TOPSFIELD — Four nursing assistants have been fired and two top administrators replaced at one of the state's top-rated nursing homes, in the wake of patient abuse allegations.

A report completed last month by state investigators alleged that at least a dozen residents of the Masconomet Healthcare Center in Topsfield were subjected to various forms of verbal abuse and humiliation — including one patient with dementia who was recorded on a cell-phone camera answering questions in a confused manner, to the amusement of a nursing assistant who then shared the video with coworkers.

The report says a group of four certified nursing assistants routinely engaged in sexually explicit or otherwise offensive taunting of patients, sometimes about their physical or mental condition, and that some would deliberately provoke patients into an agitated state to avoid having to provide care for them during their shifts.

All four were suspended from their jobs and later fired, a lawyer for the facility said. The administrator of the 123-bed facility and the director of nursing were also suspended and have been replaced, said Kathy Soderberg, corporate counsel for the nursing home's parent company, Whittier Health Network.

Criminal charges are also possible. Topsfield Police Chief Evan Haglund said he is aware of the matter but referred questions to the Attorney General's Office.

At least seven other employees, including a nurse, were aware of at least some of the incidents but failed to report them to administrators, who did not learn of the violations until February, the report by the Department of Public Health says.

The facility is still considering disciplinary action against those employees, Soderberg said.

The alleged abuse was brought to light by an employee at the facility, Soderberg said.

The report charged the facility with providing substandard care, specifically by violating regulations requiring that patients be free from abuse or involuntary seclusion, that any such abuse be immediately reported and that the facility's care and environment provide for quality of life.

The facility was ordered to pay a $3,000-a-day fine starting March 25, the date of the report, and continuing until the violations were addressed. A plan of correction has since been filed and accepted by the state, which notified the nursing home last Wednesday that it now considers it to be in substantial compliance.

Soderberg said in the statement that the violations have all been corrected, and workers are being retrained in, among other issues, abuse-reporting requirements. The facility is also scheduling meetings with patients and their families.

The report, which does not identify any of the fired workers by name, depicts an atmosphere where the four accused nursing assistants regularly used profanities around patients; engaged in conversations about their personal lives, including sexual activities and illicit drug use, in front of patients; played loud music on their cell phones; and were at times more concerned with sending text messages to friends than providing care to patients, who were told to wait.

Taunting, ridiculing patients

But the alleged abuse of patients went far beyond that, the report states.

One patient, suffering from dementia, was recorded on a cell phone answering a series of questions from a nursing assistant identified as "accused CNA #1" in the report, who can be heard laughing at the patient's confused responses. That CNA went on to share the video with others at the facility.

An employee interviewed by investigators said that same CNA regularly took photos in patient rooms on her cell phone. It is not known what became of those photos or whether they included patients.

In addition, a patient at another, unidentified nursing home where one of the four accused nursing assistants had gone to work last December was apparently photographed while sitting on a toilet, partially undressed, a photo that was then shared with two other CNAs working at Masconomet at the time. They then showed the photo to coworkers.

Another patient with confusion and a history of making sexually inappropriate comments was taunted by an employee identified as "accused CNA #3," who was overheard telling the patient that she was engaging in sexual relations with the patient's husband and that "he tells me I am better in bed than you are" and that her husband was leaving her.

The same accused CNA allegedly told another patient that she was going to die at the facility because her husband no longer loved her. That patient was also taunted about her weight by at least three of the accused CNAs. "Accused CNA #3" allegedly shoved a cookie into the woman's mouth and called her a "pig," according to the report.

A male patient was allegedly taunted and mocked by all four fired workers for having a penile implant, which one of the group demanded that he use in her presence.

A woman patient with short-term memory loss was driven to tears by repeated requests to recount past domestic abuse. When another employee tried to cut off the questioning, two accused CNAs slammed the door in her face. When that employee then tried to report the incident to a nurse, the nurse told her to mind her own business, according to the report, and never reported it to her superiors.

'Driven to tears'

Another patient was driven to tears by "accused CNA #3," who complained to the patient that her colostomy bag smelled.

The workers regularly engaged in behaviors such as mocking and mimicking patients in order to get them agitated, which would then allow them to avoid caring for those patients, the report said.

One patient, now deceased, was referred to as a (expletive) who "doesn't deserve our time," by three of the workers. Another patient was allegedly denied care because he was unable to complain.

A male patient was called a "sexy dog" and invited to slap the backside of "accused CNA #2" while she danced around him.

And one patient with dementia would be rapidly undressed, upsetting her, by two of the CNAs, one of whom would also grab the patient's doll and pull it away from her to upset her, then joke about it later.

When another worker confronted two of the CNAs about their inappropriate conversations in front of a patient, they contended that the patient did not understand because he or she had aphasia (a language ability disorder).

The incidents allegedly occurred in 2010 and in the first two months of 2011.

Reports of patient abuse are forwarded as a matter of law to the Attorney General for possible prosecution. A spokesman for the agency said he could not confirm the existence of an investigation at this point.

The license status of the four fired workers also remains unknown.

The Salem News obtained a copy of the report and related correspondence from the federal Department of Health and Human Services under a Freedom of Information Act request. State public health officials denied a similar request for the report under the Massachusetts public records law.

Masconomet Healthcare, which is located on High Street a short distance from Route 1, is owned by LNF Corp., operating under the name Whittier Health Network. It is a Haverhill-based company that owns nine nursing homes around Massachusetts and in upstate New York, and three rehabilitation hospitals.

The company's founder and president, Dr. Alfred Arcidi, is a well-known figure in the Merrimack Valley, where in addition to health care facilities he has also developed or attempted to develop other projects.

Courts reporter Julie Manganis may be reached at 978-338-2521 or at jmanganis@salemnews.com.

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