Crestview Parke Care Center v. Tommy Thompson United States Department of Health and Human Services

373 F.3d 743, 2004 U.S. App. LEXIS 13230, 2004 WL 1432719
CourtCourt of Appeals for the Sixth Circuit
DecidedJune 28, 2004
Docket02-4084
StatusPublished
Cited by26 cases

This text of 373 F.3d 743 (Crestview Parke Care Center v. Tommy Thompson United States Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Crestview Parke Care Center v. Tommy Thompson United States Department of Health and Human Services, 373 F.3d 743, 2004 U.S. App. LEXIS 13230, 2004 WL 1432719 (6th Cir. 2004).

Opinions

MOORE, J., delivered the opinion of the court, in which MARTIN, J., joined. KENNEDY, J. (pp. 757-59), delivered a separate opinion concurring in part and dissenting in part.

KAREN NELSON MOORE, Circuit Judge.

Petitioner Crestview Parke Care Center (“Crestview”), a skilled nursing facility, appeals an order holding Crestview responsible for a $27,600 civil money penalty (“penalty”). Following several inspections of Crestview’s Cincinnati facility in 1999, Respondent Centers for Medicare and Medicaid Services (“CMS”) determined that Crestview violated several regulations and levied a penalty against Crestview. Crest-view requested a hearing to dispute the penalty. The parties filed briefs and gathered evidence in advance of a hearing, but the ALJ declined to hold an in-person hearing, believing that the written record was sufficient to adjudicate the matter. CMS filed a motion for summary judgment, which the ALJ granted, reasoning that no genuine issues of material fact existed regarding any of Crestview’s alleged acts of noncompliance. The ALJ upheld the penalty, finding it to be reasonable. Because genuine issues of material fact do exist as to some of the acts of noncompliance, and it was thus improper not to hold an in-person evidentiary hearing, we VACATE the order and REMAND for an in-person, evidentiary hearing on the disputed material issues as we outline below.

I. FACTS AND PROCEDURE

Crestview, a skilled nursing facility, is periodically surveyed by the CMS in order to assure compliance with Medicare and Medicaid regulations. On August 12, 1999, the Ohio Department of Health (“ODH”), which often examines skilled nursing facilities for CMS, see 42 C.F.R. § 488.20(a), completed a Life Safety Code survey of Crestview’s Cincinnati facility. The ODH surveyors determined that Crestview violated a federal regulation requiring emergency lighting because Crestview’s emergency generator failed to start. See 42 C.F.R. § 483.70(b)(1).

The following day, the ODH investigators returned and discovered numerous additional infractions. First, the ODH found that Crestview had failed to provide “[hjousekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior.” 42 C.F.R. § 483.15(h)(2). The surveyors pinpointed fifteen different infractions, including a hole in the tile floor of a restroom, missing ceiling tiles, and dirty showers. Second, the ODH found that some residents did not receive care and services necessary to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. 42 C.F.R. § 483.25. Specifically, two residents (Residents 44 and 90), needed elbow or heel protectors to ward off pressure sores, but were observed lying on their beds without these protectors. Third, Crestview failed [745]*745to ensure that “[a] resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable.” 42 C.F.R. § 483.25(c)(1). Resident 68 had two pressure sores and did not have pressure-relieving devices. Resident 93 was observed wearing pillowed heel protectors that were contaminated with dried serosanginous drainage. Fourth, the ODH alleged that Crestview failed to “[s]tore, prepare, distribute, and serve food under sanitary conditions,” 42 C.F.R. § 483.35(h)(2), noting seventeen different food-related violations, including dirty equipment, dried food spills, and potentially botulinus food containers. Fifth, the ODH found that Crest-view failed to provide the annual twelve hours of in-service training that were “sufficient to ensure the continuing competence of nurse aides,” 42 C.F.R. § 483.75(e)(8)®, for fourteen of the twenty-nine nurse aides employed at Crestview.

On August 30, 1999, the ODH informed Crestview that it was noncompliant and recommended to CMS that it impose a penalty of $400 per day unless Crestview remedied the problems by October 2,1999. ODH revisited the facility on October 5, 1999. It discovered not only that Crest-view had failed to remedy the deficiencies discovered during the August inspections, but also that it had committed twelve additional housekeeping violations. CMS imposed the $400 per-day penalty. See 42 U.S.C. § 1395i — 3(h)(2)(B)(ii) (giving the HHS Secretary the authority to impose penalties not to exceed $10,000 per day of noncompliance). A fourth inspection on October 21, 1999, demonstrated that Crestview had remedied the problems and achieved substantial compliance. On November 19, 1999, CMS informed Crestview that it owed $27,600 for sixty-nine days of noneompliance.

Crestview appealed its penalty on December 30, 1999, in accordance with HHS regulations. See 42 C.F.R. §§ 498.40(a)(1), 498.5(k). The case was assigned to an ALJ, but just before the filing of the final exhibit and witness lists in December 2000, the case was reassigned to a different ALJ, who set a hearing date for September 18, 2001. The parties participated in a prehearing telephone conference on September 10, 2001, during which the ALJ admitted all the exhibits that had already been tendered into evidence. The ALJ attempted to delve deeper into the exact nature of Crestview’s claims, but found that Crestview's attorneys were unable to answer many of her questions regarding the contours of its appeal.

Tragedy followed on September 11th, forcing the postponement of both the pre-hearing conference call and the hearing itself. The parties resumed their prehear-ing teleconference on September 19, 2001. The ALJ learned during the phone call that the parties had failed to stipulate to any factual matters. The ALJ consequently ordered the parties to draft pre-hearing briefs that would more clearly outline the facts and the legal arguments to be made at the hearing. The ALJ also asked the parties to append all witness affidavits and declarations to these pre-hearing briefs. The ALJ stated clearly that the record at this point was closed.

The parties then exchanged prehearing briefs. CMS filed its prehearing brief on October 19, 2001, asking for a summary affirmance of the penalty because there were no disputes of material fact. Crest-view filed its prehearing brief on November 29, 2001. It challenged all of the facts as presented by CMS and attached declarations from Julie Hrybiniak, the Regional Administrator for Crestview and Alejandro Bayalan, the Food Service Manager at Crestview. Crestview also filed a declara[746]*746tion from accountant Bert Cummins, who had not been previously listed as a witness. Cummins’s declaration purported to show that Crestview was unable to pay the penalty.

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Bluebook (online)
373 F.3d 743, 2004 U.S. App. LEXIS 13230, 2004 WL 1432719, Counsel Stack Legal Research, https://law.counselstack.com/opinion/crestview-parke-care-center-v-tommy-thompson-united-states-department-of-ca6-2004.