What is HIPPA
HIPPA stands for the Health Insurance Portability and Accountability Act. It was enacted by Congress in 1996 to address health-care reform, administrative simplification and patient health care information privacy and security issues. The privacy regulation has three major purposes:
• To protect and enhance the rights of consumers by providing them access to their health information and controlling the appropriate use of that information;
• To improve the quality of health care in the United States by restoring trust in the health care system among consumers, health care professionals and the many organizations and individuals committed to the delivery of health care; and
• To improve the efficiency and effectiveness of health care delivery by creating a national framework for health, privacy and protection.
Source: Georgia Department of Community Health.
Bonnie LeRoy has been described as the light of her family’s life, but on July 26 that light went out when the 92-year-old died at Abbey Hospice, 21 days after suffering injuries while she was a resident of Merryvale Assisted Living.
Merryvale officials are calling the incident an accident, the kind that is common at assisted-living facilities, while LeRoy’s family is questioning what happened on July 6, the night that she was injured.
According to reports from Merryvale that the family provided, one employee said that she saw LeRoy "sleeping on couch" around 11:32 p.m. A statement made by another employee, which does not have a time attached, says that "Bonnie was on the floor & there was blood on the floor." And yet another note section in a report says that she "had a fall" around 1:39 a.m.
The family says that they were paying extra (a total of $3,700 a month) for LeRoy to be in bed at a reasonable time, with oxygen on, and that if she was not cooperating, they were to be called immediately. The fact that she was sleeping on the couch the night in question is yet another sign, they say, that she was not being taken care of appropriately, and that her needs were being neglected.
LeRoy began her stay at Merryvale in August of 2012 as a resident of its memory care unit. She had dementia, as well as other age-related issues, such as osteoarthritis, according to medical records supplied by her family.
According to her granddaughter, Beth Rockmore, and her grandson-in-law, Ricky, there were "difficulties" with the facility from the beginning, when the staff "appeared not to grasp the concept of her voice machine," which she needed to communicate after throat cancer more than three decades earlier. LeRoy was left without a means of communication on several occasions, according to the family, because the staff either did not charge her voice box, failed to change the battery, or overcharged it.
The family also expressed concerns with what they called "a constant struggle" to ensure LeRoy’s personal hygiene was taken care of, including helping with bathing, clean clothing and clean dentures.
Although Merryvale is an assisted-living home, not a nursing home, according to its website, staff can assist with residents who need the help that LeRoy required. Typically an assisted-living home has residents who are more independent, while a nursing home takes care of those residents who have more trouble (or are unable) to do for themselves.
But the issues with her hygiene and dead batteries pale in comparison to the injury that sent her to the hospital in the early morning hours of July 6.
According to family members, they received a call from an employee around 2:25 a.m. During the call, the employee reportedly told the family that LeRoy had fallen and was complaining of a sore hip and that 911 had been called as a precaution.
While an accident report filled out by Merryvale says that LeRoy complained of pain in the right hip, the 911 call report shows that the employee who called in the incident said that LeRoy had "blood on her face."
"The tone of the call (to the family by the Merryvale employee) was very low-key, with no sense of urgency whatsoever," said Ricky. "(The employee) told us she (LeRoy) had already been placed in the ambulance, and that we should just go to the Newton Hospital emergency room."
According to a statement family members provided to the Georgia Department of Human Resources, when they arrived at the hospital they found LeRoy "covered in blood and semi-conscious," incapable of communicating because her voice machine was not brought to the ER with her.
Medical records from Newton Medical Center supplied by the family confirm that LeRoy had lacerations to her head, as well as bruises to her leg, hip, elbow and bottom of her spine.
According to the family, she was in unfamiliar, non-blood-stained clothing, and the blood had begun to dry and flake on her face, chest and hair.
Her death certificate stated that LeRoy’s death was accidental and caused by heart failure and an intracranial bleed (bleeding in the brain).
In a report made by the family to the Georgia Department of Health and Human Services, family members state they later spoke with the same employee who had called them originally and said LeRoy had fallen and hurt her hip, not mentioning a head injury. She reportedly told the family that she did not tell them what LeRoy’s injuries were because it would violate HIPPA regulations. HIPPA does prohibit personal medical information from being shared; however LeRoy’s family was the HIPPA respondent for her, and paperwork they signed allegedly says as much.
"When you are lied to on the initial phone call, that makes you take everything else with a grain of salt," said Ricky. "There’s just too many unexplained things going on here."
As for Merryvale, Executive Director Gina McLendon said in an email that because of privacy issues, very little about LeRoy can be shared.
"Here is what we can tell you, however — the residents who live with us are our family members. We get to know them well and we grieve when any of them pass on. It’s a difficult time for everyone involved and we certainly feel for family members during these times.
"The difficult reality in assisted living is that with residents there will always be accidents. We do everything we can to avoid them, but still we plan extensively for when they occur. We practice responses. We are routinely inspected by the state and other agencies to ensure we are following all the rules. We take swift action when something happens and even then, sad results are sometimes unavoidable."
McLendon said in the email that the staff "responded well" and followed all procedures and that she is "confident any investigation into the matter will show this to be true."
Although an investigation by the Newton County Sheriff’s Office initially cleared anyone of wrongdoing in LeRoy’s death, the state is currently investigating. The state is not required to investigate any death that occurs at a facility like Merryvale, though the facilities are required to report them to the state. This investigation began at the insistence of the family.
And while McLendon said that the staff followed all procedures in LeRoy’s case, two previous state investigations have concluded that isn’t always the case.
In January of this year the Georgia Department of Human Resources Department of Regulatory Services — the office responsible for inspecting, monitoring and licensing health care facilities, and making sure they operate as mandated by the state statues, rules and regulations — found that Merryvale did not meet all requirements of those rules, regulations and state statues when a patient was found unresponsive and the employee did not initiate CPR. According to the report, the staff member said "she knows she was supposed to (initiate CPR), Staff B (the employee) stated she panicked."
The state concluded that Merryvale must change "procedures … in resident condition," involving administrative policy and procedures. The report states, "In case of an accident or sudden adverse change in a resident’s condition or adjustment, a home shall immediately obtain needed care and notify the representative, or legal surrogate."
In an investigation completed at the end of 2011, the state found that procedures again were not followed when a resident complained of pain in the head, but was not taken to the hospital until the next day, when it was found he had a fracture in his neck.
In that instance, the staff told the state that the resident refused to go to the hospital, but family members said that since he had dementia, he was not able to make those decisions. Although Merryvale is not a nursing home, its website indicates it does provide dementia care.
A month after his neck was fractured, he was found on the floor and complained of hip pain around 5:13 a.m. He was not taken to the hospital until 1 p.m., when he was found to have a fractured hip. A staff member is quoted in the state’s report as having said that at 7 a.m. on the day of the fall, she "determined the resident was not in acute distress."
In this case, the state found that reporting was not done properly, stating, "The personal care home shall report in a standardized departmental format to the Heathcare Facility Regulation Division of the Department of Community Health no later than 24 hours after the incident has occurred; whenever any of the following incidents involving residents occurs or the personal care home has reasonable cause to believe that an incident involving a resident has occurred: (a) any death of a resident; (b) any serious injury to a resident that involves medical attention."
Currently, the state is investigating LeRoy’s death. Although the NCSO has closed its investigation, coroners in Walton County (where LeRoy succumbed to her injuries) and Newton County (where the injuries occurred), are currently looking into LeRoy’s death.
"We have spoken with the family of Mrs. LeRoy on a couple of occasions and they have expressed concern as to how and why she passed away," said Newton County Coroner Tommy Davis. "If her cause and manner of death has any type of injury involved in it, it is the obligation of the Newton County Coroner’s Office to investigate that death, and we will."
"She was the light of my life," said Beth Rockmore. "She is the reason I am an artist … She was my main support in a career that is not always accepted in society, and she was proud of me."