nursing Home Deaths

Roger Morris, Washington County coroner, shows one of a few unclaimed cremated human remains that he stores at his office Aug. 15 in Fayetteville. Morris received an extra $20,000 from the Quorum Court to do spot checks on deaths at nursing homes this year.
Roger Morris, Washington County coroner, shows one of a few unclaimed cremated human remains that he stores at his office Aug. 15 in Fayetteville. Morris received an extra $20,000 from the Quorum Court to do spot checks on deaths at nursing homes this year.

— Washington County Coroner Roger Morris decided to check on the death of an elderly nursing home resident with a cracked skull earlier this month.

The nursing home reported the 91-year-old man’s death to the coroner’s office.

Morris would like to go to every death reported at nursing homes. Coroners in Benton and Pulaski counties do.

At A Glance

The Law

State law outlines requirements regarding reporting deaths that occur in nursing homes. Part of the law says: In all cases of the death of a long-term care facility resident or a hospice facility resident, that facility shall immediately report the death to the appropriate coroner. All hospitals must also report the death of a person who was a long-term care facility resident within five days before entering the hospital. The report is required regardless of whether the hospital believes the death to be from natural causes, the result of maltreatment or any other case.

Source: Arkansas Code Annotated 12-12-1709

Morris received an extra $20,000 from the Quorum Court to do spot checks on deaths at nursing homes this year.

“What we’re doing is checking on them to make sure things are up to par and that the families are happy with how they’re treated,” Morris said. “If no one does, who’s going to do it?”

Morris said he’s also there to protect nursing homes from people looking to make money by suing facilities for neglect. He’s seen family members in the past do harm to elderly people in order to sue facilities, he said.

Morris arrived at the nursing home about 45 minutes after being called. He grabbed two equipment boxes containing his camera, gloves, syringes, vials and other equipment.

He checked in with a nursing supervisor, who looked a little surprised he was there to review documentation about the man’s death. He later said most nursing home staff members in Washington County aren’t used to seeing a coroner visit a facility to review a death.

Morris found the pale, yellow-skinned man, laying face up on a bed with arms to his side and white bandages wrapped from his chin to the back of the skull. The blankets laid crumbled at his feet.

He asked nurses to leave while he reviewed the body. He jotted observations on his notepad about the position of the body, such as his head and feet lay in a north/south direction.

Morris took dozens of photographs before moving limbs and the body.

He lifted the hands and feet checking for any defensive wounds. He found none and took more pictures.

“I’m looking for bed sores, bruising, any kind of bandages,” Morris said. “If they have bandages, they have to be dated.”

He opened the man’s mouth and took photos of his unobstructed throat and airway. The man’s jaw, limbs and legs were loose, meaning he died recently, Morris said.

He suspected the yellow skin to be a symptom of jaundice, a liver disease.

Morris felt the man’s head, looking for the skull injury. He carefully examined the rest of the body, looking at creases in the skin and coloring. He took blood samples.

After 30 minutes, Morris clothed the man, fluffed the pillows under his head and rested both hands on the man’s stomach. He wanted the man to appear at ease for his family.

The man’s wife was sitting at a table in a nearby lounge. The wife explained the man fell and injured his head during a walk near their home in December. She was convinced the fall catalyzed his body to shut down.

A day later, Morris said the man likely died from the end stages of dementia, despite the head injury. He couldn’t release specifics or the cause of death to avoid publicly identifying the man, he said.

The nursing home properly cared for the resident, he said.

Death Reviews

Coroners are the eyes and ears of the state Department of Human Services’ Office of Long Term Care, said Daniel Oxford, Benton County coroner.

The state office licenses nursing homes and other long-term care facilities. State officials also inspect nursing homes and follow up on complaints.

“In Benton County, we sign all of the nursing home death certificates,” Oxford said. He or his deputies also examine many deaths of the elderly at local hospitals.

Gerone Hobbs, Pulaski County coroner, said he and his deputies review all deaths at nursing homes unless they’re busy with a homicide or a high priority death.

State law requires nursing homes to report all deaths to the county coroner. Hospitals must report a death if it occurs within five days of the patient being transferred from a nursing home, according to the law.

A person, official or institution that makes false notifications could be guilty of a class A misdemeanor or also a class D felony, if previously convicted, according to state law.

Oxford and Morris said coroners don’t have to examine all bodies.

Morris said his office can’t go to every death because his office doesn’t have enough money to pay his two part-time deputies for the extra work.

Washington County budgeted $55,000 this year for part-time salaries compared with $35,000 for 2012. Morris said the extra money is specifically for spot checks.

Morris hopes in the future to have enough money to pay his deputy clerks to review all deaths at nursing homes, he said.

Only doctors, coroners and hospice nurses can pronounce deaths, Oxford said. However, an elderly person who dies at 2 a.m. in Benton County will not likely have a doctor visit the nursing home to pronounce a death.

“If they notify you, are they going to tell you the person fell off the bed and bumped their head at night? Maybe not,” Oxford said.

Since the 1999 state law went into effect, coroners have referred 74 questionable cases to the long-term care office, said Amy Webb, spokeswoman for the Human Services Department. Of those 74, three came from Benton County and none from Washington County, she said.

“Though we don’t receive a large number of reports from coroners, we do appreciate and act on any information we receive,” Webb said.

The long-term care office, after receiving a complaint, sends inspectors to the nursing home. Inspectors can conclude no violation occurred or fine a facility or require it to create a corrective action plan.

Most coroners in smaller counties don’t have the training or the money to properly review deaths, said Martha Deaver, president of the Arkansas Advocates for Nursing Home Residents. Deaver said hundreds of nursing homes are cited for violations by the long-term care office.

She said from Jan. 1, 2011, through Jan. 31, 2012, more than 2,800 violations from 232 nursing homes were reported that could have resulted in serious harm or death, according to data she requested through the long-term care office. That report shows the largest number of violations deal with food procedures, infection control and accident hazards.

“I deal annually with many family members and residents in Washington County,” Deaver said. “Every single year I hear about serious neglect issues in that area. It is wonderful for me to hear the coroner’s office is focusing to improve the effort to review deaths in nursing homes.”

Administrators with Katherine’s Place, North Hills Life Care and Rehabilitation and the Fayetteville Health and Rehabilitation declined to comment about Morris’ spot checks.

Several messages left last week with the Arkansas Health Care Association were not returned. The organization represents most nursing homes in the state, according to its website.

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