Arizona Health Director Cara Christ says auditors looked at a “very narrow non-representative sample” of complaints.

PHOENIX — State health officials are slow to investigate reports of abuse and neglect at long-term-care facilities, to the point that residents may be put at risk, according to a new audit.

The sometimes blistering report about the Arizona Department of Health Services found that 14 of 33 complaints it examined had been open at least 229 days without an investigation.

State auditors cited one complaint, submitted by another state agency, which alleged inadequate staffing levels had caused a resident who was unable to feed or to use the restroom without assistance, to be soaked in urine and have their clothes stained with dried food. That complaint, the report said, was not investigated for 851 days.

The auditors’ report does not name any of the facilities or the patients.

The report also faulted the health department for classifying a third of “self-reports,” those submitted by licensed long-term-care facilities, as needing no action beyond reviewing a facility’s internal investigation of the incident.

That makes no sense, the auditors said, as facilities are required to report only items that are potential regulatory violations — incidents in which the health department is required to determine if a violation occurred.

Auditors pointed to one self-report that was closed with a “no action necessary” conclusion on the same day it was reported, an incident that involved “allegations that a resident with ambulatory issues was being thrown around like a ‘rag doll’ by a staff member.”

In a formal response, state Health Director Cara Christ disputed the findings, contending the auditors failed to “provide context” in terms of all of the roles of her agency.

“Long-term-care facilities represent less than 0.5% of total licensees under department regulation,” Christ said.

She said the auditors, who acknowledged they looked at only a sample of all reports, saw only 0.4% of all complaints received by her department during the two-year period under evaluation.

“Rather than articulating how the department performs across this wide range of activities to protect public health and safety and investigating and resolving complaints within its jurisdiction, the audit findings focus on this very narrow non-representative sample,” Christ said.

Christ also said her department evaluates facilities for the federal Centers for Medicare and Medicaid Services and “is currently in compliance with those requirements.”

“The audit establishes expectations for the department beyond those that exist in its agreement with CMS or as currently established by the Legislature,” she wrote, including determining acceptable time frames — and without regard to available resources.

She did, however, agree to do more to allocate new staff or reallocate existing staff to prioritize, investigate and resolve complaints about long-term care facilities. And she said her department is assigning two additional staffers to handle complaints.

But Christ suggested that resolving the problems may require more than just changing assignments.

“The department believes an additional 44 staff and an additional $3.3 million appropriation and general fund allocation will be needed to timely adjudicate the nearly 2,500 complaints received annually,” she said.

State auditors said the primary responsibility for investigating allegations of abuse, neglect and exploitation of vulnerable adults in Arizona is with the Department of Economic Security.

But it is the role of the health department to review the facility’s practices, policies and procedures to determine if there are “appropriate safeguards in place to mitigate the likelihood of abuse occurring.”

And the report warns that the health department not investigating complaints or taking too long to get them resolved “may put residents at risk.”

The auditors cited one complaint by a nursing student who was on rotation at a long-term care facility who alleged residents were being subjected to abuse, neglect, unsanitary conditions and inappropriate quality of care and treatment. Yet that complaint had been open and uninvestigated for 299 days.

“By not initiating an investigation of this complaint, the department has yet to determine whether the allegations were substantiated (or) unsubstantiated,” the report says.

And if they were substantiated, the auditors said, the health department should take action, ranging from requiring the facility to develop and implement a plan of correction, to revoking the facility’s license.

“The longer a complaint or self-report remains uninvestigated, the more likely potential problems or violations will remain unaddressed,” the report says.