Recently, a state appellate court issued a written opinion in a personal injury case that illustrates a key issue that arises in many Maryland nursing home negligence cases. The case presented the court with the opportunity to discuss the validity of an arbitration clause contained in the nursing home’s pre-admission paperwork. Ultimately, the court concluded that the clause should be upheld and dismissed the plaintiff’s case, holding that the plaintiff was required to submit the case through arbitration.

Reviewing the ContractThe Facts of the Case

The plaintiff arranged for himself to stay at the defendant nursing home. The plaintiff was a resident of Nebraska, and the nursing home was a North Dakota corporation with its principal place of business in South Dakota.

Prior to his admission, the nursing home presented the plaintiff with a pre-admission contract. Contained in the contract was an arbitration clause. The clause contained a check-box next to the statement that the parties agree that “any legal controversy, dispute, disagreement or claim arising between the Parties” would be resolved through arbitration. The plaintiff checked the box marked “yes, I do.”

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A state appellate court recently ruled on a case in which a nursing home’s arbitration agreement failed to strictly comply with the state’s requirements concerning arbitration agreements. In that case, when the patient had moved into the nursing home, she received an admissions packet with forms that included an arbitration agreement. The state’s Health Care Availability Act required that arbitration agreements contain a four-paragraph notice in a particular font size and bold-faced type. In the arbitration agreement on the patient’s form, the language was in the correct font size, but was not printed in bold typeface.

Arbitration ClauseAfter the patient’s death, her family brought a wrongful death claim against the nursing home. The nursing home moved to compel arbitration based on the arbitration agreement. A trial court and a state appeals court found that the agreement was void because it failed to strictly comply with the Act’s requirements in that the required language was not printed in bold type.

On appeal to the state’s supreme court, however, the court found that the Act only required substantial compliance, not strict compliance. The court also concluded that the agreement in this case substantially complied with the requirements under the Act. Here, the nursing home had printed the relevant language in all capital letters, which the court found substantially satisfied the law’s requirements. The court held that the nursing home brought attention to the text in the same way that bold type would have. Therefore, the nursing home was able to force the family into arbitration to resolve the wrongful death claim against it.

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The right of unhindered access to the court system is one of the bedrock principles the founding fathers enshrined in the United States Constitution. At its essence, the concept stands for the proposition that anyone who has been harmed by another party should have equal access to a neutral forum that will hear the evidence presented and decide the case.

Signed ContractAt the same time, parties generally have a right to freely structure business arrangements through the use of binding contracts. A common example of this is an arbitration clause that may be included in the pre-admission paperwork in a Maryland nursing home facility.

What Is Arbitration?

Arbitration is an alternative to the court system, in which an arbitrator – rather than a judge – will hear the evidence and come to a conclusion. Arbitration is less formal than the traditional court system, and may have slightly different rules of evidence and procedure. Generally speaking, parties that frequently engage in litigation prefer to arbitrate claims. This is because arbitration yields a faster result, is less expensive than, and more private than the traditional court system.

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Nursing homes are not necessarily known for their focus on patient safety. To the contrary, some Maryland nursing homes have lengthy records of fines and other citations for failing to comply with state requirements or, worse yet, instances of patient abuse or neglect. One may expect that it would be an easy task to find the allegations made against a nursing home prior to making the decision to place a loved on in their care; however, this is not necessarily the case.

Using a WalkerNursing homes take every effort to conceal allegations, especially those involving substantiated claims of neglect or abuse. One way nursing homes are able to do this is through settling such claims out of court with the stipulation that the other party will not discuss the terms of the negotiations or make the allegations public. However, nursing homes are not able to legally keep these records from state and federal agencies.

According to a news report, one North Carolina company that operates several nursing homes in the state was fined more than $567,000 over the past three years after hidden cameras revealed that staff members were abusing residents. The company owns 16 nursing homes, six of which were fined. The largest of the fines was over $234,000.

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Despite the increase in attention that Maryland nursing home abuse and neglect have received over the past several years, instances of nursing home abuse continue to occur. Indeed, according to a local news report, one state’s lawmakers have begun a push for stricter reporting requirements for allegations of nursing home sexual abuse.

Nursing Home BedEvidently, lawmakers in Missouri have proposed House Bill 1635, which, if passed, would make reporting sexual abuse to law enforcement mandatory. Currently, state law only requires nursing homes to report the abuse to the state agencies involved in overseeing elder care.

The article discusses the tragic account of a 93-year-old nursing home resident, who was raped by a staff member and then died the following day. After the resident’s death, the nursing home reported the abuse to the state but not to the prosecuting authority. The family, believing the nursing home reported the incident to the police, did not report the abuse either.

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Earlier this month, a state appellate court issued a written opinion in a wrongful death case brought by a woman whose mother died a short time after being released from the defendant nursing home. The issue was whether the plaintiff, who was named as an alternate attorney-in-fact in her mother’s power of attorney document, had the authority to sign a binding arbitration contract on behalf of her mother. The court concluded that she did and thus held that the nursing home was entitled to arbitration.

Pre-admission ContractThe case presents an interesting and important issue for those seeking to hold a Maryland nursing home accountable for abuse or neglect. Matters involving the validity of arbitration clauses often arise in Maryland nursing home abuse lawsuits, and this case is instructive as to how courts may view various arguments.

The Facts of the Case

The plaintiff’s mother (Mother) executed a durable power of attorney (DPOA) document designating her son (Son) as the person who could make decisions on her behalf if she became incapacitated. The DPOA listed Mother’s daughter (the plaintiff) as an alternate.

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Earlier last year, the current administration rolled back certain regulations that the Obama administration put into place regarding the issuance of Civil Money Penalties (CMPs) to nursing homes that were found to have provided inadequate care to residents. Essentially, the regulations allowed for the federal government to fine nursing homes that were not in compliance, including Maryland nursing homes.

Signed LetterThose in favor of the rollbacks claimed that the additional regulations took caregivers’ attention away from residents, requiring that they focus on meeting the regulatory framework set forth by the lawmakers. However, in reality, it seems as though the rollback of the previous regulations has merely allowed for nursing homes to act with impunity as it relates to the level of care they provide to residents.

According to a recent news article, 17 state attorneys general – including those in Washington, D.C. and Virginia – authored a letter to the Trump administration. The letter discusses the importance of senior care, noting that by 2060, the number of people dependent on skilled nursing facilities is expected to double. This means that one in three people will find themselves in a nursing home at some point in their life. Given the fact that about 35% of all nursing homes were cited for a violation of the quality of care being provided to residents, these figures are alarming to say the least.

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Nursing homes have long been fairly scrutinized for the level of care that they provide to residents. Indeed, it is difficult to go more than a day or two without reading a headline discussing a family’s claims that a nursing home employee has abused their family member.

Surveillance CamerasWith the advent of affordable and low-profile video-recording technology, more families are considering placing a camera in their loved one’s room in hopes of being able to see how their loved one is being treated. In Maryland nursing homes, families can place cameras in a loved one’s room as long as both the resident as well as the nursing home are made aware and consent to the placement of the camera.

Under Vera’s Law, families can install a camera under certain circumstances. A few of the requirements are:

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The Office of the Inspector General (OIG) is a division of the U.S. Department of Health and Human Services (HHS) that is tasked with monitoring and preventing, among other things, nursing home abuse. Periodically, the OIG conducts audits of various HHS programs and their contractors.

Clip BoardUnder federal law, nursing homes that are involved in Medicaid and Medicare programs will be audited by the federal government. These audits are intended to reveal any defects in their care or service and ensure that they are corrected. Nursing homes must meet certain standards of safety and care, and if they do not provide the auditing agency with a correction plan, they are at risk for being sanctioned and shut down.

In previous years, issues have arisen because some state agencies failed to ensure that nursing homes actually completed their correction plans. This is very alarming because these nursing facilities are entrusted with many emotionally and physically fragile individuals, who are often unable to advocate on their own behalf or report their abuse.

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Nursing home residents are one of society’s most vulnerable populations. Often, residents have a reduced ability to advocate for themselves due to their health issues, and they may have little contact with the outside world. Thus, Maryland nursing home abuse and neglect is not often reported, and when it is reported, nursing home administration too often ignore the complaints. Even when nursing home administration reports a complaint, the Maryland government is often slow to respond.

Legal BooksThe State of Maryland Nursing Homes

According to a recent government study, Maryland ranks seventh-worst in the nation for on-time investigation of nursing home complaints. Perhaps because of that fact, Maryland nursing homes are notorious for the level of care they provide. In fact, reports of Maryland nursing home abuse rose 25% between 2016 and 2017. And with about 15% of nursing home residents and their families saying they would not recommend the nursing home that houses their family member, it seems that some instances of abuse and neglect are going unreported or uninvestigated. However, two pending bills hope to improve Maryland’s response time to complaints of nursing home abuse and neglect.

A recent news report discusses two proposed bills. Under proposed Senate Bill 386, the Maryland Department of Health would have 10 days to respond to a report of nursing home abuse or neglect that resulted in actual patient harm. If the report indicates that there is an immediate threat to a resident, the Department must initiate an investigation within 24 hours and begin the investigation within 48 hours. The proposed bill would also add 10 full-time employees to the state’s Office of Health Care Quality.

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