After Gov. Wes Moore in March fired the contractor running the state’s veterans home over abuse allegations, the state spending board on Wednesday approved a $159 million deal with a new corporate vendor, despite the operator’s low federal quality ratings and abuse allegations in other facilities it runs.

The Maryland Department of Veterans Affairs awarded the four-year contract to run Charlotte Hall Veterans Home in St. Mary’s County to Georgia-based PruittHealth, making Maryland’s only long-term care facility for veterans one of more than 180 operated by the care provider. The Charlotte Hall Veterans Home contract marks the company’s first venture in the state and includes a one-year extension option.

“We’re excited to add this to our collection of veteran homes that we serve,” said Neil Pruitt Jr., CEO and chairman of PruittHealth ahead of the spending board’s decision.

PruittHealth, which also runs homes in the Carolinas, Georgia and Florida, will replace HMR of Maryland LLC, a move announced by the Moore administration in March after reports of abuse and neglect surfaced, and Charlotte Hall’s federal quality rating fell to one star out of five stars.

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But a review of PruittHealth’s facilities revealed that 17 of its Georgia-based nursing homes also have one-star ratings and three of its North Carolina nursing facilities have been flagged for abuse. One resident suffered a black eye and said a staff member hit them. The complaint was noted as credible; PruittHealth took immediate corrective action. Another inspection revealed the operator failed to prevent physical abuse between two residents, resulting in one resident suffering a fractured eye socket.

In the last three years, PruittHealth homes have incurred more than $1.2 million in fines for inspection violations, and in 2021 it settled a $4.2 million whistleblower suit with the U.S. Department of Justice over allegations that the company submitted false Medicaid and Medicare claims. PruittHealth was found not liable.

Federal star ratings tell consumers how well a long-term care facility is complying with a host of health, staffing and quality measures, including federal and state law. The five-star scale is used by the Centers for Medicare and Medicaid Services to rate facilities receiving federal funding. Nursing home operators can be fined and denied federal reimbursement for inspection violations.

One Augusta, Georgia, news outlet report in 2019 found dozens of Pruitt-run homes in two states had violations.

Other investigations detailed harrowing stories of neglect. One woman at a Pruitt-run facility in Lafayette, Georgia, died in 2015 after suffering an infection caused by parasitic mites, a condition known as crusted scabies. A Georgia family filed a lawsuit against the company after their relative died in 2019 from complications due to a bed sore.

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Toby Edelman tracks the country’s nursing home industry as a senior policy analyst for national watchdog Center for Medicare Advocacy. Edelman questioned whether Maryland had done its due diligence in finding another provider, given what she has read about PruittHealth over the years.

Edelman pointed to reports documenting PruittHealth’s poor quality ratings and lawsuits alleging patient neglect.

“Did they really look into this out of state corporation they had no experience with to make sure that chain would would do a good job for Maryland veterans and their families?” Edelman asked.

Despite the Moore administration’s attempts to receive bids from eight possible vendors, none submitted a pitch, blaming the tight turnaround time and oversight restrictions. The state agency then engaged PruittHealth as the current vendor’s contract expiration date approached.

Multiple lawsuits filed against PruittHealth

Attorney Lee Cope of Parker Law Group in South Carolina has represented families who have sued PruittHealth because their loved ones were injured while in the operator’s care. He’s said he’s worked on at least 10 cases in the last decade that involved “really bad bedsores, falls with injuries, things of that nature that tend to fall back on not having sufficient staffing to meet the needs of the residents.”

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Ken Connor has litigated nursing home neglect and abuse and medical malpractice cases for more than 40 years. He didn’t want to speculate on a number of cases he’s worked on versus PruittHealth. But he expressed he was wary of the company’s practices.

“If the past is prologue, that doesn’t necessarily augur well for the future of any facilities that they may take over,” he said.

Georgia-based attorney Camille Godwin said she’s worked on around 20 cases involving PruittHealth in the last 10 years, many of which resulted from PruittHealth understaffing and under-resourcing their facilities.

Godwin said she’s seen the decisions of larger nursing home operators, like PruittHealth and others, lead to a lack of quality care.

“Staffing numbers don’t change in response to the needs of the residents or in response to lawsuits,” Godwin said. “They’re always just the bare minimum level they can possibly get away with.”

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So why choose PruittHealth?

In a statement, a Moore spokesperson confirmed that the agency was aware of PruittHealth’s one-star ratings.

“Because the circumstances at each retirement home are unique, we spoke at length with PruittHealth about their approach to improving care outcomes at Charlotte Hall,” said Carter Elliott IV in a statement.

PruittHealth’s CEO and his team toured the Maryland veterans home with agency staff, Elliott said. During talks, Elliott said, PruittHealth demonstrated their capacity to facilitate coordinated transition plans and communicate openly.

After the agency had researched a number of contractors, “PruittHealth emerged as the strongest contender,” Elliott said. “Especially given their experience not only operating veteran retirement homes, but also in stepping in to right similar situations.”

Elliott included that three of four Pruitt-run state veterans homes in North Carolina have attained a four-star rating, and the company ”has demonstrated a consistent record of managing facilities and providing a high level of care and service to the more than 24,000 patients under their care.”

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The state struggled to find a bidder

During the Board of Public Works meeting Wednesday, Moore thanked Veterans Affairs Secretary Anthony Woods for his work finding a new vendor, a process the governor called “amazingly complicated.”

Moore said his administration moved “with intentionality and speed to make sure that we are correcting these issues and providing our veterans the level of support and the level of care that they have very, very richly earned.”

Woods called the contract approval “a first step in a journey” to honor the commitments made to the veterans of Charlotte Hall Veterans Home. After describing the agency’s vendor choice, Woods noted that 10 PruittHealth locations were recently named “Best Nursing Home for 2022-23″ from U.S. News & World Report.

The Moore administration in March requested bids from eight vendors they said met the requirements and had histories of turning around struggling long-term care facilities. After a few walkthroughs by potential bidders, none placed a bid.

Prospective contractors said the request for proposal lacked financial and operational data, the contract term was too short, and they needed more time to prepare a bid. Among the complaints: “the current structure not financially feasible due to all the restrictions and additional oversight,” according to the spending board report.

While it’s not immediately clear to which restrictions contractors were referring, a new law passed by legislators frustrated by the failings of the previous contractor increased reporting requirements on any new contractor at Charlotte Hall Veterans Home.

As the last day of HMR of Maryland’s contract, June 5, rapidly approached, the veterans affairs department pursued PruittHealth, according to the contract approval request.

Staffing shortages blamed for low ratings

CEO Pruitt said that while he couldn’t comment on details of the cases that resulted in settlement or litigation, he said, “the point here is that a family member has experienced loss, and that’s unacceptable. And our sympathy goes out to those families.”

Pruitt faulted the challenges of recruiting registered nurses to work in rural facilities and staffing shortages experienced during the pandemic for the low star ratings.

“I’m not here to say we’re perfect on the survey record because we aren’t. We make mistakes just like everyone else,” Pruitt said.

“We’re relying on people doing their jobs every day. Sometimes people make mistakes, but we go to every effort to make sure that we keep a constant eye on our operations,” Pruitt said.

Pruitt said the company strives for the highest standards. He said all of the company’s veterans homes and 97% of its other homes are accredited by The Joint Commission on Accreditation of Healthcare Organizations, or JCAHO, a nonprofit authority that certifies health care facilities. Seeking JCAHO is voluntary and Pruitt says he would like Charlotte Hall Veterans Home to receive the gold standard certification.

Pruitt said that his team has visited the Southern Maryland facility several times. He said he was “pleased” with the level of care the patients were receiving and that “the building had a good feeling.” Pruitt said he’s ready to get to work on turning the facility around.

“Our team, upon takeover, they’ll do a head to toe assessment of every single resident, we’ll redo their care plans,” he said, sharing a to-do list. “And so basically, we’ll have a baseline, and we’ll start from scratch.”

Pruitt confirmed that the state asked his firm to submit a proposal.

“We had good discussions with them, like kind of laid out our objectives, they aligned with the state objectives; and we were able to come to a partnership agreement,” he said.

The proposed contract includes a one-year renewal option for $39,288,000.

HMR of Maryland LLC, had already alerted the state labor department of 233 pending layoffs and a new long-term care and skilled nursing provider was going to need time to hire specialized staff.

Pruitt highlighted the privilege of serving veterans in North Carolina and Georgia. “It’s good to give back those who have served our country,” he said.

Brenda Wintrode covers state government, agencies and politics. Before joining The Baltimore Banner, Wintrode wrote an award winning series of long form investigations for Wisconsin Watch.

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