A resident of a long-term care facility had maggot-infested wounds so advanced that skin peeled off her legs when a hospital emergency room nurse removed her clothing, state inspectors found.

Riverwalk Communities, which has a history of violating nursing home standards, could face state action for the woman's care, said Jennifer Dunlap, a spokeswoman for the State Department of Health.

According to the state's investigation, the woman, whose age was not released, had refused treatment for her wounds and to be bathed for five days at the licensed 113-bed health-care facility before she was taken Nov. 3 to Deaconess Hospital.

The hospital's emergency staff found festering sores on both of the woman's legs and maggots emerging from wounds infected with treatment-resistant bacteria, according to the state's report.

An emergency department nurse told the state surveyor the woman's right slipper and pants legs were stuck to her skin, the report said.

"He indicated he soaked her right foot in warm water for 45 minutes and bugs/cockroaches were crawling out of the house slipper. Upon removing the house slipper, he indicated the skin came off of the right foot and toes," the report said.

When the nurse removed the woman's pants, the material pulled the skin off the woman's legs, from the knees to the ankles, according to the report.

Christine Goad, Riverwalk Communities' administrator, defended the center's performance in caring for the woman, whom she said Wednesday had returned to Riverwalk after her hospitalization.

Goad said that in late October, an aide noticed sores on the woman's legs when she was bathing her and immediately contacted a physician, who prescribed an antibiotic, an ointment for the sores and specified regular dressing changes for them.

The woman agreed to the medication and treatment for four days, but then began refusing all medications and the treatment and refused to be showered, Goad said.

She said the woman was hospitalized Nov. 3 after she became combative.

Goad said the state report reference to cockroaches being found in the woman's slipper is not true. She said the center does not have a roach problem.

"I contacted a wound specialist and an ordinary house fly could have laid an egg on those dressings and it would develop into a maggot in 24 hours. He said he's seen it many times," Goad said.

The state's survey report found, among other things, that Riverwalk officials had failed to notify the woman's physician when she refused his prescribed treatment.

While residents can refuse treatment, "that does not absolve the facility from protecting the resident," said Michelle Motta, Vanderburgh County's long-term care ombudsman.

Goad said that under a compliance plan approved by the state Dec. 5, Riverwalk staff must now contact a doctor immediately if any resident refuses medication or treatment specified by their physician.

Dunlap said she could not release any details about the woman due to federal privacy laws governing medical records.

Vanderburgh County Prosecutor Stan Levco said he did not plan criminal charges in the case.

Last year, the center was at risk of losing both its Medicaid and Medicare reimbursements. After Riverwalk officials agreed to stop operating as a comprehensive-care nursing home, the center received a state license to operate residential or intermediate care.

It later converted from a nursing home to a long-term care facility.