Case: United States v. Marion County Nursing Home District

2:13-cv-00026 | U.S. District Court for the Eastern District of Missouri

Filed Date: March 14, 2013

Closed Date: 2016

Clearinghouse coding complete

Case Summary

On March 14, 2013, the United States Department of Justice filed this complaint in the United States District Court for the Eastern District of Missouri. The United States sued a Marion County-owned skilled nursing facility, the operation of which was largely funded through Medicaid, under the Civil Rights of Institutionalized Persons Act (“CRIPA”) and Title II of the Americans with Disabilities Act (“ADA”), alleging that the Defendant had a practice of violating the constitutional and statutor…

On March 14, 2013, the United States Department of Justice filed this complaint in the United States District Court for the Eastern District of Missouri. The United States sued a Marion County-owned skilled nursing facility, the operation of which was largely funded through Medicaid, under the Civil Rights of Institutionalized Persons Act (“CRIPA”) and Title II of the Americans with Disabilities Act (“ADA”), alleging that the Defendant had a practice of violating the constitutional and statutory rights of residents at the nursing home.

Specifically, the Plaintiff alleged that the Defendant deliberately disregarded known harm or serious risks of harm to residents, and that its actions and failures to act caused harm to residents, including unnecessary segregation, and physical, mental and psychological harm. The Plaintiff alleged that the Defendant was violating the ADA by failing to serve individuals in the most integrated setting appropriate to their needs, by not taking sufficient steps to assess, identify, and prepare individuals for discharge from the facility to programs in the community. The Plaintiff also alleged the Defendant failed to adequately screen individuals who are required by federal law to be screened before admission, resulting in individuals being served in a more restrictive setting than appropriate to their needs.

The Plaintiff also alleged that the Defendant’s healthcare services “substantially depart from professional standards,” and thus failed to provide adequate healthcare, a constitutionally protected right. The Plaintiff alleged that the Defendant failed to monitor, evaluate, update, or review individual’s care plans, despite new diagnoses or changes in conditions. For example, the Plaintiff alleged that on multiple occasions, residents showing symptoms of a stroke or began to foam at the mouth sometimes waited hours before nursing staff noticed or notified a physician. These failures allegedly resulted in unnecessary harm, including hospitalization, preventable falls, and a decline in functional abilities.

Concurrently with the Complaint, the United States filed a settlement agreement, which it had already negotiated with the Defendant. The settlement involved a permanent injunction and declaratory judgment, and mandated improvements in three areas: (1) placement in the most integrated settings, (2) conditions of care and treatment, and (3) protection from harm.

On March 22, 2013, Judge Charles A. Shaw for the United States District for the Eastern District of Missouri issued an order entering the settlement agreement as an order of the court. The Agreement provided for a third party to serve as the Monitor of compliance with the Agreement. The Agreement provided that it should terminate when the Defendant achieved substantial compliance with each provision of the Agreement and has maintained substantial compliance with the Agreement for a period of two years.

First, to ensure placement in the most integrated settings, the Agreement required the Defendant to conduct adequate pre-admission evaluations to ensure that individuals were not inappropriately admitted to the facility. The Defendant was also required to implement a discharge and transition process to ensure that individuals who could be served in more integrated settings were identified and that such individuals would be part of a robust and individualized discharge planning process and implementation. The Agreement also provided for “in-reach” by community service providers to residents to actively support them in moving to more integrated settings.

The Agreement established specific requirements for the “care plan,” or formal written individualized plan of treatment, required for each individual living at the nursing home and those at risk of being institutionalized there.

The Defendant was required to implement a quality assurance process to oversee the discharge and transition process. It was required to review this information on a quarterly basis, and on an annual basis, create a report summarizing its quality assurance activities, findings, and recommendations, and evaluate whether it had been effective in addressing the barriers preventing individuals from receiving services in the most integrated, appropriate settings.

Second, to improve the Defendant's conditions of care and treatment, the Agreement required the Defendant to provide individuals at Maple Lawn with adequate and appropriate protections, treatment, supports, and services to meet the individualized needs of the individuals and that are consistent with generally accepted professional standards. This involved the following: improving health care assessments and care plans, establishing an effective infection control program to minimize the spread of infections or communicable diseases, ensuring that nutrition and hydration services as well as aspiration prevention care were sufficient, improving its psychiatric and psychosocial services, specifically its policies about psychotropic medication, improving pressure sore prevention and treatment policies, providing adequate pain management services, mortality reviews for individuals who die at the Defendant’s facility or at an acute-care facility after being transferred from the Defendant’s facility, and annual quality assurance reporting.

Third, the Defendant was required to provide individuals with a safe and secure environment and ensure protection from harm. The Agreement mandated improvements in the Defendant's fall prevention and reporting policies, adequate reporting and investigation of all incidents where individuals sustain injuries, and annual quality assurance reporting.

The Agreement provided for a third party to serve as the Monitor of compliance with the Agreement. The Agreement provided that it should terminate when the Defendant achieved substantial compliance with each provision of the Agreement and has maintained substantial compliance with the Agreement for a period of two years.

The Monitor’s first Semi-Annual Compliance Report was adopted by the Defendant and filed with the court on September 19, 2013.

On January 30, 2014, the Plaintiff and Defendant filed a joint statement regarding Defendant’s compliance with the settlement agreement, informing the court that they both agreed with the Monitor’s finding that as of January 15, 2014, the Defendant had achieved substantial compliance with the terms of the Agreement.

For the next two years, the Monitor and Defendant filed semi-annual reports on compliance with the settlement agreement.

On April 15, 2016, the Plaintiff and Defendant filed a joint stipulation and motion for dismissal, in which they agreed and stipulated that the Defendant achieved substantial compliance on January 15, 2014 and remained in substantial compliance at all times through January 15, 2016. The parties jointly stipulated to the dismissal of the action, and each paid its own costs. District Judge Rodney W. Sippel dismissed the case, and the case is now closed.

Summary Authors

Elizabeth Greiter (10/6/2017)

People

For PACER's information on parties and their attorneys, see: https://www.courtlistener.com/docket/6562298/parties/united-states-v-marion-county-nursing-home-district/


Judge(s)

Sippel, Rodney W. (Missouri)

Attorneys(s) for Plaintiff

Barkoff, Alison (District of Columbia)

Bohan, Mary (District of Columbia)

Deerinwater, Verlin Hughes (District of Columbia)

Hill, Eve L. (District of Columbia)

Holder, Eric H. Jr. (District of Columbia)

Houston, Katherine (District of Columbia)

Lareau, Alyssa Connell (District of Columbia)

Perez, Thomas E. (District of Columbia)

Smith, Jonathan Mark (District of Columbia)

Judge(s)

Sippel, Rodney W. (Missouri)

Attorneys(s) for Plaintiff

Barkoff, Alison (District of Columbia)

Bohan, Mary (District of Columbia)

Deerinwater, Verlin Hughes (District of Columbia)

Hill, Eve L. (District of Columbia)

Holder, Eric H. Jr. (District of Columbia)

Houston, Katherine (District of Columbia)

Lareau, Alyssa Connell (District of Columbia)

Perez, Thomas E. (District of Columbia)

Smith, Jonathan Mark (District of Columbia)

Attorneys(s) for Defendant

Harding, R. Ryan (Missouri)

Documents in the Clearinghouse

Document

Docket

April 18, 2016 Docket

RE: Investigation of the Maple Lawn Nursing Home, Palmyra, Missouri

No Court

Jan. 25, 2011 Findings Letter/Report
1

Complaint

United States of America v. Marion County Nursing Home District

March 14, 2013 Complaint
5

Settlement Agreement

United States of America v. Marion County Nursing Home District

March 22, 2013 Settlement Agreement
19

Joint Stipulation and Motion for Dismissal

United States of America v. Marion County Nursing Home District

April 18, 2016 Pleading / Motion / Brief

Resources

Title Description External URL

The Caged Canary

Elizabeth Alexander

The United States has experienced an explosion in the number of people in prison, an explosion that cannot be attributed to changes in the crime rate, but rather reflects changes in public policy, pa… Dec. 1, 2008 http://scholarship.law.wm.edu/...

Docket

See docket on RECAP: https://www.courtlistener.com/docket/6562298/united-states-v-marion-county-nursing-home-district/

Last updated May 11, 2022, 8 p.m.

ECF Number Description Date Link
1

COMPLAINT against defendant All Defendants Non-Jury Demand,, filed by United States.(Deerinwater, Verlin) (Additional attachment(s) added on 3/15/2013: # 1 Civil Cover Sheet, # 2 Original Filing Form) (DLB). (Entered: 03/14/2013)

1 Civil Cover Sheet

View on PACER

2 Original Filing Form

View on PACER

March 14, 2013 PACER
2

WAIVER OF SERVICE Returned Executed filed by United States Marion County Nursing Home District, Inc. waiver signed on 3/14/2013, answer due 5/13/2013. (Deerinwater, Verlin) (Entered: 03/14/2013)

March 14, 2013 PACER
3

MOTION for Settlement Agreement Entry as Order of Court by Plaintiff United States. (Attachments: # 1 Attachment A - Settlement Agreement, # 2 Text of Proposed Order)(Deerinwater, Verlin) (Entered: 03/14/2013)

1 Attachment A - Settlement Agreement

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2 Text of Proposed Order

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March 14, 2013 PACER
4

MEMORANDUM in Support of Motion re 3 MOTION for Settlement Agreement Entry as Order of Court filed by Plaintiff United States. (Deerinwater, Verlin) (Entered: 03/14/2013)

March 14, 2013 PACER

Case Opening Notification: Waivers issued - 1 at 60 days. Judge Assigned: U.S. District Judge Rodney W. Sippel. (DLB)

March 14, 2013 PACER
5

ORDERED SETTLEMENT AGREEMENT. Signed by District Judge Rodney W. Sippel on 3/22/2013. (RAK) (Entered: 03/26/2013)

March 22, 2013 PACER
6

ORDER ENTERING SETTLEMENT AGREEMENT. Signed by District Judge Rodney W. Sippel on 3/22/2013. (RAK) (Entered: 03/26/2013)

March 22, 2013 PACER
7

ENTRY of Appearance by R. Ryan Harding for Defendant Marion County Nursing Home District. (Harding, R.) (Entered: 03/29/2013)

March 29, 2013 PACER
8

STATUS REPORT Maple Lawn Nursing Home by United States of America. (Attachments: # 1 Attachment Monitor's Report, # 2 Attachment Monitor's Spreadsheet)(Deerinwater, Verlin) (Entered: 07/25/2013)

1 Attachment Monitor's Report

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2 Attachment Monitor's Spreadsheet

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July 25, 2013 PACER
9

MOTION for Extension of: Time to Implement Policies Pursuant to Settlement Agreement by Defendant Marion County Nursing Home District. (Attachments: # 1 Exhibit)(Harding, R.)Exhibit 1 fld. in error, letter was attached but should be a Report of Monitor Attorney will file attachment as seperate filing - Document #10. Modified on 9/20/2013 (LMY). (Entered: 09/19/2013)

Sept. 19, 2013 PACER
10

MEMORANDUM- EXHIBIT (A) Report of Monitor re 9 MOTION for Extension of: Time to Implement Policies Pursuant to Settlement Agreement by Defendant Marion County Nursing Home District. (Harding, R.) Modified on 9/20/2013 (LMY). (Entered: 09/20/2013)

Sept. 20, 2013 PACER
11

Docket Text ORDER: Re: 9 MOTION for Extension of: Time to Implement Policies Pursuant to Settlement Agreement by Defendant Marion County Nursing Home District. (Attachments: # 1 Exhibit)(Harding, R.)Exhibit 1 fld. in error, letter was attached but should be a Report of Monitor Attorney will file attachment as seperate filing - Document #10. Modified on 9/20/2013 (LMY). filed by Marion County Nursing Home District ; ORDERED GRANTED. Signed by District Judge Rodney W. Sippel on 9/23/2013. (RAK) (Entered: 09/23/2013)

Sept. 23, 2013 PACER
12

STATUS REPORT Joint Statement of Plaintiff, Monitor and Defendant Regarding Implementation of Policies by Marion County Nursing Home District, United States of America. (Harding, R.) (Entered: 11/15/2013)

Nov. 15, 2013 PACER
13

STATUS REPORT re Joint Statement Regarding Defendant's Compliance With Settlement Agreement by Marion County Nursing Home District. (Attachments: # 1 Exhibit)(Harding, R.) (Entered: 01/30/2014)

1 Exhibit

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Jan. 30, 2014 PACER
14

NOTICE Filing of First Annual Report of Monitor and Defendant: by Defendant Marion County Nursing Home District (Attachments: # 1 Exhibit A)(Harding, R.) (Entered: 04/10/2014)

1 Exhibit A

View on PACER

April 10, 2014 PACER
15

NOTICE Filing of Semi-Annual Report of Monitor and Defendant: by Defendant Marion County Nursing Home District (Attachments: # 1 Exhibit A)(Harding, R.) (Entered: 10/03/2014)

1 Exhibit A

View on PACER

Oct. 3, 2014 PACER
16

NOTICE Filing of Second Annual Report of Monitor and Defendant: by Defendant Marion County Nursing Home District (Attachments: # 1 Exhibit A)(Harding, R.) (Entered: 03/31/2015)

1 Exhibit A

View on PACER

March 31, 2015 PACER
17

NOTICE Filing of Semi-Annual Report of Monitor and Defendant for the Period of 3/19/2015 to 9/20/2015: by Defendant Marion County Nursing Home District (Attachments: # 1 Exhibit A)(Harding, R.) (Entered: 10/06/2015)

1 Exhibit A

View on PACER

Oct. 6, 2015 PACER
18

Joint MOTION to Dismiss Case Joint Stipulation and Motion for Dismissal by Defendant Marion County Nursing Home District. (Harding, R.) (Entered: 04/15/2016)

April 15, 2016 PACER
19

ORDER entered granting 18 stipulation and Motion to Dismiss Case Signed by District Judge Rodney W. Sippel on 4/18/16. (LGK) (Entered: 04/18/2016)

April 18, 2016 RECAP

State / Territory: Missouri

Case Type(s):

Nursing Home Conditions

Key Dates

Filing Date: March 14, 2013

Closing Date: 2016

Case Ongoing: No

Plaintiffs

Plaintiff Description:

United States Department of Justice

Plaintiff Type(s):

U.S. Dept of Justice plaintiff

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

Marion County, MO (Palmyra, Marion), County

Case Details

Causes of Action:

Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997 et seq.

Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.

Constitutional Clause(s):

Due Process

Availably Documents:

Trial Court Docket

Complaint (any)

Injunctive (or Injunctive-like) Relief

Outcome

Prevailing Party: Plaintiff

Nature of Relief:

Injunction / Injunctive-like Settlement

Declaratory Judgment

Source of Relief:

Settlement

Form of Settlement:

Court Approved Settlement or Consent Decree

Amount Defendant Pays: 0

Order Duration: 2013 - 2016

Content of Injunction:

Monitoring

Reporting

Issues

General:

Bathing and hygiene

Classification / placement

Discharge & termination plans

Failure to train

Food service / nutrition / hydration

Neglect by staff

Reassessment and care planning

Discrimination-basis:

Disability (inc. reasonable accommodations)

Disability:

Least restrictive environment

Mental Disability:

Intellectual/developmental disability, unspecified

Medical/Mental Health:

Bed care (including sores)

Medical care, general

Mental health care, general

Skin Infections

Type of Facility:

Government-run

Benefit Source:

Medicaid