BELLINGHAM, WA - State surveyors cited Shuksan Healthcare Center for immediate jeopardy to resident health and safety after the facility's laboratory services were suspended due to unpaid bills, preventing critical medical testing for multiple residents.
Critical Medical Testing Suspended Due to Financial Issues
The Washington State Department of Health determined that immediate jeopardy conditions existed at Shuksan Healthcare Center beginning April 23, 2025, when the facility's laboratory services vendor placed a hold on services due to non-payment. This disruption affected at least four residents who required essential blood work to monitor medication levels and health conditions.
According to the inspection report, the laboratory services provider confirmed that facility lab services were placed on a non-payment hold on April 23, 2025, which had not been corrected at the time of the survey. The facility's primary laboratory vendor, Trident Lab Corporation, was owed $9,536.92 with invoices dating back to November 30, 2024.
The suspension of laboratory services created dangerous gaps in medical monitoring for residents with serious health conditions. Four residents specifically identified in the report faced potentially life-threatening situations due to missed testing.
Medication Monitoring Crisis Endangers Residents
Two residents requiring Depakote level monitoring were particularly at risk during the laboratory service suspension. Depakote is an anti-seizure medication that requires regular blood level monitoring to ensure therapeutic effectiveness while preventing dangerous toxicity.
Resident 10's Depakote level was not obtained during the suspension, as was Resident 34's Depakote level, according to the survey findings. These tests are critical because Depakote has a narrow therapeutic window - too little medication may fail to prevent seizures, while too much can cause serious side effects including liver damage, blood disorders, and neurological complications.
Medical protocols for patients on Depakote typically require blood level monitoring every few months or more frequently if dosage changes occur. When these levels cannot be monitored, healthcare providers cannot safely adjust dosages or detect early signs of toxicity. Patients may experience breakthrough seizures if levels drop too low, or face serious adverse reactions if levels become too high.
Additionally, Resident 95 missed both a Comprehensive Metabolic Panel and Complete Blood Count. The Comprehensive Metabolic Panel provides crucial information about kidney function, liver function, blood sugar levels, and electrolyte balance. A Complete Blood Count evaluates red blood cells, white blood cells, and platelets, helping detect conditions ranging from anemia to infections to blood disorders.
Resident 7 was unable to receive a Hemoglobin A1C test, which measures average blood sugar control over the previous three months. This test is essential for diabetes management, helping determine if current treatment plans are effective or need adjustment.
Healthcare Provider Notification Failures
The inspection revealed concerning gaps in communication regarding the missed laboratory testing. When asked whether healthcare providers had been notified about the inability to obtain ordered lab work, the Resident Care Manager stated they did not know if physicians had been informed.
This communication breakdown represents a significant failure in continuity of care. Healthcare providers rely on timely laboratory results to make informed decisions about medication adjustments, treatment modifications, and ongoing care planning. When providers are unaware that ordered tests were not completed, they may continue with treatment plans based on outdated information, potentially compromising patient safety.
Standard healthcare protocols require immediate notification of physicians when ordered tests cannot be completed, along with documentation of alternative arrangements or revised monitoring plans. The facility's failure to ensure this communication occurred placed residents at additional risk.
Systemic Financial Distress Threatens Operations
The laboratory service suspension was part of a broader pattern of financial difficulties that threatened essential services throughout the facility. Multiple vendors had issued demand notices or threatened service disconnections due to unpaid bills.
Cascade Natural Gas issued an urgent past due notice requesting payment of $1,877.85 by April 22, 2025, warning that service could be disconnected without payment. Gas service is essential for heating, hot water, and food preparation in nursing facilities.
The City of Bellingham sent a water shut-off notice on April 7, 2025, with a scheduled disconnection date of May 7, 2025, for $2,487.91 in past due charges. Water service is fundamental to basic sanitation, infection control, and resident care.
Staffing agencies were also affected by payment delays. Kavala staffing agency was owed $191,210.01 for services from November 25, 2024, through March 21, 2025. Clipboard staffing agency, owed $2,563.89, threatened to cease sending staff after May 5, 2025. Adequate staffing levels are regulated requirements essential for resident safety and quality care.
The facility also owed KCI medical supply company $12,550 for supplies dating back to October 21, 2024. Medical supplies are necessary for wound care, medication administration, and infection control procedures.
Impact on Staff and Payroll Operations
The financial difficulties extended to employee compensation, with anonymous facility staff reporting that the facility had delayed payroll on one recent occasion. During this period, staff lost benefits and had to pay out of pocket for medical appointments and prescriptions.
Payroll delays can significantly impact staff retention and morale, potentially leading to increased turnover rates. High turnover in nursing facilities is associated with decreased quality of care, as experienced staff leave and new employees require time to become familiar with resident needs and facility procedures.
The loss of employee benefits creates additional financial hardship for workers and may affect their ability to maintain their own health, potentially impacting their capacity to provide quality care to residents.
Administrative Response and Corporate Structure
During interviews, facility administrators indicated that while they received and processed invoices, payment decisions were made at the corporate level. The Business Office Manager stated that invoices were processed and sent to the corporate office for payment, explaining that they received calls daily from vendors regarding overdue balances and could only forward that information to corporate.
The facility Administrator was aware of the lab services hold but thought it had been taken care of. They also acknowledged awareness of demand bills from the natural gas company and confirmed that the facility was paying bills late or had payment plans in place with some vendors.
The Chief Operating Officer stated that the corporation managed vendor contracts and payment plans according to individual arrangements and that the facility was managing cash flow.
This corporate structure created a disconnect between local facility operations and financial decision-making, potentially contributing to delays in addressing critical vendor relationships that directly impact resident care.
Resolution and Corrective Actions
The facility was able to remove the immediate jeopardy citation on April 26, 2025, after taking corrective actions. The facility ensured past due resident lab testing had been completed and established an active laboratory services vendor. They provided evidence of vendor contract payments to ensure continuity of essential services and audited all resident laboratory orders to identify and complete missing tests.
However, the incident highlighted significant systemic issues regarding financial management and its potential impact on resident care and safety in nursing home facilities.
Additional Issues Identified
Beyond the laboratory service crisis, surveyors documented the facility's inability to meet financial obligations to essential service providers including utilities, staffing agencies, and medical supply companies. The facility owed the state Safety Net Assessment account $119,996.01 as of April 7, 2025, which was 60 days past due. These widespread payment delays created vulnerabilities across multiple aspects of facility operations essential for resident safety and quality care.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Shuksan Healthcare Center from 2025-05-01 including all violations, facility responses, and corrective action plans.
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