On January 15, 2009, the United States Department of Justice filed this lawsuit in the United States District Court for the District of South Carolina. The United States sued South Carolina, as the owner and operator of the C.M. Tucker, Jr. Nursing Care Center, under the Civil Rights of Institutionalized Persons Act (“CRIPA”), 42 U.S.C. § 1997.
The Department of Justice conducted an investigation of Tucker pursuant to CRIPA beginning in 2006. In a findings letter of May 6, 2008, the Department of Justice found that certain conditions and practices “substantially departed” from professionally accepted standards of care, exposing residents to significant harm and risk of harm and violating residents’ statutory and constitutional rights. Specifically, Tucker notably departed from professional standards of care in the development and review of healthcare plans; proper diagnosis and treatment of psychiatric illness and proper use of psychotropic medication; management of pain and suffering; safety and fall prevention; nutrition and hydration; and safe and sanitary living conditions. As a result of these deficiencies, Tucker residents “suffered preventable injuries, illnesses, and deaths.”
The findings letter described Tucker as an “atypical nursing facility” in that nearly all of its residents have one or more psychiatric diagnoses, many patients having previously been patients in the State psychiatric hospital system. The inadequate mental health care was found especially egregious considering the population at Tucker. Despite nearly all residents having one or more psychiatric disorders, only about half of residents had been appropriately assessed by psychiatrists. Further, the investigation found inadequate psychiatric staffing to meet the needs of the population. Psychoactive medication was used inappropriately, with little to no monitoring of dose, drug interactions, or adverse side effects. Tucker failed to address behavioral issues in an organized fashion, and the inadequate behavioral programming was considered an “especially acute deficiency” given the high percentage of Tucker residents with psychiatric diagnoses exhibiting behavior problems.
Further, Tucker Center failed to properly conduct assessments to ensure that residents were receiving treatment, supports and services in the most integrated setting appropriate to their needs, as required by the Americans with Disabilities Act. The investigation identified residents who had not been evaluated for lower levels of care and possible community placement, finding that there “should be more people ready for community placement.”
The findings letter set out minimal 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. While the Department of Justice indicated that the facility had begun to take some remedial steps, it filed its complaint and the parties jointly moved for settlement the day the complaint was filed.
The parties entered a Memorandum of Agreement and moved to conditionally dismiss the action, conditioned upon the Tucker Center achieving substantial compliance with the terms of the Memorandum of Agreement. The Agreement’s contained substantive requirements addressing: 1) timely assessments and care planning; 2) nutrition and hydration care and aspiration prevention; 3) mental health assessments, psychiatrist staffing to ensure adequate psychiatric services, and proper use of psychoactive medications; 4) pressure sore prevention and treatment measures; 5) pain management and end-of-life care; 6) fall prevention and protection from other harm; 7) meaningful activity programming; 8) environmental conditions, improving food services, laundry sanitation, housekeeping, and infection control; and 9) serving residents in the most integrated setting appropriate to residents’ needs.
District Judge Matthew J. Perry approved the terms of the agreement and conditionally dismissed the case on February 17, 2009. The Department of Justice monitored South Carolina’s compliance with the requirements of the Memorandum of Agreement, and the court retained jurisdiction over the implementation and enforcement of the measures for two years.
On February 15, 2011, Judge Perry finalized and closed the settlement. The case is now closed.
Sarah McDonald - 01/24/2018
compress summary
