Kathy Stark-Brewer of Rapid City was frantic when she reviewed her mother's prescription bill in July and found she had gone through hundreds of prescription painkiller pills over the course of a couple of months.

"I was very upset to think that someone would harm my mother, and I was fearful she was getting the medication and that my 93-year-old mother possibly had a drug addiction," Stark-Brewer said.

She said she noticed 600 Percocet tablets were ordered for her mother in one month while she was a resident of Morningstar Assisted Living center in Rapid City.

"It's not possible for someone my mother's age and body weight to consume that much in that amount of time," she said. "It would kill her."

But Stark-Brewer later found out that her mother, Marie Huckfeldt, was not taking those pills, OxyContin and Percocet, which had been prescribed for her occasional migraine headaches.

Upon reviewing her mother's medical records, Stark-Brewer said she found that her mother had been given the Percocet only three times and the OxyContin once over the course of a few months at Morningstar.

That's when Stark-Brewer said she discovered an employee at Morningstar was pocketing the pills. She immediately confronted the employee and facility owner and contacted police.

Sgt. Mark Hughes of the Unified Narcotics Enforcement Team said the incident is under investigation.

The employee's name has not been released because an indictment has yet to be made.

Janice Zandtra, owner of Morningstar, said the employee was immediately fired.

Zandstra said the center now has measures in place to prevent such an incident from happening again. "We don't condone anything like that."

Zandstra said she was shocked at what happened.

She said residents at Morningstar can have visitors at any time and receiving visitors is good for their mental and physical health.

She also said it is a good idea for family members of long-term care facility residents to periodically look at prescription records.

Zandstra said family members should not hesitate to ask questions of the facility staff and their loved one's physician.

"Keep track of what's being done and why," she said.

Stark-Brewer said she had no idea how long Medicare had been paying for prescription drugs her mother was not taking. When the amount of pills being ordered by the Morningstar employee increased and Medicare would not pay the prescription, Stark-Brewer had to foot the bill.

"Basically, it was Medicare fraud," she said.

Clare Absher, a registered nurse with Care Pathways, a long-term care assistance directory based in North Carolina, said having family members or friends stop in regularly is the best way to ensure a resident is receiving the best possible care.

The first priority of family members moving someone into assisted living or long-term care is to have that facility be in the same region as at least one family member.

"If it's at all possible, have them be at least somewhat near a family member," Absher said.

That allows for more visits, which helps ensure better care.

Gina Schweitzer, one of the owners of There's a Hart assisted living center in Rapid City, said regular visits are also good for the residents' health and raise their spirits.

"We encourage visitors," she said.

Schweitzer said patients in long-term care or assisted living centers have the right to have visitors at any time.

At There's a Hart, visitation after 10 p.m. is discouraged because most residents are asleep by then, but it is not restricted.

Susan Feeney, spokesperson for the American Health Care Association, based in Washington, D.C., said abuse, neglect and fraud in long-term care facilities are rare but when incidents occur, nursing facilities must deal with them as quickly as possible.

"Issues of fraud, abuse or neglect should never be tolerated in long-term care facilities," Feeney said.

"It is important for family members to be involved in the care of their loved one," she said.

Feeney said that applies whether the person lives in long-term care or independently.

Feeney said concerns about care should be directed to the facility manager and, in some cases, to authorities.

"Any time anyone has questions or care, it should be reported immediately to the administrator of the facility," she said.

"If the administrator acts promptly, that's a sign that the facility recognizes what needs to be done and keeps the needs of the residents a top priority."

Now, Stark-Brewer is more vigilant and said it is crucial that others with loved ones in long-term care facilities be cautious as well.

"For me, it's critical that I understand what drugs are being dispensed to my mother and why," she said.

That means sitting down with her mother's doctor, asking a lot of questions and keeping a closer tab on prescription billing statements.

Schweitzer said confidentiality laws do not allow just anyone to view a resident's medical charts, but primary family members can speak with staff and look at records if they are concerned about anything.

"The rights of the resident are always first and foremost," she said.

Schweitzer said that at There's a Hart, prescription drugs are monitored closely and locked in a secure place.

Every time medication is administered, it is documented on the resident's record.

Stark-Brewer decided to keep her mother at Morningstar.

"I am comfortable that she's well cared for," she said, adding that she believed the owner and other staff members handled the situation well.

Also, Stark-Brewer said she was also worried about moving her mother, who suffers from minor dementia, because it might confuse her.

Stark-Brewer has since asked her mother's doctor to prescribe something other than addictive narcotics to treat the migraines.

"If your loved one must be on narcotics, you really need to scrutinize how much is being bought and used," she said.

At the same time, Stark-Brewer does not want people with terminal illness and daily pain to be denied the relief narcotics provide.

"It's got to be a balance of the two," she said.

Contact Katie Brown at 394-8318 or katie.brown@rapidcityjournal.com