Court Rules California Nursing Home Law Unconstitutional
Last week, a California court ruled that a state law permitting nursing homes to make medical decisions for mentally incompetent residents without representatives is unconstitutional, Kaiser Health News reports.
Under the 1992 law, nursing homes can make such decisions if a physician determines a patient is unable to do so and has no one else to represent them. The law was passed to give nursing homes a way to make medical decisions for incapacitated residents without waiting up to six months for state approval.
According to KHN, the medical decisions are made by a team that includes a doctor and a nurse.
In 2013, the California Advocates for Nursing Home Reform filed a lawsuit against the California Department of Public Health, alleging that nursing homes were using the law to:
- Administer psychotropic drugs;
- Deny patients life-sustaining treatments; and
- Put individuals in physical restraints.
Details of Ruling
In the decision last week, Alameda County Superior Court Judge Evelio Grillo ruled that the state law violates patients' right to due process because nursing homes are not required to:
- Inform patients that they have been deemed incompetent; or
- Give patients an opportunity to object to the decision.
Grillo said that patients' rights outweigh any potential problems created in the way nursing homes work as the result of the ruling. Grillo added, "The stakes are simply too high to hold otherwise."
According to KHN, DPH is reviewing the decision.
Mort Cohen, a law professor at Golden Gate University who filed the lawsuit, said the next step is for the judge to issue an order to DPH. According to Cohen, the state could appeal the decision or ask for a stay.
Reaction to Ruling
Meanwhile, Tony Chicotel, an attorney for the California Advocates for Nursing Home Reform, said that the court's decision will significantly affect the most vulnerable nursing home residents.
Chicotel said, "What [nursing homes] used to do was routinely make decisions big and small for their residents without really any regard to due process," adding, "Now the residents are finally going to have their rights acknowledged and honored."
However, Mark Reagan -- a lawyer for the California Association of Health Facilities, which was not part of the lawsuit -- said that the decision could have negative consequences.
For example, Reagan said the ruling could make it more difficult for:
- Nursing homes to provide care to individuals who cannot make their own medical decisions; and
- Patients without representatives to find a nursing home willing to house them.
He said, "If this decision makes it more difficult to supply necessary care at the bedside, this population is going to be less served," noting that the process of seeking court approval to administer anti-psychotic medication can be costly and time-consuming.
However, Grillo in the decision wrote that informing patients and allowing them to object likely would not result in a significant burden for nursing homes (Gorman, Kaiser Health News, 6/26).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.