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Officials of the Health Care Financing Administration, a section of the Department of Health and Human Services that enforces federal nursing-home rules, were unable to justify to TIME the gap between recommended penalties and those that were ultimately exacted. The officials say nursing homes "have a right" to correct problems before penalties are imposed. But a former government inspector disagrees. "Congress said to impose these penalties, and they're not," says Charles Bailey, a lawyer who left the HCFA this year after spending nearly seven years trying to punish bad nursing homes.
California fined nursing homes $2.4 million last year but has collected only $500,000 (the state gives nursing homes a 50% discount on fines that are not appealed).
And then there are the maggots. In 1994 a nurse at the Fairfield Health Care Center in Fairfield, Calif., found about 40 maggots in a bedsore on the left heel of an 87-year-old man. State inspectors recommended a $24,000 fine, but the nursing home appealed, saying the wriggling larvae didn't constitute evidence of poor care. Besides, the nursing home argued, maggots are good for eating away dead tissue inside a wound. The state hearing officer agreed with the nursing home and threw out the fine.
Brenda Klutz, deputy director of licensing for California's health department, calls that decision "very distressing and emotional," but she doesn't call it wrong. In fact, she echoes the nursing home's argument. "In an era of alternative medicine, maggots are being used for debridement of dead tissue," she says. "The fact that these sorts of eggs and maggots can hatch in a 24-hour period may not even mean that there was improper wound care." With regulators like that, the elderly in nursing homes may have more to fear than either the maggots or the nursing-home operators.
--With reporting by James L. Graff/Chicago and S.C. Gwynne/Austin