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 A. Holly Patterson Geriatric Center ("Patterson"), a public nursing home facility in Uniondale, New York, operated by a public benefit corporation which, under state law, was a state agency. The investigation resulted in an August 3, 2004, findings letter being sent by DOJ to the governor. The letter stated that in May and November 2003, DOJ conducted an investigation of the facility pursuant to CRIPA authority. The investigation relied upon site visits by DOJ personnel and consulting experts, reviews of medical records and facility documents setting out procedures, policies, and practices, and interviews of Patterson administrators, professionals, staff, and residents.
The findings letter advised the state that residents of Patterson suffered from (1) inadequate mental health care services; (2) improper and dangerous use of restraints; (3) substandard clinical care; (4) inadequate nutritional and hydration services; (5) quality assurance and incident management shortcomings, and (6) inadequate discharge planning and community integration, in that the state failed to provide services to certain Patterson residents in the most integrated setting, as required by the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12132 et seq.
The letter set out specific examples of the many deficient practices at Patterson. These included unjustified use of psychotropic medications, inadequate side effect monitoring following use of such medications, a lack of integrated treatment and coordinated care across disciplines, and poor maintenance of mental health documentation. Physical and chemical restraints were used on residents whose charts in no way justified such techniques, and without consideration of less intrusive alternatives, according to the findings letter. While Patterson's skin care and wound management practices seemed adequate, the investigators found inadequacies in the areas of Patterson's assessments of residents' needs, implementation of care plans, restorative care, and psychosocial/therapeutic treatment and activity services. Patterson's administration of feeding tubes, like its' assessment, provision, and monitoring of nutritional status, hydration systems, and meal services, were unsafe, inadequate, or unsupportive. Quality assurance and incident prevention and management practices were lacking, according to the findings letter, and Patterson's insufficient discharge planning, policies and practices led to non-compliance with the "most integrated setting appropriate" standard set by Title II of the Americans with Disabilities Act ("ADA"), 42 U.S.C. § 12132.
The DOJ findings letter proposed that the facility implement what DOJ termed as "minimum" remedial actions to remedy the deficiencies. DOJ invited the state and the public benefits corporation to address the issues, and alerted both to the possibility of a CRIPA lawsuit brought by the United States to compel remedial action.
The DOJ's letter described a cooperative approach with the state and corporation officials during the course of the investigation. This atmosphere evidently continued during ensuing negotiations, because the parties, in January 2006, entered into a memorandum of understanding ("MOU"). This agreement obligated the state to improve, within 60 days, a wide range of policies and practices at Patterson. The settlement contained substantive provisions addressing (A) mental health care, (B) restraint usage, (C) clinical care, (D) nutritional care, (E) quality assurance and incident management, (F) discharge planning and treatment in the most integrated setting appropriate to individualized needs, and (J) compliance with applicable federal laws and implementing regulations, including Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395i-3 et seq.; Title XIX of the Social Security Act, 42 U.S.C. §§ 1396r et seq.; the Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101 et seq.; and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794.
The MOU called for appointment of jointly-selected monitors, Marie Boltz and Susan M. Renz, having duties to observe, review and report findings, and make recommendations to Patterson with regard to implementation of MOU. The settlement also allowed the monitors, DOJ, and its' consultants to access Patterson, its' residents, and documents and records, for monitoring and technical assistance purposes. The state, through its' public benefits corporation, had to implement the changes called for in the MOU document. By its' terms, the documents' obligations expired in three years, if the monitor reported substantial compliance had been achieved for twelve consecutive months during that period. Attorneys for the public benefits corporation and those for the DOJ signed the MOU agreement on or about January 27, 2006. The matter was closed on April 7, 2008.Mike Fagan - 06/23/2008