In July 2011, after Rahn Hoskins suffered a stroke and lost the use of his right side, he was admitted to a skilled nursing facility run by Fairmont Hospital in San Leandro.
He was beginning to learn to walk again with assistance and his wife, Sandra Newell, was hoping he would be able to return to their Oakland home soon. Instead, a sore developed that was so severe that the Air Force veteran of the Vietnam War lost his leg.
Doctors only discovered his condition when he was delivered to Eden Medical Center's emergency room on Nov. 28, 2011. There, staff unwrapped the bandage on his left foot and found two infected wounds whose stench "enveloped the room," according to a lawsuit filed against Fairmont Hospital in the Alameda County Superior Court by his wife for "reckless or willful neglect."
Doctors had to amputate his gangrenous foot to save his life. They had to take the leg below the knee because the infection had spread from his foot into the bone and into his blood, causing kidney failure, according to the lawsuit and a California Department of Public Health inspection report from April 2012.
An Eden doctor later stated, according to the lawsuit, that the pressure sores would have had to have festered for at least three weeks in order to have reached such a dire stage.
Hoskins, then 56, was also anemic and malnourished. Pneumonia had developed in both lungs and he had lost so much blood that he required a transfusion. The infection had produced a fever that left his disoriented for at least two days.
The state fined the facility $15,000 in April 2012 and its investigation reinforced Hoskins' claims about his treatment at Fairmont, a taxpayer-funded hospital that is part of the Alameda County Medical Center. State records from a previous inspection also show a pattern of neglect and understaffing endured by others at the San Leandro facility.
"I was learning to walk one day and the next thing I knew I was in the hospital, and my foot was gone," Hoskins said Wednesday. He was sitting in a wheelchair, which he had received that day through his Veterans Affairs benefits, outside the whitewashed long-term care wing of the Fairmont campus. Carefully clipped hedges, trim lawns and towering evergreens and magnolia trees surrounded the building.
"There was nothing I could do about it," he said in a quiet slightly slurred voice as two men in wheelchairs rolled by. "But I wondered why they did it."
State inspectors who investigated Hoskins' care at Fairmont attributed the festering sores on his foot to plastic support braces he wore under his tennis shoes. He couldn't feel the sore festering because of nerve damage to his extremities.
Newell had to battle staff to get Hoskins to the hospital, where the full extent of his injuries became clear to her on Nov. 28.
Hoskins and his wife had previously complained about Fairmont staff. He was often left sitting for hours and once his wife found him sitting in soiled adult diapers.
"There was nothing I could do but sit there," Hoskins said.
On another occasion, Hoskins had to slide out of bed and crawl on his hands and knees to get help from staff, who ignored his call light for hours. Staff documented the incident: "Patient found on the floor by patient room door, stating he was trying to go to the bathroom." In addition, the internal bleeding that had required a transfusion stemmed from staff withholding a gastrointestinal medication despite a doctor's prescription and weeks of heavy vomiting by Hoskins, the lawsuit claims.
State Public Health Department investigators had already documented similar complaints at Fairmont during a May 3, 2011, inspection. Their report described one patient forced to sit in a dirty diaper for hours after being given a laxative. One had a bed sore and another showed signs of one beginning.
Hoskins said some nurses have tried to be helpful, but are overruled by their superiors. "Unless you have someone to speak up for you, they'll throw you to the wayside," he said.
Alameda County Medical Center has hired an independent consultant to review practices at Fairmont's skilled nursing facility but would not comment directly, except to say the center takes the situation seriously because the case is being litigated. An ACMC spokeswoman would not say whether staff has changed at the facility or what has been done in the meantime to ensure that care there improves. The hospital administrator, James Jackson, did not return a message left with his assistant.
Newell visits her husband almost daily. Her efforts to transfer him to another facility were bogged down for a year while she tried to get Medi-Cal for her husband, a former guard employed by ABC Security Service Inc. in Oakland.
He had slipped through the cracks of the Veterans Affairs bureaucracy as well.
After Hoskins was released from Eden, Newell said he had return to Fairmont, although a VA spokeswoman said it didn't make sense for him to go back. But Newell said she couldn't get Hoskins out until he got Medi-Cal.
Hoskins said nothing has improved. Fairmont, he said, stopped teaching him how to use his prosthetic leg provided by his veteran's benefits about a month ago, and will not allow him to keep the artificial limb in his room. "The hard part is the waiting," he said, gripping his chair nervously and looking through the glass door at the clock inside the lobby, which read 2:45 p.m. "After 3 p.m. forget it."
If he's not in his upstairs room by 3 p.m., the staff will not help him get in bed, he said.
Hoskins now is Medi-Cal but said it will be at least two months before he can return home and receive in-house care.
"He's a grown man and he has to be in bed by 3 o'clock," Newell said, shaking her head before following him inside Fairmont.