One nurse slept on the job. Another didn’t show up at all. A third scalded a child so badly that her skin peeled.

Still another failed to check on a toddler who depended on a breathing tube. By the time the nurse returned, the child’s hands and feet were purple.

The little girl was dead.

All of these incidents have something in common: the dark side of private equity.

The nurses worked for Aveanna Healthcare LLC, a company assembled through a series of corporate takeovers, with two goals in mind. One is to provide quality at-home nursing for the sick and disabled, mostly children who may need near around-the-clock care to stay alive. The other is to maximize profit.

The outcomes, at times, have been devastating. Under the control of two prominent private-equity firms, Bain Capital LP and J.H. Whitney Capital Partners LLC, Aveanna has left a trail of injury and death in some of the biggest states where it does business, Bloomberg News found.

More than 1,000 pages of state health documents, many released under public-records laws, show Aveanna has had a disproportionate number of safety violations.

At least seven children have died in Texas, Pennsylvania and Colorado. In these fatalities, reported over the past year, health officials found that Aveanna’s nurses failed to check vital signs, follow emergency procedures, appear for their shifts or give the proper doses of medicine. Aveanna says injuries and deaths on its watch, while unacceptable, are rare, and that it cares for more seriously ill children than other companies.

But internal company documents reveal financial incentives that favor corporate growth and cost-cutting over clinical care. In interviews, more than a dozen former Aveanna employees described how the pressure to meet financial goals jeopardized the quality of care for children.

Despite misgivings, some families say they have little choice but to keep hiring Aveanna’s nurses. The company is so big that it dominates children’s at-home care. Now, it’s about to buy one of its largest rivals.

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