Nursing home records may have been falsified

State regulators are investigating whether nurses falsified patient records, and then lied about their actions, at a troubled Wilmington nursing home where two residents died, according to the Massachusetts Department of Public Health.

That agency has referred the case to the Board of Registration in Nursing, which has the power to strip nursing licenses.

The investigation highlights a troubling and all-too-common problem at nursing homes — inconsistent and sometimes manufactured nursing notes — say attorneys who have represented families of patients harmed at other facilities.

Federal regulators last week closed their investigation of Woodbriar Health Center, saying the nursing home submitted acceptable plans to correct significant health and safety problems linked to two patient deaths since December. But documents from that investigation indicate inspectors doubted the veracity of nursing notes Woodbriar submitted to the health department during its review.

The company that owns the nursing home, Synergy Health Centers of New Jersey, did not respond to a request for comment.

Woodbriar was “unable to provide documentation that a thorough clinical assessment” was completed on a woman after she fell out of bed Feb. 8, begins one 30-page report from the health department. The resident was discovered dead in her bed several hours later.

The report details several documents reviewed by the health department, including a medication record generated two days after the patient died.

Inspectors also reviewed a handwritten “neurological assessment” report that allegedly reflected doctor-ordered checks by nurses of the patient every two hours after she fell out of bed. That record was faxed by Woodbriar officials to the health department March 22.

The department compared the signatures of two nurses on that document to their signatures on employment applications and education records and determined they did not match, according to the inspection report.

Investigators also interviewed the two nurses separately March 22 and March 23 and heard conflicting stories that changed over the course of two days about the care they provided the patient, according to the report.

The nurses’ accounts also clashed with the documents sent earlier by Woodbriar, the state’s report said.

On March 25, Woodbriar e-mailed a copy of yet another record regarding the patient’s care in the hours before she died.

“This documentation was not consistent with initial statements made by [the two nurses],” the report concluded.

A nursing supervisor later told state inspectors that all of the patient’s records were included in one electronic file, but it did not include a copy of the handwritten neurological assessment Woodbriar had faxed the department.

It is not clear how many nurses from Woodbriar are being investigated by the state nursing board.

The inspection reports did not identify nursing home workers by name.

“I can confirm that there are multiple nurses,” state health department spokesman Scott Zoback said in an e-mail. He declined to elaborate.

Several lawyers who have sued Massachusetts nursing homes after patients were hurt said they have rarely encountered such a blunt state inspection report. But the attorneys said they often confront nurses’ notes that are clearly fabricated.

“We have had plenty of instances of [nursing assistants] documenting they repositioned people who are dead. They were already in a funeral home,” said Tom Worboys, a Boston attorney who specializes in nursing home cases at Colucci, Colucci, Marcus & Flavin.

Worboys, who used to represent nursing homes, said sometimes the inconsistencies were honest mistakes stemming from chaotic situations in which nurses were caring for too many patients.

“More often than not, there really is no good explanation,” Worboys said.

Marianne LeBlanc, a partner at Sugarman law firm in Boston, said she, too, has sued nursing homes in cases that involved doctored records.

“It calls into question all of the record keeping,” LeBlanc said.

“The documenting of care provides the premise for future care, so people need to be looking at that to know what is going on with the patient,” LeBlanc said. “If it is not being done contemporaneously, that puts the patient or resident at risk.”

Massachusetts Senior Care Association, the trade group that represents nursing homes, said in a statement it has never heard of altered nursing records being a common problem.

“We expect all registered nurses in nursing homes to adhere to licensure guidelines and practices, which are very clear,” said Jennifer Chen, the association’s spokeswoman. “We work regularly with state officials to ensure nursing home regulation is fair, thorough, and of the highest standard.”

The federal Centers for Medicare & Medicaid Services fined Woodbriar $288,400 for health and safety violations in connection with the February patient death and a resident death in December.

Three families with relatives in Woodbriar said staff members in recent weeks have worked hard to address problems at the facility.

“I truly have noticed a huge improvement in the past few weeks,” wrote one family member who asked that her name not be used because she worries it will affect her mother’s care.

“I have also noticed a lot of new staff who display a much better understanding of dealing with the patients than I had previously observed.”