Lawsuit: Once “lucid and vibrant,” Citadel nursing home resident gravely ill with COVID-19 because of substandard care

By: - April 22, 2020 12:00 pm

Ms. Garvin died on the evening of April 27, five days after this story was published.

Marjorie Fuller Garvin, 96 years old, was “lucid and vibrant” when her family and caretakers decided to place her at the Citadel of Salisbury in February. For $11,000 a month, paid by the family, not Medicare, Garvin was “assured she would have a private room and quality care.”

Instead, Citadel staff Garvin moved her to a “quarantine hall” and unnecessarily exposed her to COVID-19, according to a civil lawsuit filed yesterday. Now Garvin is gravely ill and among the nearly 100 residents who are sick with the disease.

The lawsuit filed on behalf of the Garvin family by the Wallace & Graham law firm, names several defendants, including the nursing home owners and its administrator, Sherri Stoltzfus. A for-profit facility, Citadel is owned by Accordius Health, which owns and operates a large chain of nursing homes, and the Portopiccolo Group, a private equity firm. Both are based in New Jersey.

An official reached by phone this morning at the New Jersey office asked Policy Watch to seek comment via email. Policy Watch has yet to receive a message from the company.

The Citadel of Salisbury, also known as the Salisbury, is a one-star facility out of five, as rated by the Center for Medicare and Medicaid Services. It has an extensive violation history, and was cited for abuse last fall after a resident broke their ankle and shinbone, but did not receive effective medical treatment or pain medication.

The recent complaint alleges that Accordius Health had not only a duty to implement infection-control measures to prevent the spread of the virus, but it had the financial resources to do so. However, the Citadel, a 160-bed facility in Rowan County, “laid the groundwork for the virus to flourish,” the complaint reads.

Garvin had been living at a different rehabilitation facility, but needed long-term care. That’s how she came to live at Citadel in February. Initially, Garvin lived in the private room she had paid for. But at some point, Citadel staff allegedly moved Garvin, who had a urinary tract infection and a fever, from her normal room to an “apparent ‘quarantine hall,'” according to the complaint.

A fellow resident on the quarantine hall had tested positive for COVID-19. The facility did not notify Garvin’s family, friends and a caretaker who has power of attorney of her infection or the move. “They were left utterly in the dark as her life was placed in jeopardy,” the complaint reads. Only after Garvin called her son did they learn of the situation. “They sought over and over again to reach the nursing home desk by phone to no avail,” the complaint reads.

Meanwhile, on April 4, the first Citadel resident was rushed to emergency room and tested positive for the coronavirus, followed by several more residents in the coming days. On April 7, the Novant Health Rowan Medical Center leadership met about the apparent outbreak; the next day emergency room personnel contacted the Rowan County Health Department.

Three days later, on April 10 all staff and residents were tested, but no one told the Garvin’s family or her power of attorney, the complaint alleges.

On April 13, a Garvin family member finally spoke to an administrator who said in effect “that corporate was handling this,” according to the complaint. Local staff did not have a copy of information showing who had tested positive or negative. “Only corporate had it,” documents read.

Finally, on April 15, family and friends learned that Garvin had tested positive. She remains hospitalized and is extremely ill, according to attorneys at Wallace & Graham.

Earlier this week, 96 residents of the Citadel in Salisbury had tested positive, as well as 17 employees, according to media reports. The number of fatalities is unknown, but according to media reports, there have been at least two.

Months before Garvin arrived, the Resident Council had complained to inspectors that nursing assistants weren’t cleaning the shower room; nor were they answering call lights for 30 to 45 minutes. Thirteen of 23 residents who attended a January meeting indicated the nursing assistants would enter their rooms, turn off the call lights, but “leave the room without addressing their concerns.”

Inspectors also found dirty shower rooms, including one with a wadded used washcloth that had dark brown spots.

An inspection in February revealed multiple violations regarding plans of care for the residents, medication and a dirty kitchen and food preparation area, which had attracted cockroaches and ants.

Because of the close living quarters and vulnerability of their residents, nursing homes are prone to disease outbreaks. So far, there have been more than 1,000 lab-confirmed cases of COVID-19 in North Carolina nursing homes, accounting for 14% of all cases statewide. Seventy nursing home residents have died.

Complaint Citadel (Text)

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Lisa Sorg
Lisa Sorg

Assistant Editor and Environmental Reporter Lisa Sorg helps manage newsroom operations while covering the environment, climate change, agriculture and energy.