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Investigative Report Hits Brius and State Regulators for Care Failures

Earlier this month, an international television news network aired a 25-minute report that focuses on a 184-bed nursing home owned by Brius CEO Shlomo Rechnitz. The news story — entitled “‘Where people come to wait to die’: COVID-19 in US nursing homes” — aired on Al Jazeera’s “Fault Lines” program on December 2 and is available at the link above.  

The report focuses on Kingston Healthcare Center in Bakersfield, California. As of early December, 104 residents at the facility had contracted COVID-19 and 19 residents had died. The California Department of Public Health reports that at least 87 staff at the facility have also contracted the coronavirus.

In interviews, Kingston caregivers describe a variety of care failures. 

Christina DeWoody worked at Kingston as a cleaner until a few months ago. Before supervisors provided personal protective equipment (PPE) she and other workers would use brown paper bags, the kind schoolchildren use for their lunches, and tie them around their noses and mouths as makeshift barriers.

‘Their quality of care was pretty much none,’ DeWoody recalled, remembering elderly patients lying for hours without access to water, suffering from a combination of COVID-19 and dehydration. She described others sitting in their urine and faeces [sic], with no one to change them – potentially leading to deadly sepsis, a common condition in nursing homes when patients become infected from their own excrement. As workers stopped showing up, patients would cling to DeWoody’s arm, begging her not to abandon them. She cried on her drive home every day.”

According to public records, Brius’s Shlomo Rechnitz owns the nursing home and leases it to Dr. David Silver, who serves as the CEO of Rockport Healthcare Services. Rockport, which operates all of Brius’s nursing homes, was recently cited by state regulators for illegally evicting low-paying residents in order to replace them with higher-paying ones.

Reporters also interviewed the family member of a resident who died of alleged care failures at a second Brius nursing home, Country Villa Westwood in Los Angeles.

Dr. Michael Wasserman, the former CEO of Rockport, tells Al Jazeera he recently left Rockport when “he found some of the practices there untenable.” Dr. Wasserman states: “I was told that I would be running the company. The long and the short was: that wasn’t true.”

The investigative report also probes into the apparent failures of state officials to protect nursing home residents. For example, the California Department of Public Health has allowed the Kingston facility to operate without a regular license for at least three years. Meanwhile, the facility has racked up dozens of complaints and violations as well as fines and sanctions for substandard care. Thus far in 2020, patients and their families “have filed 192 formal complaints against it, compared with the state average of 21,” says Al Jazeera.

The Kingston facility has been cited for four times more care violations than the average US nursing home. For more than two years, the nursing home has appeared on the federal Centers for Medicare & Medicaid Services’ (CMS) short list of the nation’s poorest-performing facilities, showing no signs of improvement in that time. The facility is currently facing a $92,500 fine as a result of numerous violations detailed in a citation report issued by Cal/OSHA in October.

Molly Davies, a Long-Term Care Ombudsman for the City and County of Los Angeles County, says: “What we’ve seen is that the regulatory enforcement system favors the industry above consumers. And that is precisely the opposite of what it is designed to do.”  

The Al Jazeera report includes interviews with multiple Kingston caregivers, family members of nursing home residents, Tony Chicotel (an attorney with the California Advocates for Nursing Home Reform), Matt Feuer (Los Angeles City Attorney), two private attorneys who are suing Brius on behalf of residents and family members, and a researcher from the National Union of Healthcare Workers.

LA Times: Brius Nursing Home’s Residents Hit by “Severe Outbreak” of COVID-19

A Brius nursing home captured headlines in the Los Angeles Times after a “severe outbreak” of COVID-19 infected 60 residents and 20 staff at the facility and killed seven residents. The outbreak, which comes amid “a steady slide” in COVID-19 infections in California’s nursing homes, has prompted concerns, according to the article published on October 8.

Source: Los Angeles Times, October 9, 2020

The Brius facility—113-bed Windsor Redding Care Center in Redding, California—has a history of resident care violations. During the past three years, the facility has averaged approximately twice as many complaints and violations of state laws as the average California nursing home, according to the California Department of Public Health.

In February 2015, Brius submitted its license application to operate the facility with the California Department of Public Health. The state’s health department ultimately denied Brius’s application due to the company’s history of understaffing its facilities and violating residents’ rights.

In denying Brius’s request for a license, the California Department of Public Health cited Brius’s track record of violating federal and state laws, including 265 federal violations at homes owned or managed by Brius during the previous three years. Thirty-nine of those violations put the health of a resident in “immediate jeopardy.”

Brius CEO Shlomo Rechnitz appealed the state agency’s licensure denial, and state officials have allowed Brius to continue operating the facility, along with four other nursing homes that Brius acquired from Windsor in 2015, on a provisional basis for half a decade. Brius has since renamed the facility and is currently doing business as River Valley Healthcare & Wellness Center, according to California’s Office of Statewide Health Planning and Development.

Since the COVID-19 pandemic, California’s nursing home residents have experienced much higher mortality rates than the general public. According to The Times, “Nursing homes and senior facilities have accounted for 7% of California’s coronavirus cases and 36% of its deaths.”

In May, California officials implemented mandatory COVID-19 testing rules that have helped to reduce infections at the state’s nursing homes, according to The Times. On September 29, Gov. Gavin Newsom “signed a law requiring skilled nursing facilities in California to report disease-related deaths to health authorities within 24 hours during declared emergencies.” According to The Times, “The law was written in response to concerns that health agencies were slow to respond to outbreaks because they did not receive timely information about the facilities.”

Former CEO alleges Brius routinely evicts low-paying residents for higher-paying ones

The former CEO of Rockport Healthcare Services, which manages Brius’s nursing homes, told the New York Times that internal orders were given at some Brius facilities to illegally evict the “least profitable patients” in order to replace them with higher-paying patients who have COVID-19.

The article, entitled “‘They Just Dumped Him Like Trash’: Nursing Homes Evict Vulnerable Residents,” cites an internal email from a Rockport executive that apparently was leaked to a journalist. Dr. Michael Wasserman, who served as the CEO of Rockport until 2018, interprets the email for the Times.

In California, Rockport Healthcare Services, which manages the state’s largest chain of for-profit nursing homes, has repeatedly been cited by state regulators for illegal evictions.

On March 31, with Covid-19 cases soaring, a Rockport executive wrote in an email to colleagues that they should begin “discharge planning immediately,” noting that any discharges should be done safely.

Dr. Michael Wasserman, who was the chief executive of Rockport until 2018, said that was code to kick out the least-lucrative residents. “You are looking to replace the poorest, least profitable patients with the highest paying ones,” said Dr. Wasserman, who resigned after clashing with the chain’s owner.

This spring, Los Angeles County designated three of Rockport’s nursing homes as preferred destinations for Covid-19 patients. Since then, one of them has tried unsuccessfully to evict at least two residents against their will, according to a lawyer who was contacted by the residents’ families.

David Silver, the chief executive of Rockport, said the company was trying to be a good partner to the state by making room for an expected surge of Covid-19 patients. “This has absolutely nothing to do with money,” he said. He declined to comment on individual residents, citing confidentiality.

Brius home hit with six citations, over $150k in fines following resident’s death

A registered nurse blew the whistle on a Brius nursing home outside Los Angeles, triggering a state investigation that revealed management failing to report serious falls and a choking death, asking workers to alter their records to avoid trouble with state regulators and leaving patients unsupervised for extended periods of time.

Following the nurse’s complaint, California’s Department of Public Health launched an investigation into Lakewood Healthcare Center in Downey. In February, state officials hit the nursing home with six Class A citations, four Class B citations and $156,000 in fines.

Responding to the complaint, investigators arrived unannounced at the facility at 5:45 a.m. Nov. 5, 2018, to a grim scene.

“The floors were observed with black stains, call lights were ringing without staff responding, a foul strong ammonia odor permeated throughout the hallways, residents’ were yelling and there were no staff members around,” investigators wrote.

Following an interview with one nurse, the investigators learned that: 

  1. Recurrent falls not reported timely to the physician and care not provided.
  2. The nurse-patient ratio did not meet the criteria to care for residents’ needs.
  3. Reports of incidents, body assessments, and nurses’ notes were being removed from the clinical record by the director of nursing.
  4. Residents with difficulty swallowing were provided with a honey bun causing one choking death and a second resident hospitalized after choking on the honey bun.
  5. Residents were left unsupervised, wet, and soiled for extended periods of time.
  6. The director of nursing had asked the licensed nurses to change their documentation because she did not want to get in trouble with the department of health.

Moreover, one nursing assistant told investigators that the director of nursing and administrator told staffers that they would lose their jobs if they spoke to state authorities.

The citations were hardly the first black mark for Brius or the Lakewood Healthcare Center.

Since 2016, the California Department of Public Health has received 315 complaints and facility reported incidents on Lakewood, while issuing it 164 deficiencies and 29 citations (state fines), according to research by California Advocates for Nursing Home Reform.

Last year, a California state audit found that Brius had the worst patient care record among California’s three largest nursing home chains, racking up .52 citations per 100 nursing home beds – nearly double the company’s two leading competitors.

Four of the Class A violations at Lakewood involved residents who were injured from falls. One resident who needed one-on-one care fell and his head on the headboard of his bed while left unattended. The impact resulted in a broken nose and bleeding in his brain, resulting in a four-day hospital stay. The other two involved the residents who choked on the honey buns. Management didn’t report either choking incident to state authorities.

Regulators also cited Lakewood for impeding their investigation. Investigators claimed that management denied them access to facility records and that key notes about the falls and choking episodes could not be found.

The facility was also cited for actively impeding the DPH investigations. Investigators were denied requested records for hours. The DON stated that facility incident records, IDT progress notes and the nurses’ notes about the fall incidents and choking episodes were not in the residents’ clinical records and were nowhere to be found.

Brius loses wrongful termination appeal

U.S. Appeals Court Judge Merrick Garland referenced the 1992 blockbuster film “My Cousin Vinny” in his March 5 ruling upholding a lower court ruling that Brius Healthcare Services violated federal law when it fired pro-union caregivers at one of its nursing homes in Marin County (Calif.) just two days before a 2015 vote to unionize.

Judge Garland, who was former President Obama’s choice to fill a U.S. Supreme Court vacancy, began his 21-page ruling citing one of the most famous cross-examinations in film history:

In 1992, Vincent Gambini taught a master class in cross-examination. Trial counsel for the National Labor Relations Board and the National Union of Healthcare Workers apparently paid attention. In this petition for review, Novato Healthcare Center challenges the Board’s finding that it committed an unfair labor practice by firing four union organizers two days before a union election. As Novato acknowledges, its “entire case turns on whether the testimony” of one of its supervisors “should be credited.” But the Board determined that the testimony should not be credited, and trial counsel’s cross-examination of the supervisor provides substantial evidence to support that determination.

Judge Garland’s ruling upholds a 2018 decision by Judge Amita Baman Tracy ordering Brius’ Novato Healthcare Center to reinstate five caregivers who were illegally fired and provide them with tens of thousands of dollars in back salary and benefits.

Judge Tracy found that a Brius nursing home administrator did not give credible testimony about allegedly having seen four of the workers sleeping on the job, which she says was the reason for their firing. Four of the five terminated employees were staunch advocates for joining the National Union of Healthcare Workers.

Judge Tracy ruled that the testimony given by Teresa Gilman, a manager at the 181-bed nursing home, “simply appeared implausible.” Judge Garland concurred, doubting Gilman’s claim that she stopped at a stop sign while driving to the facility at 3:50 a.m. and then proceeded to see the sleeping workers just 10 minutes later at their work station.

During those 10 minutes, Gilman claimed to have:

– driven three more blocks to the Novato facility, stopping at another stop sign along the way;

– parked her car and went into the facility;

– walked to her office, where she logged on to her computer and checked her emails;

– walked to the facility’s kitchen, where she checked the temperature logs for a refrigerator, for a walk-in refrigerator, and for a walk-in freezer; and checked the labels and dates of the items in the refrigerators;

– walked to and through the break room, where she used the restroom and then collected Novato union opposition campaign flyers, on which someone had written “derogatory stuff”;

– gone back to her office and read the flyers;

– walked down the hallway toward Station 4, peeking in rooms along the way; and

– arrived at Station 4 for the first time, where she saw the sleeping employees.

Moreover, “Gilman’s testimony about how long the tasks had taken in the aggregate was rendered even more implausible by counsel’s further cross-examination about how long some of them had taken individually,” Garland wrote.

“In response to counsel’s questions, Gilman testified that: “from the stop sign to [the facility] that’s three or four minutes”; “[i]t takes three to four minutes to log onto my computer”; “[w]hat I did in my kitchen took a few minutes”; “I went over to the break room, [which] took three or four minutes”; and then “I left and went back to my office [put down the flyers, and looked at them again] just briefly.”

By Gilman’s own account, then, those activities alone took about 15 minutes. Given the additional, unaccounted-for activities that Gilman also had to complete, (Judge Tracy) reasonably concluded that Gilman’s aggregate time estimate was ‘unlikely and unbelievable due to the length of time she allocated to each task she completed’ before first encountering the sleeping employees.”

Judge Garland’s ruling is another black eye for Brius, which has faced increased scrutiny from federal and state authorities for widespread patient care violations. Last year, a California state audit found that Brius, headed by Shlomo Rechnitz, had the worst patient care record among California’s three largest nursing home chains, racking up .52 citations per 100 nursing home beds – nearly double the company’s two leading competitors.

Despite the company’s illegal acts of intimidation, workers at Novato Healthcare Center voted to unionize in 2015 and are continuing to fight to improve staffing levels and care for residents.

California Auditor’s nursing home recommendations go unheeded

California State Auditor Elaine Howle

Nearly one year after California State Auditor Elaine Howle issued a scathing report criticizing state regulators for failing to safeguard nursing home patients from unscrupulous operators, only one of her recommendations has been fully implemented.

In a status report released this month, Howle found that of her 12 recommendations to improve nursing home care, five had been partially implemented and six had not been implemented at all.

The only recommendation that lawmakers or regulators have acted upon was legislation requiring nursing home operators to submit profit-and-loss statements for related businesses that service their nursing homes.

The audit was requested by State Sen. Mike McGuire and Assemblymember Jim Wood after they reviewed data compiled by the National Union of Healthcare Workers showing that in 2015 Brius Healthcare owner Shlomo Rechnitz had his nursing homes pay for $67 million worth of goods and services from 65 companies also controlled by Rechnitz.

The audit focused both on whether state agencies were effectively monitoring the financial dealings of nursing home operators and protecting nursing home patients from serial patient care violators.

Howle found that Brius had the worst patient care record among California’s three largest nursing home chains, racking up .52 citations per 100 nursing home beds – nearly double the company’s two leading competitors.

Although Howell said that oversight failures “increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents, very little has been done to follow up on her recommendations.

The legislature has so far failed to implement the following recommendations:

1) Redistribute quality assurance fee payments from nursing homes that do not demonstrate adequate quality-of-care improvements to those that do.

2) Require the Department of Public Health to develop by Nov. 2018 a proposal for legislative consideration that outlines the factors it will consider when approving or denying applications from nursing facilities based on each applicant’s ability to provide quality patient care.

3) Require the Department of Public Health to conduct state and federal inspections concurrently by aligning federal and state timelines and require that state inspections occur every 30 months.

4) Require the Department of Public Health to increase citation penalty amounts annually by – at a minimum – the cost of inflation.

5) Require that the Office of Statewide Health Planning and Development, Department of Public Health and Department of Health Care Services collaborate to assess the information that each collects from nursing facilities and to develop a proposal by May 2019 for any legislative changes that would be necessary to increase the efficiency of their collection and use of the information.

6) Require a state agency to develop, implement and maintain for consumers by May 2020 an online dashboard that includes at a minimum information about nursing facilities’ net income and quality of care.

The following recommendations for state agencies are listed as pending:

1) The Department of Public Health should take the steps necessary to ensure that its oversight results in nursing facilities improving their quality of care by amending its application licensing reviews by developing a defined process that specifies how an analyst will determine whether an applicant has demonstrated its ability to comply with state and federal requirements.

2) The Department of Public Health should take the steps necessary to ensure that its oversight results in nursing facilities improving their quality of care by ensuring that it issues citations in a timely manner, especially for immediate jeopardy deficiencies.

3) To ensure that it provides the public with nursing facility information that is accurate and comprehensible, the Office of Statewide Health Planning and Development should update its regulations.

4) To improve the availability and transparency of information, the Department of Public Health should upload all inspection findings to Cal Health Find and review ownership data by May 2019.

5) The Department of Healthcare Services should use current data to revise and update the peer groups it uses to set Medi-Cal rates. In doing so, it should take into consideration the consolidation of the nursing facility industry.

To see the full auditor’s report, click here.

Understaffed Brius Facilities Request Exemption to California’s New Staffing Rules

Dozens of Brius nursing homes, including several that have been fined for understaffing, are asking to be exempted from a new California regulation requiring them to spend more time directly caring for patients.

The new rules, which went into effect last July, but still have not been enforced, require nursing homes to provide at least 3.5 hours of direct care per resident per day — up from 3.2 hours of care previously.

State records show that Brius homes across California are seeking waivers to avoid the new staffing rule claiming either that it’s unnecessary or that there are too few available workers to implement the requirement. In many cases, Brius, the state’s largest nursing home operator, sought waivers based on both criteria. State officials have not yet ruled on the waiver requests.

One home where Brius has sought a waiver is the 99-bed Eureka Rehabilitation and Wellness Center, which was fined $160,000 by the California Department of Public Health in 2017 in part for failing to provide adequate staffing to prevent falls. The report quoted an unnamed worker who said company officials increased staffing levels when state inspectors were present in an apparent effort to conceal the facility’s understaffing.

In Marin County, Brius sought a waiver for the San Rafael Healthcare and Wellness Centre even though the facility was fined $15,000 for understaffing.

In nearby Novato, Brius is seeking a waiver for its Novato Healthcare Center, even though state investigators found that the 181-bed facility was “woefully understaffed” in a 2018 report. Residents were forced to go weeks without shower and sit in the own excrement for hours waiting for assistance, according to the report.

Patient advocates say low pay is the primary reason nursing homes struggle to find workers.

“If they paid them better, they’d have plenty of staff,” even in remote parts of California, Suzi Fregeau, long-term care program manager in Humboldt and Del Norte counties, told Kaiser Health News. The mean hourly wage for certified nursing assistants in California was $16.13 in 2017, according to federal labor data.

The California Department of Public Health, which oversees nursing homes, is expected to announce in later this month which — if any — facilities it will exempt from the new regulations, according to Kaiser Health News. But some patient advocates don’t like the nursing homes’ balking.

 “We’re appalled by the waiver system. Mike Connors of California Advocates for Nursing Home Reform, told the publication. “It’s sending the worst possible message to California nursing homes that it’s OK to staff at levels that endanger residents.”

Caregivers Strike to Protest Understaffing at Brius Nursing Home

Caregivers at Brius-operated River Valley Healthcare andWellness Centre in Redding, CA, held a two-day strike in late November 2018 toprotest understaffing, according to media reports.

Caregivers – including Certified Nursing Assistants and LVNs – say the quality of care at the facility has nosedived since Brius took over the 113-bed nursing home in November of 2014. Caregivers’ criticisms will be familiar to Brius observers. Nursing staff at the Redding facility say they are so short staffed that CNAs must care for as many as 20 patients during some shifts.

Meanwhile, the nursing home is having a tough time holding onto its staff. From 2015 and 2016, the facility’s annual staff turnover rate jumped from 31 percent to 61 percent, according to public records held by California’s Office of Statewide Health Planning and Development. This means that three of every five staffers left her job at the nursing home during 2016.

Although conditions at the facility have reportedly declined, its profits have soared, according to public records. From late 2015 (the first full reporting period with Brius as the facility’s operator) through 2017 (the most recent year for which data is available), the nursing home pocketed a staggering $2.3 million in profits. The facility’s operating profit margin has gone from -6 percent in 2014 to 12 percent in 2017. At the same time, the nursing home has entered into costly contracts with various businesses owned by Brius CEO Shlomo Rechnitz and his family members.

It’s unclear why Brius is still permitted to operate the facility. On July 8, 2016, the California Department of Public Health denied Brius a license to operate the nursing home based on Brius’s record of substandard care and legal violations. Brius appealed the health department’s decision, but it’s unclear why the state has failed to resolve the appeal more than two years later.

California passes nursing home transparency law

California Gov. Jerry Brown signed legislation this month requiring nursing home owners to provide more information about “insider” companies that may siphon scarce resources away from nursing residents through nursing homes’ inflated payments for supplies, rents, and services.

The legislation authored by Assemblyman Wood (D-Healdsburg) stemmed from a state audit of nursing homes earlier this year that focused on Brius Healthcare, California’s largest nursing home company.

Wood and Sen. Mike McGuire (D-Healdsburg) requested the audit following concerns raised by the National Union of Healthcare Workers (NUHW), which published a report showing that during 2015 Brius nursing homes purchased $67 million in goods and services from 65 “insider” companies owned by Brius CEO Shlomo Rechnitz and his relatives.

In 2015, Rechnitz’s “insider” companies – including paper landlords – stood to gain as much as $12 million by charging inflated rents to Brius nursing homes, according to NUHW’s report. This money, says NUHW, should have been spent on care and services for nursing home residents who often lack adequate staffing, support and care.

The state audit, published in May 2018, found that the California Department of Public Health failed to perform necessary inspections or issue timely citations for substandard care. In addition, California State Auditor Elaine Howle found the reporting rules for nursing homes failed to show whether operators are profiting from business deals with “insider” companies owned by nursing home executives.

To improve transparency of these related-party transactions, Wood’s bill (Assembly Bill 1953) requires nursing home owners to disclose whether they have “an ownership or control interest of 5% or more in a related party … that provides any service to the skilled nursing facility.”

Under those circumstances, the nursing home must disclose all of the services provided by the related-party company, the number of people who provide the service, and any other information requested by state officials.

If the nursing home receives goods, fees, and services worth $10,000 or more per year from a related-party company, then this “insider” company must give state officials a copy of its profit and loss statement as well as data on caregiver staffing levels inside the nursing home.

The bill “will now ensure transparency and reporting that will allow us to make sure that these companies are not being used to generate excessive profits for the owners of these facilities on the backs of the residents,” Wood told Skilled Nursing News.

Sen. McGuire, who voted for the bill, praised the new law.

“AB 1953 ensures that accurate data is collected regarding skilled nursing facility third-party transactions, such as what services are provided, for how much money, and how those costs potentially affect facility staffing rates,” he told the Eureka Times-Standard.

The law will take effect January 1, 2020.

Brius hit with over a dozen class action lawsuits

Brius has been hit with 15 class action lawsuits accusing the nursing home conglomerate of systemically understaffing its nursing homes to maximize profits, while delivering substandard care to thousands of elderly residents.

“These lawsuits are an effort on behalf of these vulnerable citizens to ensure that their needs are met,” Attorney Stephen Garcia told the Eureka Times-Standard. Garcia’s law firm and The Arns Law Firm in San Francisco allege that Brius homes across California misled potential residents about their compliance with staffing requirements.

In a statement to the Marin Independent Journal, Jill Basinger, a spokeswoman for Brius owner Shlomo Rechnitz, claimed that Brius homes “not only maintain” minimum staffing requirements, “they even exceed them.”

However, Brius has been cited multiple times in recent years for understaffing, including at the Novato Healthcare Center and San Rafael Healthcare and Wellness Center, which were included in the class action lawsuits. In March, Brius caregivers from both homes, represented by the National Union of Healthcare Workers, joined residents and their loved ones at a public forum to call on Brius to put an end to chronic understaffing.

Earlier this year, a state investigation found the 181-bed Novato facility “woefully understaffed,” forcing residents to go weeks without a shower and sit in their own excrement for hours waiting for assistance.

Last year, the California Department of Public Health fined Brius’ San Rafael facility $15,000 for violating the state’s minimum staffing laws.

There has been heightened attention to nursing home staffing after recent reports found that major skilled nursing facilities were not providing accurate data to state and federal regulators.

In June, Medicare lowered its star ratings for staffing levels in one in 11 of the nation’s nursing homes because they either had inadequate numbers of registered nurses or failed to provide payroll data that proved they had the required nursing coverage, Kaiser Health News reported.

The lawsuits allege that understaffing at Brius, which is California’s largest nursing home operator, resulted in tragic outcomes for residents.

One lawsuit filed in Alameda County Superior Court alleges that understaffing at Brius’ Alameda Healthcare & Wellness Center contributed to the 2017 death of Cathy Campbell, a 61-year-old Stockton woman.

According to the lawsuit, Campbell, who suffered from hypertension and chronic kidney failure, developed a severe bedsore and urinary tract infection that worsened because the facility lacked sufficient staff to care for her. Her health continued to suffer after she was transferred to a second Brius home in Oakland.

Garcia, who wrote that Campbell’s needs were “flat-out ignored,” blamed the Alameda facility for failing to properly treat her in a statement to the East Bay Times. It “knew that by not elevating her to a higher level of care when the sore reached a Stage III, they were violating the law, but in the interest of profits over patients, they made a conscious choice to wrongfully deny needed medical care.”