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State sues firm over disabled woman's care

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BY CORY MATTESON / Lincoln Journal Star

Wednesday, Oct 15, 2008 - 12:55:35 am CDT

Of Connie Guhde’s two daughters, LeAnn “Annie” Guhde wore the bows and ribbons. She loved shopping, signaling with head nods or a smile if she saw something she liked.

“Annie has to make noises to express her needs,” Connie Guhde said. “But someone’s got to listen.”

By early 2004, according to the Nebraska attorney general’s office, the company responsible for providing care for Annie Guhde, a person with developmental disabilities, wasn’t addressing her needs.

Story Photo
LeAnn "Annie" Guhde (Courtesy)

And on Friday, the office sued Community Alternatives Nebraska, more than four years after Annie Guhde was admitted to Saint Elizabeth Regional Medical Center dirty and malnourished, her body covered with bed sores.

The services provided to Annie Guhde from April 2003 to Feb. 9, 2004, “essentially lacked value,” according to the lawsuit filed in Lancaster County District Court.

Annie Guhde was 29 when she was hospitalized Feb. 9, 2004, and she fully recovered. She died last Nov. 24 of natural causes.

She was mentally retarded, diagnosed with cerebral palsy and wheelchair-dependent, the lawsuit states. The lawsuit and a 2004 state Department of Health and Human Services investigation report from which the lawsuit stemmed say staff members at Community Alternatives Nebraska were not qualified to care for her.

But during that time, the center filed 22 claims seeking nearly $76,000 for her care, the lawsuit states. 

Now, the state wants that money, and more, back.

“The plaintiff paid $75,880.28 for services which were not performed with the skill and knowledge normally possessed by providers of community based developmental disabilities services in good standing,” the lawsuit alleges.

Because of the poor care Annie Guhde allegedly received while at the center at 4821 S. 30th St., the suit says, the company violated the state’s Fraudulent Medicaid Claims Act and broke its contract with HHS.

The state is requesting $150,000 for violating the act plus $5,000 for each of the 22 claims in violation of the act — for a total of $260,000.

Since the state created a Medicaid Fraud Control Unit in late 2004, Attorney General Jon Bruning said, more than 300 cases have been investigated and $15 million has been recouped by the state.

But it is the first time to Bruning’s knowledge, he said, that a lawsuit of this nature — using the False Medicaid Claims Act to recoup losses related to the alleged neglectful care at a care center for developmentally disabled people — has been filed in Nebraska.

“The goal is to make sure people are cared for properly,” he said. “If we have to use the courts, we will.”

Bruning said he does not expect criminal charges to be filed in the matter and that this is the only incident of its type his office is pursuing at this time.

The state is using a “heavy hammer” as a deterrent, to warn providers that serious repercussions will result if patients aren’t treated properly, he said.

“The lawsuit was a surprise to us and is distressing,” Community Alternatives Nebraska Executive Director Kellie Watson said in a statement. “We don’t feel it is appropriate to address any issues contained in the lawsuit until our legal counsel has been served with the action.”

The parent company, ResCare, is not based in Nebraska. 

Connie Guhde, a registered nurse, said she decided to place her daughter in residential care in 2001 because she could not provide her the full-time care she needed. She said she wanted her time with Annie to be special, rather than work.

Annie Guhde had been going to programs at the South 30th Street center and was treated well there, her mother said. She became a resident in April 2001.

“I felt it was really good at first,” Connie Guhde said Tuesday night. “Somewhere along the line, something happened.”

Bruning said the lawsuit stemmed from disciplinary action taken by HHS against Community Alternatives Nebraska in 2004.

Following an HHS investigation of Guhde’s care, the state fined Community Alternatives Nebraska $8,000 in August 2004, placed the center on probation for one year and prohibited new admissions during that year.

The center accepted the punishments without requesting a formal hearing. Since then, the state has taken the company off probation. It is licensed as a center for developmentally disabled people and it can serve as many as six at once, said HHS spokeswoman Jeanne Atkinson.

“The incident addressed in the lawsuit occurred more than four years ago,” Watson said in the statement. “It was investigated both internally and externally. We worked very closely with the state at that time to address any and all issues they had.

“Our priority is always the safety and health of the people we support and we will not tolerate actions that will place them in jeopardy.”

According to the lawsuit filed by Bruning’s office, Annie Guhde suffered from seizure disorder, chronic congestion and other serious medical conditions, and she was fed through a tube.

The lawsuit states Community Alternatives Nebraska staff members provided inadequate care for Annie Guhde as her condition worsened, and that a part-time nurse on staff rarely provided help. Annie Guhde’s nutritional needs weren’t assessed. Her weight was not measured. Her medication and nutritional information weren’t properly maintained, according to the suit.

The lawsuit states she also developed numerous pressure sores, some going to the bone, because she was not regularly repositioned in her bed.

Two days before her hospitalization, staff members had concerns about Annie Guhde’s health. According to the HHS investigation report filed in August 2004, staff members at the center “felt severely underqualified to care for the nature of the wound.”

It was “further documented they did not want something to happen to (Guhde) and they felt helpless.”

“The bottom line is the girl was not well-cared for,” Bruning said.

Connie Guhde said that all people with special needs, not just her daughter, deserve the type of care that providers would want if roles were reversed. But she’s not sure a financial penalty will make a difference.

Reach Cory Matteson at 473-7438 or cmatteson@journalstar.com.


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A. Day Late wrote on October 15, 2008 3:17 am:
" Let me see if I understand this situation correctly. The state is suing a company it hired to provide care to the developmentally disabled. If the state had done its job in the first place and provided adequate oversight of the services provided by this contractor, this woman would have been properly cared for and never would have ended up in the hospital, dirty, malnurished and covered in bedsores. But, since the state failed to provide adequate oversight of the contractor, the state is now suing the contractor. When will the HHS learn that it's better to do a good job in the first place, than have innocent people suffer and try to clean up the mess later? Winston Churchill said that Americans cold be entrusted to do the right thing -- once they'd exhausted all the alternatives. The more things change the more they stay the same. "

 HORRIBLE wrote on October 15, 2008 5:15 am:
" But as a parent why did you keep her there? I know it is difficult to find places for disabled individuals that you feel intrusted to for your loved one. And putting them in a facility is a difficult decision and not done with haste. But to have this happen not only to her but hundreds in care facilities is not acceptable. This place needs to be closed, it is obvious they have had violations for 4 years and HHS maintains their license. Why wasn't something done sooner with her care? "

 ... wrote on October 15, 2008 8:46 am:
" Coming from someone who worked in the HHS system for people with disabilities, I can tell you these kind of things happen in every company who provides these types of services. One of the main problems is they do not pay staff members nearly enough money for the amount of work they do. From there it attracts people who are not qualified and really have no business working in this type of field. Then, the companies train the staff members poorly, so they are ill-equipped with the skills and knowledge necessary to care for the people they serve properly.

People with disabilities are treated as second class citizens, and the companies providing their care are very good at making sure they remain this way. It's unfortunate that the people who these companies serve are of last concern to them. Their only concern is how to get as much money from the state as possible and pad the pockets of the executives running the company.

The mother is right; a financial penalty will not make a difference. "

 Family wrote on October 15, 2008 9:08 am:
" It is unfortunate this had to happen; I hope the state wins! Furthermore, when the state does win, I hope they pass on some of the $ to the family for the time they had to spend supporting/fixing what the unqualified people were (not) doing.

Also, if the company was on probation, how did they get taken off...then years later sued for something that should be a pretty basic oversight?

Throw the books at 'em. Do it for Annie Guhde and her family! "

 to horrible wrote on October 15, 2008 9:41 am:
" Please don't be so quick to pass judgement on the family of Annie for placing her in the care of this facility. Caring for a disabled or even elderly family members isn't easy. And the family made the best decision that they could at the time. Perhaps they didn't realize exactly how bad the situation was? Regardless, it is a terrible thing that Annie had to endure. I wish the people responsible for her poor care (the staff at the facility) would be brought to justice for this. Unfortunately, as in most cases, they won't be. The staff - if they even still work there - will get away free and clear, and won't think about Annie, or what they did to her, ever again. Rest in peace Annie. "

 Its ODD wrote on October 15, 2008 10:26 am:
" It's odd that someone from the family or friends didn't notice something was going wrong over that 4 year period.Not to take away from the responsibility of Community Alternative Nebraska, but if the mother is a nurse, surely she noticed something was wrong, and why would see wait this long, VERY ODD. "

 fire john bruning wrote on October 15, 2008 10:37 am:
" Just once I'd like an attorney general who's actually looking to enforce the law rather than looking to score political victories or satisfy some sense of malicious narcissism. the sooner we get this guy out of office the better. "

 dont be so quick to judge wrote on October 15, 2008 11:01 am:
" Please don't be so quick to pass judgment on the family of Annie for placing her in the care of this facility. Caring for a disabled or even elderly family members isn't easy. And the family made the best decision that they could at the time. Perhaps they didn't realize exactly how bad the situation was? Regardless, it is a terrible thing that Annie had to endure. I wish the people responsible for her poor care (the staff at the facility) would be brought to justice for this. Unfortunately, as in most cases, they won't be. The staff - if they even still work there - will get away free and clear, and won't think about Annie, or what they did to her, ever again. Rest in peace Annie. "

 go figure wrote on October 15, 2008 11:39 am:
" Let's review. Governor Heineman wants to privatize services (his latest: foster care) because private agencies can do it better and cheaper. But government run agencies have more stringent oversight than private (see history of BSDC) and constant cuts to HHS make those investigations few and far between. And the only issue to this administration is they want their medicaid dollar back and nothing more? Who is running this state? This is like "saving" the U.S. banking system by handing over money to the big guys and not fixing the existing problems in the system.
A society is judged on how they treat their most vulnerable population.
"Family values" politicians like Johanns and Bruning and Heineman need to understand the obligations of their jobs and that cutting corners doesn't work. You don't save taxpayer dollars by ignoring problems and cutting positions. And if they "get it" they need to be replaced by those who do. For anyone who wants to cast stones on a mom who has to leave her daughter in a state licensed facility - start asking yourselves whether that same standard applies to your kid's day care, your parent's nursing home or ignoring the oversight needed to other agencies serving "vulnerable" populations of Nebraska. "

 Caring Person wrote on October 15, 2008 11:46 am:
" I work in Human Services and have worked with individuals with developmental disabilities for over twenty years.It is a largely thankless job in many respects. Let me tell you that it hurts to be judged by a whole community for what we do because of this mistake. It hurts to know this happened to a wonderful woman who did deserve excellent care and who's family suffered immensely. But, lets not be so quick to judge all service workers by this and remember that we cannot judge all for the misdeeds of a few. I love my work and would not change my experiences for the world. Our society needs to change the way they treat the workers too, in the field of Human Services. More training, more education and more attention NEED to be paid and give us ALL back our dignity. "

 Remember... wrote on October 15, 2008 11:51 am:
" Remember tha lawsuit DSN won over the city...well Jon is trying to make some money back. I am a former staff and way more is asked of you than you can safely provide and should be provding! The state won't pay a nurse to work at a house or a CNA just an average Joe needing a job. The system needs a major overhaul! Or these things are just going to continue to happen! "

 A friend... wrote on October 15, 2008 12:46 pm:
" I am glad to finally see something coming out the the ill care LeAnn was given while receiving services through Community Alternatives. I actually worked with LeAnn and her family, at another provider, right after she recovered from the wounds. Laws changed state wide as a result of LeAnn's suffering, I only wish it had been sooner and not as a result of what she had to go through. And I also wish she was still alive to hear of this, it would have been a sweet relief to her to know that someone is being asked to be accountable for what happened. LeAnn had significant needs, but with the correct training, sincere care and an attentive eye, those needs were able to be met. I have to disagree with the comment from "..." below, not ALL companies throw under - trained , poorly paid staff in to work with people with disabilities, nor do they all desire to pad their pockets and work to keep people who experience at second class citizens. I worked for a company that was lucky to break even at the end of the year, and that often barely happened, if at all. Families and guardians just have to be very, very careful of the providers they choose. "

 evelc wrote on October 15, 2008 4:14 pm:
" An honest question ---- shouldn't this poor woman have been in a nursing home? Is Community Alternatives a skilled nursing facility? "

 Concerned Citizen wrote on October 15, 2008 6:41 pm:
" As a former employee of Community Alternatives, I can tell you this is not a surprise. The company runs their business with one thing in mind - their profit margin. Rescare (the parent company of CAN) has numerous businesses all over the country that bring them millions of dollars each year, as well as numerous lawsuits due to poor training and inadequate staffing (just due a Google search for "Rescare + lawsuits" and you'll see what I mean). A fine of $260,000 isn't going to get them to change their practices. The only thing that may make them sit up and take notice is if the state closed them down. Before I left the company, I was told by someone with the state that CAN had never passed a single inspection by HHS but somehow remained open for business. For some reason, businesses that provide services to the mentally ill and/or developmentally disabled are allowed to continue operating even if they don't meet state regulations. What other businesses are allowed to do that?? I can't think of any either. As long as the state allows these people to continue to operate, nothing good will happen. If Mr. Bruning is serious about using a "heavy hammer" he would perform a serious investigation of all these businesses currently operating in Nebraska and shut down those that fail to meet state regulations. I guarantee Community Alternatives would be shut down if that were the case. "

 Been there still there wrote on October 15, 2008 6:49 pm:
" I just wanted to explain something - I work for Community Alternatives of Nebraska. We are a company of many houses throughout the city, and unfortunately we work in a field where we are one on one with clients, so if someone is not doing their job, it takes a while for the next person to realize and pick up the slack. If several people are not doing their job well, it takes even longer.

I work in an EXCELLENT C.A.N. home, our clients are very well cared for, and very healthy. Please do not paint the system or the company with the same brush. The majority of us are knowledgeable, we honestly care and love our clients, and we respect them. On the other hand, it sounds as if she needed much more in depth care, and for that, there are better facilities. I feel awful that someone in 'our' care was injured to this degree, and I agree things need to change. But please understand that we provide a much needed service, and the majority of us are there because it is a job we believe in and we are there for the clients. "

 Danell GUHDE Lattimer wrote on October 15, 2008 6:52 pm:
" I am Leann sister, the one who wasn't into bows and ribbons. The decision to put Leann in a group home was one that wasn't taken lightly. If anyone has something they would like to discuss or imply about my family I invite you to email me at danelllattimer@yahoo.com. I will be happy to answer any question you have about our role in Leann's life. "

 Its Too Bad.... wrote on October 15, 2008 10:10 pm:
" I am a cousin of Leann's. I have never met a family more dedicated to the love and care of someone. Leann's family kept her in their home, caring for her every need as long as they physically could, into her late 20's. When it became too much, they had no other choice but for her to go into other care - she needed that. It was so hard for them, but they did all they could. The family fought for Leann's best care down to the last day. Anyone who has a special needs loved one wants them to have the most opportunities possible, which usually means trying a group home first. She was in that home for a short time and then was relocated after her hospital stay, thanks to the fight her family fought.

I think it's so interesting people are so willing to judge when they have no idea the unconditional love this family had for her. Some people need to find better things to do....if you're really so intersted in the case that you want to judge, maybe you should find out all the facts and the about the amazing family Leann had. Thank goodness Leann's in heaven dancing and not down here having to listen to all of this. Let's stick to the point here - a facility provided horrible care to someone in need - not acceptable, no matter the situation. "

 Nina wrote on October 16, 2008 9:05 am:
" While this doesn't let CA off the hook, a practical and wise comment was made here earlier - someone with bedsores typically needs to be in a skilled care facility, not the type of limited care facilities CA offers. Of course, a nursing home is much more expensive, and CA may have been all the family could afford. And in all levels of such facilities, there are stellar employees as well as those who sluff off. Staff supervision is necessary. With a bedsore, one or two days can make a massive difference. Would that all human care people, from parents to teachers to physical care providers for the public, keep in mind, 'What you do unto the least of these, you do unto me.' "

 OmahaAnnie wrote on October 16, 2008 12:46 pm:
" Great that the state is suing for "Annie" wouldn't it be nice if they gave her the money so she can receive her proper care.
I also wonder why the state is suing on behalf of one person yet when the state lost its lawsuit against an elderly woman who was a volunteer with the Juvenile Probation Office the state has yet to pay and one of Jon Bruing's lovely attorney asked "isn't she dead yet?". Where is the outrage for her care Mr Attorney General???? Pay Lucille!!!!!!!!!!! "

 green wrote on October 16, 2008 1:29 pm:
" Leann's family were dedicated and never left her side...They were truly dedicated. And when Leann smiled, everyone had to smile because she was beautiful.

What people need to understand is when someone sees someone being neglected, you have to go through the appropriate avenues. You follow procedure as to how to report it. Facilities are given a chance to correct the situation as well. Four years really isn't long when you consider all the avenues that the family must have gone through.

And neglect is not always visible to the eye, so they might not have noticed things right away. Neglect can be very subtle at first.

But to Leans family, you all were wonderful and Leann was loved. She is smiling down on you now waiting for the day when you can walk together the green pastures of heaven. "

 wrote on October 16, 2008 7:31 pm:
" I agree with other comments to this matter. If she needed so much care than why didn't the family put her in a place that could care for her every needs. They knew the kind of care that she needed because they couldn't keep and take care of her anymore. And if her family was so much involved in her life and her mother being a nurse should of seen the signs. People that work for CAN are not nurses and are not trained to do nurses jobs. If she sits in a wheelchair all day and then lays down she has no where to go to get off her sores so what are you to do? I do feel bad that her family and Annie that she had to go through this. "

 former employee wrote on October 17, 2008 12:04 am:
" I am a former employee of CAN and I can attest to the fact that there are some wonderful and caring employees who work very hard for the individuals in their care. I can also tell you that they are under-paid, under-appreciated and under-staffed. Because CAN is a for profit company they are constantly cutting budgets which can and does affect the care that individuals receive. This is true with most for profit companies. CAN does not stand alone.

I strongly feel that this an unfortunate situation where there really is no one particular to place the 'blame' on and the staff that worked with LeAnn have not just forgotten her and moved on. That was an insensitive thing to say. This affected all involved not just the family. "

 Advocate wrote on October 17, 2008 12:31 am:
" A tragedy such as this should serve as a reminder that as citizens of Nebraska, we are all mandatory reporters. Just as you would report abuse or neglect of a child to Child Protective Services, we are each required to report suspected abuse or neglect of vulnerable adults. If you ever have suspicion that a vulnerable adult is being neglected or abused, make a report to Adult Protective Services. If you work for a DD provider agency and believe that someone in your agency's care is being mistreated, contact APS. The agency will not be told who made the report. It is always better to over-report than under-report; advocate for those who may not be able to do so for themselves. "

 A.B. wrote on October 21, 2008 5:33 pm:
" As someone who worked at CAN I can attest to the horrible way they do business over there. There are many caring individuals that work there, but the way they operate on a daily basis makes no sense. They are very quick to use restraints and other things that other companies are not accusstomed to using. I can also say that blaming LeAnn's Family for the way she was treated residentially is ridiculous. I worked with LeAnn at a workshop way back in 1999 and her family was nothing but concerned with every care their child received, this was BEFORE she was in CAN residentially. Her mother is one of the most caring women I have ever met. I still work in this same profession now and it is my wish that every parent was this concerned with their children in services. I also work for a company now that would never keep a client we couldn't accuratly take care of just to keep state funding the way that CAN does. Also it really doesn't matter what the family saw that should have been warning signs, sometimes staff is able to hide certain things and only tell parents what they want them to know.....As an old staff of LeAnn's I would like to send my deepest condolences to her family and hope that they receive some justice for the beautiful life that was taken from them.

A.B. "

 Very Concerned wrote on October 25, 2008 2:44 pm:
" Maybe the Department of Health and Human Services should immediately suspend this service provider unless and until this matter is resolved. Recent news accounts about this organization raises a lot of concerns, for the clients and the taxpayers. I hope the legislature will increase its oversight of HHS and its contractors. This particular service provider is a subsidiary of the ResCare Corporation which is a huge for-profit company. It seems as though its priorities are different than one would expect. "

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