Loretta Benzel's son is still filled with questions about his elderly mother's death at the Presbyterian SeniorCare nursing home in Oakmont Sept. 24, but state officials found reason to penalize the facility for its care of her.

The Allegheny County medical examiner's office ruled Mrs. Benzel's death a suicide after she fell through her third-floor window. The 89-year-old former Plum resident entered the facility July 28 with a variety of ailments, ranging from heart problems and glaucoma to dementia and depression, according to a Pennsylvania Department of Health report.

The report made public this week said the Willows nursing home, as Presbyterian SeniorCare's 202-bed skilled-care facility is known, has been downgraded to a provisional license through March 28 because it did not do enough to prevent Mrs. Benzel's death.

State inspectors found that five days before her death, according to notes in the facility's records, Mrs. Benzel "attempted to exit the facility via the stairs in a wheelchair and had expressed a desire to jump out the window."

However, the report said there was no record that Presbyterian SeniorCare's staff made a responsible physician aware of the patient's intent, or that it "developed measures to protect the resident and to prevent injuries." A physician was told she had a urinary tract infection, but not informed of her suicidal urges, according to the inspectors.

Although monetary fines often accompany provisional licenses, which last six months instead of the year of a regular license, the health department did not impose that additional penalty. A department spokeswoman had no information on why no fine was involved.

Pat Kornick, a spokeswoman for Presbyterian SeniorCare, said the facility disputes the accuracy of the state findings and is appealing them. She said confidentiality provisions, however, prevented her from describing the specific objections.

"We believe the report has omitted several key facts," Ms. Kornick said. The report "looks like we went from Sept. 19 to Sept. 24 without any type of intervention, and that is not accurate."

She added, however, that all windows in patients' rooms have been ordered locked shut since the incident, and the staff has undergone retraining about making reports of patients' significant mood and behavior changes.

Ron Benzel said he never would have viewed his mother as suicidal, but stated that she had become increasingly unhappy at the nursing home, which she thought she had entered only temporarily. She also complained of fearing one aide who cared for her, he said, but Mr. Benzel had wondered at the time if that was just her imagination.

"The last seven days she really became very paranoid, to the point where she had in her possession a knife and put it in her sock, and I took it away," he said.

Mr. Benzel said he's still uncertain if his mother had legitimate fears, if she fell out her window by accident, or deliberately set out to jump. He said she had a hard time breathing and regularly in a wheelchair. He visited her most days and would usually crank open the narrow window on warm days to give her fresh air.

He said he observed no firsthand problems with his mother's care, but the provisional license might be helpful "if it would put people more on the ball and aware these things can happen." Her personal physician, he said, was "totally shocked" to learn of her suicide.

Ms. Kornick said Mrs. Benzel's death was "a devastating situation" unprecedented in the facility's 81-year history.

It has been more than a decade since the nursing home's last provisional license, but it was fined $13,250 by the state last year for lacking sufficient safeguards to prevent wandering outside the facility by dementia patients.

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