Staff supervisor Beverly Crawford said that an administrator reprimanded her for documenting patient neglect, and demanded that she remove the report from the books.
"You report something, you get fired," Crawford testified.
The administrators also falsified staffing schedules and intentionally miscalculated nursing hours to trick state regulators into believing the home was properly staffed, according to Zakaib's ruling, which cites evidence presented at trial.
Zakaib found that the nursing home's history of neglect was directly related to the short staffing issues, and company policy that sought to keep profit margins high by hiring as few nurses' aides as possible.
Manor Care's 2009 tax forms, which were presented at trial, listed more than $4 billion in revenue that year and assets worth nearly $8 billion. The company generated $75 million in pure profit.
"Indeed, to accomplish punishment and deterrence of such a wealthy company, a punitive damage award must be necessarily high," Zakaib said in his ruling. "This verdict sends a clear 'deterrence' message to a multi-billion dollar nursing home corporation that its misconduct will not be tolerated in West Virginia."
Manor Care officials offered to settle the case for $150,000 during a mediation session, and raised the offer to $500,000 at one point, the ruling states. Douglas spent more than $200,000 in litigation costs alone.
In November 2011, Manor Care lawyers argued that the verdict should be subject to the state's medical malpractice caps, which limit the amount a jury can award in medical malpractice cases involving wrongful death to $500,000.
Zakaib said a small portion of the damage award fell under the caps, and reduced the verdict from $91.5 million to $90.5 million two months after the trial.
But he said in Wednesday's ruling that Heartland does not qualify as a "health-care provider" under state law. The medical malpractice law is intended to apply to health-care providers.
Heartland lawyers argued that Douglas' lawyers presented the company's financial information during the trial to inflame the jurors and mischaracterized its earnings by failing to compare the $4 billion in revenue alongside the $75 million in profit.
The Heartland lawyers also said the verdict form incorrectly lumped all of Manor Care's subsidiaries together as a single client.
Reach Zac Taylor at zachary.tay...@wvgazette.com or 304-348-5189.