STUART -- The recent outbreak of COVID-19 at Blue Ridge Therapy Connection didn’t surprise one man who says he had trouble this spring getting appropriate care for his mother, a resident there, with another infectious disease that is troublesome but not deadly.
“If they can’t handle scabies, they can’t handle COVID,” said Johnny Kastretsios, who said his mother, 90-year-old Goldie Kastretsios, has had both – making her one among 55 residents and employees who have tested positive for the novel coronavirus.
The outbreak of COVID-19 at the skilled nursing facility first became known about two weeks ago when the first cases were reported. Two of the patients who had tested positive at the facility for coronavirus have died.
But Goldie Kastretsios first was diagnosed and treated for scabies, a highly contagious condition, at Northern Regional Hospital in Mount Airy, N.C., after her son enlisted the help of her attorney, Wren Williams, and Patrick County deputies to get her removed from the nursing home for medical treatment after he became concerned that the condition was advanced and doubted the facility would have cared for it appropriately.
The Virginia Department of Health describes scabies as an infestation of the skin caused by a mite that burrows under the skin to feed and reproduce. That results in intense itching, and the skin has red and bumpy blisters.
“Scabies is most commonly transmitted through direct, person-to person skin contact … but it is possible to transfer mites on clothing, bedding, or furniture if they have been contaminated by an infested person,” the VDH website states.
Treatment involves applying a topical cream over the entire body, and measures must be taken to deal with potentially contaminated items such as clothing, bedding, linens or furniture.
VDH West Piedmont Health District Nurse Manager Verna Burnette said nursing homes are expected to report outbreaks of two or more scabies cases, whether the case was diagnosed through a skin-scrape or just visual assessment. That would allow the VDH to work with the facility to stop the infestation from spreading and to help prevent it from recurring.
There has been no report of scabies outbreaks from nursing homes in recent memory, West Piedmont Health District staff members said.
But two employees at Blue Ridge Therapy Connection have told the Bulletin that the facility had a known outbreak of scabies in May that affected many residents. These employees talked about the outbreak and other situations at Blue Ridge separately and independently from each other. They spoke on the condition of anonymity for fear of losing their jobs but out of concern for the residents. Their accounts also were confirmed by Kastretsios’ experiences.
Scabies is easy to diagnose visually, the Blue Ridge employees said, and many residents were diagnosed with scabies and treated with standard scabies treatments. They said the administration did not allow the diagnoses to be recognized officially to avoid the requirement that the outbreak be reported to the health department.
The Bulletin made repeated attempts on Thursday and Friday to speak about the alleged scabies outbreak with Blue Ridge Administrator Anthony Brunicardi, Blue Ridge Director of Nursing Holly Lambert and with Stephanie Shelton, an employee of neighboring assisted living facility The Landmark Center who recently was named spokesperson for Blue Ridge.
None of them responded, but at 5 p.m. Thursday Susan Almeida of The Rytes Company, a New York City-based crisis management public relations firm for health care companies, called to say that a statement would be sent that night or the next morning.
At 10 a.m. Friday, the Bulletin received a statement. It was 340 words long, but only 63 words at the end addressed the matter of scabies: “With regard to the incident to which you refer, we cannot confirm or deny any diagnosis for a particular resident but can say that a resident was sent to the hospital on or about May 28, 2020, at the insistence of a family member and was sent back to the facility by the emergency room without a confirmed diagnosis to support any allegation.”
But the Bulletin reviewed a medical report for Goldie Kastretsios from Northern Regional Hospital, issued at 8 p.m. May 28, that stated that Dr. Adam McHone diagnosed her with scabies, treated the condition and recommended a follow-up appointment.
‘What I saw shocked me’
Shortly after that incident on May 28, Johnny Kastretsios wrote down an account of what had happened. He said he had not realized until Friday that Williams, the attorney, also had made a 40-minute video of the situation. Both the written account and the video were provided to the Bulletin, and both men also described what happened. Patrick County Sheriff’s Deputy Matt Rorrer also confirmed their accounts.
At 2:50 p.m. on May 28, Kastretsios said, he called Blue Ridge Therapy Connection to bring his mother to a cafeteria entrance so he could visit with her through a window, which had become a daily routine during her (by now) year at the facility.
As Goldie Kastretsios was telling him that the pandemic-required isolation was difficult for her, he said, he noticed that her bottom lip was abnormally red and asked her about it. She said it was dry and sore, so he asked a certified nursing assistant to bring her some lip balm.
Not long after that, he said, he noticed that her neck looked red and irritated. He asked her to pull up her shirt so he could get a better look – and “what I saw shocked me so bad I pushed away from the door,” he wrote.
“Her torso was literally covered in small sores which she had been scratching to the point of bleeding.”
After he pressed a health care worker for an explanation, the worker, whom he didn’t identify, told him it looked like scabies, he said. He asked how staff could not have noticed such a severe case – her torso covered in red marks – when they were helping her change her clothes.
He demanded to speak to Lambert and a social services representative, he said. He said that Lambert, after looking at the marks on her torso, told him it looked like an allergic response to medication.
Johnny Kastretsios is the son of the late Dr. John A. Kastretsios, a longtime Stuart doctor, and a certified emergency medical responder with various related certifications through the U.S. Department of Defense. He is familiar with health care and knows that an allergic reaction can be deadly.
He said he told Lambert his mother should be seen immediately by a doctor, and Lambert told him that she would be seen the next day.
Kastretsios said he thought the situation was too dire to wait another day. He went home “to clear my mind and think the situation over. I came to the conclusion that their [Blue Ridge officials’] track record of getting back and replying was not good. I also felt under the circumstances I should have pictures,” he wrote in his notes.
Back with backup
Kastretsios went back to Blue Ridge around 4 p.m., calling ahead to have his mother back at a window, to get pictures. He also called his mother’s lawyer, Williams, who, in turn, called the Patrick County Sheriff’s Office.
“I knew this was not going to go well,” Williams said of his reason for calling law enforcement.
Kastretsios, having had arrived first and alone, wrote that Brunicardi and Lambert met him at the entrance without his mother -- “with what seemed to be a rather long eye-to-eye showdown.”
He said Brunicardi told him that he had heard Kastretsios was there for pictures and that taking pictures was “not going to happen.”
Kastretsios asked why, and, he said, Brunicardi replied that pictures are not allowed to be taken in the facility. Kastretsios said he pointed out that Facebook is full of pictures taken there.
Captured on video
Williams started recording the video when arrived. Kastretsios waited outside the building while Williams waited in the foyer.
“The tone that the facility was giving us changed a lot with the police officers showed up,” Williams said. “It changed from ‘You’re not taking her; she can’t leave, we’ll have her checked out tomorrow’ to ‘We’ll roll her over to the window, you guys can investigate … and then we will do what you guys request. They were more receptive.”
Twenty-three minutes into the video, Brunicardi comes from deeper inside the facility, walking past Williams and the deputies without comment to go outside to talk to Kastretsios, who is heard on the video telling him, “I’m done talking with you. I gave you a chance. You talk to my lawyer.”
“I would like to see Goldie Kastretsios. She’s my client,” Williams is heard on the video saying.
“Not unless there’s a medical reason,” Brunicardi replies.
“There is,” Williams says.
After a bit more talk, Brunicardi tells them that Goldie Kastretsios would be brought to a window for her son to see her and take a picture.
“I just got to make sure we honor her dignity. I had to talk to [indistinct] our nurse managers to make sure I’m doing the right thing here, because normally we don’t,” Brunicardi said. “But – we’ve got to get her somewhere over here, [indistinct] through the door. I can’t open the door under federal regs.”
Twenty-nine minutes into the video, Goldie Kastretsios is brought in a wheelchair to the window of a door.
“Hey, Mom, I got upset because you’ve got all those bumps on you,” her son shouts through the window. “You understand?”
A nurse lifts up her shirt, revealing deep red marks spaced just centimeters apart all over her torso. When Kastretsios asks if she would like to go to the hospital for that, she said yes.
When her son tells her it would have to be by ambulance – he had said separately that the administration told him she could not return to Blue Ridge if she went in the car with him – she becomes visibly upset and protests. He and the nurse talk her into agreeing.
“Mom, it’s going to be OK,” he says. “I want somebody to take care of this.”
Rorrer calls the dispatch center for an ambulance.
Reflecting last week on that experience, Kastretsios said, “People will look at the event and say, ‘What a horrible event,’ and what they should be looking at is: Why do they go to that extent keeping them [patients] there?”
Return to the West Wing
An ambulance from Jeb Stuart Rescue Squad took Goldie Kastretsios to Northern Regional. After she returned that night by ambulance, she was put in a 14-day quarantine in Blue Ridge’s West Wing, Williams said.
That is the area used for quarantine for patients who come from the outside to Blue Ridge, and it also had housed residents who had showed symptoms of the novel coronavirus.
A third statement from Blue Ridge Therapy Connection, in response to repeated requests for interviews, received at 4:39 p.m. Friday, was similar to one received at 2:37 p.m.
“We have people at the facility whose lives are at risk because of COVID-19 both those infected and those who are negative. We had hoped that journalists would understand our need to keep our focus on care. We sincerely hope that you do not paint our facility in a poor light, but our jobs and life’s mission is to protect the health, safety, and welfare of our residents. We intend to stay focused on that mission.”
‘Difficult to get through’
Kastretsios said this one instance is just an example of what he sees as troubles in the facility.
Forty-two residents – a quarter of the 160 people who live there – and 13 staff members have tested positive for the coronavirus, according to a statement released by the company’s public relations firm.
His mother ended up being one of them. He said he doesn’t remember the exact date he learned, but the first positive test at Blue Ridge was confirmed about two weeks ago.
He has had difficulty getting information about her and the coronavirus situation there, he said. It’s consistently been “very difficult to get through” by phone, and of course, visits aren’t allowed.
Blue Ridge Therapy Connection and The Landmark Center formerly were operated by a family and were purchased in July 2019 by Hill Valley Healthcare, Shelton has said. Hill Valley Healthcare is a new company formed by “operators of other skilled nursing facilities prior.” It owns a third facility in Pulaski County and aims to buy more, she had said.
Blue Ridge employees who have spoken with the Bulletin said the reason the outbreak there is so bad is that the administration held off as long as possible in getting facility-wide testing, because they wanted to be able to continue to say they did not have any cases.
Many patients had shown symptoms of COVID-19, they said. A few patients with the most severe cases were tested (before the first positive cases two weeks ago), and results came back negative. However, many other patients had milder symptoms of COVID-19 and were not tested.
Meanwhile, those employees said, several employees were coming to work with signs of being sick – some of them after trips to known coronavirus hot spots, such as the beach. The administrators at first told sick employees they had to come to work but had to wear masks while there, but eventually they stopped reinforcing the mask rule.
The employees said Blue Ridge required staff to wear a mask for about two weeks or until it was obviously dirty before getting a replacement mask. Paper gowns that were supposed to be changed between patients were expected to be worn all day.
However, many employees do not wear masks at all, or wear them hanging from their ears or below their noses, they said.
“Due to the COVID-19 pandemic, Blue Ridge Therapy Connection needs to devote 100% of our attention to the care of the residents,” reads the second of the three statements Blue Ridge sent the Bulletin about the scabies outbreak. “We will try to provide updates from time to time and respond to questions in writing as we can. We hope that you understand.”
Blue Ridge 9 mother talks to son
Blue Ridge 1
Blue Ridge 2 a Brunicardi enters foyer
Blue Ridge 2 Brunicardi enters foyer
Blue Ridge 4 deputies go around back
Blue Ridge 5 Johnny waits for his mother
Blue Ridge 7 Goldie Kastretsios
Blue Ridge 8 hands
Blue Ridge 10 deputy calls ambulance
Blue Ridge 11 deputy calls ambulance 2
Dr and Mrs Kastretsios
-- HIDE VERTICAL GALLERY ASSET TITLES -- (copy)
Blue Ridge Therapy Connection building
Blue Ridge Therapy Connection building entrance
Holly Kozelsky is a writer for the Martinsville Bulletin; contact her at 276-638-8801 ext. 243.
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