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 Nim Henson Geriatric Center ("Henson"), a county-operated skilled nursing facility in ...
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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 Nim Henson Geriatric Center ("Henson"), a county-operated skilled nursing facility in Jackson, Kentucky. The investigation resulted in a findings letter being sent to Breathitt County's judge executive on March 6, 2003. The letter stated that in June 2002, DOJ and certain of its expert consultants toured the facility, interviewed administrators, residents and staff, and reviewed medical and other records. The DOJ's investigation led it to conclude that certain conditions at Henson violated residents' federal constitutional and statutory rights. According to the DOJ, residents at Henson suffered from deficiencies in the following areas: 1) general medical care, 2) chemical restraints, 3) wound and nutritional care, 4) restorative care, 5) psychiatric care, and 6) incident management and quality assurance.
The findings letter described that the DOJ investigators determined that the facility's medication management practices; its medical notes and documentation; and its oversight and management of medical care did not meet generally accepted standards of care. Among the identified systemic deficiencies were unjustified use on residents of polypharmacy and psychotropic medications, inadequate monitoring of medications' effects, and failure to re-evaluate the continued necessity or dosage units of certain drugs. The investigation found poor or absent (i) physician-pharmacist consultations, (ii) medication policies and guidelines, (iii) diagnosis and treatment of underlying disorders (rather than symptoms), (iv) medical notes and documentation, and (v) oversight and management of medical care.
The facility employed sedation for reasons not associated with a medical condition, and the intermediate care unit within the facility provided substandard wound assessment, identification, care and tracking. Failure to appropriately respond to instances of weight loss and overuse of feeding tubes reflected poor nutritional care at the facility. Henson's failure to provide active (as opposed to passive) group activities, an absence of functional furniture, and care plans that failed to include restorative interventions addressing preventable declines in residents' functioning were other shortcomings described in the findings letter. Particularly in the intermediate care unit, DOJ found that the nursing staff lacked a systematized approach to resident assessment and to the provision of early intervention regarding significant changes in resident status. Additionally, at least half of the residents sampled were receiving psychiatric care that substantially departed from generally accepted standards. No psychiatric and no behavioral professionals were available to the facility; physicians and nurses at the facility had no training in geriatric psychiatry generally, or in treating individuals experiencing dementia or depression; and residents who badly need acute psychiatric care were rarely transferred to psychiatric hospitals. Henson's incident management efforts, ineffective in several ways, failed to pull relevant disciplines together to identify and provide needed supports and services to prevent falls and injuries. Likewise, the facility lacked an effective quality assurance system to track significant trends and events and ensure that proper corrective action occurs. Regarding discharge planning, the DOJ found that Henson's staff did not adequately evaluate or assess residents for their discharge potential. It failed to have its treatment professionals periodically assess whether community-based treatment was appropriate. These latter inadequacies 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. § 12132 and 42 C.F.R. § 35.139(j).
The DOJ findings letter proposed remedial actions to remedy the multiple deficiencies, invited the county to address the issues, and alerted the county 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 - 06/19/2008