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Case: U.S. V. BREATHITT COUNTY, KENTUCKY

5:04-cv-00076 | U.S. District Court for the Eastern District of Kentucky

Filed Date: Feb. 17, 2004

Closed Date: Oct. 30, 2006

Clearinghouse coding complete

Case Summary

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 con…

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 needed acute psychiatric care were rarely transferred to psychiatric hospitals. Henson's incident management efforts 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.

On February 17, 2004 the United States filed a complaint against Breathitt County, Kentucky, and Breathitt County Geriatric Corporation for violating CRIPA, 42 U.S.C. §1997, within the Nim Henson Nursing Home for the violations noted in the findings letter above. Specifically, the complaint alleged that the defendants failed to protect residents from harm and, further, failed “to provide adequate medical, nursing, nutritional, wound, restorative, and psychiatric care to residents” in the nursing home. Moreover, the complaint alleged that the defendants failed to continually assess whether the treatment needs of residents were being met.

On February 19, 2004, a settlement agreement was entered with the court. Through the settlement agreement the parties agreed to the following terms: Defendants would ensure that residents shall be promptly assessed, diagnosed, treated, monitored, and, when necessary, reassessed, diagnosed, and treated with current, generally accepted standards of care, including documentation adequate to withstand clinical scrutiny. Defendants would develop policies to fully monitor medication distribution, and the effects of medications on patients. Defendants would keep accurate, current, complete, and organized medical documentation. Defendants would cease using restrictive controls and chemical restraints except in narrow situations. Defendants would create and maintain a documentation system, as well as a formulary, for patient wound care. Furthermore, defendants would ensure that nurses knew “the wound status of each resident in their care.” Defendants would monitor the weight and nutrition of residents and ensure that necessary interventions occurred. Defendants would ensure residents are able to have the highest quality of life possible and develop a restorative care plan for all residents. Defendants would provide necessary psychiatric care for residents. Defendants would investigate and follow up on all “unusual incidents” or incidents involving injury. Defendants would routinely assess residents to see if community placement is necessary. Defendants would provide the United States Department of Justice with status report within 90 days and provide continual, unrestricted access to buildings and facilities, staff, residents, and records relating to the settlement agreement, staff, or residents

Two years after the settlement agreement, the government found that the Nim Henson Nursing Home had been complying with all the terms of the settlement agreement. As a result, the case was dismissed.

Summary Authors

Mike Fagan (6/19/2008)

Cianan Lesley (10/22/2017)

People


Judge(s)

Forester, Karl Spillman (Kentucky)

Attorneys(s) for Plaintiff

Ashcroft, John (District of Columbia)

Clay, Marianna Jackson (Kentucky)

Johnson, Elizabeth (District of Columbia)

Patel, Shennie (District of Columbia)

Tayloe, Benjamin O. (District of Columbia)

Van Tatenhove, Gregory Frederick (Kentucky)

Attorneys(s) for Defendant

Miller, Brendon (Kentucky)

Expert/Monitor/Master

Warrix, Lewis H. (Kentucky)

Judge(s)

Forester, Karl Spillman (Kentucky)

Attorneys(s) for Plaintiff

Ashcroft, John (District of Columbia)

Clay, Marianna Jackson (Kentucky)

Johnson, Elizabeth (District of Columbia)

Patel, Shennie (District of Columbia)

Tayloe, Benjamin O. (District of Columbia)

Van Tatenhove, Gregory Frederick (Kentucky)

Attorneys(s) for Defendant

Miller, Brendon (Kentucky)

Expert/Monitor/Master

Warrix, Lewis H. (Kentucky)

Documents in the Clearinghouse

Document

5:04-cv-00076

Docket

United States of America v. Breathitt County

Oct. 30, 2006

Oct. 30, 2006

Docket

Re: Nim Henson Geriatric Center

United States of America v. Breathitt County

No Court

March 6, 2003

March 6, 2003

Findings Letter/Report
1

5:04-cv-00076

Complaint

United States of America v. Breathitt County

Feb. 17, 2004

Feb. 17, 2004

Complaint
2

5:04-cv-00076

Settlement Agreement

United States of America v. Breathitt County

Feb. 19, 2004

Feb. 19, 2004

Settlement Agreement

Docket

Last updated Sept. 2, 2022, 3:12 a.m.

ECF Number Description Date Link Date / Link
1

COMPLAINT filed by United States of America. (Attachments: # 1 Civil Cover Sheet, Case Assignment)(LKM) (Entered: 02/18/2004)

Feb. 17, 2004

Feb. 17, 2004

PROPOSED Settlement Agreement (tendered to Judge for Signature). (LKM) (Entered: 02/18/2004)

Feb. 17, 2004

Feb. 17, 2004

2

SETTLEMENT AGREEMENT . Signed by Judge Karl S. Forester. (KJR)cc: COR (Entered: 02/19/2004)

Feb. 19, 2004

Feb. 19, 2004

JOINT GENERAL ORDER re privacy policy re public access to electronic case files. (cc: COR). (KJR) (Entered: 03/16/2004)

March 16, 2004

March 16, 2004

3

JOINT MOTION to Dismiss by United States of America, Breathitt County (Attachments: # 1 Proposed Order)(Clay, Marianna) (Entered: 10/26/2006)

Oct. 26, 2006

Oct. 26, 2006

***MOTION SUBMITTED TO CHAMBERS of Judge Forester for review: 3 JOINT MOTION to Dismiss by United States of America & Breathitt County. (MWZ) (Entered: 10/26/2006)

Oct. 26, 2006

Oct. 26, 2006

4

ORDER Of Dismissal re 3 JOINT MOTION to Dismiss: it is hereby ORDERED that this case is dismissed w/ prejudice. Signed by Judge Karl S. Forester. (MWZ)cc: COR (Entered: 10/30/2006)

Oct. 30, 2006

Oct. 30, 2006

Case Details

State / Territory: Kentucky

Case Type(s):

Nursing Home Conditions

Special Collection(s):

Multi-LexSum (in sample)

Key Dates

Filing Date: Feb. 17, 2004

Closing Date: Oct. 30, 2006

Case Ongoing: No

Plaintiffs

Plaintiff Description:

Plaintiff is the United States of America through the 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: No

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

Nim Henson Geriatric Center (Breathitt), County

Defendant Type(s):

Hospital/Health Department

Case Details

Causes of Action:

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

Availably Documents:

Trial Court Docket

Complaint (any)

Injunctive (or Injunctive-like) Relief

Outcome

Prevailing Party: Plaintiff

Nature of Relief:

Injunction / Injunctive-like Settlement

Source of Relief:

Settlement

Litigation

Form of Settlement:

Court Approved Settlement or Consent Decree

Order Duration: 2004 - 2006

Content of Injunction:

Hire

Reasonable Accommodation

Reporting

Recordkeeping

Monitoring

Issues

General:

Counseling

Food service / nutrition / hydration

Habilitation (training/treatment)

Incident/accident reporting & investigations

Individualized planning

Informed consent/involuntary medication

Neglect by staff

Reassessment and care planning

Record-keeping

Rehabilitation

Restraints : chemical

Staff (number, training, qualifications, wages)

Totality of conditions

Disability:

disability, unspecified

Integrated setting

Mental impairment

Mobility impairment

Medical/Mental Health:

Bed care (including sores)

Medical care, general

Medication, administration of

Mental health care, general

Wound care

Type of Facility:

Government-run

Benefit Source:

Medicaid

Medicare