article: On March 14, 2013, the United States Department of Justice filed this complaint in the United States District Court for the Eastern District of Missouri. The United States sued a Marion County-owned skilled nursing facility, the operation of which was largely funded through Medicaid, under the Civil Rights of Institutionalized Persons Act (“CRIPA”) and Title II of the Americans with Disabilities Act (“ADA”), alleging that the Defendant had a practice of violating the constitutional and statutory rights of residents at the nursing home. Specifically, the Plaintiff alleged that the Defendant deliberately disregarded known harm or serious risks of harm to residents, and that its actions and failures to act caused harm to residents, including unnecessary segregation, and physical, mental and psychological harm. The Plaintiff alleged that the Defendant was violating the ADA by failing to serve individuals in the most integrated setting appropriate to their needs, by not taking sufficient steps to assess, identify, and prepare individuals for discharge from the facility to programs in the community. The Plaintiff also alleged the Defendant failed to adequately screen individuals who are required by federal law to be screened before admission, resulting in individuals being served in a more restrictive setting than appropriate to their needs. The Plaintiff also alleged that the Defendant’s healthcare services “substantially depart from professional standards,” and thus failed to provide adequate healthcare, a constitutionally protected right. The Plaintiff alleged that the Defendant failed to monitor, evaluate, update, or review individual’s care plans, despite new diagnoses or changes in conditions. For example, the Plaintiff alleged that on multiple occasions, residents showing symptoms of a stroke or began to foam at the mouth sometimes waited hours before nursing staff noticed or notified a physician. These failures allegedly resulted in unnecessary harm, including hospitalization, preventable falls, and a decline in functional abilities. Concurrently with the Complaint, the United States filed a settlement agreement, which it had already negotiated with the Defendant. The settlement involved a permanent injunction and declaratory judgment, and mandated improvements in three areas: (1) placement in the most integrated settings, (2) conditions of care and treatment, and (3) protection from harm. On March 22, 2013, Judge Charles A. Shaw for the United States District for the Eastern District of Missouri issued an order entering the settlement agreement as an order of the court. The Agreement provided for a third party to serve as the Monitor of compliance with the Agreement. The Agreement provided that it should terminate when the Defendant achieved substantial compliance with each provision of the Agreement and has maintained substantial compliance with the Agreement for a period of two years. First, to ensure placement in the most integrated settings, the Agreement required the Defendant to conduct adequate pre-admission evaluations to ensure that individuals were not inappropriately admitted to the facility. The Defendant was also required to implement a discharge and transition process to ensure that individuals who could be served in more integrated settings were identified and that such individuals would be part of a robust and individualized discharge planning process and implementation. The Agreement also provided for “in-reach” by community service providers to residents to actively support them in moving to more integrated settings. The Agreement established specific requirements for the “care plan,” or formal written individualized plan of treatment, required for each individual living at the nursing home and those at risk of being institutionalized there. The Defendant was required to implement a quality assurance process to oversee the discharge and transition process. It was required to review this information on a quarterly basis, and on an annual basis, create a report summarizing its quality assurance activities, findings, and recommendations, and evaluate whether it had been effective in addressing the barriers preventing individuals from receiving services in the most integrated, appropriate settings. Second, to improve the Defendant's conditions of care and treatment, the Agreement required the Defendant to provide individuals at Maple Lawn with adequate and appropriate protections, treatment, supports, and services to meet the individualized needs of the individuals and that are consistent with generally accepted professional standards. This involved the following: improving health care assessments and care plans, establishing an effective infection control program to minimize the spread of infections or communicable diseases, ensuring that nutrition and hydration services as well as aspiration prevention care were sufficient, improving its psychiatric and psychosocial services, specifically its policies about psychotropic medication, improving pressure sore prevention and treatment policies, providing adequate pain management services, mortality reviews for individuals who die at the Defendant’s facility or at an acute-care facility after being transferred from the Defendant’s facility, and annual quality assurance reporting. Third, the Defendant was required to provide individuals with a safe and secure environment and ensure protection from harm. The Agreement mandated improvements in the Defendant's fall prevention and reporting policies, adequate reporting and investigation of all incidents where individuals sustain injuries, and annual quality assurance reporting. The Agreement provided for a third party to serve as the Monitor of compliance with the Agreement. The Agreement provided that it should terminate when the Defendant achieved substantial compliance with each provision of the Agreement and has maintained substantial compliance with the Agreement for a period of two years. The Monitor’s first Semi-Annual Compliance Report was adopted by the Defendant and filed with the court on September 19, 2013. On January 30, 2014, the Plaintiff and Defendant filed a joint statement regarding Defendant’s compliance with the settlement agreement, informing the court that they both agreed with the Monitor’s finding that as of January 15, 2014, the Defendant had achieved substantial compliance with the terms of the Agreement. For the next two years, the Monitor and Defendant filed semi-annual reports on compliance with the settlement agreement. On April 15, 2016, the Plaintiff and Defendant filed a joint stipulation and motion for dismissal, in which they agreed and stipulated that the Defendant achieved substantial compliance on January 15, 2014 and remained in substantial compliance at all times through January 15, 2016. The parties jointly stipulated to the dismissal of the action, and each paid its own costs. District Judge Rodney W. Sippel dismissed the case, and the case is now closed.
summary: The United States sued a Marion County-owned skilled nursing facility under the ADA and CRIPA for alleged violations of the residents' constitutional and statutory rights. Concurrently with the complaint, the parties submitted a settlement agreement, requiring the Defendant to meet certain requirements related to terms of placement in the most integrated settings, conditions of care and treatment, and protection from harm. The District Judge issued an order entering the settlement agreement as an order of the court. After the parties agreed that the Defendant had met the Agreement's requirement of two years of substantial compliance, the parties filed a joint stipulation and motion for dismissal, and the case was dismissed.