This company owns dozens of N.C. nursing homes rated substandard. At one, COVID has killed 19.
The for-profit chain that owns a Salisbury nursing home crippled by North Carolina’s worst outbreak of COVID-19 has a slogan.
“Care before corporate,” the Accordius Health website tells potential clients.
Yet, new affidavits in a lawsuit over The Citadel Salisbury’s handling of its deadly viral outbreak accuse the facility’s leaders and Accordius of basing potentially life-or-death treatment decisions more on financial considerations than the health and safety of residents and staff.
The lawsuit, which was filed in Rowan County on behalf of two Citadel residents, accuses the nursing home and its corporate owners of violating the state’s “Patients Bill of Rights” and accelerating the spread of disease by operating with an undersized staff that was poorly trained and lacked necessary supplies.
Last month, The Citadel and its owners fired back in federal court. They’ve asked a judge to throw out the earlier complaint on the grounds that residents agreed when they signed The Citadel’s contract to use arbitration to settle any disputes.
Officials with the nursing home and Accordius Health have said the allegation that they worsened the spread of the disease is untrue. “No one did anything wrong to create this,” Citadel Administrator Sherry Stoltzfus told the Observer in an email.
In response, Salisbury attorney Mona Lisa Wallace, who helped file the residents’ lawsuit, said the Accordius demand to move the dispute to arbitration is an effort to keep damaging information hidden from a county “where loved ones and elders are sick and dying even today.”
The latest sworn statements from contracted nurses track earlier allegations that the facility’s leaders refused to provide masks and protective clothing to nurses who were dealing with symptomatic patients, and that employees were banned from wearing their own.
The affidavits also allege that officials with Accordius, a 4-year-old company that has rapidly acquired 39 nursing homes across North Carolina and Charlotte, played a role in blocking testing at The Citadel. Accordius took over the nursing home on Feb. 1.
Starting in March, according to the affidavits, the nursing home’s resident physician, Dr. Yuthapong Sukkasem was rebuffed on several occasions by Citadel and Accordius management when he sought to have ill patients tested for COVID-19.
In one example, the nursing home tested a female resident for flu and pneumonia when she experienced “profuse coughing, shortness of breath and profuse sweating,” an affidavit claims.
Sukkasem, better known around The Citadel as “Dr. Yut,” also wanted the woman swabbed for COVID-19, according to the affidavit.
When Sukkasem went to nursing home Administrator Sherri Stoltzfus for the go-ahead for testing, she refused, according to the affidavit filed by a nurse who says she witnessed the exchange.
“Sherri said that corporate did not want anyone tested for coronavirus and therefore the patient would not be tested,” the affidavit says.
Other nurses in their sworn statements said Stoltzfus believed testing would cost too much money and take too much time, and that it would be reserved only for patients sick enough to be hospitalized.
Within weeks, The Citadel would be engulfed by North Carolina’s worst nursing home outbreak of COVID-19. According to state figures this week, 157 cases of the disease has been reported among residents and staff. Stoltzfus says 19 have died.
No COVID tests
In a email to the Observer last month, Stoltzfus, who began work at The Citadel on Feb. 17, said several of the major allegations in the latest round of nurse affidavits are not true.
Contradicting multiple sworn statements by her current or former employees, Stoltzfus said nurses “were never denied appropriate (protective clothing).“
The Citadel did not withhold testing, she said, because it had no tests to give. When comprehensive testing of patients and staff did begin on April 10 after the first COVID-19 cases from The Citadel began showing up at a local emergency room, test kits donated by Novant Health were used, Stoltzfus said.
Stoltzfus also said that Sukkasem “did not ask permission ... for testing residents. He did ask me if we had tests, at that point we did not.”
Asked if earlier testing would have saved lives, Stoltzfus said, “I do not think earlier testing would have changed the outcome.”
Sukkasem did not return an Observer phone call seeking comment.
Whether the Accordius chain, which now includes about 90 nursing homes in nine states, could have supplied tests is not known. Chief Operating Officer Kim Morrow of Bradenton, Fla., did not respond to several Observer emails seeking information about testing and corporate decisions affecting treatment at The Citadel.
In an April 17 letter to Accordius’ residents and families, Morrow said the chain’s early response to the pandemic was hampered by the lack of tests.
“In early March, there were simply no test kits available and if there was, results from labs were taking anywhere from 11-14 days to come back,” Morrow said in her letter.
Wallace, the lawsuit attorney, said it remains unclear how a facility such as The Citadel Salisbury can belong to one of the country’s largest nursing home chains and still be so poorly supplied and staffed to combat the pandemic. She says The Citadel has relied on donated gloves, masks and other protective gear from the Rowan County Health Department even though Accordius’ founding partners once ran a highly profitable medical-supply business.
“Despite having the finances and resources to step up and take care of its residents and staff, the corporate owners continue to fall short,” she said in a statement last week. “The actions and inactions of the owners of The Citadel has deeply affected my hometown.”
Affidavits by the facility’s nurses says Citadel leaders appeared at times to be minimizing what was happening within their walls.
When one nurse asked why so many sick residents were being housed behind the closed doors in one wing, she was told it was because of “allergies,” an affidavit alleges.
“It did not make sense to us as nurse personnel why the corporate owners were not jumping all over this and testing everyone immediately for the virus and getting masks for us and communicating what was happening,” said one nurse whose name, as with the others, has been redacted from their filings.
Accordius in North Carolina
Accordius quickly became a major player in the North Carolina nursing home industry because of two New York investors, Simcha Hyman and Naftali Zanziper.
In 2012, they started a medical-supply company, which they sold before forming The Portopiccolo Group, a private equity firm in the greater New York area that began investing heavily in nursing homes and assisted living centers through the newly created Accordius, according to public documents and the group’s website.
In 2016, Accordius bought its first N.C. nursing home in Gates County, then five more in 2017. From that point, the chain’s expansion accelerated. Accordius acquired 15 facilities in 2018 and 19 more last year, including The Citadel Salisbury. Two other nursing homes in the state have been purchased by a relative of Hyman, government documents show.
In a statement on its website, Accordius touts its rapid growth.
“Our quest for quality began just four short years ago,” it says. “Since then, we have successfully implemented our business model and rapid cycled our acquisitions through changes that have improved both satisfaction scores and regulatory outcomes ... and you will always find us improving.”
Any improvements Accordius has made are not yet reflected in the federal ratings of many of their N.C. homes.
The Centers for Medicare and Medicaid Services rates 21 of the chain’s facilities — including The Citadel Salisbury — as one star, or “well below average.”
Another nine Accordius properties are rated two stars or “below average,” meaning more than three-quarters of the Accordius properties are graded at below average or worse.
Medicare and Medicaid reimbursements are the main source of income for for-profit nursing homes, which make up two-thirds of the U.S. industry. The ratings by the federal programs are based on state inspection reports, staffing and quality measures.
Stoltzfus, The Citadel’s administrator, says it can take several years for improvements in conditions to be reflected in government ratings.
The Observer emailed the Portopiccolo Group questions about Hyman’s and Zanzibar’s acquisitions, the facilities’ ratings, and any role that the investment group played in setting treatment policies for The Citadel during the COVID-19 outbreak.
In an unsigned reply, Portopiccolo referred all questions to Accordius’ Kim Morrow, who did not respond to a follow-up email. In a previous interview with the Observer, Morrow said Accordius’ treatment policies were based on guidance from federal, state and local health officials.
Ratings vs. Covid-19 cases
Other than The Citadel, the only other outbreak of any size in an Accordius-owned home in North Carolina is at Pelican Health Henderson, a three-star facility north of Durham. There, 77 cases have been reported and 14 have died, the state Department of Health and Human Services says.
Across the state line, the one star-rated Accordius Health in Harrisonburg had one of Virginia’s worst COVID-19 outbreaks. Eighty-one residents and staff tested positive for the disease. So far, at least 22 people have died.
An employee of the Virginia facility made many of the same complaints appearing in the affidavits filed by The Citadel nurses. In both places, employees said they were unprepared and under-protected for what they had to face.
In Harrisonburg, nursing assistant Kanesha Hamilton told the Staunton Daily News-Leader that the Accordius staff lacked adequate protective clothing and equipment, and that she was forced to reuse a medical gown she wore to treat a COVID-19-infected resident.
“All of this could have been prevented,” she said. “We told them over and over and over that we didn’t feel comfortable working there. I’ve never been in the dark so much. It was like we’re figuring it out as we go.”
In an April 19 statement, Morrow said the virus hit the Harrisonburg nursing home “like a freight train.”
“We literally went from 1 mildly symptomatic case to 50 in 72 hours. There is still so much scientifically that is unknown about this virus and we, along with the rest of the medical and healthcare community are learning every day.”
A week earlier and 250 miles to the south, the results from the donated tests had come back for The Citadel’s residents and staff.
There, the cases jumped from one to 96.
This story was originally published June 12, 2020 at 1:35 PM.
