Lawsuit Challenges Nursing Home Liability Protections for Non-COVID Death

Survivors of a former North Carolina nursing home resident are suing the facility where she died in what McKnight's Long-term Care News reports "could be a litmus test for the patchwork of liability protections granted to healthcare providers across the country."

North Carolina is one of nearly 30 states that extended nursing homes legal immunity to shield them from lawsuits during the pandemic. Nursing homes claimed that they need protection since they became ground zero for the contagion.  The industry  lobbied unsuccessfully for national liability protections. 

The family of Palestine Howze is pursuing a case against Treyburn Rehabilitation Center in Durham, NC, where she died in April of non-COVID causes. In many cases, immunity given during the pandemic extends beyond COVID-related cases.
The family’s lawsuit is believed to be the first of its kind to challenge nursing home immunity.” The family claims that Howze developed a pressure ulcer that became infected, and the facility declined to send her to the hospital for treatment citing the pandemic.

North Carolina passed its liability shield law a month after Howze’s death and made it retroactive to March 10, 2020. It runs through the end of the public health emergency, which is currently extended into April but is projected to be lengthened at least through 2021.

“For the Legislature to say that the nursing homes need protection in the middle of a pandemic, not the nursing home patients, is outrageous and it’s unjust,” Elizabeth Todd, the family’s attorney, told NPR.

In October, a federal court ruled that a Pennsylvania nursing home could not claim preemption and federal immunity under the “Public Readiness and Emergency Preparedness Act,” or PREP Act. Although then-Sen. Majority Leader Mitch McConnell (R-KY) argued for federal corporate liability protections, he abandoned the fight in agreeing to a second COVID-19 relief package in December.
ProPublica and The News & Observer first reported on the Howze family’s suit.  A lawyer for Treyburn’s owner, Sovereign Healthcare Holdings, reportedly stated that “the case is defensible, factually and legally, and we would prefer to let the legal process run its course on both fronts.”

Many have expressed concern that protecting institutions from liability will only discourage institutions from behaviors and policies most likely to protect residents.  This is troubling given that more than 40% of COVID-19 death nationwide are attributed to long term institutional care facilities like nursing homes and assisted living facilities. New reports suggest the numbers of institutional care COVID-related deaths is frighteningly under reported. Legal experts have opined that facilities may still be held liable for gross negligence under the orders.  

The Howze case could prove the accuracy of the latter opinion. A North Carolina Superior Court judge must now decide whether to dismiss it because of the immunity statute or allow it to continue, possibly in arbitration. That could take months in a state where courts are already backed up due to the pandemic.

IRS Contests Value of Prince Estate, Who Died Without A Will Claiming Estate Worth $163.2 Million

The ongoing controversy over the money left behind by Prince when he died without a will is heating up again after Internal Revenue Service calculations showed that executors of the rock star's estate undervalued it by 50 percent, or about $80 million.

The IRS determined that Prince’s estate is worth $163.2 million, overshadowing the $82.3 million valuation submitted by Comerica Bank & Trust, the estate’s administrator. The discrepancy primarily involves Prince’s music publishing and recording interests, according to court documents.

Documents show the IRS believes that Prince's estate owes another $32.4 million in federal taxes, roughly doubling the tax bill based on Comerica’s valuation, the Star Tribune reported.

The IRS also has ordered a $6.4 million “accuracy-related penalty” on Prince’s estate, citing a “substantial” undervaluation of assets, documents show.

Prince’s death of a fentanyl overdose on April 21, 2016, created one of the largest and most complicated probate court proceedings in Minnesota history. Estimates of his net worth have varied widely, from $100 million to $300 million.

With Prince’s probate case dragging on, his six sibling heirs have grown increasingly unhappy, particularly as the estate has doled out tens of millions of dollars to lawyers and consultants.

Comerica and its lawyers at Fredrikson & Byron in Minneapolis maintain their estate valuations are solid. Comerica sued the IRS this summer in U.S. Tax Court in Washington, D.C., saying the agency’s calculations are riddled with errors.

“What we have here is a classic battle of the experts — the estate’s experts and the IRS’ experts,” said Dennis Patrick, an estate planning attorney at DeWitt LLP in Minneapolis who is not involved in the case. Valuing a large estate, Patrick added, “is way more of an art than a science.”

Comerica, a Dallas-based financial services giant, has asked the tax court to hold a trial in St. Paul. A trial could dramatically lengthen the settlement of Prince’s estate and generate more legal fees at the expense of Prince’s heirs, Patrick said.

Source: NBC News  

Picture: Photo 22858528 © Furesz | Dreamstime.com

Florida Investigates Nursing Home Reportedly Funneling Vaccines to Rich Donors

The State of Florida is investigating allegations that an upscale West Palm Beach nursing home diverted scarce COVID-19 vaccinations meant for residents and staff to members of the facility’s board of directors and donors.  

Appearing at a press conference in Vero Beach, Governor Ron DeSantis said that the Florida Department of Health was investigating reports that MorseLife Health System chief executive Keith Myers offered vaccinations to some of the long-term care facility’s board members and wealthy donors.  DeSantis said he also directed Florida Inspector General Melinda Miguel to investigate the allegations in stories published this week.

Emily Smith of Page Six reported that real estate moguls Bill and David S. Mack arranged for their “wealthy friends from Manhattan and the ritzy Palm Beach Country Club to get the COVID-19 vaccine at a Florida retirement home.”  The Washington Post reported that MorseLife made the vaccinations “available not just to its residents but to board members and those who made generous donations to the facility, including members of the Palm Beach Country Club, according to multiple people who were offered access, some of whom accepted it.”  DeSantis assured the public that Florida started the investigation “as soon as we found out about it.”

The governor’s remarks came on the heels of U.S. Sen. Rick Scott’s public call for an investigation into the allegation.  "It is absolutely disgusting and immoral that anyone would take vaccines intended for nursing home residents to distribute them to their friends," Scott, a Republican and former Florida governor, said in a statement. "This type of gross mismanagement will not be tolerated, and those responsible must be held accountable."

The federal government inked agreements last year with CVS and Walgreens to provide COVID-19 vaccinations to staff and residents of nursing homes and assisted-living facilities.  Hospital frontline health-care workers and residents of the long-term care facilities were the initial groups of people who qualified for Pfizer Inc. and Moderna vaccinations.

DeSantis on Dec. 23 announced that he was broadening eligibility to include all health care workers as well as people who are 65 or older.  The move led to chaos, resulting in jammed phone lines, overwhelmed websites and, in some instances, lines of seniors camping out over night to be first in line for vaccines.  In other words, it may be that the nursing home was simply providing the vaccine to its donors and others who it thought may have qualified under the broader DeSantis eligibility.  Regardless, the optics couldn't be worse for the nursing home provider.  

DeSantis emphasized Thursday that the vaccinations at the center of the controversy were not supplied by hospitals or county health departments, but were part of the federal arrangement with retail pharmacies.

“The nursing home and long-term care program is for residents and staff of long-term care facilities. That’s who it's for. Look, if you’re not a resident or a member of a long-term care facility but you’re 65 and up, there’s other options for you. We want you to get vaccinated. But to go under that rubric when you are not a resident and you’re not a staff member, that is definitely going outside of what the guidance is and what the program is for,” the governor said.

Potential Miracle Treatment Promoted by Feds for SNFs

COVID-19 monoclonal antibodies are now widely available for use by skilled nursing facilities  — and early results show promise, according to long-term care pharmacy leaders. Kimberly Marselas, writing for McKnight's Long-term Care News outlined the great news in her article, A potential ‘miracle’? Feds push monoclonal antibody treatments toward SNFs.  The following is an annotated reprint of her excellent article.

The Department of Health and Human Services’ (DHS) Project SPEED, or Special Projects for Equitable and Efficient Distribution, aims to get monoclonal treatment to COVID patients in non-hospital settings with priority populations, including nursing homes and assisted living facilities [some links added]. It goes beyond an earlier pilot spearheaded by CVS Health that targeted nursing homes and patients at home in seven cities with rapidly rising COVID rates.

The program is now open to any licensed pharmacy, said Chad Worz, PharmD, CEO and executive director of the American Society of Consultant Pharmacists, during an online update last week. He said LTC pharmacies around the country are beginning to add the therapeutic drugs, which mimic the body’s natural immune response, to their formularies.

As word spreads about availability, Worz expects increasing demand from skilled nursing providers who see antibodies as a way of mitigating COVID symptoms and preventing hospitalizations.

On the same webinar, T.J. Griffin, R.Ph., senior vice president of long-term care operations and chief pharmacy officer at PharMerica, said he is working closely with two nursing homes in Chicago and San Antonio that have used antibodies on a total of 70 patients since the program’s launch.

“The medical directors of both places have called it a miracle,” Griffin said. “So far, none of these patients have gone back to the hospital.”

Because most clinical data on monoclonal antibodies comes from hospitals, there’s not much evidence about its success in nursing home residents. But Griffin said he is working to gather and report information to HHS, and urged others to document and share patient responses.

Use protected during public health emergency

One pharmacist on the call noted a facility he worked with declined to administer the antibodies, citing liability concerns. But Worz said federal PREP Act protections would apply to skilled facilities that administer them safely and effectively and monitor for anaphylactic shock.

Arnold Clayman, ASCP’s vice president of pharmacy practice and government affairs, said infusion could be handled by staff members with an infusion license where required. Non-skilled facilities, or those without nurses to spare, could also tap into a separate program being led by the National Home Infusion Association in 46 states and Washington, D.C.

To date, only bamlanivimab, widely known as BAM, has been made available to LTC pharmacies. But Worz is also advocating for doses of Regeneron’s version, which requires pharmacists to compound casirivimab and imdevimab.

Both types of monoclonal antibodies received Emergency Use Authorization in mid-November with initial shipments sent to hospitals. But many said they were simply too busy treating severe COVID cases to deliver the outpatient therapy. As of late December, just 20% of the available antibodies had been used.

“That’s the reason they’re pushing it to long-term care, because (HHS) saw stockpiling in hospitals,” Worz said.

Wider use covered by CMS

Pharmacies can order for weekly delivery, or arrange for an emergency shipment in the case of a known outbreak, but Worz said HHS is tracking inventory to ensure the potentially life-saving product doesn’t continue to sit unused.

Medicare and Medicaid coverage of the use of monoclonal antibody therapy for COVID-19 treatments extends to beneficiaries in nursing homes at no cost during the public health emergency.

AMDA — The Society for Post-Acute and Long-Term Care Medicine, which initially expressed skepticism about the efficacy of antibody treatments in nursing homes because of a lack of data, has now partnered with ASCP to assist with Project Speed.

John Redd, M.D., MPH, chief medical officer, Office of the Assistant Secretary for Preparedness and Response at HHS, previously told McKnight’s that medical directors and physicians who care for long-term care patients are “crucial” to expanded delivery of the antibody treatment.

“We intend to engage them with every phase of the rollout,” he said.  “This therapeutic is intended to treat patients with COVID-19 risk factors who are early in their disease, which includes the majority of residents of long-term care facilities.”

Surprise! New Law Bans "Surprise" Medical Billing

A legislative "solution" to surprise billing managed to find it's way into the year-end spending and COVID-19 relief packages.  The heretofore elusive ban on surprise billing, ironically, comes as a surprise, albeit one welcome by consumers and advocates. 

“It seemed like déjà vu,” wrote Modern Healthcare’s Rachel Cohrs, “another mid-December bipartisan compromise on banning surprise medical bills negotiated behind closed doors is announced just days before a crucial end-of-year government funding deadline....[But] [u]nlike their 2019 failure, lawmakers this year succeeded in sealing the deal."  The surprise billing ban takes effect in 2022. 

Surprise bills occur:

 “when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay,"

explained Sarah Kliff and Margot Sanger-Katz,  writing for the The New York Times. 

According to Kliff and Sanger-Katz:

Academic researchers have found that millions of Americans receive these types of surprise bills each year, with as many as one in five emergency room visits resulting in such a charge. The bills most commonly come from health providers that patients are not able to select, such as emergency room physicians, anesthesiologists and ambulances. The average surprise charge for an emergency room visit is just above $600, but patients have received bills larger than $100,000 from out-of-network providers they did not select.  

The new law will make those surprise bills illegal. Instead of charging patients, health providers will now have to work with insurers to settle on a fair price. The new changes apply to doctors, hospitals and air ambulances.  The law does not apply to ground ambulances.

The new law requires insurers and medical providers who cannot agree on a payment rate to use an outside arbiter to decide. The arbiter would determine a fair amount based, in part, on what other doctors and hospitals are typically paid for similar services. Patients could be charged the kind of cost sharing they would pay for in-network services, but nothing more. Several states have set up their own arbitration systems, and have found that most price disputes are negotiated before an arbiter is involved. 

By the way, an excellent description of the legislative path for this welcome consumer protection, is provided by Modern Healthcare’s Rachel Cohrs, who has recited the work and effort expended both in support, and in opposition to the bill.  It is an interesting read.