In California, $1 million in unpaid fines for assisted living centres

A ProPublica review of records from the California Department of Social Services shows the state collected less than half of the more than $2 million in fines it issued against assisted living facilities from 2007 to 2012

The California Department of Social Services issued more than $2 million in fines against assisted living facilities throughout the state from 2007 to 2012.

But a ProPublica review of department records shows it collected less than half of that. Indeed, the agency failed to wrest any money from the vast majority of facilities it hit with the most serious sanctions.

Of the 50 largest fines assessed over those years, the review showed, the department collected no money in 39 cases. In one instance, a facility in a tiny Shasta County town that was operating without a license accrued more than $250,000 in penalties and paid none of it.

“The fact that the fines were not paid is a concern,” said state Sen. Leland Yee, a Democrat who represents San Francisco and San Mateo County. “The reason we have fines is to deter individuals from breaking the rules and breaking the laws.”

ProPublica, as part of its ongoing examination of the multibillion-dollar assisted living industry, had asked California officials to produce records detailing their oversight of the state’s 7,700 assisted living facilities, which have tens of thousands of seniors in their care. The officials ultimately conceded they could not produce basic data about fundamental aspects of the department’s regulatory operations. For example, they could not say how many inspections the department conducts each year, or how many “unusual incidents” – injuries, abuse allegations, medication errors – the facilities report to the state.

The revelations come as state lawmakers, advocates for the elderly, and news organizations have heightened their scrutiny of the department’s performance. Last month, in a case that garnered national publicity, the department failed to take prompt action after the owners of a Bay Area facility abandoned its residents, effectively leaving 19 frail or impaired seniors to fend for themselves. Working without pay or training, a janitor and a cook tried to care for the clients.

While the federal government regulates the nursing home industry, it has left oversight of the assisted living business to the states, which, over the past two decades, have crafted a hodge-podge of widely divergent laws. Today some 750,000 elderly Americans reside in assisted living facilities, many operated by national chains.

Home to more assisted living facilities than any other state, California is widely seen as one of the loosest regulatory environments in the country. ProPublica’s examination of the state’s regulatory records lends evidence to that view.

Our review shows that troubled facilities often pay pennies on the dollar after they have been fined. A Southern California facility hit with $19,200 in fines in 2009 paid only $1,600. Another facility was fined $5,400 but wound up writing a check for $600.

Department spokesman Michael Weston pointed to an array of factors that slow – and sometimes halt – the state’s collection of fines. Some facilities go out of business and never pay. Some pay off fines in installments. Some choose to appeal the fines repeatedly – there are four levels of appeal – eventually succeeding in getting fines reduced or dismissed altogether.

Yee chairs the state Senate’s Human Services committee and intends to convene hearings on the state’s oversight of assisted living early next year. “When we hold hearings in January that is one of the things we’ll be looking at – why the fines were not paid,” he said.

Weston said “the department is committed to improving” the process of collecting fines and is “looking at creating an automated system to track the unpaid debts. We don’t have that presently.” He added that the state expects to collect at least a portion of the money that has so far gone unpaid.

By one measure, the state appears to be growing more aggressive in policing assisted living facilities.

In 2008, the department revoked the licenses of 52 facilities, exercising what officials describe as their most effective enforcement tool. In 2012, the most recent year for which data is available, the state moved to revoke 72 facility licenses and is still litigating to shutter many of those facilities.

But in other regards California’s oversight efforts are faltering. The state maintains one of the least rigorous inspection schedules in the nation. Ten years ago as state leaders stared at grim budget shortfalls, lawmakers dramatically revamped the department’s inspection regimen, decreasing the frequency of routine inspections from once a year to once every five years. The revised law is unequivocal: “Under no circumstance shall the department visit a residential care facility for the elderly less often than once every five years."

But the state has not been perfect in meeting even this relaxed mandate. Weston said the department had failed to inspect 13 facilities during the past five years. Weston said he did not know why the state had failed to meet its own requirement, but said the 13 facilities had now “been flagged.”

“Somebody is going to go out and perform an inspection,” he said.

In recent years, an industry lobby group, the California Assisted Living Association, has emerged as a force for reform, pushing repeatedly for more frequent inspections. Last year, the organization supported an unsuccessful bill that would’ve required inspectors to make unannounced visits to facilities every two years.

“We believe that more frequent inspections will further enhance the integrity of assisted living,” said CALA president Sally Michael, adding that the group’s members are willing to pay 20 percent more in annual licensing fees to help fund increased inspections.




Making cancer treatment worse?

 “He’s the best physician that knows the worthlessness of the most medicines.” -Benjamin Franklin

The great 19th century physician, Robert Hutchinson, had a daily prayer which ran: “God! Give me deliverance from treating sick human beings as cases, not letting the well alone and making my treatment worse than his disease.”

More than one hundred fifty years later we are just doing exactly the opposite in the field of medicine. Professor David Wotton, of Lester University, in his new book Bad Medicine: doctors harming patients since Hippocrates gives graphic descriptions of what doctors do. The efforts of Dr James Wakeley in starting a new science journal, The Lancet, in 1823 or George Bernard Shaw writing the play The Doctor’s Dilemma only had marginal effect, if at all.

I was in Mumbai on 8 November 2013 to inaugurate a blood cancer specialists meet event at The Taj Mahal Palace and Towers, which, for a change, was well organised and ran with  clockwork precision,  with Professor MB Agrawal of the Bombay Hospital fame as the man in charge. The highlight of the meet was the absence of celebrities and politicians on the inaugural dais. It was a large crowd of Indian and International cancerologists of all hues and colour. The food was lavish, to say the least. The opulent hotel ambiance was a bonus.

My main thrust in the inaugural address was to appeal to them to go back to the happy days of doctoring of Hutchinson's era. Hippocrates had also told us to be careful in doctoring to “cure rarely, comfort mostly but to console always." I had Professor Bidwae, a Padma Shree awardee and director of Tata Cancer Hospital on the dais with me as the event’s Guest of Honour. He called my thinking as ‘scepticaemia’ with very low infectivity. He also urged the new generation of cancerologists not to be just textbook worms but to keep their eyes and ears open to the buzzing activity going on in their arena. It reminded me of what Churchill had said many years ago that truth was just about pulling up its pants while falsehood and mystery had completed a full circle of the globe, or something to this effect.

The so called cancer has become a death warrant to the hapless victims. Unfortunately, today medical diagnosis has become the biggest menace, more so in the cancer area where there is now a plea from the world's apex institute, the American Cancer Institute, to change the diagnosis of cancer; more than 70% of the so-called cancers today do not really grow to kill the owner. Dr Harold Varmus, the Nobel Laureate new director had put together a group of nine experts to sort out those 71% cancers of today as non-cancers.
This includes about half of breast cancers, large section of thyroid, prostate, and other solid tumour cancers. Hopefully, they will soon be labelled benign. Organ-based diagnosis seems to be the bane as there has been a new understanding of human illnesses, with quantum physics opening new vistas in science of the human body,  about which I have written elsewhere. Professor Mary Tinnetti of the Yale University has called for an end to this disease era.

These days, young and enthusiastic cancerologists have become astrologers! As soon as they see a scan or biopsy report, both of which have little scientific standing (as scans are shadows and biopsy reports are nothing but tombstones of dead cells), they pronounce their judgements on the future life span of those hapless human beings: "You only have six months to live without immediate chemotherapy, radiation and mutilative surgery.” How on earth do those medical astrologers know the future is anyone's guess. In quantum physics there is no tomorrow; it is yet to be born. But doctors have been predicting the unpredictable future of their patients all the time, observed Professor William Firth, physicist at the Strathclyde University in Glasgow in the British Medical Journal way back in 1991. I had made a fervent plea to those wise doctors in the meeting to desist from such unscientific feat. This is all the more important as the very fear of cancer kills for sure.

A significant study published in the prestigious Nature Medicine journal shows how our treatment with chemical drugs, at times, makes tumours grow faster and bigger. This was proved at least in prostate cancers. These cancers should be left alone for the patient to live his normal life as they outlive man in most cases. Drugs make the tumour genes change their protein expression, thus making the cell environment so hostile to the cell that the latter induces cancer pluripotent stem cells survive the hostile environment.

The foundation in science is very shaky and cancer specialists should always be careful in announcing the death warrant to their patients. The science of cancer is so weak that out of the 53 notable studies on cancer science in the last five years, only 11% could be replicated and reproduced. The remaining 89% of papers were not replicable and so are not scientific. Interestingly, false studies were funded by vested interests in the industry.
The 11% that was replicable was independently funded. So, I appealed to them that they should not to be overconfident of curing any cancer. The war on cancer, so proudly declared by president Richard Nixon with a budget of $100 million, is yet to be won. They are still fighting that war on cancer just as they were fighting other wars in Vietnam, Iraq, Afghanistan and, now, in Pakistan.

The last but not the least, I also appealed them to be parsimonious in their effort to help patients. Money makes man behave irrationally. Doctors are trained to look after the health of the public and not just to make a business out of it. Earning money by authentic means is no sin.

Finally, they were reminded that doctoring is a holy vocation and not just a wealthy business. What we do is adopt the ‘health-scare’ system. We have large controlled studies waiting to be authenticated. The poorest of the poor with cancer many times survive to ripe old age unmindful of their diagnoses as they do not have money to see doctors and go to hospitals.

Our best effort should be to prevent cancer as the latter is highly preventable as seen in smoking control for the fall in lung cancer deaths. We live in the sea of carcinogens in life, from chemically damaged foods and water, inhospitable environmental pollution and absence of any control. Patients might think that doctors are not active in prevention as that might break their rice bowl!

”Given one well-trained physician of the highest type he will do better work for a thousand people than ten specialists.” -William James Mayo


(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London.)




3 years ago

Dear Dr. Hegde, your articles are very interesting to read and offer a viewpoint to think about healthcare in a holistic way.

I have one specific topic which I want your opinions on. Newspapers are rife with discussions on large amount of pesticides & other -cides in the fruits & veggies that we eat.

first of all your take on this issue and is there any way to reduce/mitigate effects of these by an average middle class consumer? does oxidising machines really help?

Thanks in advance.

A regular reader


Professor Dr BM Hegde

In Reply to PS 3 years ago

Oxidising machines do help as far as the contact pesticides are concerned (The ones on the surface of the fruit and veggies)These days greedy farmers use systemic pesticides, which are very cheap, that go into the plant and God only can save us.
Of course, a sensible Govt. can ban those pesticides but the MNCs do not allow that to happen.

In fact, many of the daily products like cosmetics, lipsticks, shampoos,antibacterial soaps and house hold cleaning agents all contain deadly cancer producing chemicals but they are all permitted by the powers that be.

I feel sometiems that the money bags want cancer to increase for them to sell more prohibitively expensive drugs and make more money.


In Reply to Professor Dr BM Hegde 3 years ago

Thanks for your reply doctor. Sad to know nothing much we can do. Organic route is one option but expensive and we don't know if they are trustworthy as well. It's really a sad situation. Don't know when will anything improve.

Thanks for your articles which show some light in these dark areas...

Sensex, Nifty headed lower: Thursday closing report

The stock market may rise on Friday but there is more downside in store

After only three days of rally, the bears have wrestled back control from the bulls. The stock markets fell sharply on Thursday, erasing in just two days, all the gains made since last Thursday. Yesterday, we had mentioned that only if the Nifty closes above 6,140, there would be some semblance of hope of an uptrend. However, this did not happen. After a huge opening decline, broad-based weakness dragged the markets down, in a steady declining downtrend, without any fight back from the bulls, throughout the day.


The BSE 30-share Sensex opened at 20,579 (which is incidentally also its day’s high) and moved down to its intraday low of 20,189, before closing at 20,229 (down 406 points or 1.97%). Similarly, the NSE 50-share Nifty opened at 6,096, hit a high of 6,097 and then trended down through the day to hit the low of 5,985. The Nifty closed at 5,999, (down 123 points or 2.02%) shy of the psychological level of 6,000.


All indices were in the red. PSU banks, media and finance were the worst hit, down 2.62%, 2.90% and 2.50% respectively.


Of the 50 stocks on the Nifty, just two advanced, showing market-wide weakness. The two gainers were Maruti (0.34%); Cairn (0.30%). While the top five losers were ACC (3.74%); Indusind Bank (3.61%); Sesa Sterlite (3.56%); PNB (3.50%) and Ambuja Cement (3.44%).


Of the 1,228 shares on the NSE, 323 closed in the positive, 855 closed in the negative while 50 remained unchanged. The number of declines outweighed the number of advances by 2.64 times, clearly indicating market-wide weakness.


Indian markets were spooked by rumours of possible tapering which could begin next year when one US Federal reserve official remarked that tapering is definitely on the agenda for FOMC’s December meet. Fitch, a ratings agency, said that there will be a lesser degree of capital outflows once taper begins. Fitch believes that the pressure on the rupee has increased inflation expectations. However, there could be further pressure on the rupee after tapering begins (resembling the sell-off that happened in June this year). Fitch also believes that global liquidity conditions are expected to tighten, going ahead.


Meanwhile, in the United States, Goldman Sachs has forecast that the S&P would fall by 10% in 2014. They predicted that the S&P, which has been hitting records, could fall 6% in the next three months and 11% over the next 12 months, to levels of 1,700 and 1,600, respectively. While a 10% decline in equity market is nothing, the forecast looks dramatic because there has been no such major decline this year and everyone believes that the market will continue to head higher.


Yesterday, the US markets closed down after trending steadily in the green for most of the day. A late sell-off saw markets close in the red. The S&P closed at 1,781 while Dow closed at 15,900.


European markets were seen mostly flat, with exception of IBEX and FTSE which were marginally up.


Meanwhile in Asia, China's HSBC Flash PMI missed expectations, falling to 50.4 vs expectations of 50.8 exp, its sharpest month-to-month fall since May, raising concerns about the state of the Chinese economy.


With the exception of Nikkei, all Asian markets were down. Hang Seng extended its losses by 120 points more. The Bank of Japan committed to continue with its ultra-loose monetary policy as Yen weakened further, which saw Nikkei shoot up nearly 2%. The US futures were trading positive.


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