Residents of Nursing Homes Receiving Medicaid Can Now Bring Civil Rights Claims Challenging Quality of TreatmentJuly 2009 – Alerts Litigation Department and Health Law Practice Group Alert
A new decision1 by the Third Circuit Court of Appeals is likely to have a significant impact on nursing home and rehabilitation facilities that provide care and treatment and are governed by the Federal Nursing Home Reform Amendments (FNHRA)2.
On June 30, 2009, the court held that an action can be brought under the Federal Civil Rights Act pursuant to 42 U.S.C. Section 1983 for a patient to challenge the treatment received at a nursing home/treatment facility governed by FNHRA. The court analyzed the language of FNHRA and determined that it was sufficiently “rights-creating” and that the rights conferred by its various provisions were neither “vague and amorphous” nor imposed upon the states a mere precatory obligation. The court also concluded that Section 1983 does provide a proper avenue for relief because the nursing home facility in question failed to demonstrate that Congress foreclosed that option by adopting another more comprehensive enforcement scheme.
The facts giving rise to the case relate to an injury and the ultimate death of Melvinteen Daniels, a resident of the John J. Kane Regional Center at Glen Hazel, a residential skilled nursing care and rehabilitation center for short-term and long-term needs located in Pittsburgh, PA, and operated by Allegheny County. Daniels developed decubitus ulcers, became malnourished and eventually developed sepsis from which she died as a result of alleged improper treatment.
The Kane Center was sued for wrongful death, survival and for violation of her rights pursuant to 42 U.S.C. Section 1983. The plaintiff ’s decedent alleged that the Kane Center deprived Daniels of her civil rights by breaching its duty to ensure quality care under the Omnibus Budget Reconciliation Act of 1987 (OBRA) and,more specifically, FNHRA. The Center moved to dismiss the complaint, arguing that neither OBRA nor FNHRA provides a basis for a claim pursuant to Section 1983 but rather merely sets forth requirements with which a nursing facility must comply in order to receive federal Medicaid funds. The district court determined that there was no right of action under Section 1983 and dismissed the case pursuant to Fed.R. Civ. P. 12(b)(6).
The matter was appealed to the Third Circuit Court of Appeals, where the court focused on the alleged violations of multiple provisions of FNHRA. The Third Circuit was thus presented with the question of whether the alleged violations of the provisions of FNHRA give Medicaid recipients like Daniels rights whose violation can be remedied under Section 1983. In analyzing the issue, the court, citing legions of precedents by the U.S. Supreme Court and various district and circuit courts, determined that Section 1983 can act as a vehicle for imposing liability against anyone who, under the color of state law, deprives a person of “rights, privileges, or immunities secured by the Constitution and Laws.”3 However, the court noted that a plaintiff must assert the violation of a federal right—not merely a violation of a federal law—to seek redress. If a plaintiff alleges a violation of a federal right as the basis of a Section 1983 action, the court must determine whether the applicable federal statute confers an individual right.
The Supreme Court has set forth three factors that must be met for courts to determine whether a statute conferred a federal right upon an individual:
- Whether Congress intended that the statutory provisions in question benefit the plaintiffs;
- Whether the right asserted is so “vague and amorphous” that its enforcement would strain judicial competence; and
- Whether the statute unambiguously imposes a binding obligation on the states.
The Supreme Court further instructed that if a plaintiff successfully meets these three requirements, she has established a rebuttable presumption that she has such a right.However, this presumption could be rebutted if Congress “specifically foreclosed a remedy under Section 1983.”
Accordingly, the Third Circuit concluded that Congress intended to create individual rights in drafting and adopting Section 1396(r) of FNHRA and that the decedent’s claims fall squarely within the zone of interest that these provisions are meant to protect. Based upon its analysis, the court held that the statutory provisions that the plaintiff is seeking to enforce under Section 1983 satisfied both rights, creating language as evidenced by the Congressional intent and the remaining factors to be reviewed by the court.
As a result of this decision, Medicaid patients who allege a lack of or improper treatment may have an additional cause of action pursuant to Section 1983, which includes a fee-shifting provision for parties who prove a violation. Even if a relatively nominal claim is pursued, the monetary exposure to the facility may become considerably higher as a result of the legal fees incurred in connection with the prosecution of the claim. There may also be questions relating to insurance coverage for claims including attorneys’ fees and costs for the prevailing party since those damages may not be included as “covered events” pursuant to any applicable insurance policy. Insurance policies should be reviewed to determine the length and breadth of coverage provided, and a review of the facility’s policies and procedures may be necessary. On-site training may also be required to review the requirements for patient care under FNHRA.
If you have any questions or would like to discuss this case in more detail, please contact Eric M.Wood at 609.572.2226 or [email protected] , or a member of our Health Law Practice.
1 - Sarah Grammer as Administratrix of the Estate of Melvinteen Daniels, deceased vs. John J. Kane Regional Centers – Glen Hazel
2 - 42 U.S.C. Section 1396(r), et seq.
3 - Citations omitted.