A Class Action Complaint filed on May 15, 2024 in the United States District Court for the District of Maryland Northern District alleges, in part:
Maryland has 225 licensed nursing facilities that participate in Medicaid or Medicare. MDH is charged with certifying annually that each of these facilities is in compliance with federal requirements and therefore eligible to participate in the Medicaid and Medicare programs … According to CMS data, there are at least 9,056 people with mobility impairment residing in nursing facilities in Maryland … Many Maryland nursing facility residents with mobility limitations need assistance with numerous care tasks: 86% require help from one or more staff members to get into or out of bed, 54% require the help of another to eat a meal, and 94% require help from one or more staff members to toilet. Id. These care needs reflect the heightened reliance that Plaintiffs have on staff assistance.
In fiscal year 2022, there were 51,656 residents in nursing facilities in Maryland; statewide, 35.7% of them were identified as Black residents.
Plaintiffs, and the class they seek to represent, are nursing facility residents with mobility impairments living in Medicaid- and Medicare-participating facilities (“Plaintiffs”). Plaintiffs surrendered life in their community in favor of placement in an institutional care setting to ensure that they receive the round-the-clock medical care and assistance with toileting, hygiene, mobility, and other activities of daily living that they need to maintain their health, safety, and dignity. The Maryland Department of Health (MDH) is the government entity charged with regularly entering Maryland’s nursing facilities to assess their operations and to ensure compliance with federal and state quality of care standards. Despite the importance of its oversight responsibilities, MDH has allowed more than 100 nursing facilities to go four years without an annual inspection (known as a “survey”), with many more facilities overdue for an annual survey, and has allowed a backlog of thousands of uninvestigated complaints from nursing facility residents to pile up. When MDH fails to carry out its oversight responsibilities, dangerously poor-quality care within nursing facilities goes undetected and uncorrected.
For years, MDH has failed to conduct statutorily-mandated annual surveys or act on Plaintiffs’ complaints within statutorily-prescribed time frames. As a result, Maryland’s nursing facilities have not been held accountable when they fail to meet mandated federal and state standards related to resident rights, quality of care, and staffing. Because of Plaintiffs’ mobility impairments, this lack of accountability leaves Plaintiffs in situations where they are vulnerable to neglect and mistreatment, which lead to pressure ulcers, falls, and unnecessary seclusion. Plaintiffs have suffered and continue to suffer personal degradation and significant physical and psychosocial harm as a result of Defendants’ failures.
MDH’s performance in timely completing annual surveys is among the worst among the states. Its failure has left the residents of a vast majority of the state’s nursing facilities without the benefit of annual surveys designed to protect
their rights.
Similarly, MDH has failed to investigate Plaintiffs’ complaints within mandated time frames. Many serious complaints alleging harm go uninvestigated for months or years, leaving the residents across nursing facilities without an
independent governmental review of allegations related to neglect and other violations of resident rights …
Plaintiffs must rely on nursing staff assistance on a daily basis to leave their rooms and interact with others, to take a shower, for toileting and incontinence care, to receive needed pain medicine, and even to have a drink of water. Where that care is lacking, Plaintiffs experience higher levels of harm, including skin problems such as skin breakdown and pressure sores, falls, and seclusion relative to residents without mobility impairments. They experience personal loss of dignity when their hygiene and incontinence needs are not met by the nursing facility.
Over the past three fiscal years, MDH reported approximately 13,173 complaints and facility-reported incidents, including serious allegations of harm to residents, of which fewer than half have been investigated.
The Plaintiffs seek, in part, for the District Court to :
Grant preliminary and permanent injunctive relief, requiring Defendants to:
(1) Completely and accurately conduct annual surveys of nursing facilities on a twelve-month cycle, and complete related enforcement activities of nursing facilities relating to compliance with the requirements of the Nursing Home Reform Act, 42 U.S.C. § 1396r(g) (referencing 42 U.S.C. § 1396r(b), (c), and (d)). Such surveys and enforcement activities are to be conducted to ensure that nursing facilities that have resident populations which are majority Black are subject to enforcement activities to ensure compliance with nursing facility requirements.
(2) Timely, completely, and accurately investigate complaints (including, as required by Md. Code Ann., Health – Gen. § 19-1408(b), initiating within 48 hours for Immediate Jeopardy, and within 10 days for other serious allegations) and complete related enforcement activities regarding nursing facility care, such investigations to include complaints where physical or psychosocial harm is alleged. Such complaint investigation and enforcement activities are to be conducted to ensure that nursing facilities serving Plaintiffs that have resident populations which are majority Black are subject to enforcement activities to ensure compliance with nursing facility requirements.
(3) Conduct timely, complete, annual surveys, and related enforcement activities to ensure that nursing facilities are in compliance with state licensing standards under Md. Code Ann., Health – Gen. § 19-1408(a), including compliance with the protections afforded nursing facility residents in the Maryland Resident Bill of Rights Act, Md. Code Ann., Health – Gen. § 19-343. Such enforcement activities are to use all available remedies necessary to ensure nursing facility compliance, including nursing facilities serving Plaintiffs that have resident populations which are majority Black.
(4) Conduct timely, complete investigations of complaints and related enforcement activities to ensure that nursing facilities are in compliance with state licensing standards under Md. Code Ann., Health – Gen. § 19-1408(b), and include complaints related to the protections afforded nursing facility residents in the Maryland Resident Bill of Rights Act, Md. Code Ann., Health – Gen. § 19-343. Such enforcement activities are to use all available remedies necessary to ensure nursing facility compliance, including nursing facilities that have resident populations which are majority Black.
(5) Timely make available to the public information respecting all nursing facility surveys, complaint investigations, and certifications made with respect to nursing facilities, including facility sanctions and corrective enforcement
actions.
Connor v. Maryland Department of Health, Case No. 1:24-cv-01423-ABA.
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