Patch and switch 

Mismanaging pain in a Ronan nursing home

Berniece Bjarko died in pain—unnecessary pain, says attorney Tony Shapiro. A resident of Westside Care Center in Ronan, Mont., Bjarko suffered from dementia and rheumatoid arthritis. To handle the pain, Bjarko was prescribed Fentanyl Transdermal pain patches, but increasing dosages didn’t seem to help. Shapiro and former members of the Westside nursing staff say that the dosage wasn’t the problem; they allege that Westside administrator Wendy Wadsworth was stripping Bjarko of the patches to feed her own drug habit.

With over 1.5 million elderly now living in nursing homes throughout the country, abuse and neglect scandals have become increasingly common. A study by the Special Investigations Division of the House Government Reform Committee found that 30 percent of nursing homes in the United States—5,283 facilities—were cited for almost 9,000 instances of abuse over a two-year period from 1999 to 2001.

“Abuse does happens,” says Shapiro, who has come across dozens of examples in his work. “And we are seeing more instances where nurses will divert pain medication. I can’t give you a number of how often it happens, but let me put it this way, it’s not unique.”

But Shapiro says that there is more to Bjarko’s case than the typical abuse story. Bjarko’s case involves a mixture of secrets, fear and small town politics, says the attorney.

Wadsworth’s parents, Faye and Wendell Abrahamson, own the facility; her husband is the local chief of police; and according to the mediation memorandum submitted by Shapiro, Wadsworth’s parents knew their daughter had a drug problem, but continued to let her work as the center’s administrator.

“I suspect that [Faye and Wendell] were willing to look the other way, where someone who was independent would not have,” says Shapiro. “There was clearly evidence that they were not taking it as seriously as they should have, and they were assuming that things were OK and not understanding their daughter’s prior history.”

Wadsworth fell under suspicion after a group of nurses heard stories from Bjarko and another resident that the administrator was taking off residents’ patches and replacing them, according to the memo. Both Bjarko and the other residents were too confused to understand why Wadsworth was doing this, says one former Westside nurse, who doesn’t want her name printed for fear of reprisal from Wadsworth’s husband.

“I was shocked, I was freaking out,” she says. “Those patches would come up missing every once in while, but with a shower that can probably happen. But that wasn’t the case with these patches. These patches were being replaced by old ones.”

According to Shapiro’s memo and the nurse, staff members began noticing that minutes after Bjarko’s pain patches were changed, Wadsworth would insist on privately visiting with Bjarko—something she didn’t do with the facility’s other residents. The memo, corroborated by the nurse, goes on to say that a few staff members developed a protocol whereby they marked the patches to be placed on Bjarko. After Wadsworth visited with Bjarko, a staff member would check and see that the new patch had been removed and replaced with an old one.

For months, the handful of staff members knew about the problem, but didn’t come forward, according to the memo.

“This was the first time I had been in this situation, and it was the first time the other nurses had been in this situation, and quite frankly we didn’t know what to do,” says the nurse. “We just had no one to go to.”

According to regulations, nurses are required to report such abuses to facility administrators, says Shapiro. But when it’s the administrator who’s the suspect, the whistleblower loophole disappears, he says.

“This is a small town, and the chief of police was the administrator’s husband,” says Shapiro. “So this was a very tangled web, and frankly the nurses were fearful for their jobs. They were fearful for a lot of things, living in very much a Peyton Place small town, and thought if they came forward they would have hell to pay.”

The nurse who won’t reveal her name eventually came clean with Bill Bjarko about her suspicions after his mother had died. By then, she had quit and was getting ready to leave town.

“Some detectives from Polson advised that it’d be best if I left,” she says. “I had to leave the state because [Wadsworth’s] husband’s the chief of police. What would stop him from pulling me over and putting drugs in my car? I’d go to jail for the rest of my life.”

Based on his conversation with this nurse, Bill Bjarko hired Shapiro and began a two-year legal battle. The case never went to trial; instead, it was finally settled out of court in late July. The terms of the settlement preclude the disclosure of the settlement amount.

Phone calls to both Wadsworth and her husband weren’t returned, but Faye Abrahamson did give the Independent one quick, deliberate statement about the settlement.

“It was mainly settled to settle it,” says Abrahamson. “But we absolutely deny the accusations and that’s in the settlement.”

While Abrahamson says that no wrong was done, her daughter no longer works at Westside, and Shapiro considers the settlement a victory based on the amount awarded to the Bjarko family. The Bjarko family, happy that it’s finally over, won’t comment, says Shapiro.

“They are very private,” he says. “They do feel that this is obviously very wrong, but they don’t want to have their lives uprooted any more.”

The nurse who left the state is glad to find out “her side won,” but says that doesn’t mean it’s over for her and the other nurses who had to leave Westside and Ronan behind.

“I should have sued, because this has made my life hell,” she says. “It hangs on me like a cloud and I wish it had never happened.”

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