Family sues skilled nursing facility after death of 86-year-old. $30M. Sacramento County.


Severe pressure sores are blamed on understaffing at nursing home owned/operated by corporate entities.

The Case

  • Case Name: Sam Rios, Jr., et al. v. Pine Creek Care Center, Plum Healthcare Group LLC, et al.
  • Court and Case Number: Sacramento County Superior Court / 34-2018-00244263
  • Date of Verdict or Judgment: Tuesday, January 24, 2023
  • Date Action was Filed: Sunday, November 18, 2018
  • Type of Case: Elder Abuse, Wrongful Death
  • Judge or Arbitrator(s): Hon. Steven M. Gevercer
  • Plaintiffs:
    Sam Rios, Jr., by and through his successor-in-interest Christina Ramirez-Ramirez Rios, Christina Ramirez-Rios, Olivia M. Rios-Acuña, Anselmo Antonio Ramirez-Rios, Bernardo Ramirez-Rios, Tomas Rio, Reyes Rios, Ruben Rios, Velin Rios and Samuel Rios
  • Defendants:
    Daisy Holdings, LLC dba Pine Creek Care Center, Plum Healthcare Group, LLC, Bay Bridge Capital Partners, LLC, New Sisu Holdco, LLC, Flower Farm Group, LLC, OpCo Holdings, LLC, California Opco, LLC
  • Type of Result: Jury Verdict

The Result

  • Gross Verdict or Award: $30,912,802
  • Net Verdict or Award: $30,912,802
  • Award as to each Defendant:

    Joint and several liability for $30,900,000 as to defendants Daisy Holdings, LLC dba Pine Creek Care Center, Plum Healthcare Group, LLC, Bay Bridge Capital Partners, LLC and New Sisu Holdco, LLC.

  • Economic Damages:


  • Non-Economic Damages:


  • Punitive Damages:


  • Trial or Arbitration Time: 10 weeks
  • Jury Deliberation Time: 2 1/2 days for liability phase and 1 1/2 hours for punitive damages phase.

The Attorneys

  • Attorney for the Plaintiff:

    Dudensing Law by Edward P. Dudensing, Sacramento.

    Nursing Home & Elder Abuse Law Center by Jay P. Renneisen, Walnut Creek.

    The Law Office of Andrew J. Collins by Andrew J. Collins, Sacramento.

  • Attorney for the Defendant:

    Wilson Elser Moskowitz Edelman by Robert W. Harrison, San Diego.

    Wilson Getty, LLP by Dawn Phleger and Mark Ginella, San Diego.

The Experts

  • Plaintiff’s Medical Expert(s):

    Kathryn Locatell, M.D., geriatrics.

    Christopher Stephenson, M.D., physical medicine and rehabilitation.

    S. Kwon Lee, M.D., pressure wounds.

    Mary Louise Fleming, RN, Ph.D, skilled nursing and long term care facility staffing.

  • Defendant's Medical Expert(s):

    David M. Young, M.D., pressure wounds.

    Karen Josephson, M.D., geriatrics.

    Heidi A. Capela, RN, nursing standard of care.

  • Plaintiff's Technical Expert(s):

    Ronald Pomares, CPA, accounting.

    Robert A. McLaughlin, publicly available financial and other data for long-term care facilities.

  • Defendant's Technical Expert(s):

    John Bowblis, Ph.D., publicly available financial and other data for long-term care facilities.

    Michael Lesnick, cost reporting data for long-term care facilities and analysis of same.

    David Mervyn Oatway, staffing studies used to determine staffing requirements for long-term care facilities.

Facts and Background

  • Facts and Background:

    86-year-old Sam Rios, Jr. was a patient for two weeks in April of 2017 at the skilled nursing facility known as Pine Creek Care Center in Roseville, located in the greater Sacramento area. Mr. Rios had been admitted for short-term rehabilitation after a fall, hip fracture and surgical repair of same..

    Mr. Rios was transferred to the facility after a stay at a Kaiser Permanente hospital. When he was admitted, he was wearing heel protectors as he was noted to be at high risk for breakdown of the skin on his heels.

    Mr. Rios’s widow and his eight adult children filed suit against the facility and its corporate overseers alleging claims for elder abuse and neglect, constructive fraud, violation of patient’s rights and wrongful death based on pressure sores that were discovered after Mr. Rios was discharged from the facility.

  • Plaintiff's Contentions:

    Plaintiffs contended that 86-year-old Sam Rios, Jr., was severely neglected during his two weeks as a patient at defendants' skilled nursing facility, Pine Creek Care Center in April of 2017. That he should have been repositioned every two hours to prevent pressure ulcers, but was repositioned only once during his two-week stay. Plaintiffs also contended the facility failed to implement other standardly required interventions to prevent skin breakdown on Mr. Rios’ heels, including floating of the heels, regularly inspecting the skin, placing him on a low air loss mattress, and using the heel protectors that had already been provided by Kaiser Permanente hospital.  

    As a result, Mr. Rios developed two unstageable heel pressure sores, one of which was discovered to be a "to-the-bone" Stage IV pressure sore that he had to live with until he died in March of 2018.

    Plaintiffs contended the main reason for the extreme failures in the care of Mr. Rios was understaffing at the facility by its owners and corporate overseers, Plum Healthcare Group, LLC and Bay Bridge Capital Partners, LLC. Plaintiffs further maintained the understaffing was the result of financial pressure by private equity GI Partners, LLC, in San Francisco, which was the largest owner of the Plum nursing home chain at the time.

  • Defendant's Contentions:

    Defendants contended that plaintiff was admitted to defendants' facility with blanchable redness to his bilateral heels and coccyx and discharged home with blanchable redness to his bilateral heels and coccyx. During his stay at Pine Creek, plaintiff received 11 sessions of physical therapy, 10 sessions of occupational therapy and assistance with his ADLs. He was seen three times by his attending physician, who made no changes to his care plan and he was seen once by his orthopedic physician’s assistant.

    Fifty hours after discharge, an unstageable wound was discovered on his right heel and a stage 2 wound was discovered on his left heel.

    Further, defendants contended that plaintiff's family failed to mobilize him and to float his heels while home. His left heel wound resolved. His right heel wound continued to deteriorate due to plaintiff's significant comorbidities including severe atherosclerosis. Defendants contended plaintiff died 11 months after discharge due to respiratory failure and heart attack. 

    Defendants denied all plaintiffs' contentions as to liability and causation.

Injuries and Other Damages

  • Physical Injuries claimed by Plaintiff:

    Stage IV “to-the-bone” pressure ulcer to the right heel followed by 330 days of pain and suffering and then death in March of 2018.

  • Wrongful death damages to Sam Rios, Jr.'s spouse of over 40 years and eight adult children.

Special Damages

  • Special Damages Claimed - Past Medical: $212,802.25

Additional Notes

Plaintiffs filed a post-trial motion for attorneys fees pursuant to California’s Elder Abuse Act that was granted on April 7, 2023, with a total award of $4,651,769.10 in attorneys fees awarded to plaintiffs. This included a multiplier enhancement of 1.33. The trial judge has not yet ruled on alter-ego liability claims against all defendants, including defendants Flower Farm Group, LLC, OpCo Holdings, LLC and California Opco, LLC, which were not included for the jury’s determination. The jury found the corporate overseers, Plum Healthcare Group, LLC and Bay Bridge Capital Partners, LLC , directly liable for the full amount of the verdict as well as under theories of aider and abettor and co-conspirator liability.

Defendants contend there were significant erroneous rulings made which essentially directed a verdict against defendants. Defendants contend the verdict was not supported by statutory limitations or by the evidence. Defendants filed post-trial motions to conform the verdict to the appropriate statutory limitations and to the evidence.

In ruling on defendants’ motions on April 5, 2023, the trial judge denied defendants’ requests to reduce the overall damages award and for a new trial. In doing so, the trial judge affirmed the jury’s award of $2,750,000 in pre-death pain and suffering damages to Mr. Rios, its award of $1,750,000 in wrongful death damages to his widow Christina Ramirez-Ramirez Rios, and its award of $150,000 in wrongful death damages to each of his eight adult children (total of $1,200,000 to the children). The trial judge also affirmed the jury’s award of $25,000,000 in punitive damages over defendants’ objections that the jury’s imposition of punitive damages was not supported by the evidence and that the amount was unconstitutionally excessive.  According to the Order, “Substantial evidence supported a pattern and practice, supported by management supervision and policy directives, to drive profits and reduce services. Substantial direct and circumstantial evidence presented a nexus between such policies and practices and patient neglect and harm. The jury was presented with substantial evidence of a willful, and knowing disregard of the rights and safety of the vulnerable elderly clients entrusted to Defendants' care.” The Order also stated, “Plaintiff here presented substantial evidence that Defendants’ conduct was repeated, and the product of a policy to maintain understaffing, increase patient acuity, and drive cost-cutting, despite the awareness of probable consequences. The jury heard substantial direct and circumstantial evidence, including real-time emails, establishing a link between private equity investors' short - term quest for maximizing profits, and a reckless disregard for patient care,” among other comments about the evidence in the case.

In upholding the $25,000,000 punitive damages amount, the trial court found the punitive ratio of approximately 8.4 to 1 to be “not unconstitutionally excessive” in light of the level of reprehensibility of defendants’ conduct, the relationship (ratio) between the compensatory and punitive damages awards, defendants’ wealth and any applicable civil penalties.