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System Failure 

A Spokane nursing home is investigated after a dehydrated patient dies.

click to enlarge Franklin Hills Health and Rehabilitation Center
  • Franklin Hills Health and Rehabilitation Center

Variations on the word “fail” appear repeatedly in state records about Franklin Hills Health and Rehabilitation Center, a north Spokane nursing home. “Failed to notify,” “failed to further evaluate,” “failed to act,” “failed to initiate,” “failed to administer the correct amount.”  

And later: “kidney failure” and “respiratory failure.”

The reports, generated by the state Department of Social and Health Services, were obtained last week by The Inlander and were first reported on Inlander.com. Together they detail how Franklin Hills staff failed to monitor and give enough fluids to a dehydrated resident, who subsequently died.

Franklin Hills is prohibited from accepting new patients until state regulators are satisfied that the nursing home has addressed its substandard care. Regulators also imposed a $3,000 fine on the facility, which has a documented history of patient-care problems.

The case is being forwarded to police, the county prosecutor, the state Department of Health, the Medicaid Fraud Control Unit and the Resident and Client Protection Program, which examines the performance of individual caregivers. It is not known what follow-up investigation, if any, the various agencies will conduct.

Franklin Hills is operated by Milwaukee-headquartered Extendicare, which owns 264 care centers in North America, including Cherrywood Place in north Spokane, the Gardens in Spokane Valley and Ivy Court and Lacrosse Health and Rehabilitation Center in Coeur d’Alene.

“They [at Franklin Hills] have a history of noncompliance,” says Shirlee Steiner, regional administrator for DSHS Residential Care Services, which inspects nursing homes and long-term care facilities for licensing. “At one point, they were a special-care facility, and that’s where you have more frequent investigations … mandated by the federal government.”

In this latest incident, an unidentified patient was admitted to the facility for rehab after several falls, according to state records. On June 3, he became ill and two nurses noticed the change in his condition, asking a third nurse to follow up. That nurse, identified only as “Staff B” in records, failed to further evaluate the man or contact a doctor.

The following day, June 4, a nursing assistant told Staff B that the patient hadn’t urinated during the night or that day, records state. Staff B inserted a catheter, no urine was returned, and a doctor was notified. An IV was ordered and for the next 17 hours no one checked on how much fluid the patient was getting.

At 5:45 am on June 5, the patient was found vomiting and in respiratory distress. Someone called 911 and the patient was taken to a hospital, where he was diagnosed with septic shock, pneumonia, kidney failure and respiratory failure. He died that day. Follow-up investigation later determined the patient had received just over half the prescribed amount of fluid.

Trent Cunningham, administrator of Franklin Hills Health and Rehabilitation Center, tells The Inlander in a written statement:

“Our primary concern is, and has always been, the health and well-being of our residents. Due to privacy laws, we are unable to provide specific details regarding the services provided to any resident in our care. As is their standard practice, the state will return to the center to verify that we have addressed their concerns appropriately.”

Franklin Hills was the subject of a 2007 Spokesman-Review article, which noted the facility then had the worst record in the county for resident care. The facility’s problems in 2006 resulted in $4,500 in fines as well as a “stop-placement” order on new patients.

Since 2008, three class-action lawsuits, including one in Washington state, have emerged against Franklin Hills’ parent company, Extendicare. The suits have generally alleged that the company put profits above care, seeking to fill beds and admit the sickest patients — regardless of whether a facility had trained staff on hand to provide proper care.

All three lawsuits were ultimately dismissed.

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