Pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997, the Civil Rights Division of the U.S. Department of Justice ("DOJ") conducted an investigation of conditions at the Reginald P. White Nursing Facility ("RWNF"), a public nursing home facility in Mississippi, evidently operated by one of the state's counties. The investigation resulted in a findings letter being sent to the governor of Mississippi on May 20, 2003. The letter stated that in August 2002, DOJ and its expert consultants completed a visit to the facility, where they had interviewed administrators, residents and staff, and reviewed policies, procedures, medical charts and records. After noting several positive aspects of the care provided at RWNF, the letter advised that the DOJ's investigation led it to conclude that certain conditions at RWNF violated residents' federal constitutional and statutory rights.
According to the DOJ's findings letter, residents at RWNF suffered from the facility's "serious deficiencies" in (1) nursing and physician medical care, (2) mental health care, (3) discharge planning, and (4) staff training and oversight. For each of these categories, the letter provided examples of the shortcomings observed by the investigation.
Medical care shortcomings existed in assessment and treatment planning (including inadequate protocols for medical complications and no written protocol for resident pain management; failure to re-assess residents following acute changes in physical or mental status or after repeated falls or accidents; inadequate assessments for those needing restorative care or supervision to preclude elopement; and insufficient involvement of physicians in treatment planning), in mechanical restraint use without adequate assessments or consideration of alternatives, in deficient mealtime practices, and in substandard provision of restorative care and therapeutic activities.
Deficient mental health care treatment resulted from RWNF's system of providing mental health care through inappropriate use of multiple medications (polypharmacy), excessive reliance on psychotropic medications (chemical restraints), inadequate monitoring of medication side effects, and deficiencies with mental health assessments and treatment planning.
Systemic weaknesses in resident treatment planning and facility end-of-life practices resulted in unnecessarily restrictive and segregated living conditions for some RWNF residents, according to the DOJ findings letter. This constituted a failure to serve persons in the most integrated setting appropriate to their individual needs.
The investigators also found that nursing and direct care staff would benefit from improved training on behavioral interventions for aggressive or agitated resident behavior, on restraint use, psychosocial planning, restorative care concepts, and the role of an interdisciplinary treatment team. Additionally, the letter stated that the physician staff would benefit from training on their obligations under federal nursing home law and generally accepted professional geriatric standards. Weak staff oversight and quality assurance practices, an absence of review and careful periodic evaluation of physician and psychiatric care, and failure to track or trend patterns of abuse and injury constituted further systemic problems at RWNF.
The DOJ findings letter proposed remedial actions to remedy the deficiencies, invited the state to address the issues, and alerted the state to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action.
We have no post-findings letter information about this matter.Mike Fagan - 06/20/2008