Twice Bitten

Fire ants continued to roam the beds of Flower Mound nursing home residents nearly two months after the state ordered the place cleaned, a state report obtained by the Dallas Observer late last week shows.

Fire ants repeatedly stung a Cross Timbers Nursing Home resident while she lay in bed about a month-and-a-half after a similar attack on an 89-year-old invalid brought state investigators to the home, according to the report. (See "Silent Scream" in the October 5 Observer.) The second woman, also an invalid, was stung on her hip and buttocks. The report does not name her or describe the extent of the bites in the second attack, but says that fire ants were still to be found in the beds of residents and that five "fire-ant beds" were outside the building.

A spokeswoman for the Texas Department of Health and Human Services previously told the Observer that the home had not been cited for deficiencies after the first severe attack in July 1998. The spokeswoman, Rosemary Patterson, says her computer records did not make a reference to the follow-up report, which not only found the home deficient, it recommended that Medicaid funding be terminated until the problems were corrected. The home came into compliance in time for a deadline that was set for October 1998, Patterson says. According to state officials, Cross Timbers operators were fined $275,000 for failing to eradicate the ants for each of the 55 days following the July 21, 1998, attack on resident Alice Joy Taylor. The fine has not been paid because the home's operators are appealing.

As a result of investigations after the fire-ant attacks, the owners of the home and its operators are being sued by the Texas attorney general for failure to meet minimum licensing standards. During the September 1998 investigation, state investigators learned that ants still dwelled inside the home and that the second woman had been attacked. They also reported that another woman died in the emergency room after staff failed to report abnormal test results to her doctor, that the staff failed to get medical care to a woman for nearly 12 hours after she fell and injured her ankle while being lifted, and that residents were not all being given care in accordance with state standards. The attorney general is seeking monetary penalties against the home's owners and operators. Lawyers representing the various owners and operators for Cross Timbers say they can't talk because of the lawsuit.

Taylor's daughter, Carolyn Osborn, and other members of the Taylor family also are suing the nursing home and its operators, which includes a company known as Cross Timbers Care Center Inc., Delta Health Care Services Inc., and the Tutera Group, based in Kansas City, Missouri. A high-level official at the Tutera Group in Missouri (which identifies itself as a third-party operator) initially said he would talk and would call back at a specific time, but then failed to do so.

Osborn says that she and her brother and sister want to send the message to the rest of the nursing home industry that the elderly cannot be neglected in nursing homes without some consequences. In telling the tale of her mother's ordeal, Osborn says after she learned her bedridden and mute mother had suffered hundreds of fire ant bites, she immediately contacted the state's Department of Human Services long-term regulatory agency, which sent investigators. The day after her mother's attack, state investigators found plenty of ants inside and outside of Cross Timbers, and they heard how ants were on other residents, in the dining halls, in the beds, and just about everywhere else. Incredibly, nursing home workers told state investigators that they were at times treating the ant infestation with Right Guard deodorant.

Osborn, whose case goes to trial in Denton County in December, says she's not surprised to hear that the home's operators were accused of taking inadequate corrective measures, even though they knew her mother had been severely attacked and should have known similar attacks could follow.

"I felt like when the state comes out, gets on their case about all these things, they'll clean their act up, but basically then they fall right back into the same pattern," she says. "Until you really get their attention, and people show them we are really serious about all this, then they are going to fall back into the routine of what they'd done."

Deadly fire ant attacks on incapacitated nursing home residents have occurred in other southern states besides Texas. While experts say ant infestations are dangerous to the very old and very young, no one keeps a common record, so it's unclear who is being affected or how often. The attacks usually are not publicized unless someone like Osborn sues.

Last month, in an effort to spread the word of fire-ant dangers, Mike Merchant, an urban entomology specialist with the Texas Agricultural Extension Service in Dallas, traveled to New Orleans to speak at a gathering of health officials from southern states about the quietly growing fire-ant problem. Merchant says he is working with the federal government to develop standards for controlling the pests in nursing homes like Cross Timbers. He also is in the process of developing standards for nursing homes that will define the problem and help exterminate it, he says.

Until better records are kept, no one will know how bad the infestations at nursing homes are or what should be done about it. "It's not a reportable disease, if something is not mandated to be reported to the state health department, there is not going to be anyone keeping statistics on it," Merchant says.

Osborn says the state should require that nursing homes provide proof of a comprehensive pest-control program so that what happened to her mother and the other woman won't happen to somebody else. It's not enough for the state to "write up" nursing homes if pests are discovered, she says. "They should have to spray and be checked on a monthly basis," she says. "It boils down to they don't want to spend the money until they get caught with something."