Rios v. Plum Healthcare LLC Lawsuit: Verdict, Appeal, and Aftermath

In January 2023, a Sacramento Superior Court jury returned a $30.9 million verdict in the Rios v. Plum Healthcare lawsuit, finding that Pine Creek Care Center in Roseville and its corporate parent, Plum Healthcare Group, LLC, neglected 86-year-old retired Sacramento State professor Sam Rios Jr. so severely during a two-week rehabilitation stay that he developed a Stage IV pressure sore, lost the ability to walk, and died months later. The award included $5.9 million in compensatory damages and $25 million in punitive damages. It became final in May 2023, when the defendants stipulated to dismiss their appeal.¹²

What Happened to Sam Rios Jr.

Rios fractured his hip in a fall at home on April 11, 2017. After initial care at a Kaiser Permanente facility, he was transferred to Pine Creek Care Center for short-term rehabilitation. Staff noted redness on both of his heels on arrival and documented him as “high risk” for skin breakdown. Kaiser sent him with heel protectors intended to prevent pressure sores.³⁴

According to the lawsuit, Pine Creek staff placed the heel protectors in a closet and never used them. The care plan contained no documentation addressing pressure sore prevention. Across 42 nursing shifts, Rios was repositioned only once. The standard of care calls for repositioning every two hours in bed and every hour in a chair. When Rios was discharged on April 29, 2017, staff did not check his heels or give his family any instructions on preventing pressure ulcers.³

Two days later, home health nurses found two large pressure ulcers on his heels. One heel had turned black. The right heel wound was diagnosed as a Stage IV pressure sore, meaning it had penetrated to the bone. Rios could no longer walk and lived in constant pain until his death on March 16, 2018.³

The Claims and the Trial

Rios’s wife, Christina Ramirez-Rios, and his eight adult children filed suit in Sacramento Superior Court (Case No. 34-2018-00244263) against Pine Creek Care Center, Plum Healthcare Group, LLC, and Bay Bridge Capital Partners. The complaint alleged elder abuse, neglect, custodial negligence, violation of patient rights, wrongful death, and constructive fraud. Pine Creek’s legal business name, Daisy Holdings, LLC, appeared on the pleadings alongside Plum’s parent structure. The family was represented by Ed Dudensing, Jay Renneisen, and Andrew Collins of Dudensing Law.¹⁵⁶

The plaintiffs’ theory tied the neglect to corporate strategy. Attorneys argued that Plum operated with a “profit-at-all-costs” attitude and deliberately understaffed its facilities to maximize investor returns. Expert witnesses in geriatrics, nursing staffing, and accounting testified to link cost-cutting decisions to the failures in Rios’s care.⁶

The trial ran 79 days. On January 25, 2023, the jury found the defendants liable for reckless, malicious, oppressive, and fraudulent conduct and returned $5.9 million in compensatory damages and $25 million in punitive damages. The trial court later denied the defendants’ motion for a new trial and awarded attorney’s fees to the Rios family.¹⁵

After the verdict, lead trial counsel Ed Dudensing said: “In just two weeks, Plum staff’s utter neglect of Mr. Rios ruined his life, left him in constant agony, and ultimately helped lead to his death. When nursing facilities understaff to drive profits, it costs people their lives.”⁶

How the Appeal Ended

The defendants initially signaled they would appeal, calling the punitive damages “grossly exaggerated” and maintaining that Rios’s care was “reasonable, appropriate, and consistent with doctor’s orders.”⁴ An appeal was filed with the California Third District Court of Appeal under the case name Ramirez-Rios et al. v. Daisy Holdings, LLC, et al.

It never produced a decision. On May 19, 2023, the appellate court dismissed the appeal by stipulation of counsel. Each side bore its own appellate costs, and the court ordered the remittitur to issue immediately, returning the case to the trial court with the verdict intact.²

The Understaffing Theory the Jury Credited

The plaintiffs argued that Rios’s neglect was the predictable result of a business model. A 2025 case study in the International Journal of Social Determinants of Health and Health Services analyzed Plum’s operations from 1999 to 2021 and found the company’s registered nurse staffing ran 13% below the California state average in hours per resident day, RN wages were 6% lower than the state average, and certified nursing assistant turnover was 15% above the state average. The study also documented gaps between staffing hours Plum reported to the Centers for Medicare and Medicaid Services and internal time sheets, with one facility’s actual hours running 36% lower than what was submitted to CMS.⁷⁸

Internal calculations cited in the study put a dollar figure on staffing decisions: every 0.1 nursing hour per resident day equaled $5.8 million in spending. From 2016 to 2020, distributions to owners and executives averaged $9 million a year, and executive equity grew from $18.6 million to $74.8 million over the same period. Plum’s facilities generated 23% higher revenue and 50% higher net income than the average California nursing home.⁷

The corporate structure the plaintiffs sued through was also deliberately layered. Each facility was split into a separate operating company and property company, an arrangement the 2025 study described as intended to “protect their assets from litigation.” By 2018, the enterprise included 14 holding companies, 54 property companies, and 63 nursing homes, with Bay Bridge Capital Partners, LLC created in 2012 as a parent entity. A court ruled in 2020 that Bay Bridge Capital Partners, Plum Healthcare Group, and its holding companies operated as a single enterprise, a finding that helped keep the corporate parent on the hook in the Rios case.⁸⁷

What Has Happened Since

In late 2021, before the Rios trial began, Plum Healthcare was sold to Providence Group, Inc., a California corporation owned by two former Plum administrators. The deal covered 58 facilities across California and Nevada, and most facility staff and leadership remained in their roles. Under terms approved by the California Attorney General, Providence assumed Plum’s future legal liabilities, while the original founders and the Harmon Group kept ownership interests in the nursing home properties.⁹⁷

Pine Creek Care Center itself was also cited in a separate 2019 regulatory matter after a certified nursing assistant was found to have abused a resident by squeezing her chin. A federal administrative law judge upheld a civil monetary penalty of $1,135 per day for 83 days, totaling $94,205.¹⁰

Dudensing Law described the Rios verdict as the first of numerous planned trials against Plum Healthcare involving similar allegations of neglect driven by understaffing.⁶ Pine Creek Care Center continues to operate at 1139 Cirby Way in Roseville under the legal name Daisy Holdings, LLC, with 99 certified beds and active Medicare and Medicaid certification.¹¹

1
EIN Presswire. Jury Returns $30.9 Million Verdict Against Plum Healthcare
2
UniCourt. Ramirez-Rios et al. v. Daisy Holdings, LLC, et al.
3
The Sacramento Bee. Jury Awards $30 Million in Sacramento Elder Abuse Trial
4
McKnight’s Long-Term Care News. $30 Million Judgment Hits Nursing Home That Failed to Document, Reposition Rehab Patient
5
Robert Kreisman. $30.9 Million Including $25 Million in Punitive Damages in Jury Verdict
6
PR Newswire. Dudensing Law Obtains $30 Million Verdict in Sacramento Elder Abuse Trial Against Plum Healthcare
7
International Journal of Social Determinants of Health and Health Services. Case Study of Plum Healthcare Group Financialization
8
International Journal of Social Determinants of Health and Health Services. Case Study of Plum Healthcare Group Financialization
9
Skilled Nursing News. Providence Group Acquires Plum Healthcare, Adds 58 New Facilities to Portfolio
10
U.S. Department of Health and Human Services. Pine Creek Care Center ALJ Decision
11
Medicare.gov. Pine Creek Care Center