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 Nashville Metropolitan Bordeaux Hospital ("Bordeaux"), a public skilled nursing care and ...
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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 Nashville Metropolitan Bordeaux Hospital ("Bordeaux"), a public skilled nursing care and intermediate care facility operated by the Metropolitan Government of Nashville and Davidson County, Tennessee. The investigation resulted in a findings letter being sent to the Metropolitan Government's mayor on April 21, 2004. The letter stated that in June and July 2003, DOJ and certain of its expert consultants twice toured the facility, interviewed residents and staff, and reviewed policies, procedures, and records. While the findings letter commended the facility for its positive changes in many areas, the DOJ's investigation led it to conclude that certain conditions at Bordeaux violated residents' federal constitutional and statutory rights. According to the DOJ, residents at Bordeaux suffered from deficiencies in the following areas: 1) general medical care, 2) psychiatric care, 3) restorative and wound care, 4) nutritional management, 5) incident management, 6) resident rights, and 7) community placement. In sum, the DOJ investigators concluded that Bordeaux did not provide levels of care consistent with federal law and permitted deficiencies which placed residents at risk of harm.
The DOJ investigators observed persistent systemic deficiencies in general medical care at Bordeaux (in the areas of medication management, oversight and management of medical care, and medical notes and documentation) that substantially departed from generally accepted professional standards of care. Additionally, the DOJ investigation found that, largely due to staffing shortcomings, Bordeaux did not provide psychiatric consultations to residents consistently or sufficiently to address their needs. The facility's restorative care services were hampered by poor individualized care planning, inconsistent and inadequate continence treatment and services, and minimal efforts to prevent contractures. Unreported instances of skin pressure sore precursors and limited training of staff hampered an otherwise commendable program of wound care at Bordeaux. According to the findings letter, Bordeaux failed to assess and manage residents' needs for therapeutic and texture-modified diets properly, failed to ensure the nutritional integrity of residents' regular and therapeutic diets, failed to conduct adequate standard nutritional assessments of residents, and failed to provide proper mealtime assistance to its residents. Among the incident management problems at Bordeaux were incomplete reports of, and failure to analyze adequately data related to, injuries, falls, and other resident incidents. The DOJ found that policies and procedures regarding advanced care planning at Bordeaux were haphazard, and at times contradictory and inconsistent. No policy ensured that residents had their advance directives placed in their charts, and Bordeaux' staff were unclear as to who was responsible for ensuring that patients' living wills were placed in their charts. There was a general lack of individualized care planning in the facility, and, as part of that failure, Bordeaux's treatment professionals failed to assess periodically whether community-based treatment was appropriate for its residents. These latter deficiencies violated the Americans with Disabilities Act-imposed obligation to treat residents in the most integrated setting appropriate to their individual needs. See 42 U.S.C. §12101 et seq.
The DOJ findings letter proposed that Bordeaux promptly implement a set of "minimum" remedial actions to remedy the deficiencies. The letter also invited the Metropolitan Government to address the issues described in the letter, and alerted the mayor to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action.
We have no post-findings letter information about additional activity in this matter.Mike Fagan - 06/23/2008