Diana Harden shot her disabled daughter and then killed herself. One major factor was the treatment her brain-damaged daughter, Yvette Harden, received at the Oakland Springs Health Care Center, according to a detailed letter the mother wrote before ending both their lives Sunday night. Diana Harden left a note indicating her daughter had been abused and mistreated by the staff at Oakland Springs and that the family's frustration in dealing with the problems was the reason she resorted to taking her daughter's life. The horrible care and treatment provided to her daughter is no excuse but after years of frustration and disappointment it must have seemed like the best way out of the terrible situation.
Yvette Harden was severely impaired by a auto crash in 1994. The accident left her partially paralyzed and with little impulse control and essentially no inhibitions because of brain damage, the mother wrote in a letter sent to KGO-TV's ABC7 News before she fatally shot her daughter and then herself. She complained in the letter that despite her efforts to educate staff of Oakland Springs Health Care Center about the brain injury, they treated her daughter like an "animal or non-person." The certified nursing aides "tell her "... she's a 'Fat Pig' and that they 'hate taking care of her,'" Diana Harden wrote. She wrote that the aides bathed Yvette "like a car," with cold water at times to punish her. When Yvette would scream, the aides would turn the hot water back on before the nurse in charge could arrive. "There's much more but you can ask my family. "... They can tell you. I can't go on like this. She has been begging me to end it for two years," Diana Harden wrote. "My health is failing and I don't want to leave her alone."
The California Department of Public Health has launched a vigorous investigation into Oakland Springs, according to spokesman Al Lundeen. He said the department could not discuss the details of the investigation but added that the facility has been the subject of past complaints--48 that were substantiated since January 2008.
Because she was partially paralyzed, Yvette Harden could get around only with a wheelchair. But staff took away the motorized chair and gave her a manual chair that she had to be strapped into because it was too small and made the pain in her legs and back worse, according to Department of Public Health records. She told her mother, "I want to die; I don't want to live without my wheelchair," according to the Department of Public Health records.
Department of Public Health records show that the director of nursing at Oakland Springs confirmed the facility's occupational therapist did not assess the appropriateness or fit of the wheelchair. Limiting mobility can put patients at "risk for depression, emotional distress, accidents, harm, pain, and diminished mobility," a Department of Public Health investigator wrote in September 2008.
On May 19, 2008, an inspector found a resident having dinner in bed with a pillow case wrapped around his neck instead of a bib, Department of Public Health records show. An inspection of the linen closet revealed that the facility lacked clean towels, washcloths, nightgowns and bedding except for one or two isolated pieces.
During an annual survey in November 2008, inspectors found peeling paint on outside walls. Inside, several rooms reeked of urine, and there were smears of brown matter on bathroom floors. The hot water heater was broken, leaving one side of the building with only cold water. A review by inspectors of medical records indicated that a mentally disabled resident who needed total assistance with daily needs because he had a gastric feeding tube had not been showered for the entire month of September 2008 and only once in October 2008.
The inspector found the teeth of another resident yellow and decayed. His tongue was discolored, cracked and dry. Thick mucous had accumulated around his mouth, and he was unshaven. He still hadn't been cleaned up when the inspector returned the next day.
When state Public Health Department inspectors arrived in May for an annual review, they found residents whose specific medical needs were ignored, according to the department's inspection records. Oakhill Springs was one of the four facilities in Oakland that ranked among the lowest on the federal government's one- to five-star rating system. Oakhill Springs' current one-star ranking is based in part on staffing levels and on the most recent annual inspection by Public Health Department inspectors.
Despite the facility's high-need patients, the majority of nursing is done by certified nursing aides. Patients saw a registered nurse only 15 minutes on average per day in May — half of the national or state average, according to Medicare, which analyzes data the nursing homes report to the Public Health Department. Certified nursing aides, who do not receive the level of training required of registered nurses, did the bulk of the work — more than two hours. While it is difficult to assess how that ratio affected care based on the limited information, the total hours of skilled nursing care each resident received — 3.5 hours per patient per day — is just above the state minimum requirement of 3.2 hours, which is insufficient to address the needs of nursing home residents, said Kathryn Locatell, a forensic geriatrician who analyzes and investigates cases of suspected elder abuse as a consultant to the U.S. and California Departments of Justice.
Public Health Department documents also revealed that the ability of one woman at Oakhill Springs to move her legs deteriorated within six months because there were no care plans or rehabilitation services to assist the woman in maintaining her ability to use her legs. That put her at risk of a permanently reduced mobility.
Out of 10 patients, seven were not given proper diets and several lost weight because they received insufficient calories to promote weight gain important to their well-being — despite orders by their doctors to the facility. One woman had lost nearly 8 percent of her body weight because she wasn't given the puréed fortified diet her doctor had prescribed. The records show the physician was perplexed at why the woman continued to lose weight despite the health shakes he had ordered three times daily. But the inspector found no record of the order having been implemented, or that diets were fortified with the high-calorie food to promote weight gain. When an inspector asked the cook how she fortified the diets, she said, "I add thickener to the puréed food."
Patients suffering from kidney disease were given high-potassium foods, which could have worsened their kidney disease or could have become life-threatening. Another resident was served fish despite a severe allergy to fish and shellfish that was recorded in the patient's medical records.
In October 2008, nursing staff put an iron medication tablet into a resident's feeding tube, which became clogged. The nurse in charge of medication said the required liquid iron had not been in stock for two weeks since the medication was ordered.
A 1998 analysis by the U.S. Government Accountability Office found that despite federal and state oversight, some California nursing homes are not being monitored closely enough to guarantee the safety and welfare of their residents. The GAO found that nearly one in three California nursing homes was cited by state surveyors for serious or potentially life-threatening care problems. Moreover, the GAO believes the extent of serious care problems portrayed in federal and state data is likely to be understated.
