Aurora Chi. Lakeshore Hosp. v. Azar

356 F. Supp. 3d 749
CourtDistrict Court, E.D. Illinois
DecidedDecember 21, 2018
DocketCase No. 18-cv-8162
StatusPublished
Cited by3 cases

This text of 356 F. Supp. 3d 749 (Aurora Chi. Lakeshore Hosp. v. Azar) is published on Counsel Stack Legal Research, covering District Court, E.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Aurora Chi. Lakeshore Hosp. v. Azar, 356 F. Supp. 3d 749 (illinoised 2018).

Opinion

SHARON JOHNSON COLEMAN, United States District Court Judge

The plaintiff, Aurora Chicago Lakeshore Hospital ("Aurora"), brought this action against Secretary of the United States Department of Health and Human Services Alex M. Azar, II, Administrator for the Centers for Medicare and Medicaid Services Seema Verma, and Acting Regional Administrator for the Centers for Medicare and Medicaid Services Captain Anna Gonzalez (collectively "CMS"). CMS, following an investigation, reached the decision to terminate Aurora's Medicare provider agreement based on a finding that Aurora was not complying with Medicare's conditions of participation. Aurora appealed that determination administratively, and subsequently filed this suit alleging that, in deciding to terminate Aurora's provider agreement, CMS failed to comply with procedural requirements established by federal law and thereby violated its rights under the United States Constitution's Due Process Clause and the Administrative Procedures Act. Aurora now moves for a temporary restraining order and preliminary injunction to prevent CMS from terminating its provider agreement before this Court can determine whether CMS's conduct with respect to that termination violated Aurora's constitutional and statutory rights. For the reasons set forth herein, that motion [6] is granted.

As an initial matter, it is important to emphasize the narrow focus of the case that is before it. Aurora, a behavioral health hospital specializing in pediatric care, has been alleged to have systematically failed to protect its patients, including minors, from physical and sexual abuse. Those extremely troubling allegations have been the subject of extensive media attention and public focus. Those allegations, however, are also not at issue before this Court, and therefore cannot be the basis for a decision on the merits of Aurora's constitutional and statutory claim. The narrow question that is presented to the Court in this case is whether, in deciding to terminate Aurora's provider agreement, CMS disregarded procedural regulations and thereby violated Aurora's procedural due process and Administrative Procedures Act rights. CMS's initial and primary focus is that the Court lacks jurisdiction.

Background

Aurora is an Illinois-licensed behavioral health hospital located in Chicago. It is one of the largest behavioral health providers in Illinois, with over one-hundred-and-sixty licensed beds and approximately 5,000 patients annually. Aurora's facility is also uniquely equipped to provide pediatric psychiatric care. Aurora is currently certified to participate in Medicare and Medicaid, and the vast majority of its patients are beneficiaries under those programs.

*753Medicare provides health insurance benefits by making payments directly to the institution or individual providing the health service or care. 42 U.S.C. §§ 1395c, 1395f. In order to receive payment for services rendered to a Medicare patient, an institution must meet the conditions of participation prescribed by the Medicare statute and accompanying regulations. If those conditions are met, the institution then becomes eligible to execute a one-year renewable provider agreement with the Secretary of Health and Human Services. 42 U.S.C. § 1395cc. Institutions certified as Medicare providers are subject to periodic surveys by designated state agencies to ensure their compliance with federal standards. 42 U.S.C. § 1395aa ; 42 C.F.R. § 405.1904.

A Medicare provider may be terminated from participation in the program if, in pertinent part, it is determined that it failed to comply substantially with the provisions of the agreement, with the provisions of Subchapter XVIII, and the regulations thereunder, or with a corrective action required under 42 U.S.C. § 1395ww(f)(2)(B). Review of decisions to terminate a Medicare provider are governed by 42 U.S.C. § 405, which provides for administrative review by the Commissioner of Social Security and, subsequently, judicial review of any final decision of the Commissioner of Social Security made after a hearing pursuant to 42 U.S.C. § 405(g). 42 U.S.C. § 1395cc(h).

The Illinois Department of Public Health conducted a complaint investigation survey at Aurora on July 27, 2018. That investigation found that Aurora was not in compliance with Medicare's Conditions of Participation regarding patients' rights ( 42 C.F.R. § 482.13 ) because (1) it failed to ensure that a patient complaint of possible sexual assault was investigated; (2) it failed to obtain informed consents from patients for psychotropic medications prior to the administration of the medications; (3) it failed to ensure that the patient's rooms were free of ligature risks from the door frames throughout the hospital; and (4) it failed to ensure that safety rounds were completed as required. It further found that at least one of those violations, the ligature risk posed by the doorframes, placed patients in immediate jeopardy. On August 1, 2018, CMS provided Aurora with notice of these findings and CMS's determination that Aurora was not in compliance with a Medicare condition at the immediate jeopardy level. CMS accordingly advised that it would be terminating Aurora's provider agreement on August 24, 2018. CMS, however, also invited Aurora to submit a "plan of correction" to immediately correct the identified violations of Medicare's conditions of participation. On August 10, 2018, Aurora submitted a plan of correction outlining the measures that it would take to address the identified deficiencies.

On August 23, 2018, the Illinois Department of Public Health conducted a second survey to determine whether the condition of immediate jeopardy at Aurora had been removed. That investigation found that Aurora remained out of compliance with Medicare conditions at the "immediate jeopardy" level because (1) it failed to ensure that patients were free from ligature risks due to wall mounted telephones with metal cords longer than 12 inches; (2) it failed to ensure adequate monitoring for a suicidal patient; and (3) it failed to ensure that the doors to public rooms were locked when not in use.

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Bluebook (online)
356 F. Supp. 3d 749, Counsel Stack Legal Research, https://law.counselstack.com/opinion/aurora-chi-lakeshore-hosp-v-azar-illinoised-2018.