MeadowWood Nursing v. HHS

RECOMMENDED FOR FULL-TEXT PUBLICATION Pursuant to Sixth Circuit Rule 206 2 MeadowWood Nursing Home v. HHS No. 02-4115 ELECTRONIC CITATION: 2004 FED App. 0107P (6th Cir.) File Name: 04a0107p.06 Before: DAUGHTREY and COLE, Circuit Judges; POLSTER, District Judge.** UNITED STATES COURT OF APPEALS _________________ FOR THE SIXTH CIRCUIT COUNSEL _________________ ARGUED: Shirley Moscow Michaelson, OFFICE OF THE MEADOWWOOD NURSING X CHIEF COUNSEL, Chicago, Illinois, for Respondents. - ON BRIEF: Shirley Moscow Michaelson, OFFICE OF THE HOME, CHIEF COUNSEL, Chicago, Illinois, for Respondents. Petitioner, - Geoffrey E. Webster, Columbus, Ohio, for Petitioner. - No. 02-4115 - v. > _________________ , - OPINION UNITED STATES DEPARTMENT - _________________ OF HEALTH AND HUMAN - SERVICES, and TOMMY - MARTHA CRAIG DAUGHTREY, Circuit Judge. By THOMPSON, Secretary of - means of the petition now before us, MeadowWood Nursing - Home seeks review of a civil monetary penalty imposed by HHS, - the Secretary of Health and Human Services (HHS) upon a Respondents. - finding that MeadowWood had failed to comply with certain N Medicare/Medicaid regulations. A survey conducted by the On Petition for Review from the Final Decision of the Ohio Department of Health on behalf of HHS turned up Secretary of Health and Human Services. several deficiencies in the facility, including MeadowWood’s No. A-02-65. failure to maintain the nursing home as free of accident hazards as possible, as required by 42 C.F.R. § 483.25(h)(1). Argued and Submitted: February 3, 2004 Waiving review of all other violations for which civil penalties were imposed, MeadowWood now appeals only the Decided and Filed: March 2, 2004* § 483.25(h)(1) penalty assessed by the Centers for Medicare and Medicaid Services, which was sustained by an administrative law judge for the HHS Departmental Appeals Board and then upheld by an appellate panel of the Appeals Board. We conclude that the Secretary’s decision finding * This decision was originally issued as an “unpublished decision” ** filed on March 2, 2004. On April 13, 2 004, the court designated the The Honorable Dan Aaron Polster, United States District Judge for opinion as one recommend ed for full-text publication. No rthern D istrict of O hio, sitting by designation. 1 No. 02-4115 MeadowWood Nursing Home v. HHS 3 4 MeadowWood Nursing Home v. HHS No. 02-4115 certain equipment in the facility unsafe is supported by 10-day period from July 23 through August 1, 1998. substantial evidence, and we therefore affirm. “Immediate jeopardy” means a situation in which a facility’s non-compliance has caused, or is likely to cause, serious PROCEDURAL AND FACTUAL HISTORY injury, harm, impairment, or death to a resident. 42 C.F.R. § 488.301. The report also recommended a reduced penalty MeadowWood Nursing Home is a 53-bed long-term-care of $50 per day for 132 days from August 2 through facility in rural southwestern Ohio. In July 1998, officials of December 1, 1998. HHS suspended payment for new the Ohio Department of Health, acting on behalf of the Medicare/Medicaid admissions effective September 29, 1998, Centers for Medicare and Medicaid Services, conducted a and proposed to terminate its provider agreement with survey to determine whether the facility was in compliance MeadowWood in the absence of substantial compliance with with the federal requirements for nursing homes participating pertinent federal regulations. in Medicare/Medicaid programs. They discovered, among other deficiencies, that at least 12 of the 53 beds in the facility MeadowWood disputed the findings of non-compliance and were unsafe due to malfunctioning side rails. filed a request for hearing in accordance with 42 C.F.R. §§488.408(g). An administrative law judge held a four-day The two most serious cases involved residents designated hearing and sustained the imposition of the penalty. in the report as Resident 2 and Resident 3. Resident 2, a frail, MeadowWood then appealed to a three-member panel of the 100-year-old man, was injured after he fell from a bed that Departmental Appeals Board, which affirmed the decision of was known to have a side rail that collapsed easily. He was the administrative law judge. In its current petition for review nevertheless returned to the same bed and was still in it of these decisions, MeadowWood renews its arguments that almost a week later when the side rail again collapsed without it was in substantial compliance, that there was no evidence warning while it was being inspected by the surveyors. that its residents were in immediate jeopardy, and that it was Resident 3, who suffered from multiple mental impairments being held to a strict liability standard for events over which but was physically strong and even violent at times, it did not have notice or control. experienced two falls from his bed. The first occurred when a side rail collapsed as he shook it, and the second when the DISCUSSION bracket connecting the rail to the bed snapped altogether. Resident 3 was then moved to a different bed that had a 3-4 Judicial review of decisions under 42 U.S.C. § 1320a-7a(e) inch gap between the side rail and the mattress, which created is limited to determining whether the findings are supported a risk for entrapment. by substantial evidence and whether the proper legal standards were employed. “Substantial evidence is defined as As a result of the condition of these two beds and some 10 such relevant evidence as a reasonable mind might accept as or 12 others, the Ohio Department of Health concluded that adequate to support a conclusion. In our review, we do not MeadowWood was not in substantial compliance with 42 consider the case de novo, nor resolve conflicts in the C.F.R. §483.25(h)(1), which requires that a facility “must evidence, nor decide questions of credibility.” Myers v. ensure that . . . [t]he resident environment remains as free of Secretary of Health & Human Services, 893 F.2d 840, 842 accident hazards as is possible.” Among the remedies (6th Cir. 1990) (internal citations omitted). proposed to HHS was the payment of a civil monetary penalty at the “immediate jeopardy” level of $3,050 per day for the No. 02-4115 MeadowWood Nursing Home v. HHS 5 6 MeadowWood Nursing Home v. HHS No. 02-4115 After careful review of the administrative record and the Moreover, even without the deference normally accorded to record on appeal, we conclude that there was substantial determinations by the Secretary in administrative proceedings evidence to support the decision of the administrative law such as this, we conclude that the record contains substantial judge to affirm the imposition of penalties under 42 C.F.R. evidence to sustain the decision to impose the remedies at §483.25(h)(1). Moreover, we find no basis for issue. MeadowWood’s claim that it was held to a standard of strict liability. In addition to the evidence supporting a finding of CONCLUSION immediate jeopardy with regard to two of the residents, the administrative law judge found that 12 other beds were being For the reasons set out above, we AFFIRM the decision of maintained in an unsafe condition, that nursing home aides the Secretary finding MeadowWood Nursing Home in non- were not properly operating the beds, and that there was no compliance with 42 C.F.R. § 483.25(h)(1) and imposing civil evidence of a routine maintenance program. The judge also monetary penalties therefor. found that MeadowWood had not presented credible evidence to the contrary. In reviewing the decision of the administrative law judge, the appeals panel likewise rejected the provider’s argument that it was being held to a strict liability standard: The sequence of the events relating to Resident 2 discredits MeadowWood's claims that only a strict liability standard could lead to holding it responsible for the failures of the bed rails because the events were unpredictable. . . . Far from imposing a strict liability standard, the ALJ's treatment of the allegations relating to Resident 3 illustrates that he considered carefully whether each accident or hazard presented foreseeable risks that MeadowWood could practicably have prevented. We likewise conclude that the factual record is replete with evidence that MeadowWood was on notice that the condition of the beds in its facility posed a risk of injury to the residents and could have taken steps to avoid the harm that befell at least two of them as a result of the unsafe conditions that existed in the nursing home. We thus find no merit to MeadowWood’s attempt to re-cast what is essentially a dispute of fact into a legal issue – indeed, we think that the strict liability argument is essentially a red herring.