On Oct. 1, 1990, two residents of California nursing homes filed this class action in the U.S. District Court for the Eastern District of California under the Medicaid Act against the California Department of Health Services. The plaintiffs asked the court for declaratory and injunctive relief, claiming that the state had failed to comply with the recently enacted federal nursing home reform law, 42 U.S.C. §§ 1395i-3(a)-(h) and 1396r(a)-(h). The plaintiffs also requested a preliminary injunction.

Specifically, the new law required all nursing homes to care for their residents "so as to promote maintenance or enhancement of each resident's quality of life." To this end, each facility was required to formulate a written plan of care for each resident, describing the medical, nursing, and pyschosocial needs of the resident, among other requirements. Under the law, each state is responsible for certifying the compliance of facilities with these requirements. The state claimed that its own statutory and regulatory scheme already complied with the reform law.

On Jan. 11, 1991, the court (Judge Garcia) granted the plaintiffs' motion for preliminary injunction and ordered the state to comply with the new federal requirements. On Feb. 25, 1991, he ordered that the injunction would remain in effect until final resolution on the merits of the case. The court also certified a class consisting of "all persons in California who are or will be residents in Medicare or Medicaid certified nursing facilities."

On Aug. 11, 1992, the Court granted the plaintiffs' motion for summary judgment in part and entered a permanent injunction against the state in the following areas: comprehensive resident assessments (the state has to ensure that the nursing home provide individualized care plans per the reform law); residents' rights (the state has to ensure that the nursing homes promote residents' rights in admissions policies); survey and certification requirements; and transfer and discharge appeals.

The court granted summary judgment to the plaintiffs on the question of the defendants' failure to timely comply with the nurse aid training and competency program, but granted summary judgment to the defendants on the question of their current compliance with the law. The court ruled similarly on the question of the nurse aid registry required by the reform law.

At the same time, the parties agreed to resolve all further issues through a settlement agreement. The agreement provided that the state would comply with all aspects of the reform law. The state also agreed to implement an enforcement program "including mechanisms and strategies to effectively apply appropriate remedies when federal requirements of participation are not met." The state also committed to new, comprehensive educational programs for facility staff, residents, and residents' representatives regarding resident assessments and car plans.

On April 13, 1993, the Court held that the stipulation was fair to the members of the class and approved the settlement. On March 16, 1999, the District Court (Judge Garcia granted the defendants' motion to dismiss the complaint in intervention for lack of subject matter jurisdiction and denied the intervenor's motion to enforce the settlement agreement. The court then directed the clerk of Court to close this file.

Andrew Junker - 12/09/2014


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