In one of the largest state sanctions against a nursing home, the Pennsylvania Department of Health fined the Charles M. Morris Nursing and Rehabilitation Center $235,000 after an investigation spurred by an accidental death last fall of one of its residents due to improper bedrail use.
The agency also downgraded the Jewish Association on Aging facility’s operating license from 12 months to six months.
The sanctions followed a determination last fall that the center was not in compliance with health regulations and a subsequent finding that Charles Morris had since brought itself back into compliance.
The delayed announcement of the financial penalty is not surprising, said April L. Hutcheson, communications director for the Department of Health. “The timing of the financial sanction is often later.”
More perplexing to some is the actual figure.
“I have never seen a fine like that, or reduction, that I can recall,” said Bruce Martin Ginsburg, a Philadelphia-based personal injury attorney whose firm has handled nursing home malpractice cases for more than 15 years.
As for how the Department of Health arrived at the $235,000 figure, “there’s a calculation, but we’re unclear exactly what the math is,” said Russ McDaid, president and CEO of the Pennsylvania Healthcare Association.
“The calculation is based on a per-instance, per-day basis,” said Hutcheson. “There is not a formula. The law describes the department’s ability to assess fines.”
As for the nearly quarter-of-a-million-dollar fine, the department representative placed it in perspective. “It is not the largest recorded in the state,” she said. “St. Francis near Philadelphia was fined more than $700,000 in December 2017 after its license was revoked.”
Still, fines in the several-hundred-thousand-dollar range are concerning, said McDaid. “That’s [money] that is no longer available for use at the patient bedside.”
Alan Meisel, a professor of law and psychiatry and founder of the University of Pittsburgh’s Center for Bioethics and Health Law, criticized such high penalties.
“One of the reasons why nursing homes have difficulties providing high-quality services is because of fiscal [difficulties],” he said. “They are very expensive to run, and they don’t always get adequate funding, especially from Medicaid, to do it. To impose a penalty on them makes things worse.”
But issuing sizable fines follows a recent trend in the commonwealth, one that has been encouraged by the administration of Democratic Gov. Tom Wolf.
One of the reasons why nursing homes have difficulties providing high-quality services is because of fiscal [difficulties.] To impose a penalty on them makes things worse.
A report by the Philadelphia Inquirer showed that by May of 2017, the Department of Health had already “fined nursing homes more in the first four months of  than in the previous three years combined, as regulators started using a more rigorous penalty system after coming under fire for going too lightly on substandard care.”
“It’s a troubling trajectory, and I’m hopeful that we’ll see an end in sight, but we certainly don’t think so at this point,” said McDaid.
From a federal standpoint, that wish may soon be granted. Last month, The New York Times reported that “the Trump administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury.”
The move is “part of a broader relaxation of regulations under the president,” said the paper.
“For the longest time the government’s approach was to impose fines and sometimes to shut down the nursing homes, and it became clear over a period of time to federal regulators that it’s counterproductive,” said Meisel.
“All things being equal, we believe we need to find a way to put those dollars to use so that the facilities can make the types of changes they believe they need to make or make the investment in their staff, make the investment in reducing turnover, the investment of putting processes and procedures in place,” he said.
“They can’t do that if significant amounts of discretionary dollars are being taken out of their hands and put in state coffers somewhere,” he added.
As for Charles Morris, “the state obviously has a real microscope on this facility,” said Ginsburg.
Even so, state health law provides an appellate procedure for nursing homes. “Once an order is issued, there is a 30-day appeal period,” said Hutcheson. “If no appeal is filed, the order will take effect.”
“Charles Morris cooperates fully with the Pennsylvania Department of Health which oversees our quality of care,” Charles Morris administrator Phil Ricci said in a prepared statement. “We appreciate and value the department’s important role in our industry and strive to adhere to the highest standards of care it expects.”
“After the department’s recent audit of our facility, we submitted a plan of correction that addressed each of their concerns,” he added. “The department subsequently approved the plan and informed us that we are in full compliance with their regulations. Now that the department has determined to revisit its resolution of these issues, we intend to work with the department and the procedures it provides to resolve these issues.” PJC
Adam Reinherz can be reached at areinherz