Resident's gruesome death warrants steep fines: court

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Judge issues ruling in $1 billion nursing home case, says IL governor's firm not responsible
Judge issues ruling in $1 billion nursing home case, says IL governor's firm not responsible

The Centers for Medicare & Medicaid Services was justified in fining a Kentucky skilled nursing facility $4,050 a day for three months following a resident's death, a U.S. Appeals Court recently ruled.

The case involves an 87-year-old resident of Life Care Center of Bardstown who experienced two episodes of vomiting prior to being transported to a hospital and dying, on Jan. 2, 2007. CMS conducted a survey after the resident's death and levied monetary penalties for a period starting on the day of the resident's death through March 27.

Life Care Center appealed the citations and the duration of the penalties. It argued the resident did not vomit a second time, but merely spat up medicine, and therefore the nurse on duty was not required to call the resident's doctor, per the physician consultation requirement. 

An administrative law judge and then the U.S. Sixth Circuit Court of Appeals upheld the citation. The ALJ and the court cited nurse's notes indicating a second vomiting episode, and two CMS surveyors who said the nurse told them a second vomiting incident had occurred, although they did not take notes of this interview.

The SNF also argued that it had a facility policy in place to record residents' vital signs only if they were abnormal. The appeals court ruled that there was no evidence such a policy had been in place. It upheld the CMS citation for noncompliance with the quality of care requirement. 

The court also upheld a citation related to the facility administration requirement, noting that the SNF's other violations placed the resident in immediate jeopardy, indicating administrative mismanagement.

CMS appropriately fined the facility on a daily basis until it could determine that proper training and other changes had resolved the immediate jeopardy issues, the Sept. 6 appeals court ruling stated.