Since 2005, the U.S. government has sanctioned six of Hawai'i's 48 federally certified nursing homes for deficient care. Here are the six and what they were fined for, listed chronologically, with the most recent fines first:

NUUANU HALE

$6,500 JULY 2009

Failed to ensure the environment remained as free as possible from accident hazards for five residents. In one case, a 74-year-old woman tended to wander from her second-floor room and several times made it outside without being detected. Once, she was found walking toward a bus stop along busy Pali Highway. Immediate jeopardy (most severe level of deficiency) was declared and corrected.

$1,950 JUNE 2009

Abandoned an 81-year-old woman at a hospital emergency room without making prior arrangements on where she would go after the hospital. The woman had accumulated an unpaid Nuuanu Hale tab of more than $30,000. The nursing home subsequently implemented a new discharge policy.

HILO MEDICAL CENTER

$6,500 AUGUST 2009

Deficient care for two residents who expressed suicidal ideas. One man told staff multiple times that he intended to kill himself by hanging or cutting his wrists. He later was founding trying to hang himself with a blanket tied to a ceiling bracket. The attempt failed. The institution said it did everything it could to treat the man, but regulators noted that his monitoring wasn't increased. In the other case, another man said he wanted to die, but regulators said the institution failed to revise his care plan to address the suicidal ideation. Immediate jeopardy was declared and corrected.

MALUHIA HOSPITAL

$6,500 OCTOBER 2008

Eight staff failed to immediately report that an elderly woman had accused a male certified nurse aide of raping her. About two weeks later, with the aide still working in the unit where the woman lived, the resident told a volunteer the same worker had raped her a second time. The administration eventually was alerted, the aide was placed in a desk job, an internal investigation was launched and police were notified. Also, all staff members were retrained on the facility's policy for reporting abuse allegations. Immediate jeopardy was declared and corrected.

WAHIAWA GENERAL HOSPITAL

$2,600 OCTOBER 2008

For multiple deficiencies, including failing to ensure that two incontinent residents received appropriate care to prevent recurring urinary tract infections.

$4,550 DECEMBER 2005

For failing to protect residents from abuse after allowing a certified nurse aide accused of neglect and stealing patient food to return to a care-giving job before the investigation was completed. The institution didn't interview the aide about the allegations before the employee was allowed to resume working with residents. While observing the facility's operations, regulators saw that the worker wasn't following proper procedures in providing care. Even though the institution couldn't substantiate the abuse allegations, it fired the aide for providing substandard care. Wahiawā also revised its policy for handling abuse allegations. Immediate jeopardy was declared and corrected.

LEAHI HOSPITAL

$6,500 DECEMBER 2005

For failing to have an alternative source of power in the event the main source fails. One of Leahi's two emergency generators became inoperable six months earlier and had not been repaired. A booster pump attached to a fire sprinkler system also was inoperable and no emergency lighting was in place for stairwells and a building's corridors. The institution fixed the problems. Immediate jeopardy was declared and corrected.

GARDEN ISLE HEALTHCARE

$1,982.50 JANUARY 2005

For failing to ensure the safety of a paraplegic man with a history of behavior problems and alcoholism and for failing to ensure adequate protection of another resident from financial exploitation. In the first case, the man was able to leave the premises at least five times in 2004 for unsupervised outings and twice purchased beer at a nearby Walmart. Once, he returned to the facility with an open can of beer. The nursing home subsequently revised his care plan, including providing one-on-one supervision. In the second case, the facility allowed two people accused of taking money from a resident to have unsupervised visits with the resident before getting the results of an investigation into the allegations. The visiting policy for the resident subsequently was changed. Immediate jeopardy was declared and corrected.

Source: Centers for Medicare & Medicaid Services