U.S. v. District of Columbia

• •

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•••

•

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BHV

III

HH

HM

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NH-DC-001-003

IN THE UNITED STATES DISTRICT COURT FOR
THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA,

)

)

Plaintiff,

)

)

v.

)

)

THE DISTRICT OF COLUMBIA,

)

the Honorable Marion Barry,

)

Mayor of the District of Columbia; )

Vernon Hawkins, Interim Director, )

Department of Human Services;

)

Frances Bowie, Acting

)

Administrator, Mental Retardation/ )

Developmental Disabilities

)

Administration; and Alberta

)

Brasfield, Executive Director,

)

D.C. Village,

)

)

Defendants.

)

Civ. A. No. 95-0948 TFH

COMPLAINT 1. This action is brought by the Attorney General, on behalf ,«of the United States, pursuant to the Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. §1997 et seq., to enjoin the named Defendants from depriving persons residing at the D.C. Village Nursing Home ("DCV") of their legal rights, and of rights, privileges or immunities secured or protected by the Constitution of the United States.
JURISDICTION. STANDING AND VENUE 2. This Court has jurisdiction over this action pursuant to 28 U.S.C. §1345. 3. The United States has standing to maintain this action pursuant to 42 U.S.C. §1997a.

4. The Attorney General has certified that all pre-filing requirements specified in 42 U.S.C. §1997b have been met. The Certificate of the Attorney General is appended to this Complaint and is incorporated herein.
5. Venue in the United States District Court for the District of Columbia is proper pursuant to 28 U.S.C. §1391. All claims set forth in the Complaint arose in said District.
DEFENDANTS 6. Defendant DISTRICT OF COLUMBIA ("District") owns and operates DCV, a facility hbusing individuals with special needs including the elderly, children, those with mental illness and those with mental retardation, located in Washington, D.C. 7. Defendant MARION BARRY is the Mayor of the District of Columbia, and in this capacity heads the Executive Branch of the District's government and, among other duties, reviews and approves budget requests submitted by Executive Branch agencies. He selects and appoints the Director of the Department of Human
••»-
Services ("DHS") and must approve the appointment of the Administrator (or Acting Administrator) of the Mental Retardation/ Developmental Disabilities Administration ("MRDDA").
8. Defendant VERNON HAWKINS is the Interim Director of DHS and, in this capacity, exercises administrative control of, and responsibility for, DCV.
9. Defendant FRANCES BOWIE is the Acting Administrator of MRDDA who, along with Defendant HAWKINS, is responsible for the administration of DCV.
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10. Defendant ALBERTA BRASFIELD is the Executive Director of DCV and is responsible for the day-to-day operations of DCV.
11. The individual Defendants named in paragraphs 7, 8, 9 and 10 above ar,e officers of the Executive Branch of the District of Columbia and are sued in their official capacities.
12. DCV is an institution as that term is defined in 42 U.S.C. §1997(1)(A), (1)(B)(i) and (l)(B)(v).
13. Persons residing at DCV include individuals with special needs including the elderly, children, those with mental illness, and those with mental retardation.
14. Defendants are legally responsible, in whole or in part, for the operation of and conditions at DCV, as well as for the care and treatment of persons residing at that institution.
15. At all relevant times, Defendants have acted or failed to act, as alleged herein, under color of state law.
FACTUAL ALLEGATIONS 16. Defendants have failed and are continuing to fail to provide adequate food, shelter and clothing to DCV residents. 17. Defendants have failed and are continuing to fail to provide adequate medical care to DCV residents. 18. Defendants have failed and are continuing to fail to provide reasonably safe conditions and to ensure the reasonable safety and personal security of the DCV residents. 19. Defendants have failed and are continuing to fail to ensure that DCV residents are free from undue or unreasonable restraint and that restraints are administered to DCV residents
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by appropriately qualified professionals in keeping with accepted professional standards, and are not used as punishment, in lieu of treatment, or for the convenience of staff.
20. Defendants have failed and are continuing to fail to provide DCV residents with that level of minimally adequate individualized training and behavioral programming to ensure and protect the DCV residents' liberty interests.
21. Defendants have failed and are continuing to fail to provide DCV residents with that level of individualized training as is necessary to enhance" independence and functioning, facilitate growth and development, attain skills needed to exercise self-determination or independence, and prevent unreasonable losses of liberty so as to preserve a person's pre-existing self-care skills from deteriorating because of his or her institutionalization.
22. Defendants have failed and are continuing to fail to ensure that medications are prescribed and administered to DCV residents by appropriately qualified professionals in keeping with accepted professional standards, and are not used as punishment, in lieu of treatment, or for the convenience of staff.
23. Defendants have failed and are continuing to fail to provide a sufficient .number of adequately trained staff to render the essential care and treatment outlined above in paragraphs 16 through 22.
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24. Defendants have failed and are continuing to fail to ensure that DCV residents are evaluated for community placement and/or appropriately placed into a community setting according to their individualized needs.
25. Defendants have failed and are continuing to fail to meet the reguirements of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. §12101 et seq., and the regulations promulgated pursuant thereto, by excluding the DCV residents, by reason of their disability, from participation in or by denying them the benefits of the services, programs, or activities of the District, or by subjecting them to discrimination, and by failing to administer services, programs, and activities in the most integrated setting appropriate to their needs. For purposes of Title II of the ADA, the Defendants are a "public entity," and the residents of DCV are "qualified individual[s] with a disability."
26. Defendants have failed and are continuing to fail to meet the requirements of Section 504 of the Rehabilitation Act of 1973 ("Section 504"), 29 U.S.C. §794, and the regulations promulgated pursuant thereto, by, solely on the basis or severity of their disability, segregating the DCV residents, excluding them from participating in, denying them the benefits of, or subjecting them to discrimination in programs or activities which receive federal financial assistance. For purposes of Section 504, the Defendants receive "Federal financial assistance," the
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residents of DCV are "qualified individual[s] with a disability" and are the intended beneficiaries of the assistance.
27. Defendants have failed and are continuing to fail to meet the requirements of the Medical Assistance Program ("Medicaid") established under Title XIX of the Social Security Act, 42 U.S.C. §1396r et seq., and the regulations promulgated pursuant thereto, and of the Health Insurance Program for the Aged and Disabled ("Medicare") established under Title XVIII of the Social Security Act, 42 U.S.C. §1395i et seq., and the regulations promulgated pursuant thereto.
28. Defendants have failed and are continuing to fail to meet the requirements of the Individuals with Disabilities Education Act, 20 U.S.C. §1400 et seq.. and the regulations promulgated pursuant thereto, by failing to ensure that all children with disabilities residing at DCV receive a free appropriate public education that meets their unique needs in the least restrictive environment.
29. In response to a recent determination of noncompliance with federal regulations and order by the District of Columbia Department of Consumer and Regulatory Affairs, Defendants have engaged and continue to engage in the practice of transferring and discharging residents out of the facility in violation of the federal Medicare and Medicaid regulatory requirements for long term care facilities, 42 C.F.R. §§483.10 and 483.12, by failing to provide the residents with adequate notice before the transfer, sufficient time between the notice and the transfer,
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0k-
sufficient orientation for the resident prior to transfer, or adequate choice in the transfer.
VIOLATIONS ALLEGED 30. The af:ts and omissions alleged in paragraphs 16 through 29 infringe upon the DCV residents' legal rights and substantive liberty interests and constitute resistance to their full enjoyment of rights, privileges or immunities secured or protected by the Constitution or laws of the United States, and deprive the DCV residents of such rights, privileges or immunities. 31. Unless restrained by this Court, Defendants will continue to engage in the conduct and practices set forth in paragraphs 16 through 29 that deprive residents of DCV of their legal rights under law and the rights, privileges, or immunities secured or protected by the Constitution of the United States, and cause irreparable harm to DCV residents.
PRAYER FOR RELIEF 32. The Attorney General is authorized under 42 U.S.C. §1997a to seek only equitable relief. WHEREFORE, the United States prays that this Court enter an order permanently enjoining Defendants, their agents, employees, subordinates, successors in office, and all those acting in concert or participation with them from continuing the acts, practices and omissions at DCV set forth in paragraphs 16 through 29 above, and to require Defendants to take such action as will provide legal and constitutional conditions of care to persons
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i}:

who reside at DCV. The United States further prays that this Court grant such other and further equitable relief as it may deem just and proper.
Respectfully submitted,

JANET RENO Attorney General of the
l i t e d Stj-

ERIC H. HOLDER, JR. United States Attorr District of Columbia"

SVAL 1A—PATRICK ^

\

Assistant Attorney General

Civil Rights Division

ARTHUR E. PEABODY^TR. Chief SpeciaL-iLitigatipn Section

DAVID RICHARD J. FARANO Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section P.O. Box 66400 Washington, D.C. 20035-6400 (202) 514-6270 (202) 307-3116 BAR # 248120

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(gffitz nf % Attorney (Unteral
: , ! . (0.2fl53n

CERTIFICATE OF THE ATTORNEY GENERAL

I, Janet Reno, Attorney General of the United States, certify that with regard to the foregoing Complaint, United States v. District of Columbia, et al., I have complied with all subsections of 42 U.S.C. §1997b(a)(1). I certify as well that I have complied with all subsections of 42 U.S.C. §1997b(a)(2). I further certify, pursuant to 42 U.S.C. §1997b(a)(3), my belief that this action by the United States in this action is of general public importance and will materially further the vindication of rights, privileges or immunities secured or protected by the Constitution of the United States.

In addition, I certify that I have the "reasonable cause to believe" set forth in 42 U.S.C. §1997a to initiate this action. Finally, I certify that all prerequisites to the initiation of this suit under 42 U.S.C. §1997 et seq., have been met.

Pursuant to 42 U.S.C. §1997a(c), I have personally signed the foregoing Complaint. Pursuant to 42 U.S.C. §1997b(b), I am personally signing this Certificate.

Signed this 8 ^ day of //4±xuJ Washington, D.C.

1995, at

TANET RENO Attorney General
of the United States

 
 U.S. v. District of Columbia
NH-DC-001-004
IN THS UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

V. ISTR

Plaintiff,

!iv H

UNITED STATES' MOTION FOR A PRELIMINARY INJUNCTION TO ENJOIN DANGEROUS AND LIFE-THREATENING PRACTICES
AND TO ENSURE BASIC CARE, SERVICES AND TREATMENT The United States moves this Court, pursuant to Fed..
a no. _-. _ . \_. r_• 2'uD \c; 5.r.3. \c*;, tor s. prsiz.rr.i.r.ar\* ir.]
deficient rredical and nursin- care at the D.C. Villacre Nursir." Home ("DC"") . The United States further requests that the Court
necessary actions to provide basic care, services, and treatment consistent with professional standards to ensure the protection of the constitutional rights of the individuals who reside =t DCV.
The specific injunctive relief requested is set forth in the accompanying proposed Order. The grounds supporting this Motion and proposed Order are fully set forth in the accompanying Memorandum. '

Ur.it e catea furur.sr rr.cves tr.is Cour" zor ar. evidentiary hearing or. this Motion, if such ahearing i: necessary, i: obtain, the relief sought.

ERIC H. HOLIi?. United S:a' E At tom e y
District o. Cclumbia

-. - --^ J •*—' — 's-f h^- ^ - ^ ^ -V- -^- V fcJ ^ J^- 1>1 J, >_ ' _ •-_* ^_* y
DEVAL L. PATRICK Civil Rights Division
Chief Special Litigation Section
^ii^^
D e o u t %' C" i e f
S"6Cisi Ljj-tj.CT3.tion S e c t i o n

L/A.n'ID i-1 i ^y-1- -i1w n
Attorneys U.S. Department of Justice Civil Rights Division Special Litigation. Section P.O. Eox 6=400 Washington, D.C. 20035-64 •' (202) 514-5270 (202) 307-3116 BAR =2 4S12 0 BAR #424225

CERTIFICATE OF SERVICE

I ce Prelirr.ina Prac-icss accompany S 3 r V e C. C V counsel o

':: that the foregoing United Siates' Motion £• injunction to Enjoin Dangerous and Life-Threa L to Ensure Basic Care, Services and 7rea:-.er. Memorandum in support, and a oropcsed Order ; ser.crer on h i s

Acting Special Counsel to the Corporation Counsel
Office of the Corporation Counsel Government of the District of Columi 4 41 4th Street, NW, 6th Floor Washington, DC 2Q001

At/bbrr.ey Sp4cial Litigation Secti: Civil Rights Division U.S. Department of Justice P.O. Box 6S400 Washington, DC 20035-54: J (2Q2) 307-3116 D.C. 5.-.H £ 424 22 5

 
 .&7/q7/95 12:29 ©202 273 0353

HOGAN

1^002

RECEIVED

THE UNITED STATES DISTRICT COURT

JUL 0 5 1995

?OR THE DISTRICT OF C0LUK3XA
Judge .THOMAS F. KOGAN

UNITED STATES OF AMERICA, Plaintiff,
v. THE DISTRICT OF COLU>GIA,fi£ftl-'>
Defandancs.

Civ. No- 95-948 T:H
JUL 6 1S95
CLERK, U $..t>?TSICT COURX

TH5 UNITED STATES' AN

the U"^ted States of America filed a civil Whereas, t w « — against the District oE Colu.rbia and officials thereof in their official capaciTt4i*es-, aa—newsi"n-g= violations -ur-der the Civil Rights cf Insta.•tuti.o-rn-naall3.i2z--od. rP^e~r°sons Act CCRIPA"), 42 U.S.C. § 1997, in the Defendants' operation of the D.C. Village Kursing Home C-DCV-); W^reas, the Long-Term Care Ottiudsman filed a motion to
intervene in this action further alleging violations under D.C. ,,m P- sec: , in theDefendants' operation of DCV, and
Code §§ 32-1^01 e^se^., the Court granted that motion;
Whe-eas the United States and the Ombudsman each rilec a -.otion /or a'preli.inarv function to re.edy alleged violations
that allegedly retire M e d i a t e preliminary relief and the ST^n filed a petition for a monitor; Whereas, the District of Colurcbia has authority ar.c ^iiitv for theoperation of DCV;
U.S. v. District of Columbia

H-DC-001-005

:O7/O7/9S 1 2 : 2 9

„ ---,. . . . . ©2°-

HOGA.N

(21003

parties de3,re to avoid p r o v e d «d a — a r i a l litigation;
— i n " thlS StiPUla"d °rder'
t do no, ad.it - yviolation of lawandthep I t — d 0 , , .ay not ,e used as evince o,

Whereas, ttihi<.* prPo1vUisior.s of this Stipulated Order are a ,.,,oi.t. roolution of th. motion.
:.;:.n;,

voluncarxlv en^e-ea -

^

• • - court for the District of Columbia ana shall

,r, o-d— °£ theCourt; and

whereas, ^-n-e ^

, ^ - na

. .nac h c pendaa=y of thelitigation, andunuil

p a r t i e s 'ar.c sna—

• •

r h e - o-ficers, agents, employees, assigns, and

p a r t i e s ; tnei- w-

successors.

•

, therefore, ^ p a r t i e s herebby agree as

-, care of Decubitus Ulcers
I

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T" 111—^n—i' '""

" "

T

.07,07/95

©00-1

* timelY treatment for decubitus ulcers and/or nursing care and timely

otHer skin b r a * * * * efficient to ^ainta.n the.r good health

T o this end. Defendants - 1 1 assess 1 1 „ . « — - « * *

breakdown within two days fro. the date of entry of this

p l a t e d Order, W

de.lop and imple.ent within twenty

- r — for each resident identified as at risk, a

treatment plan
treat existing rfci , ca-e of Incontinent Residents

.esidelts receive a v i a t e , adequate and ti,ely nursing c ^ in accordance wit. SenS,ally accepted nursing s t a n c e , . Pc. residents who hav. been identified as s ^ e c t to beco^ng ^
. -v-rsing staff shall make rounds to check on tnerr

staff s-nai1l1 tnaakkee aa-11A e-xp-ropriate s « p 3 to care for • -.nts who need nursing attention due to their

incontinence. N t r e a t ulCerated area, that .ay have heco.e soxled due

incontinence. 3 Adecuate and Appropriate Nursing Staff
a' De,^dants shall ensure that continuity of nursing staff

is

. .. maintained

tt oo

t

h

e^toximura

extent

feasible

during

all

ahif«,

8 e v e a days a week, on all DCV living units. b By no later than January 1. ^ , Defendants shal.

'that there is a sufficient permanent nursing staff at DCV ensure that tnci^

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.OT,OT/«

0202 273

to

tthh aatt

D^CV does

not

routinely _ ^^

rely on contract ^ ^ ^^ ^ ^ ^

nurses,
e[nergen

;; -

_ t h a t a d e q

nursing staff is

situations or to ensu-=

to care for DCV residents.

4 Medication Errors . nefendants snail ensure, within fifteen days fro. the

o_- c h < s stioulated Order, that allnursing starr on

d a t e o, entry o ^

. ^ ^ ^ administration practice3,

d u t y are tra.n.c

^ s u f f i c i e n t l y aware of

and are adequately inserv

* 1 «*^ds o- the residents no whom tney are the individual neeas o- ^

isrering medications.

b DefendantS shall ensure, within firt.« cays fro. this Stipulated Order, that all medication

error, that any causes for.ed.cat.on
all and readied, and * « anyother needed

A

action is ta.en in a cicely — no

.edicacicn error r i * to theDCVresidents.

B.

ht

T. pood and Drink

'

shall iruruediately ensure that sufficient suppl.es

d aoD-ooriate food and drink are consistently

1
well-balancec according to

dividual nutritional needs

in

.07,07,9= 12-30 C 2 0 2 273 0S5S

(&006

2 Medications, Medical Supplies and Equipment
a ' D-fendants shall ensure that ade^ate and appropriate o"f necessary medications, that . e e t the individual needs
r x:;:.——=«- -—supolies and equipment, that meet the

neeaed, no

than five days from the date of entry o- ...

Stimulated Order. c Defendan.s shall maintain the plumbinS and heat.ng
D C V t o ensure that ad.qo.te amounts of hot water, at

€afa temperatures, a-e *

h d a t = o f entrv of this Stipulated Order. Defendants

d a y 3 from the

-

^ wat=r ^ properly

shall also ensure that the.e

aaniti2e and clean eating utensils, plates ana meal-rela.ed

items.

Personal Care Items

. ^ fihaii ensure that adequate and appropriate

Defenaants sr.a—

^ _

o£, poe^-ssoorr.aaxl care iteras, including .but not limxtec to

entry o-r t«.nvi,is«Ss^tJi-^pulated Order,

c Pavment_olJiendsrs

.

*«.„,

1 7 n 7 I a ^ n a 7 £ o r t y - £ i v e dayS from the date ofentry

this Stipulated Order, Defendants shall pay in full all

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07/07/9"5 12:30

273 0355

individuals and vendors who have supplied

_.

- - -«-

-

••«-•

••—••;•: r = r

nt of individuals or v . c c r , Retardation

l n d a ^ shall place all DCV resident with ««t.X

appropriate cotnmunicy-based residential and day

/

•

I "

indi.id.al needs as identified

Z X995. D e f e n d s ^ 1 1 ensure tnat th. p l a c e t s a.e

r-P;ich individual's needs.

adequate to meet each

^

2 - in t*e interim, Defer.aanuS snail e-su-e u \ ^ c e s , babiliwtion. and other services to all DCV

idents with mental retardation are

T

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^u ! • — I T •"

"i—in

n—l

• 0"/07/9o 12:31

202 273 0355

HOGA.N

E. ^tnnitor A Mentor shall b .appointed with full authority to oversee
t h e . . n d a n ^ c « * H « c . with the provisions of this Stipulated C W e r andin accordance with D.C. Code §S 32-1*01 ^ * • Th= Onited States -tall . « * » " « i c h i » " ^ ^ " " ^ ^ " * c u r , i C T U vitae of r e c o r d e d candidate(3l for the Monitorfor the Coup's aporoval- The Monitor shall sub.it within thirty d a y s of his/her designation an initial budget for .onitor.n, activities which shall be approved by the Court. Defendants shall bear all costs of the Monitor. F con^u^ii^^d-IsrismSStation
x m construing, implementing and monitoring Defendants'
compliance with the t a r - « d provisions of this Stipulated

O^der, the parties agree to the following:

T h e Defendants shall submit every 3 0 days compliance

report to the United States, the O.buds.an andthe Court, t- -m LS95 and continuing until such time as this
beginning August i=, •'•"-'.

Stinulated Order is terminated;

.

" b Each compliance report shall describe the Defendants

progress towards implementation and compliance with each

provision of this Stipulated Order; c Each compliance report shall also include: x" T , e ,arae and aS. of every resident who has died during n n e reporting period, the date and cause of death, and any investigative findings related to the death,-

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ff7,07/95

« 2 0 2 273 033=

HQCA>

I&009

2. A list of all hospitalizations specifying the nameof
2.
the resident, date of the hc-spitalization, and the reason

for the hospitalizatian; 3. Statistics onthe number ofplanned and emergency restraints; a list of residents put in emergency restraints specifying name, date and cause precipitating the emergency

restraint; 4. A list of any emergency use of psychotropic medication soecifying the name of the resident, date, and cause

precioitating the emergency use ofpsychotropic medication;

5. Chronological lists of all incident reports specifying

name of residents involved, date, and a brief description of

the incident;

.

•

• .

6 All final unusual incident reports pertaining to the

care and treatment of DCV residents; •..

7 N*mes of residents who have been or are planned to be

placed into the c o ^ n i t y , specifying the date of discharge

and location of ultimate residence;

. .

d All parties shall bear their own costs, including

attorney fees. G c>nt-pet;"° Order.

3517Cb), no persons, be they residents, staff, District o r otherwise, reporting conditions which may " be subjected . a
.to retaliation in any manner for so reporting.
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„«„ .-
H piahh of f During any investigative tours to assess compliance with
t*I. Stipulated Order, the United States and its agents shall nave the right to revest, inspect, review and copy facility
*« r-,<d«t charts and other documents, conduct interviews with residents and staff outside the presence of supervisory staff and observe activities normally conducted at DCV. Except where an emergency exists, such investigative tours will be conducted upon reasonable notice.
/ / / I

I /

B

KM

_Q _

«. -07/07/95 12:32 ©202 273 0353

CONSENTED TO BY THE UNDERSIGNED

FOR THE DEFENDANTS:

: >

FOR THE PLAINTIFF:

GARLAND PINKSTON Acting- Corporation_ Counse: District of Columbia

i
DAVID DEUTSCH Senior Trial Attorney Special Litigation. Section

RLOiARIT J. /FARANCSenior Tr^al Attorney Special Litigation Section Civil Rights Division U.S. Department oz Justice P.O. Box SS4QG Washington, D.C. 20a35-c400 (202} 514-6270 (202) 307-3115 D.C. Bar #424223
FOR THE PLAINTIFF-

JONATHAN D. SCHlbSS-^, Es WILLIAM A. ISAACSON, Esc. Kaye, Scholer, Fierrnan,
rlays & Handier 901 15th Street, NW, Ste. 1100 Washington, D.C. 20005 (202) 632-3500 D.C. Bar £414783

WHEREFORE, the parties to this action having agree<

the

provisions in the Stipulated Order set forth.above, and the Court

being advised in the premises, this Stipulated Order is hereby

entered, as the ORDER, and JUDGMENT of this Court.

7X-. IT IS SO ORDERED, this

day of

1395,

at Washington, D.C.

Thomas F- Hogan UNITED STATES DI
- 10 -

JUDGE

"wmv

 
 U.S. v. District of Columbia

NH-DC-001-006

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

FILED

UNITED STATES OF AMERICA

)

)

Plaintiff

)

)

M. ANNE HART, THE DISTRICT OF

)

COLUMBIA LONG-TERM CARE OMBUDSMAN, )

)

Plaintiff-Intervenor, )
I

NOV 7 1995
CLERK, U. S.,D^TRICT COUfiE
asiRi.ciP5couA.BiA
Civ. No. 95-948 TFH

THE DISTRICT OF COLUMBIA, et al., )

Defendants

)

MnnTFVTNG STIPULATED ORDER OF JULY 6. 1995
Pursuant to the July 6, 1995 Stipulated Order resolving issues raised in the United States' and the Plaintiff-Intervenor's motions for a preliminary injunction, the parties, with the express sanction of this Court, agreed to the appointment of a Monitor to evaluate, compliance with outstanding orders. By Order filed August 1, 1995, the Court formally appointed Harriet Fields, Ed.D., R.N., as the Monitor.
On August 15, 1995, Defendants notified this Court and the Plaintiffs of their intent to close D.C. Village, the facility which is the subject of this action. At a status conference on September 12, 1995/ Defendants confirmed their intent to close D.C. Village.
_

Given this significant change in circumstances, it is appropriate at this time to modify the Monitor's duties to enable her to appropriately monitor the process Defendants will employ to close the facility, to monitor that the proposed closing is accomplished in an orderly manner consistent with the rights of the residents, and to monitor that all residents are transferred to appropriate residences which meet their individual needs.
Therefore, it is hereby ORDERED that the July 6, 1995 Stipulated Order is modified to state that:
A. The Monitor appointed pursuant to the July 6, 1995 Stipulated Order shall have the authority to oversee the Defendants' compliance with the provisions of this Order.
B. The Monitor shall have authority to review and advise on Defendants' compliance with District and federal law with respect to the announced closure of D.C. Village and the discharge of residents to alternate residences, including but not limited to 42 C.F.R. SS 483.10 and 483.12, and 28 C.F.R. S 35.130, and D.C. Code S§ 32-1431 et sea.
C. Defendants shall promptly provide to the Monitor for her review the overall facility discharge plan drafted pursuant to D.C. Code S 32-1440(b), and any subsequent amendments thereto. The Monitor shall have authority to review Defendants' compliance with the provisions of this plan to ensure the safe and orderly removal of the residents and to protect their health, safety, welfare, and rights, including the residents' rights to an opportunity for participation in their discharge process. The Monitor shall
- 2-

periodically review Defendants1 plan to ensure that a schedule for the placement of residents i s being implemented in an appropriate
manner. D. Prior to discharge, the Monitor shall have the authority
to review each resident's individual discharge summary and to attend any regularly scheduled meetings at which the plans for discharge and placement of the residents are discussed, to review whether placement decisions are made on an individualized basis, and to review any individualized transition plan that isformulated pursuant to District and Federal laws and rules in advance of placement for each resident. The Monitor shall be given notice of any regularly scheduled meetings referred to in the preceding sentence. The Monitor shall also review whether all necessary services and support have been arranged and are ready to be provided at the newresidence, but the Monitor shall have no ongoing monitoring duties with respect to such new residences after
discharge has been satisfactorily andsuccessfully completed. E. The Defendants shall provide to the Monitor copies ofany
notices required to be provided to a D.C. Village Resident, his or her representative, or the Long Term Care Ombudsman regardingthe discharge and placement of a resident.
F. In any case where the Monitor finds that the proposed placement of a resident is inadequate, the Monitor shall advise Defendants, who shall take action as they deem appropriate. If the Monitor finds that the inadequacy has not been remedied promptly in
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a reasonable manner, she shall include a full description of the inadequacy in a report to the Court.
G. The Monitor shall include in regular reports to the Court and the parties reports on her monitoring activities pursuant to this -edification to the Stipulated Order.
H. This order supplements the stipulated Order of July 6, 1995, which shall remain in full force and effect until dismissed or o^erwis. modified by this Court. Consistent with Section t of the Stipulated order, Defendants shall include in their monthly compliance reports a description of their progress towards implementation and compliance with the provisions of this Order. Dated:
HON. THOMAS F. HOGAN' / United States Distrret Judge
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Richard James Farano,t Esq. U S DEPARTMENT OF JUSTICE General Litigation Section Suite 1708

N-w-

 
 U.S. v. District of Columbia

• •

• • • * mm m

NH-DC-001-007

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES Or AMERICA,

v.

Civ. No

MEMORANDUM IN SUPPORT OF THE UNITED STATES' MOTION FOR A PRELIMINARY INJUNCTION TO ENJOIN
DANGEROUS AND LIFE-THREATENING PRACTICES AND TO ENSURE BASIC CARE, SERVICES AND TREATMENT Pursuar." ~o Fed. R. Civ. P. 65 ana D.D.C. R. 205 (c) ar.d (d) , ~he Ur.iced. S:a;es moves for a. preliminary injunction requiring the Defendants immediately to remedy practices and conditions at cha D.C. Village Nursing Home ("DCV") which jeopardize the lives, health, and safety of the individuals who reside at DCV and violate their constitutional rights.
PRELIMINARY STATEMENT Defendants are failing to provide DCV residents with basic medical and nursing services in fundamental areas necsssarv for the adequate care of elderly persons with serious medical needs and of other persons with special needs. Inadequate care of DCV residents has resulted in widespread suffering of preventable pressure sores, knowr. as decubitus ulcers. Inadequate treatment of these sores has resulted in serious harm, including preventable amputations and the death of residents. Within the last three months alone, DCV lists "multiple decubitus ulcers" as
as^.yiv^^

a cause of death for two residents. Unless immediate action is

taken, many 2CV residents are in imminent danger of infection,

potential less of limb, sepsis, and even death.

In addition, other critical areas of basic care a: DCV are

also dangerously inadequate. Bed-ridden residents are left :c

sit in their own urine and faces for hours. Adequate amounts of

nutritious food and drink are not always available. Essential

medical succlies and nesded medications are not provided tz ihe

residents. A- times, ever, hot water for bathing is insufficient

or unavailable.

,

The District's grossly delinquent payment of vendors who

supply critical goods and services to DCV, including food and

dietary suppliers and medical equipment providers, is placing the

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failure to pay "contract nurses" in lieu of permanent and

reliable staff are resulting in severe deficiencies in nursing

and basic care, including widespread medication errors.

These deficiencies at DCV expose residents daily to

unreasonable risk of harm, suffering, and iife-threacening

conditions. The evidence in support of these deficiencies co~.es

from muliiiole sources -- DCV residents and relatives, service

providers, advocates, and independent experts - - and is supported

by over two dozen declarations that are attached to this

Memorandum.!/ The evidence is indisputable and overwhelming.

1/ The declarations are attached as Exhibit 1. The United States is also prepared to offer additional evidence through an
(continued...
- 2-

It: leads ~c cr.lv cne conclusion: Immediate relief throucrh intervention by chis Court is needed to prevent continuing
T_-rrans*"^'il -^ " ' ; '._! r V .
On May 15, 1995,the United Scates brought an action fcr equitable and injunccive relief against Defendants, the district of Columbia ej: a_l., pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1937.2./ The Complaint alleges that the Defendants are violating the constitutional and legal rights of the approximatelY 279 individuals who live at DCV, a residential, District-operated nursing horr.e housing a wide variety of cersor.s with serious medical problems. The Complaint outlines wide-
-*- — — — • T.~ « =,- • *• • a - - " ^ _ P 5 > v i t i r ^ c a r ° a
inc"'' * ^i " C7 "" *~ad"^ cuamteedimedical DSvc Eased upon recent allegations of irr.~ir.ent har~ by a r-u-.ber
of infor~ants, the United Spates and three nationally reccgnize
c A . ^ c r i_ o , K= w ~ v-^.a i J - L i O i i , i'. . I J . , vv. . i r . r i . , D i d _ u 2 O - b - S S - . A ^ . - ,
M.D . , and Eller. Anderson, E. S . N. , M.A. , J.D . , conducted an exoedited tour of the facility in order to assess current

1/ (...continued) evidentiary hearing which is requested in the Motion for Preliminary Injunction.
2./ This lawsuit is the produce of the District's intransigence over a protracted period of time to either correct voluntarily the conditions at DCV depriving residents of their constitutional and legal rights or to negotiate an enforceable settlement agreement.

:

• -3 -

rum i mm—n—i

— - ^ TW

conditions sr.d services .2/ They found Chat medical, psychiatric, and nursing care and treatmen. at DCV fall significantly below accepted professional standards and exrcse residents tc harm. Elon Decl. at 4, 20 1*I 10, 4S; Greer.vald

experts found that the deficiencies they had identified in the

prior year's CRIPA investigation had not been corrected, and had

/Ha^ov-i / ^ i - a ^s-' a v a l f u r r l i ^ r

r-, ! a H i n ,*r r a q i n a i l - q a !~ i n^v-ss s i ~ ^- - = V O ^

significant harm. Elon Decl. at 5 *i 12; Greenwald Deci. at 5-5 %f\ 11, 12; Anderson Decl. at 4 *j S.4./

All of these deficiencies, as well as additional p^ fir7' 9~^"i5s ^de^^if^ed bv the U^ ited Ststes ir1 ''ts cr>"wi*"l=';'—

are serious and in need of correction. There are, however,

rviev/s wiwn
DCV residents, and ether sources of information that have led the

3./ Dr. nlor. is a board certified gerontologist who is the Medical Director at the Johns Hopkins Geriatric Center. She is also an Associate Professor of Medicine, Division of Geriatric Medicine and Gerontology, at the Johns Hopkins School of Medicine. Dr. Greenwald is a board certified psychiatrist who is the Director of the Geriatric Psychiatry Division, Associate Chairman of the Department of Psychiatry, and attending psychiatrist for the Hillside Hospital-Long Island Jewish Medical Center. He is also an Associate Professor in the Department of Psychiatry at the Albert Einstein College of Medicine. Ms. Anderson is a clinical nurse who has served as the Deputy Director for the State of Maryland's Department of Health and Hygiene, Mental Hygiene Administration. For further details or. the backgrounds of these individuals; see attached curricula, vitae. Drs. Eion and Greenwald toured DCV on May 30, 1995; Ms. Anderson toured on May 25, 25 and 30, 1995.
4_/ Dr. Elon, Dr. Greenwald, and Ms. Anderson previously toured DCV on June 6-7, 1994 as part of our investigation of the facility pursuant to CRIPA.

"••T

United State; to seek a preliminary injunction to preven: irreparable : njury. Those areas of most immediate conce: include : (1". inadequate prevention and treatment of decu: ulcers; (2• . .".adequate care of incontinent residents; (3) shortage of food, drink, medical supplies, and hot w-r (4) lack of = dequate nursing staff; (5) medication error;
r.t of vendors for critical goods and servic-

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h'na tp_ciii^ "^O"^ n m.m5"^ l S t a v s l i o f i r-i 1- 'n ^ c ^ :

w 11 n tat ions to supporting declarations and docu:

are summari ze d be low.

- ;

II. FACTS S" 3STANTIATING THE NEED FOR A PRELIMINARY I No"

Inadequate Prevention And Treatment Of Decubitus

M °d ica 1 and nursing services at DCV are inadequate • care, preven- ,ion and trea — mS":;. on oressurs sores or ciecui ulcers. Elo:. Decl. at 5, 6 *!*! 13, 17; Anderson Decl. a: ft c, 11. C- :r medical and nursing consultants both cor.:! that DCV res..dents continue to suffer unnecessary skin b: that are not being assessed, evaluated and treated prooe: Elon Decl. a : 5 U 13; Anderson Deci. at 6 <j 15.5./

5/ Because the DCV population has become largely immobile through old age, disease or injury, a high percentage of DCV residents are at risk of developing decubitus ulcers. Ander Decl. at 5 ( 13. In fact, more Char, one out of every ter. DC residents suffers from decubiti. Elon at 6-7 ^ IS; Anderso Decl. at 6 *i 15. These sores are not only painful, but if not treated properly, could lead to progressively worsening infe ion and sepsis, leading to risk of limb amputation or even death Elon Deci. at 5-6 1 14. However, most decubitus ulcers are preventable and all are treatable if identified at an early stage. Elon at 6 1 15; Anderson Decl. at 5 1 12. The DCV residents are entitled to reasonable and professional nursin an:
(continue
- 5-

ana improper care ot cecuoitus ulcers at Z

had "~d*ire consequences" for a number of residents. Elcn De

at

17; Ancerson Decl. at 6 x 16. For example, a relative recently deceased DCV resident described the lack of a:s.-. ^ "••--=.

care DCV crcvided for his father's sores:

At the time of his death, my father had become afflicted with severe bed sores. Before entering DCV, my father r.3.d never suffered with bed sores. The sores started appearing a j_e<v monttiS a-tsr placement at D\_V. iney keot gsctir.~ worse. At first the bed sores were "^ust larcre* the" ~'~ev became deep too. By the time he had reached the hoseital just prior to his death, the hospital doctor showed me that the sores on his buttocks were so deeo, he could cut his hand in them. I saw these sores personally, and I can attest that the sores were humongous ... Given the size of the leg sores and the potential for infection, it was decided that the best course of action would be to have both his legs amputated. This was done at the hospital. Given my father's frail health, he died a few days later. The sores developed in the first place because the DCV staff had failed to keep my father walking and active and because they

3 ur cs ss Decl. at 2-3 j•, 5, 6 (e mohasi s ad ded) . 6 / Our nursing consultant observed the condition of anctt'hner DCV
resident, Claude B., on her most recent visit and described a similarly graphic way:
[T"ne" decubi tus ulcer on his hio is one of the wors t I nave seen in my professional career. It was deep, red and :~aw with the skin completely eaten away. It was sickening and hard to view such sores on the body of another human b- iing. Claude kept squirming and crying out from pain while t!

5/ (. . .continued) medical care that will treat the sores once they develop, but more irmcortantly, will prevent their occurrence in the first place. "Elon at 6 W 15* 15; Anderson Decl. at 5 f 14.
§_/ A review of records at DCV indicates that the facility lists "multiple decubitus ulcers" as a cause of other, more recent deaths. See Elon Decl. at 7-8 K 20 (John B. on March 5, 1955; Marie D. on May 5, 1995).

treating physician manipulated the skin tissue to examine the wound. Claude had to be restrained by the nurse. I have seen some pretty hideous bedsores over my 23 years cf nursing practice but this particular sore was horrible and one of the worst I have ever seen. In my opinion, given the inadequate care and treatment, further skin breakdown is imminent for Claude unless corrective action is taken immediately ... I watched the physician, pull off the layer of skin tissue on top of the decubitus ulcers [on Claude's foot]. Claude continued to cry out in pain. The skin was • red, raw and bruised inside.
Anderson Decl. at 6-7 <[<[ 17, IS. Dr. Elon described Claude's hie
: — cio
looks like cli ha~burger." Elon Decl. at 8 1 22. She observed
the bone." Elon Decl. at S *j 22. Dr. Elon concluded that because of DIV's inadequate care of Claude, he was at "high risk cf having his wounds becoming infected and is in danger of potentially losing his leg unless corrective action is taken
.— a _ — _v
Indeed several DCV residents have recently suffered arr.putation cf parts of their bodies due to inadequate care cf decubitus ulcers . Elon Decl. at 7 1J 19 . For example, William S . had his leg a-putated in April 1995 because decubitus bed sores were allowed to deteriorate. Dr. Elon concluded that his "amputation was a direct result cf inadequate care and neglect coupled with improper delayed notification by nursing staff of signs cf infection. The result was the amputation of a resident's leg that could have been prevented." Elon Decl. at 10
26. Cur nursing consultant also concluded that the amputation
- 7-

of William' s leg "ecuId have been avoided and prever.ted" . Anderson Decl. at 8 1 20.2/
Marco Wafers, another DCV resident, declares that he h=d his lower leg amputated in Decerr.ber 1994 after his foot had cec~me infected f rcm a sore that had developed at DCV. Waters l e d . at 1 ^ 2 . The s:re became infected and spread to the res: cf his foot and to his lower leg. Mr. Waters declares that ever, though his foot became progressively worse, his doctor came to see him personally "only a very few times. Instead of visually inspecting m.e and my foot, he would rely on the written retrrzs of the nurses ... even though his office was right around the corner from, m.e. " Waters Decl. at 1 \ 2 .
Mr. Waters indicates that his foot turned completely black ano. that he r.ac to cs sent to tus loca^. hospital wnere tne doctors were "shocked1' at the condition of his foot. Waters Decl. at 2 r 3 . They ir.forrr.ee hin that the infection was likely to spread to the rest of his body and possibly kill him., =: y.r. Waters was forced to lose his leg to amputation. Waters l e d . a2 H 3. After reviewing Marco's care, Dr. Eion concluded thai he had "lost a limb after a long history of deteriorating decubitus

l_f William, currently suffers from additional sores including a large hole in his right hip that has "eaten into the muscle," a decubitus ulcer on his right buttock that is "raw, red and beginning to eat into muscle tissue." Anderson Decl. at S ^ 20. Dr. Elon described the current sores as "oozing green pus." Eion Decl. at II 1 28. The wounds can easily become infected, however, no cultures of the wounds had been ordered. Elon Decl. at 11 *I 28; Anderson Decl. at 8 1 20. In addition, Dr. Eion observed that William was left to lie on an air mattress that was improperly inflated, thus "offering no pressure relief." Elon D e c l / at 11 1[ 28.

;

. 8-

T - II"

ulcers that came infected and gar.grsr.e . . . the inadequate ar.d neglect by D. C. Village was a significant contributing factor." Elcr. Decl. aatt 1133 *1 32

Moses I. had both of his legs amputated after very del

treatment a; ~ CV. Elon Decl. at 11-12 % 29. Ke currently has an

ulcer at the b ase of his spine with the top layer of skin m

over the entire area and skin breakdown complete to the r.u;

Anderson Decl . at S *j 22 . Within the past several weeks, M

Anderson :wice personally observed that he was left sitting ror
"*i i**] ^ i***) ™~ i 1 7"^ *^ 1 ^" r* "* " £"J *,A/^ 1" V* 1 T"1 ^ TA7 ri 1 i*"1 i O 'V* 3 -^* ^ v ^ — ™" —

ulcers. Anderson Deci. at 9 *[ 2 2. Dr. Elon also observed

lying in his wn urine an feces. Elon Deci. at 12 *> 30 . further noted

wound was not

:rlv hvcrated due to an inaoorocriats dr=ssin'

i^\~inent risk of infection due to his inadequate treatment.

Elon Decl. at 13 |j 30-1/

Many residents hav

ed recently for

complicati ns related to decubitus ulcers: Georae A. (ijossibL infected decubitus ulcer, dehydration); Marie D. (amputation of

left leg due to infected decubitus ulcers); William S. (septic

right knee; leg amputated above the knee due to necrosis and

gangrene); Willie V. (flap closure); Claude B. (flap closure);

8./ Dr. Elon also observed inappropriate treatment of Houston J.'s two decubitus ulcers which place him at "imminent risk that the wound will get larger and get infected ... [resulting in] a potential loss of limb, sepsis, and even possibly death." Elon Decl. at 10 ^ 25.
- S-

Houston J. '.surgical flap, letc hip) ; Milton B. (cellulitis, right leg); James T. (ceiiuiitis). Eion Decl. at 7, 13-14 r 19, 33, 34. Other residents have been hospitalized for seosis which rr.ay be related to poor ulcer cars. Elon Decl. at 8 1 21.
The facility treats some decubitus ulcers improperly with Elase, an cir-tmer.t that aids in the debridement of dead tissue. Dr. Elon observed a DCV physician spread the ointment on Claude B. beyond the sore area onto adjacent healthy tissue. Elon Decl. at 9 ^| 23 . As Dr. Eion stated, "If extended beyond the necrotic area, the result is that healthy adj acent tissue may be da-aged, resulting in extending the decubitus ulcers. The result was that the D.C. Village 'cure' could actually exacerbate the problem." Eion Decl. at 9 1j 23.9/
DCV alsc improperly uses Intrasite gel, which is normally
!'^-^^ f- ^ i=— *- = 'p n a s ' ' r'"'/ t ' S S U ^ CT^O'-v'^I". t O ("''aa f- n-^r" *~r\ f~ i <~ o •-- A — g n
skin tissue. Eion Decl. at S *i 24 . Dr. Elon concluded that D C V s use of Eiase and Intrasite for Lamont R. significantly departs frcrr. professional standards and "place [s] Lament at risk of imminent harm." Eion Decl. at 9 at % 24. She concluded that past inappropriate treatment has led to a progression of Lament's wounds and "predisposes him. to potentially losing a limb unnecessariiv. » Elon Deci. at 9 1 2 4.1CL/
9_/ The facility uses Elase for other residents with decubitus ulcers, including Lament P.. E.g.. Elon Decl. at 9 1 24 (sixty day order for Elase for Lamont's foot ulcer is inappropriate}. 10/ See also Anderson Decl. at 7 f 19 (Lamont R. has decubitus ulcers on his left ankle and on the ball of his left foot; M[t]he
(continued...) - 10 -
"•'

Finally, the District of Columbia's Long Term Care

Ombudsman, Ms• Anne Hart, states that she has observed the

effects of ~he facility's poor care of residents' decubitus

ulcers. Hart Decl . H 7-10 .

In sum., the facility's deficient medical and nursing c

decubitus ulcers is having a broad and profound effect on z-

different DCV residents. The impact ranges from amputation

life - threatening illness to death. Such practices are danc

grossly deficient, and in need of immediate correction.

B.

Of Incontinent Residents Is Inadeauat1

The DCV nursing and direct care staff routinely neglec

basic care needs of incontinent residents, lea.vir.cr them to

their own urine or feces for long periods of time. V.s.Bau

declares that she has personally observed dependent DCV res icer.es "left in fecal matter for hours simply because the staff

ntinent residents a e le 't to sit in their own feces fr 1:00 in the afternoon until after 6:00 at night. Baugh De 7 (| 16 . Nurses are supposed to be monitoring the resident cut many of them sit at the nursing station all day talking. Ceci. at 7 * 15. Mr. Forte, the President of the DCV Resi ™ « — ~— •-* ' Association, declares, "I've also seen residents left wet prolonged periods of time. You can smell the urine. I no

10/ ( . ..continued) decubitus ulcer I observed looked infected, was raw and deep and had increased to the size of a quarter"; urine allowed to seeo down his leg onto sore
- 11 -

this just a few days ago." Forte Deci. at 3 <| 9. The Long Terr
Care Ombudsman has found that the smell of urine is so
overpowering zr. one unit that residents "complain they can't
breathe and ask for fresh air." Hart Deci. K 27.
Our nursing consultant personally observed Moses D. laving
in bed in his own urine on two separate recent occasions:
I observed that the [ulcer] dressing was saturated with
the bed linens were soaked. The best way to describe what I saw was a pool of urine. Around the edges, the urine had dried, leaving huge stains. This indicates to r?.e that Moses had beer, left laying m his own urine for hours without being checked. As a professional nurse, I was appalled to see that. A resident requiring total care who is bed-ridden should never be left for long periods of time without supervision ... After the charge nurse removed the dressing, I observed that Moses' urine had seeped through and was laying directly on the wound contaminating the decubitus ulcer ... I returned a second time to review Moses' care four days later on May 30, 1995, and was utterly appalled to find alrr.ost the exact same situation. Moses was again laying in his bed with a urine soaked dressing over his decubitus ulcers. The bed was soaking wet. It apceared that Moses had been neglected again for hours.
Ar.dersor. Decl. at 9-10 at ^ 22 .11/
Mr. Burgess commented on deficient nursing care of his
deceased father in this area as well:
I was very dissatisfied with the care my father received at DCV. As soon as I placed him at DCV, his health deteriorated rapidly. When I would visit him, 1 often found that my father had beer, sitting in his own feces or laying in bed full of his own feces. The smell was awful. The nursing staff had completely neglected to meet his r.ee.ds. I was left to clean him uo and change him myself. The staff would only act when I would complain. In fact, care always got worse the longer I stayed away from the facility. Only when I spoke up all the time, did the staff ever act to provide anything to my father.

11/ Our medical consultant also personally observed Moses lying in his own urine and feces. Elon Decl. at 12 ^ 30.

• •

•

.

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Burgess Decl. at 1-2 * 3. Charlease Hatchett, a relat ive c f Mazie Edwards, a DCV resident who died, also declared that s" was "shocked" at the conditions at DCV, noting a urine smell the rcorr.s. H=tchett Decl. at 1 1 2.
DCV resident Lament R. , who is paralyzed from the r.e~'< told our r.ursing consultant during our recent visit thac he noticed urine flowing out of his tennis shoe. Anderson Decl 7 H is. The urine had spilled out of his catheter tubing, d his cants leg and into his shoe and was affecting a decubi-u ulcer on his foot. Anderson Decl. at 7 ^ 19.
DCV resident Saundra Baugh indicates that she was force rorr -21 i1"1 irr~r~iC'iie m Deo. ror an entire W S S K last mo7*11h w*iia '•" wheelchair was being repaired. Baugh Decl. at 6 ^
-i £_ T 2 / •p,,,vi ^~ tir^t t i m ^ s**e i n d i c a t e d tha*~ n *- v- ^ ^.i -*- ^ -• •—~
and direct care staff failed to attend to my basic needs ... staff regularly left me in bed wet with urine for 10-12 hou: a time after I had been incontinent. Needless to say, it La very uncomfortable, unhealthy and embarrassing to be left wet fc: such a long time." Baugh Decl. at 6 1j 15.
In sum, incontinent residents are grossly neglected an; routinely left to sit in their own urine and feces for unnecessarily protracted periods of time. This neglect is abhorrent, beyond any standards of decency and is simply unacceptable.
12/ Mr. Royster indicated that when his wheelchair was being repaired, he was left in bed for four to five months. Royster Decl. at 3 H 9.
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C . S hcr^aaes Have P.e suited In Unnecessary Suffering The United States has attached the declarations of seven DCV residents whe exolair., at length, ongoing shortages that, have resulted in current basic care deficiencies at the facility..13.-' Their stories nutually reinforce one another, revealing, fcr example, severe shortages of food, medications, medical supplies, hot water for bathing, clean and appropriate eating utensils, and adequate staff. See Baugh Deci. at 1-r *f
J - o , C ~ - L ^ , _ = , z i ; : O r u = b - _ : . ci_ ±- £ , 3 "ii| & - a , I'J ; r.O > = _ - r
Deci. at 1-3 f^ 2-7; Veasey Decl. at 1-3 *|^| 2-1C; Scott D e d . at 1-2 *|1) 3-5; Morton Decl. at 1-2 *!*i 2, 5; Waters Decl. a; 2 f =.
The consequences and reasons for these shortages are readily identifiable by DCV residents. For example, Ms. Baugh indicates,
District] has caused real p roblems for residents at facility." Forte Decl. at 2 1 2.
The prevalence of these problems is also readily acoarent to outside advocates who frequently visit DCV. For example, the District's Long Term Care Ombudsman indicates that she has received many complaints about the shortage of su-poiies at DCV. Kart Decl. *| 15. She states, " I have verified throuch r* ; y-^.•
13/ The vast majority of DCV residents are unable to effectively communicate with outsiders. Many suffer from dementia, Alzheimer's disease or some other condition that renders them unable to speak clearly or at length. There are few DCV residents without such limiting conditions. As a result, the few declarants necessarily must speak for the others.
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and personal observation that various units a i D.C Village have been without diapers, bibs, clean sheecs, duod
~inQ dressincs for decubitus ulcers drinkincr j uice, milk, Procardia, Xar.cax, A & D Ointment, and all man...•=r o_ vitamins c ha • are prescribed to assisc in the healing of decubitus ul: ers," Hart Decl. <j 15. Another advocate, Ms Laurence, cf DC Arc, declares that DCV staff have indicate C CO her that cer a in activities related to resident care "do r. occur in the manner they are supposed to because of a lack

i:CvC3BoLV ~ w.

^ L,i

s _d.z i. _:.s

4.14./

1.

And Drink

There are serious food and drink shortacres DC'

"" 3

adversely
£3 **1 ^ *~ <*"*" ^ ^~ ^ -^

months; they have been forced to endure pear.u

sandwiches for meals as a substitute for meat; ana tnsv r.ave ~ot been served :resh vegetables cr salad for months. Baugrh D

1-3 *J1 3-5; "orte Decl. at 1-2 5[*[ 2, 3; Royster Decl. at 2

i

Veasey Dec! at 2-3 1*1 4-7; Scoct Decl. at 1 1 3; Morton D ~Z-. c^

14/ Ms. Laurence

irvisor of Volunteer Advocacy

Services at DC Arc, which is the court-appointed Monitor for the

class of individuals with developmental disabilities who have

been outplaced into the community from Forest Haven, a Discrict-

run institution that was forced to close under court order in

1991. Laurer.ee Decl. a" 1 *j 1. She is responsible for

monitoring conditions and services provided to class members with

mental retardation who were transferred to DCV. Laurence Decl.

at 1-2 <I<j 2, 3.

.5 -

1 H 2. During the past few months, there have been feed shortages at all meals. Forte Deci. ac 2 !j 3 .15/
The District's Long Term Care Ombudsman, Anne Kart, confirms in her declaration that theinsufficient quantity and cualiiy of fcod leave ZIV residents hungry simply because they are r.cz getcing enough to eat. Hart Decl. ^ 16. DCVrarely, if ever, serves fresh vegetables to theresidents. Kart Decl. r\ 17. She also indicates that instead of real food, DCVis serving seme residents licuid nutritional supplements as their entire source of r.ucrition simply because of food shore ages. Kart Decl. f 21.
In addirion, there is evidence that special, medically -*-:=o"_^i T^Q die ~ s arenotbe m " Hollowed. For exa"~ole w^
, of DC Arc, discovered that a specially selected liquid used in a tube feeder could not be given to a rreessiiddeent as crescribed "because of unavailability." La
p,j=-1 = - £ f 7

i;.i; C : . O i O lias Impcuw'-c^ i.O^ O::j.V C u e O u 2 -i. •_ 1 i_ V D'

quality of the meals. For example, Ms. Laurence overheard a

staff member comment on the poor cuality of thefood shewas

feeding to a resident, "I'm surprised you can eat it, it's so

i.ei-L *~i, .

aurence Deci. at 4 *i6 .

15/ Virtually every resident indicated that food qualityand quantity improved markedly when the United States' experts were present at DCV. However, they indicated that theinadequate food and drink were sure to return again, as it always does, once they wars gone. See, e.g. , Baugh Decl. at 2 *j 4; Forte Decl. a; 2 f 3; Royster Decl. at 3 (j 7; Veasey Decl. at 3 % 3,- Scott Deci. at 2 % 4; Morton Decl. at 1 % 2. Seefurther discussion of this issue below.
- 16 -

~Vr'i'fi 'f i - • - T T - —

No- cr.ly do the food shortages cause hunger, they also

cor.tribute tc nutritional problems that car. compromise health,

including unduly slowing the healing of pressure sores. See

Anderson Decl. at 11 1 25.

2.' Medical Supplies And Equipment

There is a critical shortage of needed medical supplies ac

DCV. The shortages range from gauze pads, ointments,

medications, to catheters -- and even scap. Significantly,

supplies needed to treat decubitus ulcers are in short supply.

Medical and nursina staff throuahout the facilitv reocrt

shortages of essential medical supplies normally used to treat

decubitus ulcers. Eion Decl. at 15 * 36. .15./ In particular

short acre s of duoderm tape and 4X4 pads were continually reported.

Eion Decl. at 15 t 36. Ms. Anderson found similar deficiencies.

Anderson usci. at lu-ii ,| 2^=.

Many residents who signed declarations in support of this

Motion have had or currently have decubitus ulcers. More than

one such resident declares that medical supply shortages such as

gauze, bandages and duoderm tape have directly compromised the

staff's ability to properly treat their sores. Baugh Dec!. at 4

C Q . D'-JV^"^^" D a ^ l a1" 1 5! 2 • V 3 a 3 a v D»^~i a1" 2 ^1 ^

£=>:= p"<=->,

Forte Decl. at 2 1 5 (observed shortace of such medical

16/ Dr. Eion observed a medical doctor forced to do a debridement of dead skin tissue using improper equipment because of lack of adequate supplies. In addition, this same doctor used an improper ointment because he thought the facility still had a shortage of the appropriate Silvadine ointm.ent. Eion Decl. at 15
- 17 -

supplies). "cr example, Ms. Baugh indicates that because cf recent medical, supply shortages at DCV, the "staff are lef c to improvise" creating a make-shift patch for her sores which "cf~en becomes disiedged, leaving the sensitive sore exposed and subjact to further irritation . . . the patch never stays in place properly." Baugh Decl. at 4 <| 5.17/
One nurse advised Ms. Anderson during her recent tour chat there had be^r.numerous medication and supply shortages, and chat they have b~~T. short for so long, staff have lost track cf what is and is not available. Anderson Decl. at 10 *i 24. Numerous other nurses and aides confided in her that supplies were an onagain/off-again proposition. Anderson Decl. at 10-11 * 24. A physician indicated that shortages of medications, especially antiDi.oti.es, r.aa bsco™s co~~onp_ace anc tnat tiie pnysj.cz.an vras forced, on occasion, to substitute alternative medications. Anderson Decl. at 10-11 *j 24. Finally, Dr. Greenwald reports that many staff told him that there were supply shortages and medicat ion snort ages. Greenwa ±c Decl. at 5-S \ 12. He accec.,

17/ Further, the District has failed to pay two companies who

'- Drovide DCV with essential produces that help prevent and treat

decubitus ulcers. Roomberg Decl. at 2 *j 4; Haynes Decl. at 1 *|

3. In fact, one company no longer provides its therapy beds to

DCV. Haynes Decl. at 2 1 4. The Chief Financial Officer cf the

other company declared that it would continue to provide its

mattress overlay systems to DCV simply because it believes "it is

against public policy to stop service to the medically fragile

DCV residents who are using our products ... [because] their

lives may be at stake." Roomberg Decl. at 2 ^ 6. Nonetheless,

he could envision a day when the District's continuing refusal to

pay for services rendered would force them away from this posture

of benevolence. Roomberg Decl. at 2 *1 6 . See further discussion

below.

:;

- 18 -

11 several physicians told me in confidence that because of medication and staff shortages, they believed nursing staff would either mark in the record that the drug had been given, even if it had not been given, or indicate that the resident refused the medication. " Greer.wald Deci. at 5-6 fl 12 .18/
The residents have detailed other current medical and basic care supply shortages. See, e.g., Baugh Decl. at 4-5 1[ 10 (toothbrushes, combs, brushes, soap, lotion, paper towels, cups, light bulbs'; Royster Deci. at I 1H 2, 3 (toothbrushes, toothpaste, CDr?.bs, brushes, soap, lotion, paper towels, cups, gauze, stretch wrap, catheters); Veasey Decl. at 1-2 *j 2 (urine bags) ; Morton Deci. at 2 *j 4 (proper hearing aid batteries) . Mr. Royster declared that he has had to pay for a catheter himself S HUkJi. because the facility had "run out of oaths
Royster Decl. at 1 *| 2. Mr. Veasay stated that because of the shortage of urine bags, he has been forced to "re-use the same dirty bag two to three days in a row." Veasey Decl. at 1 *j 2. In sum, basic supply and equipment shortages have forced the DCV
IS/ Dr. Greer.wald also found that inappropriate psychotropic medications are being prescribed, which is but one of the many deficiencies that he found in psychiatric care arid treatment at DCV. Greer.wald Decl. at 6-10 *H 13-24 (concluding that DCV7 s care is utterly bereft of adequate and appropriate psychiatric assessment, proper psychiatric differential diagnoses, aopropriate treatment and sufficient monitoring of signs and symptoms). Dr. Greer.wald also concluded that because of the lack of proper assessments, some individuals likely are inappropriately placed at DCV. See Greenwald Decl. at 10-12 HH 26-30 (DCV physician admitted "plenty of people are here who should not be here").
- 19 -

T 'Ml'

•nr

residents tc endure squalid conditions and improper care zcr

their ailtner.:s.

3 . Hc~ Water For Bathing And Cleaning Eating Utensils

In addition to the supply shortages listed above, there has

been a lack of hot water for bathing and a lack of hot wa;~r for

washing and sanitizing eating utensils at DCV. See, e . c:. , Esugh

Decl. at 1, 5-6 <j*| 3, 11, 12; Forte Decl. at 2 1 6; Royster Decl. at 2 f<[ 4, 5; Scott Dec!. at 2 f 5; Morton Decl. at 2 f\ 5; Waters Decl. at 2 f $ . In fact, Ms. Baugh, Mr. Forte, and Mr. ?.oys:er

ail claim that there was recently no hot water for bathing zr.

some units for at least a week. Baugh Decl. a. 5 t 11; Forte

Dec!. a: 2 f 6; Royster Decl. at 2 1 4.

j

Ms. Karr confirms that because silverware eating utensils

are not provided regularly to the residents, they are often left

to use plastic "sporks." Hart Decl. % IS. Some residents cannot

use these "sporks" properly and end up not eating a sufficient

amount of food. Hart Decl. * 18. Last month, she observed

residents crying and very distressed over having to eat food with

their fingers because there were no eating utensils available.

Kart Decl. ^i 19, 20. See also Laurence Supp. Decl. at 1-2 *i*j 2-4

(no adaptive equipment available for use by residents who need it

at mealtimes; one resident was observed eating fallen food off

her bench; another resident suffered weight loss seemingly from

not having adaptive equipment to help her eat) .

- 20 "•nra— ' • T

D . 5ursincr Def icier.cies Needlessly Subiect Residents To Harm And Risk Or Harm

1 . Lack Of Adequate N'ursina Staff

Appropriate nursing care is crucial to the health ar.d

welfare cz the medically fragile and/or otherwise involved I_V

population. .Vot only does this comport with common sense, it is

consistent with reasonable professional standards. Inadequate

'" '

receiving the care and attention they require. Anderson Detl . at

14,15*^34,35.

Our nursing consultant concluded that nurse staffing at DCV

is "professionally unsound ar.d dangerous." Anderson Decl. at 13

*i 31. As she had concluded a year earlier, she found that the

existing nursing staff is forced to operate in a perpetual

"crisis mode." Anderson Deci. at 3, 14 <[<[ 7, 31. As a result,

the overburdened staff have failed to meet the basic and rcutine

needs of the residents. See Anderson Deci. at 15 % 35 (residents

not bathed frequently enough, not turned on a regular basis to

prevent or minimize incidents of decubitus ulcers, not provided

with needed therapy, weights and nutritional needs not monitored

in a timely fashion). Ms. Hart has similar concerns and cices to

a pattern of unexplained injuries and a high incidence of falls

which demonstrate inadequate supervision and a lack of proper

care and monitoring of vulnerable residents. Kart Decl. 1 11.

Ms. Baugh declared "over half the time we do not have enough

nurses on the unit. The nurse shortage means that they cannot

attend to the needs of the full care residents. There always

.'

- 21 -

•wrr

seer^s to be = shortage of nurses and staff on the weekends. " Baugh Decl. a: 9 1 21.19./ Mr. Forte indicated that "[w^e'r-

Laurence has also concluded that there is not adequate staff to rceet the needs of the residents. Laurence Dec!. at 3 *• 5.
Dr. Greenwald was told by DCV staff that there are nurse and nurse's aide shortages that lead to situations where there are not enough staff to feed people or to bathe people. Greenwald Deci. at 5-c f 12. The staff also indicated that the

administration have overwhelmed the DCV nursing manpower. Greenwald Decl. at 5-6 1j 12.2_0_/ See also Laurence Supc. Decl. at 2-3 f*j 6, 7 (nursing staff failed to monitor feeding tubes closely enough) . One staff person corker-ted to Dr. Greenwald that as a result, "there's gotta be mistakes." Greenwald Deol. at 5 % 12.
Nurses often do not carry out the duties they are obligated to undertake. Ms. Baugh declares, "[f]cr nurses at DCV, paperwork is "ore important than the residents. Nurses often

19/ Ms. Baugh indicated that even though she is unable to brush her own teeth, "no staff person or nurse had brushed rcy teeth fo: the entire week before the outside surveyors arrived." Baugh Decl. at 7 fi 17. Ms. Morton has observed that the "staff and nurses often don't groom the residents properly. I' ve seerresidents in need of such services left with their hair not combed and nappy all day long." Morton Decl. at 2 f S.

20/ Ms. Anderson, for example, noticed that nursing staff had twice failed to provide Moses with his physician-ordered water bolus injection which serves to exacerbate Moses' skin breakdown and places him at risk of dehydration. Anderson Decl. at 10 % 23 .

;

- 22 -

n—r

write entries in the record without interacting with or saving a word to the residents." Baugh Dec!. at 8 f 19. Ms. Laurence
sitting i- the dayroom at a table talking to one another with [residents! sitting idle while the TV is on in the background. I have never seen a supervisor tell the staff that this type of behavior is unacceptable." Laurence Deci. at 3 1 5.
A relative of a recently deceased DCV resident detailed similar r.eglect by nursing staff:
While he was alive, the DCV staff did not take care cf ~y brother adequately; they didn't provide for his basic tare needs. It was a crime the way they treated him. They just ignored him ... The staff were very unprofessional; in fact, they were a disgrace to their profession. Whenever Z visited him, I found him needing a shave and needing :: be cleaned up. I couldn't even find staff to help me take care of him when I visited. I would have to find my own razor and shave him myself. I would also do my best tc clean him. up myself. I never saw staff around to help. I think this was outrageous neglect.
Hawkins Decl. at 2 1 5. Nurses often write in the record that they perform certain
duties and yet, in fact, they do not. For example, Mr. Forte indicated that "[a] lot of residents have gotten what I call a 'pencil bath' where the nurses write in the record that they bathed the person, but in fact, they had not." Forte Decl. at 3 1 9. Ms. Baugh confirms that many times, nurses will "write in the record that they have done something, like change a dressing for a bed sore, yet they will have not done anything at all." Baugh Decl. at 8 1 19.
- 23 -

i—r w'in—i

r HI—n—r

Our nursing consultant found several instances where scaff had written in the record that they had performed certain duties when, in fact, they had net. In one instance, Ms. Andersen confronted the medication nurse on a unit who had marked in the ; record of Charles L. that he had received his physician-ordered ; seizure medication. The medication nurse admitted, however, that the dosage ha5 not been administered and that the written record was ir. accurate. Anderson Dec!, at 12-13 ^j 27. Ms . Anders en ~1 so found that the night shift staff had marked in the record cf ; Catherine S. that a certain procedure had been done throughout ; the shift, despite the fact that the shift had not yet her;:..
Moreover, the District has traditionally failed to staff DCV Witn an aoeeua>_e num.eer ct Dermanen_ nurs ir,y s^ at t i_o meet tne j needs cf the residents. As a result of this failure, for at least the past year, DCV has been forced to rely on using agency or contract nurses to fill staff unit positions.
Ms. Anderson found that the nursing staff complement, comprised of almost fifty percent temporary contract nurses, failed to meet the needs of the DCV residents and placed them at risk of harm. Andersen Dec!, at 3-4, 14 *i*j 7, 32. She concluded that such widespread use of contract nurses presents "serious ; risks to the health and safety" of the residents. Anderson Decl. at 14 ^ 32. She added, "[tjhis overreliance on temporary staff
21/ Dr. Elan also noted irregularities in entries in a medical record. Elon Decl. at 18-19 1 46.
- 24 -

is inappropriate and dangerous in a facility such as D . C . Village where continuity of care and familiarity with residencs are critical tc ens;: 14 If 33.^2/
In su~., acknowledged nursing and staff shortages as wall as the overuse of contract nurses have compromised care and service to the DCV residents placing them at further risk of harm.
2. Medication Errors Our nursing consultant also found an excessive number of medication errors at DCV. Anderson Decl. at 3, 12 f <j 6, 27. She concluded that medication errors were a "systemic, on-going problem exacerbated by a nursing staff that is understaffed; overburdened and confronted -with the prevalent use of temporary a~ency/ contract nurses v*^o ^rs no^ acecrus^e^.y t3.~ij.i5r witr, t.is needs of D. C. Village residents.!T Anderson Decl. at 13 f\ 30. See also Anderson at 14 fj 3 2 (several individual members of the contract staff did not know the names and identities of the residents to whom they were providing care and nursing services and administering medications). Ms. Baugh indicates, "I invariably have to tell the [contract] nurses what medications 1 take and when I take them. Often I have to correct the nurses after they hand me the wrong pills at the wrong time. Even after I correct their mistake, if
22/ Consistent with this, Ms. Baugh indicates that because th contract nurses are not familiar with Che residents, they make mistakes such as improperly treating residents' decubiti and constantly making medication errors. Baugh Decl. at 7-8 % 18.
- 25 -

it's just a tiding error, the contract nurses often encourage me to take the pills that they've given me at the time anyway." Eaugh Deci. at 7-8 * 13. Mr. Forte also indicates that the contract nurses have committed a lot of medication errors: "On many occasions, I've been handed the wrong medication by a contract nurse, forcing me to correct her mistake. " Forts T e d . a: 3 1 8. Mr. Veasey indicates that contract nurses have m.ade c'^ ts s. rev." '".iscskss in disoensinc medications. ^"•=i added " ~ know what I' r. supposed to be taking, and when I tell the nurses that they've made a mistake, they dor.' t like it." Veasey Z e d . a^ 3 c 9
Our consultant further found that medications were routinely documented as having been administered to residents when in fact, they had not been. See Anderson Decl. at 12-13 €A 27-30 (all medic at ions on Unit 3.-. ware markea as having been admin, is tered when they had not been; medication nurse admitted that the record documenting that seizure medication had been administered to Charles L. was inaccurate and that medication had not been given; three dosaces of seizure medication had not been given to Houston J.; Edward S. had not been given his anti-seizure medication twice in the crior week). Ms. Anderson concluded that "this type of nursing practice grossly violates accepted nursing standards and is professionally unjustifiable." Anderson Decl. at 13 *i 27,
In sum, grossly deficient practice and the overuse of temporary nurses have produced an unacceptably high risk of
- 2-

dedication error each time medications are dispensed t residents at DCV.
E. Failu To Pay Vendors Has Resul-ed Ir.Or Ex Shortages And Deficier-cies

caused rr.ar.v if not all of the food, supply and staffing shcrzages
d ^ J-'^V, ^ _-=^. O - L u c r^;a iuc..^5 iriaj.».ai.e 1-- L I . C I T C . C ^ S T ^ ^..^

employees aur.itted as much tc therr. en a nutriar of different occasions. Baugh Decl . at 1-2 *I 3; Forte Decl . at 1-2 * 2. See also Robinson Dscl. at 2 *j 5 (admission from Chief, Facility Support Services Division, DCV) ; Laurence Supp. Decl. a: 2 r 5 (admission froTL DCV nurse); Veasey Deci. at 2 % 4 (adr.issicn from DCV kitchen staff).
The District has admitted that it currently owes over SI, 000, 000.CC in past due amounts to vendors who supply necessary basic care and other services to DCV. Exhibit 2. Specifically, the District admitted that as of March 1, 1995, it owed a- least, forty different vendors $1,022,173.55 in past due amounts caring back to last Fall.11/ Exhibit 2,

23/ Since March I, 1995, the situation has only worsened

drastically. For example, as of the time of its current signed

declaration in June, the District owed SR.T MedStaff over $200,000

for agency nursing services the company had already provided at

DCV. Duval Decl. at 1 1 3. Because of the District's non-

payment, SRT completely stopped furnishing DCV with nurses

earlier this month. Duval Decl. at 1-2 *|4. As of the tir.e

National Nurses Service, another contract nursing service, signed

its recent June declaration, it was owed over $180,000 ir. psst

due amounts for agency nursing services it had provided at DCV.

Messenheimer Decl. at 2 1 S. If the District continues to fail,

• :

(continued...)

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Vendors owed past due amounts include food and dietarv
suppliers, pharmaceutical and drug companies, medical supply
providers, a m.edicai oxygen supplier, laundry service provid
hoc water boiler repairmen, agency/contract nursing agencies ana providers of therapeutic beds and mattress overlay systems f
Che prevention and treatment of decubitus ulcers. Exhibit 2
few of these vendors, including those who supply food produc
laundry services, and contract nursing services, have signed
declarations detailing amounts they are owed by the District
gee generally Dorr Decl. (hot water boiler repair), Duvai Ze
(contract nurses) , Kayr.es Decl. (therapy beds) , Messer.heim.er
Decl. (contract nurses), Mogenson Decl. (food and dietary),
Robinson Deci. (laundry), Roomberg Decl. (mattress overlay
system.s) , Sohimpff Decl. (laundry) , Williams Dec!, (medical
products and suoolies).
23,/ (. . .contir A \ to pay, National has declared that it is now at the point of having to discontinue future service to DCV. Messenheimer at 3 1 7. As of the time National Patient Care Systems, Inc., a supplier of mattress overlay systems, signed its June declaration, it was owed over $56,000. Roomberg Decl. at 2 *| 4 . It had not received payment for services rendered sir.ce October 1994. Roomberg Decl. at 2 f 4. As of the time it signed its June declaration, District Healthcare and Janitorial Supply, Inc., a medical products supply company, was owed close to $50,000. Williams Decl. at 1-2 1 4. As of the time they signed their declarations, the District owed Nutech Laundry and Textiles, Inc. over $80,000, and owed Healthcare Laundry Services over $100,000. Robinson Decl. at 2 ^ 6; Schimpff Decl. at 1 % 4. Nutech no longer provides laundering services to DCV. Robi.:r.son Decl. at 1 *| 3 .
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Because of the District's delinquent payment practices, some vendors have stopped supplying DCV with critical goods and services; ether vendors have threatened to stop supplying ~CV or are at great risk of being forced to stop soon. See Duval Deri. at i, 2 *1<| 4, 7 ("[bjecause of the District's failure to pay us, we have had to cancel all contract nursing services with DCV"); Messer.heimer Deci. at 2-3 flt 5-7 ("I told [Vernon Hawkins, Interim Director, Department cf Human Services ("DHS")] that we would be unable to continue service at DCV after the evening of June 3, 1935 unless we received payment for the past due amounts"); Williams Deci. at 2 % 4 ("without payment of the past due amounts, we won't be able to supply them with goods in the future sirr.rly because we can't afford to do business indefinitelv without getting paid"). See also Robinson Deci. at 2, 3 €f 5, 3 (District officials stopped using vendor because "budgetary restraints have forced us to take this action"; vendor declined to bid on future work because District is not "reliable") -,2_4./ The actual loss of basic supply or nursing

24/ The District has made it exceedingly difficult for these

vendors to obtain payment for amounts they are owed. Statements

made include: "we have been forced to speak with many different

District officials. Working with the D.C. Government has been an

administrative nightmare," Robinson Decl. at 2 f 7; "some

individuals would not return my calls until I left a message with

the magic words that we were threatening to terminate services,"

Duval Decl. at 3 t 7; "we were forced to call repeatedly various

District officials in an attempt to obtain the funds we were due.

Many times, our phonecails were not returned ... we were often

asked to re-fax the invoices we had already submitted causing

further delay," Messenheimer Decl. at 1-2 <| 3; " [w] e have made

repeated telephone calls ... in an attempt to obtain payment. We

are always promised payment, but it never arrives," Roomberg

i

(continued..-)

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vendors, or ever;, just the risk of loss, greatly compromises t' health and veil-being of the residents who need continuity cf care and whc need such goods and services to meet their often complex needs.
There is also a real danger that critical specialized support services for twenty-two individuals with mental retardation w'r.o 1ive at DCV, provided through a cortract with Georcetown ^niversii-V, Wiii cease L G 2x1 s^ 3. J_ ^ 5r uur.s .2 - , .;;

T . a n r p i r a C•••—--

n^f-1"!

a *- "3 ", £

3 n , ^ s f- !- s • - 'n ,3,-? "1 ^ f- f- ,»v Is >-,—i — " s -^ i —

lay/ DiTc .r, JJ^ ^-.r^ r r ^ . . t'l^-.^^^r-^g t-rocra.n, Ai^no--.. —
District has oaken steps co provide nore appropriate servic s ror these individuals by transferring the~ to community residen the District has fallen behind its June 30, 19 95 deadline f

accomplishing this.

Clay let

As a

Laurence Supp. Ceci. at 3 li S, atts.cr.ea sult cf the District's delac y -.- __=.--;=_•=-- - L ^

r- • • v v 3.

lvincr at DC v would bJoee lefztt without needed habi 1 itat ion and

training or other necessary supports for the remainder of th:

stay at the institution if the Georgetown University contrao'

not renewed uninterrupted.

24/ { . ..continued) Decl. at 2 f 5; "[t]raditionally, the District has been slow in paying our invoices," Haynes Decl. at 1-2 *| 3.

:"

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F. Claim Of Improved Or Changed Conditions Does Not Eliminate The Meed For Immediate Relief
Any claim that the District might make that they have undertaken initiatives to correct past problems and that conditions have generally improved, does not eliminate the n for immediate relief.25/
Efforcs already undertaken to purportedly improve condi and services seem to have not ultimately reached the DCV residents. For example, .Maria Laurence, the representative rrom DC Arc, declares, based upon her recent visits to DCV, thai although DCV has put a loc of new processes in place, "I hav =. r*,r-\l

improvements for the resider.es. The facility director, Ms. Brasfield, and the District administrators seem to have gocc intentions, but their initiatives, like total quality ~a~ag~ and peer review, seem to have had little real impact on res: care and services." Laurence Decl. at 2 *j 4.
Further, any attempts a: temporary improvement apparer.tly only take place when DCV is under intense scrutiny, such as

25/ See United States v. V7.T. Grant Co. , 345 U.S. 629, 632 n.5 (1953) (" [i]t is the duty of the courts to beware of efforts to defeat injunctive relief by protestations of repentance and reform, especially when abandonment sea™s timed to anticipate suit, and there is probability of resumption"); LaShawn A. v. Dixon, 762 F. Supp. 959, 952, 937 (D.D.C. 1991), aff'&, 990 F.2d
1319 (D.C. Cir. 1993), cere, denied, U.S. , 114 S. Ct. 691 (1994) (in response to the District's late attempts to alleviate some deficiencies in the foster care system, the Court held that the District's proposed remedial actions were still too tentative to make injunctive relief unnecessary and that it would not rely on defendants' good faith alone given that it'amounted to nothing more than unsubstantiated promises to improve).

•

•

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during tours cy outside surveyors.2_£/ Once the outs leave DCV, hcwever, conditions revert to being
d e f i c i e n t . 2 ".••

26 For exa •.pie, or. the first day of our tour, the DC"1 i _ s. a..--

to the fac clinic to being star

.-y trumpeting the kick-off of a brand newconducted over the next few days. The cl : even though the Department of Justice ha

2 •- . . = . ^ _ cv
C "/•' 2. S

DCV based

its tour of the facility about a year ear .. at 11 % 26; Elon Decl. at 16-17 % 40.

27/ See. e. -z. , Baug.i Deci. at i* \ 4 ("oasic services to residents were enhanced and increased [the week of the United States' tour] to make it appear to the outsiders as if there were no basic care shortages. However, this is misleading. For example, the meals served to us that week were of better quality and greater quantity than tney had been for months. The facility always puts on a good show for the surveyors, yet poor services always return once the outsiders leave"); Forte Decl. at 2 f. 3 ("[o]nce the outsiders arrived last week, conditions improved and we had everything we needed ... Before they arrived, zha meals were bad ... Now that the outsiders are gone, conditions are worsening again"); Royster Decl. at 3 *[ 7 ("[wjhile the outside surveyors were here last week, we were provided with juice at all meals for the first time in months. The meals improved during that time as well. However, I fully expect the quality of the meals no go down, again once they're gone. This is always the pattern") ,- Veasey Deci. at 3 If 7 ("[t]he facility always improves conditions and services when outsiders tour DCV. Other thar. when the outside surveyors were here last week, we had not had juice for months. In fact, last week when the surveyors were here, food quality improved greatly .., However, once the surveyors leave, things always revert back to the way they had been"); Scott Deci. at 2 1 4 ("[l]ast week, when the outside surveyors were here, the food was positively beautiful. This always happens when outsiders are visiting. However, the food is not to my liking once they go"); Morton Decl. at 1 1 2 (IT[l]ast week, I was happy because I knew the food would improve while the outside surveyors were here11); Anderson Decl. at 10 1| 24 (an evening charge nurse reported to our nurse consultant that the medical supply shortages were as recent as the prior week, however, another nurse stated: "things have gotten better this week").

111 - S~syp.-S.ZS FOR A PRELIMINARY INJUNCTION In de"err.in.ing whether a preliminary injunction, is
warranted, fcur factors are to be considerad: 1) the likelihood that the parcy seeking the preliminary injunction will prevail on the merits; 2; the likelihood that the moving party will'z~ irreparably injured absent such relief; 3) the prospecz thai other part-ies interested in the proceedings will be harme if the Court cra~ts a crsiiminary iniuncticn- and 4} the ^ub
"nr M
.2d 841, 842-43 (D.C. 1977) ; Virginia Petroleum Jobbers Ass'n v. Federal Power Cz~-.' r., 259 F.2d 921, 525 (D.C. Cir. 1958). See also National Slack Police Ass'n v. District of Columbia Bd. of Elections and Zthlcs, S 5S F. Supc . 251, 263 (D.D.C. 1934); Nat ior.al Fed'n of Fed. Employees v. Carlucci, 6S0 F. Supp. 41? (D.D.C. 1S33); Huvnh v. Carlucci , G79 F . Su^D . 61 (D.D.C. 1933); ? . I . M . E . - DC , I r.c . v . I.A.M. Nat'I Pension Fund, 557 F. Supp. 256 (D.D.C, 1954).
These four factors are to be balanced relative to one another. Tr.enecessary level for possibility of success or. the merits will vary according to the Court's assessment of the other equitable factors. Washington Metre. Area Transit, 559 F.2d at 843-44 . Importantly, courts have recognized that where the irreparable injury alleged involves denial of constitutional rights, the moving party's burden of proving each of the four factors is lessened. A. Wright & Arthur R. Miller, Federal Practice and Procedure, Civil, § 2943 at 440 (1973); Phillips v.
- 33 -
•wr

Michigan Dec't of Corrections, 731 F. Supp. 792, 801 (W.D. Mich. 1990), aff'd, 932 F.2d 959 (5th Cir. 1991} (in a prison conditions case, the court concluded that "when an alleged deprivation cf a constitutional right is involved, no further showing cf irreparable harm is necessary").
A.. The United States Is Likely To Succeed On The Merits As outlined above and as clearly set out in the many attached declarations signed by individual DCV residents, relatives of DCV residents, the United States' experts, and others, the United States is likely to prevail on the merits here given the District's clear violation of the DCV residents'
There is no question that individuals living in stateoperated facilities have a right, at a minimum, to decent and humane care cf their basic human needs. For examole indivii ;..- T — in state-run institutions have a "right to adequate food, shelter, clothing, and medical care." Younaberc v. Romeo, 457 u.S. 3u7, 3—3 (1982/ . i nese are ti^e essentials o^ tuc care t.

28/ In deciding this issue, the Court is not required to find that ultimate success by the movant is a wooden mathematical probability. Washington Metro. Area Transit, 559 F.2d at S43-44. Such an approach could be unnecessarily harsh and lead to an exaggeratedly refined analysis of the merits at an early stage in the litigation. .Id. If other equitable elements are present, "it will ordinarily be enough that the plaintiff has raised questions going to the merits so serious, substantial, difficult and doubtful, as to make them a fair ground for litigation, and thus for more deliberative investigation." Id. at 844, quoting Hamilton Watch Co. v. Benrus Watch Co., 205 F.2d 738, 740 (2d Cir. 1953).
- 34 -

TT

i—rail IM

the Siate r:; = : provide. " Id. at 3 24. 2j5/ However, it is
evident that these essentials are currently not being provided at
DCV, producing daily violations of the residents' basic and
fundamental constitutional rights.
In the :;s:er care context, this Court recognized such
constitutional rights and found similar constitutional violations
by the same defendants, the District of Columbia and the
Department cf Human Services. LaShawn A. v. Dixon, 75 2 ~. Sup?.
959 (D.D.C. 1951), ar'f'd, 990 F.2d 1319 (D.C. Cir. 1953), cer: .
denied, ".S . , 114 S. Ct. 691 (1994). There are s~rising
similarities between the LaShawn case and the present: ac;ic~.
For example, in finding constitutional and legal violations in
LaShawn, the Court held that although the plaintiff class members
had "corr.micr-d no wrong, they in effecc have been punished as
though they had." Id. at 993. As is true of the LaShawr. class,
the DCV residents have done society no wrong and they deserve no
punishmer.-. Id. at 996.3_0/
29/ Such individuals also have a constitutional liberty ir.-erest in reasonably safe conditions, freedom from undue bodily restraint, and a right to minimally adequate or reasonable training to ensure safety and liberty interests. Younaberc, 457 ^ U.S. at 315-15, 318-19. This Court has found that children in the Distric"'s foster care system had analogous rights that included the right "to safety from psychological and emotional harm." LaShawn A.., 762 F. Supp. at 992-3. The Court also held that the plaintiffs had a constitutional liberty interest in appropriate placements and case planning if such services were necessary to prevent harm. I_d. at 993.
30/ The class members in LaShawn and the DCV residents are both "wards of the District who rely wholly on the District to provide them with all of life's necessities ... to protect them from harm and ensure their well-being." LaShawn A.. 762 F. Supp. at 993.
(continued...)
- 35 -

Giver. the weight and breadth of the facts in. suoccr: cf this Motion for Preliminary Injunction, that: derail black letter lav violations of residents' rights, the United States has . demonstrated a likelihood of success on the merits in this case.
B. , Irreparable Injury Will Result If The Challenged Practices Are Not Enjoined
In this case, the injuries to the DCV residents are clearly irreparable. There can be no compensation or correction creviced to the DCV residents who daily face pain, suffering, loss cf limb, hunger, and risk of death because cf the negliger.ee and deficient care afforded the- by Defendants.,!^/

30/ (...continued)
As was the case in LaShawn, DCV residents must "rely on the District to provide them with food, shelter and day-to-dav care LaShawn A. , 762 F. Supp. at 560. The two cases share ether similarities as well, including: beleaguered cityy emp ees
ying to do their best to provide basic care necessitie s while plagued with excessive caseloads, staff shortaaes, inadetuatresources, inadequate administrative supports, and budgetaryconstraints ; the upper management of the DKS, as well as the former mayor, repeatedly being made aware of most, if not all of the deficiencies; the District hiring temporary employees rather than permanent employees to fill vacancies; the District arguingthat it is operating at a severe deficit and that all departments within the city are under stringent budgetary constraints; and the Court using the language "perpetual state of crisis" to describe the widespread deficient conditions in the foster care system. Id. at 970, 977, 981, 987, 989, 996.

31/ D.C. Circuit courts, including this Court, have found irreparable injury on much less compelling facts: National Fed'.n of Fed. Employees v. Carlucci, 680 F. Supp. 416 (D.D.C. 1S33) (granted plaintiffs' application for an expanded preliminary injunction where government's compulsory random urinalysis drug testing was held to be a substantial intrusion and violative of plaintiffs' constitutional rights); Huvnh v. Carlucci, 675 F. Supp. 61 (D.D.C. 1938} (granted plaintiffs' motion for a preliminary injunction against enforcement of a regulation that denied security clearance to recently-naturalized citizens where irreparable injuries included injury to careers and injury to
(continued...)

• •'

- 36 -

-mrm

v—r WITH

The irreparable injury stemming from the deprivation cf 2CV
residents' constitutional rights is amply captured in the wtrds
cf a relative of a DCV resident who recently died after
amputation due to pressure sores:
Every tirr.e I visited my brother at DCV, I became upset ever the deplorable conditions ... I'm overcome with guilt sometimes because I left my brother there and he ended uc dyincr. It's been very difficult for rr.e to live with. I wish the place could be shut down so that no one else will hav; o t h!
" a « . < l i . o Li — - . S i . X - ^ || ii -3 , ^ .
The evider.c= that DCV residents have suffered irrepsr-bis
harm is overwhelming. The many attached declarations by experts,
residents, relatives, and advocates, and Defendants' owr.
admissions through interviews and documents, demonstrate that the
individuals confined in DCV under present conditions will suffer
irreparable harm without this Court's intervention.
C. There Is No Substantial Harm To Other Parties
In order to prevent the issuance of a preliminary
injunction, the D.C. Circuit has advised that it must have a
"serious adverse effect" on other interested parties. Virginia
Petroleum Jobbers Ass'n, 255 F.2d at 925.
There can be no "harm" or "serious adverse effect" to
Defendants by the issuance of a preliminary injunction in this
31/ (...continued) self-worth and well-being); T.I.M.E.-DC, Inc. v. I.A.M. Nat'l Pension Fund, 597 F. Supp. 256 (D.D.C. 1984) (granted plaintiff's motion for preliminary injunction to enjoin defendants from pursuing its withdrawal liability assessment against plaintiffs where irreparable injury was the threat of diminished consumer confidence and the elimination of business opportunities) .
- 37 -

1—r -mr'im i

m m

case. Any efforts undertaker, or expenses incurred to ~ee: z'r.e needs of the OCV residents are simply basic and fundamental obligations cf the District cf Columbia for a.s long as it undertakes :: provide a haven to individuals who need nursing care and services. Defendants cannot be "harmed" by ccir.g vha: they are already legally obligated to do. See, e.g.. Sclthcuse v. Continental Winaate Co., 655 F. Supp. 620, 630 (W.D. Xich. 1937) ("defendants cannot claim that they will be harmed by complying with [the law] since an injunction will only require that which -he law already requires") ; Association for ?.e~arded Citizens of North Dakota v. Olson, 551 F. Supp. 473, 484 '.'~.>:.D. 1932}, aff'd and remanded in cart on other grounds. 713 7.2d 1334 (8th Cir. 19S3) (if the state chooses to operate such facilities, the operation of these facilities nus: meet minimal constitutional standards, and the obligation to meet those standards may not yield to financial considerations; the Constitution requires that the state either provide adequate funding to bring its facilities into compliance with constitutional standards, or abandon operation of such facilities).
Any expenses incurred in the future to provide minimally adequate care and services to residents captive in ths institution, do not amount to "harm" or a "serious adverse effect" to the District. Any monies ordered to pay vendors will simply remunerate them for goods and/or services the District had
- 3

already asked them to provide. That certainly is no hardship .3_2/
The Court must consider the harm not only to the Defendants, but also to those parties r.cz before the Court who rza.y be interested in the proceedings. Amalgamated Transit Union, .-.71CIQ v. Donovan, 554 F. Sup?. 5S9, 599 (D.D.C. 1982). In this case, other interested parties include the vendors who supply goods and services to DCV. However, any form of relief thai would issue from this Court requiring the adequate provision of services to residents should involve payment of past due amounts to the venders and could therefore lead to the resumption cf business for them at DCV. As such, injunc~ive relief will net harm the vendors, but will help them.
The Long Term Care Ombudsman and DC Arc are other interested parties who, as is evidenced by their attached declarations, substantively support the requested ir.junctive relief. They will not be harmed by its issuance and the interests of the DCV residents whom they represent will be helped by intervention.
32/ This is consistent with the Court's earlier ruling in LaShawn, where the Court found the District's arguments about fiscal constraints unavailing: "The Court is well aware of the District's financial plight, but this cannot relieve the District of liability for depriving the children in its foster care of their constitutionally protected liberty interests." LaShawn A., 76 2 F. Supp. at 997.
- 39 -

For the roregoir.g reasor.s, the United States has
demonstrated that neither Defendants nor other parties will be
harmed by the issuance of a preliminary injunction. 0'. The Issuance Of The Preliminary Injunction Is In The Public Interest

The D. C. Circuit indicates that the public interest may r.ave "many faces" with competing interests. Virginia Petroleum Jobbers Ass'r., 259 F.2d at 925. However, there can be no

! ; ; CT

— r ^ ^ _ o L\~ — S L1 _ — ci —i -^ > ^ L a ^ i ^ C diWciv a i,s.i a ^_r_.--^

f; ;-
of a preliminary injunction served the public interest "by ensuring protection of constitutional rights." Huvnh, G7? 7. Supp. at 67. See also National Fed'n of Fed. Employees, czl 7. Supp. at 43 5 ("the public interest lies in enjoining unconstitutional searches11); National Black Police Ass'n, =55 7. Supp. at 263 ("it is in the public's interest to protect che infringement of plaintiffs' constitutional rights").
By enacting CRIPA, Congress recognized that there is a national, or public, interest in protecting the rights of institutionalized persons. Through CRIPA, Congress authorized the Attorney General to bring suit to secure those rights.In doing so, Congress stated "the Attorney General's authority extends to initiating suit 'for or in the name of the United States,' in order to represent the national interest in securing constitutionally adequate care for institutionalized citizens." K.R. Rep. No. 897, 95th Cong., 2d Sess. 13 (1930) (emphasis

•. . . .

;.

- 40 -

•

"

TT—r -anr

added). There is an especially strong public interest in protecting a population like the DCV population at issue here which is dependent upon the District for vital and basic care, captive in an institution, and desperately in need of halo from the Court. Hence, the issuance of the requested preliminary injunction would further the national/public interest inherent in protecting their rights. See Soaye v. Milliken, 497 F. Sucp. 2 54 262 (W.I. Mich. 1930) (uoholdina the constitutional ri~hts of institutionalized persons "serves not only their personal interests, but the interests of the society in which they live").
The long-standing and clear public interest in protecting the constitutional and legal rights of its citizens along with the greater need to protect those who cannot help themselves,
of dem.onstrating that a preliminary injunction satisfies the public interest. IV. NECESSARY REMEDY
Based on all of the foregoing, immediate injunctive relief is necessary to prevent substantial and serious harm to DC" residents. The United States has drafted a proposed order set tine: forth the required remedies in order to enjoin the Defendants from dangerous practices and to provide appropriate care and treatment in the following areas: (1) care of dscubitus ulcers; (2) care of incontinent residents; (3) nursing staff and practices; (4) medication administration; (5) food and drink;
- 41 -

{6) medicacicr.s, medical supplies, and equipment; (7) personal care items; and (S) services and alternative placements for people with mental retardation. In addition, the United 3cat.es seeks an order requiring Defendants to pay in full all outstanding debts to individuals and vendors who have supplied goods and/cr provided services to or or. behalf of DCV residents and to provide prompt payments to them in the future. Mcrecver,

violations, the United States seeks the right co conduct

unannounced visits of DCV as well as the appointment of a Mcnito:

to oversee Defendants' compliance with the preliminary

injunction. Finally, the United States seeks protection fr:~

retaliation for any individuals who provide information cn

conditions at DCV Village.

V. CONCLUSION

The evidence in support of the United States' Motion for

Preliminary Injunction demonstrates a sufficient basis for

granting a preliminary injunction to prevent continuing harm, and

the threat of irreparable injury. For ail the foregoing reasons

the United States respectfully requests that the Court enter an

order for a preliminary injunction pursuant to the attached

proposed order to remedy the dangerous and life-threatening

conditions and practices at DCV that violate residents'

constitutional rights.

•;

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HT

ERIC K. K' 'ZR, JR. United St, :3 Attorney District ( Columbia

Respectfully submitted,

DEVAL L. PATRICK Assistant Attorney General Civil Rights Division

ARTHUR E. PSA3QDY, JR. Chief Special Litigation Section

ROBINSUE FR0H30ESE

;

Deputy Chief

Special Litigation Section

/

RICHARD J. FARANO
-— — 2
U.S. Department of Justice Civil Rights Division Special Litigation Section P*0. Box S5400 Washington, B.C. 20035-64' (202) 514-S270
D.-vTl TT -£ — O J. / a
BAR =424225

. 43 _

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

F I LED

UNITED STATES,
Plaintiff, and M. ANNE HART, DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,

DEC 2 2 1995
CLERK, U. S. DISTRICT COUgU DISTRICT OB COLUMBIA
Civ. No. 95-948 (TFH)

Plaintiff-Intervenor, v. DISTRICT OF COLUMBIA, et al., Defendants.

U.S. v. District of Columbia

I ! • • • ! Ill !!•••• - - • "

"

•NH:DC-OOI-5IO"

ORDER For the reasons set forth in the Court's bench ruling of December 20, 1995, and additionally for the reasons set forth below, it is hereby ORDERED that the plaintiffs motions for contempt and further remedial relief are GRANTED. As stated in the bench ruling, the defendants are in civil contempt of this Court for failing to comply with the provisions of the July 6, 1995 stipulated order and subsequent orders ofthe Court, j r r NT P p " ™<"*n* Poocorn Co.. 659 F.2d 1173,113335 (D.C.Cir. 1981); Pettiesv, ni^trirt nf Columbia. 897 F.Supp. 626 (D.D.C. 1995) (setting forth elements of civil contempt). The Court's orders have been in effect and have required particular conduct on the part of the defendants, but the defendants have not complied. The noncompliance exists even though the principal order at issue here - the July 6,1995 order - was stipulated to by the parties andwas not imposed unilaterally upon the defendants by the Court There appears to be no wayto rationalize the defendant's willingness to enter into the stipulated order with their present noncompliance.
(3)

The defendants' noncompliance is widespread and substantial. The principal areas of concern presently involve the payment of vendors, the provision of supplies and services necessary for adequate care, the discharge and outplacement of residents with mental retardation, and the psychiatric evaluation of residents with mental illness.
As for vendor payment, the Court ordered that the defendants pay vendors supplying goods and services to D.C. Village within 45 days of receiving invoices in order to avoid work stoppages and supply shortages. By the defendants' own admission, at least $161,000 in vendor payments are overdue beyond the 45-day period. This figure was provided by counsel during the status call on December 20, 1995, but the defendant's written submissions suggest an even higher indebtedness total of $380,323.34. Whichever figure is correct,1 there is no disputing the substantial backlog in payments. The nonpayment has caused more than one threatened removal of contract nurses and now threatens to deprive the residents of the service of a physical therapist. Furthermore, as discussed immediately below, various supplies shortages have resulted from the nonpayment.
The supplies shortages, whether the result of vendor nonpayment, slow procurement
processes, or poor planning, are serious. The Monitor reports that D.C. Village was temporarily
without duoderm, a medication needed for the treatment of decubitus ulcers. D.C. Village was
also temporarily out of its normal supply of saline used to cleanse these ulcers and other wound
and incision sites. Perhaps most alarmingly, the Monitor reports that the stock of some
categories of perishable food was once reduced to a one-day supply.
1On several occasions, the proceedings in this case have been hampered by counsel for the defendants' fectual and legal misrepresentations to this Court. Though these problems do not form the basis for the present finding of contempt, they concern the Court, regardless of whether they are intentional. The difficulty has risen in discussions with respect to many topics, including the status of vendor payments, the legal requirements of the reporting of outplacements to the Ombudsman, the legal requirements and factual status of the handling of the residents' personal needs allowances, and the defendants' ability to produce a list of vendors. Though some contemporaneous treatment of these problems can be found in the transcripts of status hearings in this case, the Court will review the matter more thoroughly if the communication problems continue.

As for the outplacement of residents with mental retardation, this process was supposed to be completed by October 31,1995. The parties and monitor report that the outplacement process is still not near its conclusion. The defendants have sought an extension until the end of January 1996, but they admitted in court that the deadline may not be realistic. The requested deadline seems to the Court to lead inevitably to further noncompliance.
As for the evaluation of residents with mental illness, the defendants have admitted that they are uncertain how many residents fall into this category because D.C. Village lacks the psychiatric services necessary to evaluate residents.
The Court will suspend the imposition of sanctions designed to compel compliance until the next status hearing. The parties are advised, however, that the Court is more inclined to impose custodial sanctions or to order the appointment of a special master or private administrator to manage D.C. Village than to impose fines, should noncompliance continue.
It is ORDERED that the defendants shall comply with the following provisions.
A. Within seven days from the entry of this order, the defendants shall begin to provide the plaintiff and the plaintiff-intervenor with biweekly reports detailing what steps they have taken within the current biweekly period to reach compliance with §D of the July 6,1995 order. The defendants shall continue te provide such sports uxi£ sH D.C. Village residents with mental retardation are appropriately discharged from the facility pursuant to the July 6,1995 order. In each report, the defendants shall identify specifically any financial and/or licensure problems which constitute barriers to placement, and the steps the defendants shall take to eliminate such barriers. The deadline for the outplacement of all D.C. Village residents with mental retardation is extended to February 28, 1996.

C. For as long as individuals with mental retardation continue to reside at D.C. Village, the defendants shall ensure uninterrupted clinical services, habilitation, and other services to all such residents.
II. r*»Tn»ral P^rharae and Outplacement Issues A. Consistent with the Court's November 7, 1995 Order
Modifying the Stipulated Order, Defendants shall ensure that prior to discharge, all D.C. Village residents are provided with an adequate and appropriate interdisciplinary assessment and individual discharge plan pursuant to federal law. All placement decisions are to be made on an individualized basis and shall be appropriate and adequate to meet each person's individualized
needs. B. The outplacement process team at D.C. Village shall be
expanded beyond the social services department to also include nursing, dietary, therapeutic recreation departments, and when appropriate, physical therapy and occupational therapy. The social services department shall work closely with the nursing department and in all instances shall inform the assistant directors of nursing of all residents scheduled for discharge.
ect t--Q the Discharge and Outplacement of
A. Consistent with the Court's November 7, 1995 Order Modifying the Stipulated Order, for D.C. Village residents with mental retardation, in order to ensure that their special care needs are met, Defendants shall immediately identify and create a team to provide these individuals with sufficient specialty consultation services to ensure a safe and effective transition

to their new residences, to train the group home staff in how best to care for the individual, and to help meet the person's ongoing individualized needs. This team shall consist of a nutritionist, psychologist, speech pathologist, and recreation specialist. In assembling this team, Defendants shall solicit input from the Monitor. This team shall provide such specialty consultation services until the receiving facility staff is stabilized and their competency is demonstrated.
B. Within seven days from the entry of this Order, Defendants shall provide a medical assessment, conducted by an independent physician, for D.C. Village residents Cynthia W.> Carla L., and Alvina B. to ensure that their respective medical needs are adequately addressed. If Defendants propose to transfer these residents to another nursing care facility, Defendants shall provide the Court, the United States and the Plaintiff-Intervenor with a detailed written evaluation from the independent physician stating that their health conditions require such a restrictive placement. I V Tulips wi*-* aspect to the Discharge and Outplacement of
"-i*-*! Mental Illness A. Within thirty days from the entry of this Order, Defendants shall ensure that all D.C. Village residents are provided with new and adequate psychiatric evaluations by appropriate professionals to determine if they have a primary or secondary diagnosis of mental illness. Defendants shall also provide D.C. Village residents with adequate psychiatric services at D.C. Village.

B. Consistent with the Court's November 7, 1995 Order Modifying the Stipulated Order, for D.C. Village residents identified as having a diagnosis of mental illness, in order to ensure that their special care needs are met, Defendants shall identify and create a team to provide these individuals with sufficient specialty consultation services to ensure a safe and effective transition to their new residences, to train the new .residence staff in how best to care for the individual, and to help meet the individuals' ongoing individualized needs. This team shall consist of a psychiatrist, psychologist, geriatricpsychiatric nurse, and when appropriate, a recreation specialist and social worker. In assembling this team, Defendants shall solicit input- from the Monitor. This team shall provide such specialty consultation services until the receiving facility staff is stabilized.and their competency is demonstrated. V. Measure? r<"> Remedy Shortages
A. Consistent with § B.2.b of the Stipulated Order of July 6, 1995, Defendants shall immediately and hereafter ensure an adequate daily supply of necessary treatment modalities for D.C. Village residents' decubitus ulcers, specifically, normal saline and duoderm.
B. Consistent with § C of the Stipulated Order, Defendants shall immediately pay in full amounts over forty-five days past due to all vendors supplying D.C. Village with these and other essential healtn care supplies to ensure that shortfalls and shortages do not occur at D.C. Village.

C. Defendants shall ensure immediately that the District of Columbia procurement office responds immediately to urgent requests for health care and other supplies to ensure that the health care needs of the D.C. Village residents are appropriately
met. D. Defendants shall ensure immediately that the food and
drink provisions of § B.I of the Stipulated Order are fully implemented to meet the needs of the residents. Defendants shall ensure that all of the D.C. Village residents are adequately hydrated at all times. To this end, Defendants shall ensure immediately that water, and cups for water, are present in sufficient quantity in each resident's room.
E. Consistent with § B.3 of the Stipulated Order, Defendants shall ensure immediately that adequate supplies of soap are available for residents and staff at all times.
VI. ProvJ A . Defendants shall implement nursing practices consistent
with generally accepted standards of care to redress the deficiencies as cited by the Court Monitor. Defendants shall ensure that basic care practices are part of daily and routine resident care for all D.C. Village residents. To promote responsibility and accountability, Defendants shall provide for adequate supervision and reporting to ensure that the residents' health care needs are met every day.
B. Consistent with § A.l.b of the Stipulated Order, Defendants shall ensure that D.C. Village residents with

or- at risk of obtaining decubitus ulcers, shall decubitus ulcers, or ac be provided with coordinated interdisciplinary care for the prevention and treatment of decubitus ulcers. Defendants shall provide these residents with routine s*in care checks that meet the residents' needs. Residents shall be positioned appropriately and turned frequently enough to prevent skin breakdown and/or to treat existing skin breakdown. Defendants shall take steps to ensure that when the treatment nur.es . « not present on the units, including weekends, decubiti care and skin
care remain an integral part of implemented nursing practice at
D.C. Village. C Defendants shall systematically and individually ensure
that the provisions of 5 A. 2 of the Stipulated Order are fully implemented to meet the needs of the incontinent residents. . Consistent with S A. 2 of the Stipulated Order. Defendants shall especially ensure that individuals with decubitus ulcers are not left to sit or lie in their own soiled linens.
D Defendants shall develop and implement hereafter infection control practices and procedures that comport with generally accepted nursing practices and that meet the needs of the D.C. Village residents. Defendants shall adeo^ately monitor ^ t a k e immediate steps to appropriately address any infections that are discovered.

December

995

Thomas F. H o United States Di:

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES,

U.S. v. District of Columbia

Plaintiff,
and M. ANNE HART, DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,

NH-DC-001-011
Civ. No. 95-948 (TFH)

PlaintifT-Intervenor, v. DISTRICT OF COLUMBIA, et ah, Defendants.

FILED •/
APR 2 6 'SS6
Clerk. U.S. District Court

ORDER Before the Court are motions by the plaintiff and plaintiff-intervenor for further remedial relief and sanctions in light of the defendants' noncompiiance with orders ofthe Court. Inorder to resolve these motions, the Court must obtain complete and accurate information about the defendants' noncompiiance, including the status ofpayments to various vendors serving DC. Village. It has been particularly difficult for the Court to learn about these vendor payments because the defendants have stated that the District ofColumbia Financial Responsibility and Management Assistance Authority, and not the defendants, is responsible for some of the delay in paying the vendors and arranging contracts with them. For this reason, it is ORDERED that a representative from the District ofColumbia Financial Responsibility and Management Assistance Authority who is familiar with and responsible forthe payments and contracts associated with D.C. Village appear before the Coun

at 2:30 on Monday, April 29, 1996, at which time the Court will inquire into the circumstances surrounding the defendants' noncompliance.
It is FURTHER ORDERED that the defendants shall designate a representative from the District of Columbia Department of Human Services who is familiar with and responsible for the payments and contracts associated with D.C. Village. The Court suggests that the Interim Administrator for Long Term Care may be the appropriate designee. The designee shall appear before the Court at 2:30 on Monday, April 29, 1996.

April ,4-996

Thomas F. Hogan

\

United States District Judi

 
 HARRIET A. FIELDS, Ed.D., R.N.
#604 1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

•illllll ll llll U-S.v. District of Columbia

The Honorable Thomas F. Hogan ' U.S. District Court Judge U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

NH-DC-001-013

Re: Stipulated Order entered on July 6, 1995, in the matter United States v. District of Columbia, et al.. Civ. No. 95-948, D.C. Village Nursing Home

Dear Judge Hogan:
The enclosed is a Preliminary Status Report on the implementation of the Court Order. Upon approval of the budget by the Court, full court monitoring activities can be commenced. I respectfully refer the Court to my August 10, 1995 submission to the Court, urging the need for timeliness of approval of the budget. Upon approval of the estimated budget by the Court and approval of payment schedule identified in my August 10 submission, I will submit my first invoice for court monitoring related activities to date.
I look forward to working with the Court in the service of the long term care residents of the District of Columbia.

Sincerely,

Harriet A. Fields, Ed.D., R.N.

end.

PRELIMINARY STATUS REPORT United States of America v. The District of Columbia, eL al
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by:
Harriet A. Fields, Ed.D., R.N. Court Monitor
Date: September 5, 1995
Each of the items in the Court Order interrelate to total quality care, quality of life, and residents rights, and although the following will relate to the areas listed in the Court Order, it is difficult to separate from a total picture of factors impinging on the residents of D.C. Village Nursing Home (DCV).
Decubitus Ulcers
Within thepast several months treatment nurses have been implemented at DCVwhose sole responsibility is to treat decubitus ulcers. There are two treatment nurses for the day shift andtwo for the evening shift. On each shift one nurse has responsibility for Units 5A, 5B, 4A, 4B and the second treatment nurse has responsibility for Units 2A, 2B,3A, 3B. This provides coverage for the entire facility. On Thursday evening, August 31,the Court Monitor observed the treatment nurse on Unit 2B treat a healing decubitus ulcer with proper sterile technique.
The treatment nurses on the evening shift are contract agency nurses, however, they are permanently assigned to DCV during the week, Monday through Friday. At this point in time, it is unclear to the court monitor why these nurses are contract employees rather than DCV staff.
Before the implementation of the treatment nurses, skin care was the responsibility of the licensed nurses on each shift on each unit, which is appropriate for professional nursing practice. Interviews on August 31 with licenses nurses on the evening shift elicited comments that decubitus ulcers are decreasing, skin care has improved. Apparently, skin care was not a routine part of licensed nursing practice at DCV before the implementation of the treatment nurses.
Further Court Monitoring activities Upon approval of the budget and availability of funds on a monthly basis: (1) resources will be brought in to assess on an ongoing basis all residents skin condition, chart reviews, round with treatment nurses, and interview staff and residents; (2) determine and assess decubitus ulcer treatment and skin care procedures on the weekend shifts when the treatment nurses are off; (3) &ssessrole of inservice in education and training of all nursing personnel - certified nurse aides CNA's, licensed nursing staff, and medical staff, on routine skin care and decubitus ulcer care prevention on an ongoing basis. This activity is not to imply that the use of treatment nurses is not appropriate in this situation.

Payment of Vendors
One agency that supplies the majority of contract nurses for DCV stopped services from August 21 to August 31,1995 for lack of payment beyond the 45 days stipulated in the Court Order.
On August 29, the" Court Monitor requested of D.C. Government a list of vendors, payments, and outstanding payments. To date, this information has not been received.
Review of 30 Day Compliance Report
Upon approval by the Court of the Court Monitor budget and availability of funds on a monthly basis, a thorough assessment of accuracy of compliance report can be commenced.
Nurse Staffing
The Nurse Staffing chart in the 30 Day Compliance Report is not accurate. At no time are there seven CNA (certified nurse aides) on the day or evening shifts. On review of nurse staffing schedules in the nursing office, three CNA's are listed for day and evening shifts on most units. Each unit develops there own staffing schedule and submits it to the nursing office. As of August 31, only one unit has a staffing schedule submitted 90 days in advance.
On direct observation on each of the units on the evening shift of Thursday, August 31, there were three CNA's on all units except Unit 2B where there were four CNA's and Unit 5A where there were two CNA's.
Contract Nursine Staff
There are at least six to eight different contract agencies supplying staff to DCV. Many of the nurses are regularly assigned to DCV, however, not to the same units, which does not help afford continuity of care.
Further Court Monitoring Activities
Determine appropriate number of staff necessary to provide resident care. It may very well be that seven CNA's listed in staffing schedule in the 30 Day Compliance Report are not necessary to provide for quality care to residents as stipulated in the Court Order, and instead, what is needed is ongoing inservice education and training of existing levels of staff. It is also unclear at this point in time, whether DCV has been reimbursed by the federal government for the increased staffing levels listed on paper but which are an inflation of actual staffing levels.
Additional Concerns
At this point in time, the Court Monitor has been able to determine that there are a number

of conditions that are not listed in the Court Order, but directly relate to it and the ability of the staff to comply with the Court Order. These conditions are the following:
(1) The announced closure of D.C. Village Nursing Home made in August 1995, by the District of Columbia City Council and the Mayor;
(2) D.C. Office of Personnel policies that delay hiring of personnel on a timely basis and retaining personnel;
(3) Current Union policies relating to weekend coverage; (4) Medical care coverage
(a) payment for (b) knowledge level of current minimum standards of practice as identified in the Nursing Home Reform Law of 1987 and current regulations; (5) Most recent Health Care Financing Administration (HCFA) Survey Report of July1995.
(1) Announced closure of DCV
This decision was announced in July-August of 1995, by D.C. Government officials with apparently little or no input from DCV residents, families, staff. According to the press, closure of DCV will help eliminate approximately 440 of the 2000 D.C. Government positions recommended to be cut by the D.C. Financial Control Board. However, according to a resource plan for personnel, staff who elect to remain D.C. employees and not take early retirement if they qualify are to be placed elsewhere in D.C. government, thus not eliminating positions.
The direct impact this closure announcement is having on the Court Order is that staff are resigning in understandable concern for their job security which adds to further use of contract staff and lack of continuity of care.
The primary impact of closing of DCV will be felt by the residents, some of who have lived at DCV for several years. There is a considerable body of literature on "transfer trauma". This is a situation whereby a significant proportion of institutionalized residents when relocated die within six months. Apparently this was even evident at DCV when Units 1A and IB were closed and long time residents transferred to other units. Institutionalized elderly often 'give up their spirits' when familiar surroundings, people, and routines are altered and/or taken from them, beyond their controL The administrator estimates that at least ten percent of the current residents of DCVwill be among the transfer trauma death statistics. This directly relates to the Court Order in the areas of decubitus ulcers and nutrition. Depression leads to inadequate nutrition which is conducive to the development of decubitus ulcers.
The Residents' Council is opposed to closure of DCV and has apparently recently sent a letter to the D.C. City Council.
(2) D.C. Government Personnel Policies
D.C. Government personnel policies are apparently impeding hiring in a timely manner needed replacement staff. For example, the Director of Quality Assurance term limit expired August 1, 1995. As of August 31, the position has not been reinstated. This Director of Quality Assurance has not been paid since August 1 and as of August 31 cannot continue service unless

reimbursed.
The multi-week delay in hiring personnel contributes to the heavy use of contract personnel. In telephone conversations with the Assistant Director of Personnel for the District of Columbia, Mr. Louis Norman, on August 30, the Court Monitor was told that there is an expedited hiring process in effect for DCV, the Director of Quality Assurance situation is an exception and "methods are being processed to remedy it." The Court Monitor is awaiting data from Mr. Norman on the number of qualified personnel who will be expedited to DCV, when this will occur, and the status of the Director of Quality Assurance employment.
(3) Current Union Policies Relating to Weekend Coverage
Local 2092 of AFSCME represents the nurse aides and Licensed Practical Nurses (LPN) at DCV. Contract agencies do not supply the nurse aides. Current union policies provide for every weekend off. This is not sufficient to cover the facility seven days a week, however further assessment must be done. Most facilities provide for every third weekend off. The Court Monitor met with the president of the local DCV employees union who was to present this situation to DCV member staff on August 31. The Court Monitor is awaiting outcome on a union compromise this working condition of their contract.
(4) Medical care coverage (a) payment for: Medical staff coverage at DCV apparently is being paid directly by the D.C. Government,
whereas, it can apparently be appropriately billed under Medicare Part B,which apparently involves a simple means of applying for it. Thus, approximately one half million dollars a year in medical doctor salaries is unnecessarily being borne by the District of Columbia Government. At this point in time, it is unclear to the Court Monitor why this situation exists.
(b) knowledge level of current minimum standards of practice as identified in the Nursing Home Reform Law of 1987 and current regulations:
On cursory assessment, more of which will be done, it appears that medical staff, as well as nursing staff, are not knowledgeable of the minimum standards of practice for nursing facility residents as reflected in the Nursing Home Reform Law and current federal regulations. This is reflected in M.D."requests" (orders) for decubitus ulcer treatment, physical and chemical restraints, parenteral nutrition. All these areas are directly related to the Court Order.
(5) Most recent Health Care Financing Administration THCFA^ Survey Report of Julv 1995 Four Level A violations were found. According to federal regulations, Level A deficiencies
warrant the following: (a) a re-survey within 90 days of the last, by October 12,1995; (b) DCV is to submit a Plan of Corrections;
If HCFA determines upon re-survey that DCV is still out of compliance with federal regulations and the plan of corrections is not acceptable, proceedings could be instituted which would result in:

(a) termination of federal portion of reimbursement as of October 1 which would be approximately $1.4 million dollars a month;
(b) staff would not be reimbursed as of October 1; (c) DCV would be closed by October 31, 1995 leaving the residents without care and placement.
This scenario, if implemented directly relates to compliance with the Court Order.
Additional Initial Overall Assessment
The Court Monitor has met with the evening staff and night staff, the day nursing supervisory staff, administration, majority of the medical staff, and all the department heads. I have found them all to be dedicated and committed and concerned for the welfare of DCV residents. Much further assessments are needed. Education and training are needed immediately on the minimum standards of practice for nursing home residents as reflected in federal regulations and the areas in the Stipulated Court Order.

 
 U.S. v. District of Columbia

NH-DC-001-022
UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES,

Plaintiff,
and M. ANNE HART, DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,

Civ. No. 95-948 (TFH)

Plaintiff-Intervenor, v. DISTRICT OF COLUMBIA, et ah Defendants.

FILED
(r£B 2 31996

ORDER Upon consideration of the United States' Motion To Assure Full Compliance With Existing Court Orders, and upon determining that the defendants remain in contempt and noncompliance with Court orders, it is hereby ORDERED that the United States' motion is granted. Therefore, it is hereby ORDERED: A. The outplacement of D.C. Village residents is temporarily suspended until Defendants come into full compliance with the existing Court orders detailed below.

B. Defendants shall immediately come into full compliance with all the provisions of § HI.A of the Court's December 22, 1995 order. Consistent with the provisions of that section, Defendants shall immediately identify and create the specialty consult transition team for the

•4°

110

iv. 8/82)

benefit of D.C. Village residents with mental retardation. Consistent with the provisions of that section, in assembling this team, Defendants shall solicit input from the Monitor.

C. Defendants shall immediately come into full compliance with all the provisions of § IV of

the Court's December 22, 1995 order. Consistent with the provisions of §IV.B., Defendants

Shall immediately identify and create the specialty consult transition team for the benefit of D.C.

Village residents with mental illness. Consistent with the provisions of that section, in

assembling this team, Defendants shall solicit input from the Monitor.

-

D. Defendants shall immediately come into full compliance with all the provisions of § II of the Court's December 22, 1995 order. Consistent with the provisions of §11.A, Defendants shall ensure that all placement decisions are made on an individualized basis and shall be appropriate and adequate to meet each person's individualized needs.

E. Defendants shall fully comply with the provisions of 42 C.F.R. §483.12(b)(3) and shall not deny DCV residents a bed at D.C. Village due to any resident's extended hospitalization or leave or deny any resident the transitional services he or she is to be provided under law.

F. Nothing in this order shall be construed to limit the authority and responsibilities of the Monitor and Ombudsman as set forth in the law and in the Court's orders.

G. While taking steps to comply with the above requirements, Defendants shall continue the process of planning for DCV residents' appropriate and timely discharge and shall notify the

AO72A (Rev. 8/82)

Monitor and Ombudsman of the planned discharges as required by the law and by the Court's orders. Nothing in this order shall prevent the discharge of those DCV residents for whom the Monitor and Ombudsman agree that the above requirements have been met. If a dispute arises between Defendants and the Monitor and/or Ombudsman over whether a particular discharge should proceed, the parties may ask the Court to consider the matter.

February

1996

Thomas F. H<

United States D

•dge

AO72A (Rev. 8/82)

 
 FILED

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA

)

APR 17 1996
Clerk. U.S. District Court District of Columbia

Plaintiff

) Civil Action No. 95-0948 TFH

v.

)

DISTRICT OF COLUMBIA, et al. )

U.S. v. District of Columbia

Defendants

) ORDER

NH-DC-001-024

Upon consideration of the motion of defendants for an order to

pay certain providers of services to D.C. Village and fehe

opposition thereto, if any, it is by the Court this

, 1996,

ORDERED: That the motion be and is hereby granted; and it is

FURTHER ORDERED: That defendants shall pay to National

Patient Care, a vendor for D.C. Village, the sum of $47,861.00

representing amounts due and owed for past services in the form of

the provision of Alamo Mattresses for the period from January, 1995

through February, 1996.

Copies to:
Barbara J. Mann Assistant Corporation Counsel 441 Fourth Street, N.W., #680 Washington, D.C. 20001
Jonathan D.Schiller, Esq. William A. Isaacson, Esq. 901 15th Street, N.W., #1100 Washington, D.C. 20005

David Deutsch, Esq. Richard J. Farano, Esq. U.S. Department of Justice Civil Rights Division 10th and Pennsylvania Ave.,
#1744 Washington, D.C. 20530

 
 U.S. v. District of Columbia

! • • • Iff m i l l H

mm

m

NH-DC-00 -027

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA Plaintiff

) ) Civil Action No. 95-0948TFH

v.

)

DISTRICT OF COLUMBIA, et al. )

Defendants

)
ft P n T? P ? ** tf fc *

FILED
MAY " 9 I99t
CLERK, U.S. D:STm>c"'•'• DISTRICT Or CO^VS

Upon consideration of the consent motion of defendants for an

order to pay certain providers of services to D.C. Village, it is

by the Court this *f day of 4*4.4%^

, 1996,

ORDERED: That the notion beand/isyhereby granted; and it is

FURTHER ORDERED: That defendants shall pay the following

identified vendors, the following specific amounts representing

amounts due and owed for past services:

Air Products

17.50

Biomerieux

14.50

Coulter Corporation

17,755.32

National Patient Care

6,300.00

Jacob Gardner

111.00

IBM

276.00

Calgon Vestal

118.08

Government Equipment

175.00

American Medical

2,631.20

Magnolia Plumbing

300.00

QS-l

2,015.75

Xerox

1,563.40

United Refrigeration

545.86

Capital X-Ray
GE Medical Systems
OCE
AssurQual, Inc.
Weaver Orthopedic
<=*<&"-' JUDGE
Copies to:
Barbara J. Mann Assistant Corporation Counsel 441 Fourth Street, N.W., #680 Washington, D.C. 20001
Jonathan O.Schiller, Esq. William A. Isaacson, Esq. 901 15th Street, N.W., #1100 Washington, D.C. 20005
David Deutsch, Esq. Richard J. Farano, Esq. U.S. Department of Justice Civil Rights Division 10th and Pennsylvania Ave., N.W., #1744 Washington, D.C. 20530

 
 U.S. v. District of Columbia
IlllIIiNHlII

NH-DC-001-032 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA

)

Plaintiff

) Civil Action No. 95-0948 TFH
FILED

DISTRICT OF COLUMBIA, e t :al. )

JUL 1 5 1996

De f endant s

)
0 RDER

NANCY MAYER-WHITTJNGTON CIERK U.S. DISTRICT COURT

Upon consideration of the motion of defendants for an

order to pay Georgetown University Child Development Center for

services provided to D.C. Village,^-and the opposition thereto, if

any, it is by the Court this

day of

1996,

ORDERED: That the motion be and is hereby granted; and it is

FURTHER ORDERED: That defendants shall, within not more than

twenty (20) days after entry of this court order, pay to Georgetown

University Child Development Center (GUCDC) the sum of $145,092.29

for services provided to D.C. Village.

Copies to:
Barbara J. Mann Assistant Corporation Counsel 441 Fourth Street, N.W., #680 Washington, D.C. 20001
Jonathan D.Schiller, Esq. William A. Isaacson, Esq. 901 15th Street, N.W., #1100 Washington, D.C. 20005
David Deutsch, Esq. Richard J. Farano, Esq. U.S. Department of Justice

Civil Rights Division 10th and Pennsylvania Ave., N.W Washington, D.C. 20530

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES,

U.S. v. District of Columbia

Plaintiff,
M. ANNE HART, the DISTRICT OF COLUMBIA LONG TERM CARE OMBUDSMAN,

NH-DC-001-034

Plaintiff-Intervenor,
y.

C.A. No. 95-094$ TFH

THE DISTRICT OF COLUMBIA fit al., Defendants.

FILED
AUG 2 2 1996

ORDER

NANCY MAYER-WHiTTINGTON, CLE.RK U.S. DISTRICT COURT

Now pending before the Court is the defendants' motion to terminate the appointment

of the Monitor on a date not later than September 1, 1996. The plaintiffs oppose the motion.

The defendants claim that because the D.C. Village facility is now closed, andall

former residents have been placed elsewhere, there is nothing left for the Monitor to oversee.

They claim that the Monitor has had ample time to determine the appropriateness of

placements, since the last resident left D.C. Village on June 24, 1996,and that any further

problems should be handled by the ombudsman, not the Monitor.

The defendants have misconstrued the scope of the Court's order. The Court has

ordered the Monitor not only to oversee the closing of the D.C. Village facility, but also to

determine that "all residents are transferred to appropriate residences which meet their

AO72A (Rev. 8/82)

ft)

individual needs." Order Mod. Stip. Order of July 6, 1995, Nov. 7, at 2. The order asks the Monitor to ensure that not only the discharges, but also the placements, of the residents are sufficient and that they satisfactorily fit their individual needs. This necessarily contemplates individualized inspections and evaluations of post-discharge placement. Until the Monitor has completed and reported to the Court on such an inspection and evaluation for each of the former D.C. Village residents, her duties under the order are not finished, and termination of her position is premature.
The thorough inspections and evaluations necessary to proper completion of the Monitor's duties must naturally take some time. The Monitor is taking all steps to ensure the swift completion of her tasks and should be given a reasonable time to fulfill her duties.
Since the Monitor has not yet indicated to the Court that she has evaluated all the placements of former D.C. Village residents and determined them to satisfactorily meet the residents' needs, termination of her duties at this time would be premature.
It is therefore ORDERED that the defendants' motion to terminate the appointment of the Monitor is DENIED. August
Thomas F. Ho United States Distr?
AO72A (Rev. 8/82)

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES, Plaintiff,
M. ANNE HART, the DISTRICT OF COLUMBIA LONG TERM CARE OMBUDSMAN,
Plaintiff-Intervenor,
v. THE DISTRICT OF COLUMBIA fit al«,
Defendants.

U.S. v. District of Columbia
NH-DC-001-035
C.A. No. 95-0948 TFH
FILED
AUG Z 2 1996
NANCY MAYER-VVHITTINGTCN, C! ERK U.S. DISTRICT COURT

ORDER It is hereby ORDERED that the attached documents, which are the Monitor's reports to the Court from September 5, 1995 to June 28, 1996, be filed as part of the docket in this

case.

., 1996

Thomas F. United States District Judge

AO72A (Rev. 8/82)

-rtr

 
 U.S. v. District of Columbia

• • v ••• • • • • • • • • • • • • • • ^
NH-DC-001-037
UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES, Plaintiff,

C.A. No. 95-0948 (TFH)

M. ANNE HART, the DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,
Plaintiff-Intervenor,
v. DISTRICT OF COLUMBIA, si aL,
Defendants.

FILED

FEB 2 J 1997
)

)

Clerk, UiS. District Court

)

District of Columbia

)

)

)

J

CONSENT ORDER

Upon consideration of plaintiff-intervenor's motion for payment of interest on

personal needs allowances to the D.C. Village residents, and for good cause shown, including the

consent of the parties and Defendants' Submission to the Court for the Reconciliation of Patient

Accounts, it is this Court's finding that payment of interest to the residents of D.C. Village in the

amount of $14,232.18 is required by law. It is therefore this Q ^ day of February, 1997:

HEREBY ORDERED that

1. Defendant District of Columbia shall pay $14,232.18 to former residents of D.C.

Village in the individual amounts set forth in the Residents' Interest Summary attached to this

Consent Order.

2. Defendants and the District of Columbia Long Term Care Ombudsman hereby

waive and release any claim against or on behalf of the residents of D.C. Village arising from or

relating to those matters set forth in Defendants' Submission to the Court for the Reconciliation of Patient Accounts.

For Defendants:

William J. E,<IHV^-»M-

y

Barbara Mann, Esq. * 33 0*7 y

Office of the Corporation Counsel

Government of the District of Columbia

441 4th Street, N.W., Room 680

Washington, D.C. 20001

For Plaintiff:

[ Deutscl LJ.Fajfcno,Esq.
Senior Trial Attorneys Special Litigation Section Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, D.C. 20035
For Plaintiff-Intervenpr:

William A Kaye, Scholer, Fierman, Hays
& Handler, LLP 901 15th Street, N.W., Suite 1100 Washington, D.C. 20005

United States District J

1 RESIDENTS INTEREREST SUMMARY FOR THE PERIOD ENDING #NUARY 1.1992 THRU DECEMBER 31,1996

LAST NAME
1 ADDISON 2 ALLEN 3 ALLEN 4 ALSOP 5 ALSTON 6 ANDERSON 7 ARMSTEAD 8 ARMSTRONG 9 ARRINGTON 10 ARTIS 11 BACKGEUNG 12 BAILEY 13 BAILEY 14 BAILEY 15 BAKER 16 BARAN 17 BARBAR 10 BARKER 19 BARNES 20 BAUGH 21 BAYLOR 22 BEALSEY 23 BEALL 24 BELL 25 BENNETT 26 BENNETT 27 BERGER 28 BETTERS 29 BILES 30 BLASINGAME 31 BOBBITT 32 BODNAR 33 BOND 34 BOOKER 35 BOWLES 36 BOYCE 37 BOYD

FIRST NAME
GEORGE MILDRED VIOLA BYRD SHIRLEY AN PATRICIA RACHEL MARGARET LUTHER LYDIA ENG FRANK HENRY THOMAS JAY LOUIS LAURA RUTH OLA MAE SAUNDRS MILTON KATHERIN OOROTHY JAMES ANGELA WANDA HUBERT HARRIET MARY ALVINA LATISHA MARYK JAMES ELMORE THOMAS FRANCES FELICIA

DCV«
0-22-95 10-15-13 10-24-87 10-20-27 10-24-22 10-24-30 10-22-51 10-23-92 10-25-32 10-23-67 10-23-99 10-17-04 10-19-64 10-20-74 10-22-06 10-20-57 10-21-86 10-22-79 10-21-75 10-15-36 10-22-90 10-20-92 10-12-75 10-23-41 10-24-16 10-15-69 10-24-76 10-13-89 10-24-62 10-19-65 10-22-43 10-11-61 10-22-66 10-21-97 10-25-75 10-23-88 10-24-31

TOTAL INTERE8T
DUE 1992
2.88 8.00 0.00 4.64 6.14 6.10 4.63 10.31 2.13 2.18 5.07 23.80 6.10 6.10 67.70 0.00 0.00 4.97 1.14 1.57 0.67 37.68 4.92 2.46 6.10 45.43 1.35 0.92 0.51 5.65 6.10 6.10 2.19 4.90 0.00 5.22 5.97

TOTAL INTEREST
DUE 1993

TOTAL INTEREST ' DUE
1994

$6.17 8.21 7.43 11.08 7.29 7.25 6.54 8.67 1.68 3.20 0.00 0.00 7.58 7.57 83.42 0.00 0.00 8.78 9.54 0.13 3.97 0.00 5 92 3.90 5.57 47.37 4.28 0.00 7.30 7.19 7.38 7.58 0.75 4.73 0.00 5.71 7.41

5.70 8.67 6.41 9.22 6.49 6.49 7.84 4.71 3.85 1.40 0.00 0.00 6.47 6.86 0.00 0.49 ! 0.00 3.94 9.88 5.41 10.48 0.00 5.95 9.15 0.00 2.85 5.46 0.00 11.72 7.08 7.31 6.88 4.50 0.00 0.14 6.12
6.60

TOTAL INTEREST
DUE 1995
96.86 11.01 2.47 13.99
9.48 8.48 10.81 0.00 5.46 6.69 0.00 0.00 10.81 7.13 0.00 6.39 0.00 000 9.50 1.64 0.00 0.00 9.03 9.26 52.54 0 00 6.73 0.00 20.55 8.51 3.78 10.71 7.94 16.54 0.75 10.25 9.00

TOTAL INTEREST
DUE 1996
129.54 15.91 0.00 19.28 9.57 6.52 8.22 0.00 0.00 8.17 0 00 0.00 14.41 3.58 0.00 0.00 0.48 0.00 2.93 2.52 0.00 000 12.91 13.34 0.00 0.00 8.54 0.00 4.94 2.82 0.00 8.82 7.35 0.00 0.00 15.59 0.00

TOTAL INTEREST
DUE
241.15 51.80 16.31 58.21 38.98 34.84 38.05 23.69 13.14 21.64 5.07 23.80 45.37 31.24 151.12 6.88 0.48 15.69 32.99 11.27 15.12 37.68 38.74 38.12 64.21 95.65 26.36 0.92 45.03 31.25 24.57 40.09 22.73 26.16 0.89 42.89 28.98

RESIDENTS INTEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1992 THRU DECEMBER 31,1996

1 RESIDENTS INTEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1892 THRU DECEMBER 31,1996

LASTNAME
61 BUTLER 62 BUTLER 63 CAMPBELL 64 CARBONARO 65 CARTER 66 CARTER 67 CARTER 68 CARTER 69 CARTER 70 CARTER 71 CHAPMAN 72 CHAPPELL 73 CHASE 74 CHEEK 75 CHESTER
/e CIFFELJ
77 CLEMENTS 78 COFIELD 79 COLEMAN 80 COLEMAN 81 COLEMAN 82 COOK 83 COOK 84 COOPER 85 CRAWLEY 86 DAILEY 87 OARGANS 88 DARKE 89 DAVIS 90 DAVIS 91 DAVIS 92 DAVIS 93 DAVIS 94 DAVIS 95 DAWKINS 96 DAWKINS 97 DAWSON

FIRST NAME
OSCAR THOMAS THELMA MARY BESSIE CLARENCE CLARENCE DANIEL MAMIE RUSSELL MABEL JEFF WALTER CLIFFORD RAU SAVINA ROSA ANNETTE ANNE DOROTHY RANDOLPH DONNA ILLEANA TIA WILLIAM LEON BESSIE VIOLET EFFIE JOSEPH LILLIAN LUCILLE MOSES LULS CLYDE KATHERINE DEXTER

DCV«
10-21-56 10-15-16 10-24-85 10-23-56 10-15-07 10-22-75 10-22-75 10-21-27 10-24-70 10-25-48 10-23-98 10-22-64 10-25-14 10-24-42 10-20-45 10-12-05 10-24-01 10-15-51 10-19-95 10-24-S6 10-16-38 10-24-21 10-24-97 10-19-03 10-24-61 10-15-77 10-13-75 10-12-71 10-21-10 10-21-58 10-23-76 10-20-76 10-22-88 10-16-39 10-24-14 10-23-61 1023-53

TOTAL, INTERE8T
DUE 1892
5.41 0.00 1.15 5.57 6.10 0.00 0.00 5.97 1.62 0.00 19.33 7.24 0.00 9.13 6.07 1.85 2.24 0.00 1.28 40.95 0.00 0.95 0.00 0.00 1.70 5.84 0.00 4.88 4.43 10.59 9.14 4.87 3.15 2.95 3.10 3.18 1.14

TOTAL INTEREST
DUE 1993

TOTAL INTEREST
DUE 1994

5.88

0.00

1.85

7.23

6.68

0.00

0.00

1.85

1.73

0.00

9.16

5.65

2.68

15.94

6.59

5.34

4.69 7.38

—

0.00

0.13

0.00

2.75

4.54

0.00

0.93

7.11

4.25

6.72

0.00

5.70

6.23

6.15

8.00

0.00

5.19

8.02

0.00

6.62 0.25 11.64 6.61 5.98 0.53 0.00 0.00 0.00 3.98 6.86 6.94 3.56 6.88 7.05 6.88 6.79 8.64 0.00 0.00 0.00 0.00 1.40 17.92 0.00 4.00 0.00 6.88 0.00 644 6.88 6.28 6.88
0.00 0.00
3.90 0.00

TOTAL INTEREST
DUE 199$

TOTAL > TOTAL

INTEREST

INTEREST

DUE

DUE

1996

10.50 0.00 10.80 8.03 9.48
1.84 0.00 0.00 0.00 7.81 1.89 9.46 9.38 10.40 8.11 2.95 8.97 0.00 0.00 0.00 0.00 0.00 7.35 0.00 0.00 0.00 0.00 7.07 0.00 9.13 10.99 9.41 9.94 0.00 — 0.00
9.06 4.70

7.49 0.00 13.60 0.00 13.80 2.80 0.41 0.00 0.00 10.99 0.00 14.19 6.16 7.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.86 0.00 0.00 0.00 0.00 0.00 0.00 6.64 4.69 15.01 9.39 0.00 0.00
13.18 0.66

35.89 0.25 39 05 27.44 42.04 5.17 0.41 7.82 3.35 22.78 37.24 43.49 21.79 49.71 25.82 17.02 22.69 16.02 1.28 41.08 0.00 3.70 25.15 17.92 2.63 16.95 4.25 25.55
4.43 38.50 37.93 41.73 37.35 2.95
8.29
37.34 6.50

RESIDENTS iNTEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1992 THRU DECEMBER 31,1996
7^

LAST NAME

FIRST NAME

DCV#

TOTAL INTEREST
DUE 1992

98 DAY 99 DEAN
100 DENT
101 DEROSA
102 DEVINE
103 DEVOE 104 DIAL
105 DIXON
106 DOBBINS
107 DONALDSON 108 DORSCH
109 DORSEY 110 DOSHER 111 DO2IER 112 DRIVERS 113 DUFF 114 DUKE 115 DUNCAN 116 EASTON 117 EDMONDS 118 EDWARDS 119 EDWARDS 120 ELLIS 121 ELLIS 122 EMERSON

MARGARET ROBERT FANNIE FRANK ANNA
SARAH RUTH JOHN CARRIE
MARIE HELEN THEODORE FANNIE JANE CLARENCE CASPER CLYDE ETHEL IRENE WILLIAMS ELSIE MA22IE ARDENA IRENE JANE

10-23-24 10-23-93 10-24-40 10-15-65
10-17-19 10-25-08 10-13-17 10-01-30 10-16-95 10-19-87 10-20-71 10-21-59 10-11-52 10-23-66 10-20-75 10-23-87 10-25-02 10-23-58 10-22-35 10-25-31 10-23-55 10-23-90 10-18-62 10-22-35 10-24-13

6.03 2.86 58.63 23.56 3.27 000 15.00 2.44 0.54 5.03 4.45 0.00 0.00 17.32 4.75 2.27 0.00 7.33 19.16 0.00 0.38 13.63 5.03 0.00 3.50
856.88

TOTAL INTEREST
DUE 1993

TOTAL INTEREST
DUE 1994

TOTAL INTEREST
DUE 1995

TOTAL INTEREST
DUE 1996

TOTAL • INTEREST
DUE

5.63

2.41 14.83

—

0.00

3.26

0.00

0.00

4.30

0.20

6.37

6.88

3.79

12.25

9.08

6.24

1.31

1.98

6.56

8.36

0.00

5.04

9.97

7.57

0.00

6.25

6.98

000

6.88

000

4.49

4.16

0.00

3.97

0.00

6.86

7.08

0.00

0.00

6.88

0.00 — • 0.00

2.12

0.00

6.87

. 1.14

4.98 0.00

—

7.45

0.00

6.37

000 0.00

-

6.03

000

5.84

0.00

0.00

2.24

3.17

4.90

9.38

0.00

0.00

5.03

8.55

0.00

9.43

0.00

10.71

8.57

0.00

0.00 10.71

0.00

10.73

000

000

0.00

0.00

6.25

0.00

0.00

7.52

5.27

45.26

8.23

0.00

0.00

0.00

12.73

0.00

17.34

000

13.10 5.37

—

0.00

0.00

12.37

3.52

14.68

18.64 5.27
86.37
23.56
23.12 4.16 15.00 20.47 9.18 68.42 36.02 3.79 12.25 38.31 3227 3.58 3088 13.89 58.21 15.08 10.40 2360 43.14 3.52 41.53

$670.14

477.53

723.81

658.03

3.386.39

DHS/D.C. \ \GE RESIDENT* ..4TEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1992 THRU DECEMBER 31,1996

LAST NAME
1 LAFOLETTE 2 LANDMAN 3 LANE 4 LANGSTON 5 LANIER 6 LANIER 7 LAWSON 8 LAWSON 9 LAWTON 10 LEE 11 LEE 12 LEE 13 LEE 14 LEMING 15 LEWIS 16 LEWIS 17 LIENDO 18 LILLY 19 LINDERS 20 LIPFORD 21 LITTLE 22 LLOYD 23 LOFTON 24 LOVELIST 25 LUCAS 26 LUCHIE 27 LUMPKINS 28 LUNCEFORD 29 LYLE 30 LYNCH 31 LYONS 32 MACK 33 MALAWISKA 34 MALLOY 35 MARKS 36 MARTIN 37 MARTIN 38 MASSEY 39 MASSEY 40 MAYES 41 MCBRIDE 42 MCCLAIN

FIRST NAME
ROBERT EROY
ROSE PEARL DEBORAH EDDIE CHARLES STANLEY ANTONIO CARLAM GRACE \4ARY RHEBA JACK JOHN JOSEPHINE ROSA JOSEPH LUCILLE JAMES JAMES MARTHA ALVIN RUBY MACK MARTHA MARGARET PIERCE VASCAR MARY E EARL EVA EDWARD FANNIE CURTIS DELORES GARY LATOYA SABRINA RUTH LARRY JOSEPH

DCV#
10-24-58 10-14-60 10-03-11 10-24-92 10-23-36 10-20-88 10-23-37 10-24-38 10-19-61 10-24-17 10-17-65 10-25-19 10-11-10 10-16-47 10-18-57 10-11-50 10-24-77 10-03-31 10-22-22 10-24-68 10-25-04 10-23-79 10-17-87 10-21-05 10-22-18 10-24-72 10-23-19 10-24-18 10-25-34 10-22-00 10-21-27 10-18-87 10-23-48 10-23-06 10-23-33 10-24-80 10-16-30 10-22-59 10-15-87 10-16-55 10-25-17
10-23-03

TOTAL INTEREST
DUE 1992

TOTAL INTEREST
DUE 1993

0.00

1192

38.48

0.00

0.00

0.00

5.18

5.27

6.10

1.33

6.10

0.00

1.00

29.32

6.03

0.57

0.00

59.52

198

16.82

0.00

6.06

1.86

3.78

0.00

1.70

7.08

6.10

0.00 — 5.77

440

1.28

610 0.96

11.07

9.27

0.00

584

4.91

5.26

0.00 ?54

—

7.73
0.00 0.00 31.14 2.87 3.94 7.51 3.34 20.39 56.05 33.31 2.75
0.00 0.00 7.71 50.52 3.76 0.00 1.45 10.84 0.16 8.24 4.33 4.72 4.50 6.53
1.78 7.53 1.15 759 0.00
000 7.41 0.00 6.36 6.13 0.00 7.47 3.97 2.75 0.18
3.25

TOTAL INTEREST
DUE 1994
6.09 0.00 0.00 468 0.00 0.94 5.65 4.17 7.45 6.89 0.00 0.47 0.00 0.00 6.49 000 0.00 000 5.80 1.17 17.36 8.74 3.97 6.35 0.00 7.08 000 7.09 3 44 7.02 0.00 000 708 000 8.28 592 0.32 686 0 00 0.00 3.57 000
•

TOTAL INTEREST
DUE '' 1995

TOTAL INTEREST
DUE 1996

TOTAL INTEREST
DUE

13.48

0.00

0.00

8.06

0.00

7.45

10.40

4.61

0.00

9.72

1.95 10.51

—

0.00

0.00

9.39

0.00

0.00

000

8.60

0.00

000

9.72

7.18

1069

0.00

9.38

0.00

938

1.91

7.72

000

0.00

9 38 0.00

1103

9.35

0.00

952

0.00

0.00

5.86

000

10.91

0.00

0.00

6.08

9.47

0.00

8.33

1.09

0.00

11.20

0.00

0.00

0.00 000

—

7.44

0.00

0.00

0.00

4.53

000

000

5.60

000

664

0.00

15.88

0.00

16.20

2.23

1393

0.00

0.00

16.19 000

27.08

12.72

000

453

0.00

0.00

31.54 0.00

--

38.21 11.92 3848 49.96 12.34 12.33 37.07 18.48 33.94 85.19 41.36 13.73
1.00 29.32 37.06 51.09
3.76 59.52 22.36 28.83 17.52 38.36 17.34 3218 450 40.57 8.86 46 30 8.73 42.03 4.40
1.28 46.16 096 63.82 43.39 0.32 34.22 888
801 41.15 4.79

DHS/D.C. \ AGE

RESIDENTS iNTEREREST SUMMARY

FOR THE PERIOD ENDING

, 1992 THRU DECEMBER 31,1996

LAST NAME
43 MCCOY 44 MCEACHERN 45 MCFARLAND 46 MCLAIN 47 MCLEOD 48 MCNEAL 49 MCNEIL SO MCNEIL 51 MCNEIL 52 MELVIN 53 MEMORY 54 MERRYMAN 55 MILES 56 MILLER 57 MILLER 58 MILLER 59 MILLIGAN 60 MILLS 61 MILLS 62 MINOR 63 MITCHEL 64 MITCHELL 65 MITCHELL 66 MONROE 67 MONROE 68 MONROE 69 MONTAQUE 70 MOONEY 71 MOORE 72 MOORE 73 MOORE 74 MOORE 75 MORALES 76 MOREJON 77 MORGAN 78 MORGAN 79 MORTON 80 MORRIS 81 MOSBY 82 MOTLEY 83 MOTLEY 84 MOUTON

FIRST NAME
BEVERLY FRANKLIN MARGARET ALBERT ELLA ROBERT ERNEST JAMES RUTH RUTH RUTH MARY WARREN BILLIE CLARENCE DAISEY ETTA NATTIE WILLIAM MARTHA DOROTHY GLOSSIELA REBECCA AUGUSTUS HEZEKIAH NORMAN A. JULIAN THERESA BESSIE JAMES MINNIE WILLIAM AMELIA SENIA JESSIE NETTIE MARIA FRANK CHARLES DONNEL EDDIE PERNELLA

DCV#
0-15-89 0-24-37 0-21-14 10-21-34 10-21-93 10-18-34 10-24-63 10-22-74 10-19-60 10-09-34 10-23-30 10-14-35 10-20-11 10-23-46 10-10-75 10-02-82 10-24-67 10-21-24 10-23-62 10-23-97 10-22-17 10-21-50 10-10-20 10-16-17 10-22-50 10-16-17 10-09-04 10-22-42 10-17-13 10-20-12 10-22-50 10-20-89 10-22-47 10-21-28 10-24-90 10-20-87 10-23-80 10-22-96 10-16-28 10-15-48
10-15-48 10-19-52

TOTAL INTEREST
DUE 1992
0.00 20.35
4.76 6.10 16.84 7.59 14.44 0.00 7.11 6.27 8.08 5.21 0.00 0.54 3.40 0.13 3.44 6.10 0.00 0 57 5.35 2.05 0.54 5.01 9.94 0.00 1.20 0.60 6.18 5.37 14.96 6.10 0.57 000 000 067 2.60 604 0.00
29.72 0.00 610

TOTAL INTEREST:
DUE 1993
1.25 6.92 18.47 7.53 0.00 7.35 34.56 0.26 4.75 8.27 6.78 5.68 0.00 3.37 4.29 2.98 5.72 13.68 4.29 0.00 6.10 1.70 20.85 0.00 3.82 4.76 0.00 0.68 6.86 0.00 0.00 7.24 0.00 6.88 0.00 0.00 0.00 7.45 0.00
d'oo
22.71 14.06

TOTAL INTEREST
DUE 1994

0.00

6.90

000

14.17

0.00

7.10

5.47

0.00

8.98

4.05

8.39

5.64

0.00

3.85

5.30

0.37 1 0.00

0.00

0.00

0 00

6.90

0.00

0.00

0.00

0.00

6.33

000

0.00

52.63

000

0.00

690

0.00

8.95

000 000

-

033

7.01

0.20

0.00

9.08

000

TOTAL INTEREST
DUE 1995

0.00

9.73

0.00 33.38

-

0.00

9.38

7.57

3.02

10.69

39.09

7.09

8.49

0.00

2.46

9.69

7.86

0.00

0.00

0.00

0.00

10.69

2.51

0.00

0 00

0.00

9.03

0.00

0.00

11.11

0.00

0.00

11.05

0.00

7.39

9.26

0.00

065

6.32

0.65

0.00

8.93

000

TOTAL INTEREST •
DUE 1996

TOTAL INTEREST
DUE

0.00

13.04

000

000

0.00

16.20

1.87

4.49

12.13

0.00

0.00

3.18

0.00

0.00

0.00

4.16

0.00

0.00

0.00

0.55

12.68

4.65

0.00

0.00

000

15.91

0.00

0.00

5.89 0.00

—

0.00

16.19

000

4.40

13.43

000

0 00

0.00

000 0.00

-

13.14

0.00

1.25 56.94 23.23 61.18 1684 47.62 63.91
7.77 43.66 57.68 30.34 28.20
0.00 10.22 22.68 15.50 9.16 19.78 4.29 1.12 41.72 10.91 21.39 5.01 13.76 36.03 1.20 1.28 82.67 5.37 14.96 47.48 0.57
27.62 2269 0.67 3.58 26.82
0.85
29.72 5386
20.16

DHS/D.C. \ <U3E RESIDENTS, .NTEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1992 THRU DECEMBER 31,1996

LAST NAME
B5 JIULLEN 86 JIURPHY 87 MURPHY 88 JIURRAY 89 NALLEY 90 NELSON 91 NELSON 92 NEWTON 93 NICKEN 94 NILAND 95 NIXON 96 NUNN 97 ODEMNS 98 O'LEARY 99 OLIVE 100 OWENS 101 PAGE 102 PALMER 103 PANNELL 104 PARDINI 105 PARKER 106 PARKER 107 PARKER 108 PARKS JENKIN 109 PARNELL 110 PAUL 111 PAYNE 112 PAYTON 113 PEAVY 114 PECK 115 PERKINS 116 PERKINS 117 PETTIGREW 118 PHARR 119 PHILLIPS 120 PINKNEY 121 PINKNEY 122 POPE 123 POPE 124 PORTEE 125 POUNCIL 126 POWELL

FIRST NAME
ERNEST ESTHER WILLIE CARRIE HENRY GRACE JAMES VALERIE ELEANORA JOHN NATHAN JAMES GENEVA JAMES BENJAMIN LOUISE -ILLIAN CARNEGIE VIRGINIA MARY BARBARA EVA ROBERT CHRISTINE LOUIS ETHEL SHEILA SARAH ALICE MARGARET HATTIE VERA ESTHER WILLIAM CORRINE JAMES MARGARET JAMES LOUISE FRANCES QUIANA PEARL

DCV#
0-21-79 0-12-87 0-24-20 0-17-05 10-24-98 10-21-36 10-25-51 10-15-91 10-23-21 10-23-40 10-22-56 10-23-13 10-24-93 10-22-77 10-20-53 10-17-45 10-08-21 10-23-05 10-22-19 10-19-22 10-18-55 10-21-72 10-21-29 10-11-47 10-24-28 10-22-98 10-18-90 10-21-42 10-25-12 10-04-34 10-14-94 10-20-91 10-17-62 10-25-26 10-15-92 10-21-96 10-17-55 10-15-50 10-22-37 10-24-02 10-15-94 10-25-06

TOTAL INTEREST
DUE 1992

TOTAL INTEREST
DUE 1993

TOTAL INTEREST
DUE 1994

5.61

1588

5.15

14.50

0.00

5.75

000

48.30

2.86 — 5.74

1.07

18.98

0.00

0.00

4.19

6.69

5.77

10.52

6.06

2.64

0 60 1.12

—

5.58

0.00

3.27

0.00

5.79

3.76

0.00

0.00

56.44

0.00

4.93

0.00

37.62

4.20

6.10

0.00 5.30

-

0.19

86.14

0.00

4.94 0.00

—

4.49

0.00

1.84

6.12

0.00

0.00

7.12

17.26

0.00

0.90

6.07

15.17

3.63

6.92

7.08

0.00

5.57

0.00

0.00 0.00

7.52

8.04

2.91

0.72

7.13

6.68

0.00

6.25

0.00

3.79

7.12

0.16

37.76

0.00

10.56

6.59

4.46

0.00

77.18

3.64

000 0.00 0.00 000 0.00
4.75 2.75 0.00 7.09 0.00 0.00 000 949 0.00 3.91 16.23 6 69 0.00 6.97 0.00 000 0.00
23.63 16.99 0.20 7.05 7.08 0.00 3.78 13.96 0.00 4.20 3.38 42.15
0.00 0.00
1083 0.00
0.00 000
0.00 4.36

TOTAL INTEREST
DUE 1995

0.00

0.00

0.00

000

0.00

7.59

12.34

000 8.38

-

0.00

0.00

0.00

10.25

0.00

4.95

12.24

2.96

0.00

9.62

0.00

0.00

0.00

11.13

11.41

0.00

9.38

9.05

' 0.00

10.34

0.00

0.00

11.81

4.42

3.60

000

000

10.67

23.65

21.25

0.00

0.00

4.33

TOTAL
INTEREST • DUE
1996

TOTAL INTEREST
DUE

0.00 0.00 0.00 0.00 0.93 1123 15.41 0.00 2.81 0.00 0.00 0.00 6.93 0.00 5.54 6.51 — 2.10 0.00 13.84 0.00 000 0.00 5.92 7.75 0.00 16.22 12.75 0.00 6.57 000 — 0.00 11.41 000 000 0.00 000 1268 000 0.00 0.00 0.00 — 0.00

10.55 15.88 9.64 14.50 2.77 35.44 30.50 4830 28.26 23 00
1.07 1988 32.74 15.17 22.22 48.59 24.60 10.52 42.06 2.64 0.60
1.12 53.78 44.19 6.38 33.37 41.80 10.44 20 69 20.21 56.44 31.21 19.85 45.91 75.38 4.20 50.84 30.24 31.01 0.19 163.32 12.33

DHS/D.C.\ VGE RESIDENTS .wTEREREST SUMMARY FOR THE PERIOD ENDING JANUARY 1,1992 THRU DECEMBER 31,1996

LAST NAME
127 PRATT 128 PRINGLE 129 QUEEN

FIRST NAME
BESSIE LARVIN VIOLA

DCV#
10-21-85 10-21-23 10-20-70

TOTAL INTEREST
DUE 1992
5.95 0.00 0.00
873.23

TOTAL INTEREST
DUE 1993
0.00 13.88 6.99
$866.39

TOTAL INTEREST
DUE •1994
0.00 0.00 8.37
515.30

TOTAL INTEREST
DUE 199S
0.00 0.00 9.38
620.10

TOTAL INTEREST •
DUE 1996
0.00 0.00 12.73
504.83

TOTAL INTEREST
DUE
5.95 13.88 37.47
3378.54

DHS/O.C. -AGE RESIDENTS INTEREST SUMMARY FOR THE PERIOD ENDING JUNE 1,1992 THRU DECEMBER 31,1996

LAST NAME
1 IAMEY 2 RANDALL 3 REDD 4 IEDDIX 5 REED 6 REED 7 REEDER 8 REESE 9 REESE 10 REEVES 11 REID 12 RICKERT 13 ROBERTSON 14 ROCHELLE 15 ROQAN 16 ROLAND 17 ROSE 18 ROTAN 19 ROUSE 20 ROWE 21 ROYSTER 22 RUSS 23 RUSSELL 24 RUTH 25 RYAN 26 SANDERS 27 SAUNDERS 28 SCHREIBER 29 SCOTT 30 SCOTT 31 SCOTT 32 SCOTT 33 SCOTT 34 SCOTT 35 SCOTT

FIRST NAME

DCV#

TOTAL INTERE8T
DUE 1902

DOROTHY JUANITA SYLVIA ETTA OTIS ROBERT HORTENSE CAROLYN WILLIE ADA MARCELLA VERNA VIOLA ONEIDA MABLE NANNETTE ELIZABETH THEODORE CLARENCE ARNITHA LAMONT ADELAIDE MABEL MARY HELEN ALEE FANNIE RUTH ANNIE EDWARD HATTIE HELEN LAURA MARY NORMAN

0-23-45 10-20-60 10-15-53 10-22-58 10-20-27 10-14-20 10-24-12 10-23-86 10-24-25 10-20-23 10-19-12 10-24-52 10-13-23 10-23-43 10-15-66 10-22-24 10-25-30 10-24-10 10-24-29 10-15-96 10-22-09 10-23-02 10-12-30 10-20-03 10-20-73 10-20-33 10-24-51 10-2081 10-24-79 10-13-45 10-23-28 10-25-36 10-15-00 1008-16 10-12-52

6 09 39.84
5.53 11.56 17.86
5.20 10.20
1.17 2.61 6.10 0.00 1.80 6.10 5.32 1.14 5.78 0.00 5.41 3.85 4.78 0.50 2.21 8.20 0.83 6.10 6.15 2.28 31.12 9.98 5.00 4.60 0.00 6.43 4.69 18.52

TOTAL INTEREST
DUE
im

TOTAL INTEREST s DUE
1944

7.68 0.00 7.14 7.24 39.67 6.46 39.22 6.19 0.00 11.56 0.00 9.98 7.73 6.77 0.00 8.07 5.97 6.72 7.26 13.94 7.38 4.16 0.36 0.00 7.53 4.42 5.64 0 00 14.45 8.32 6.91 2.29 5.53 0.00 0.00

6.82 0.00 6.91 6.39 0.00 6.70 6.99 4.63 0.00 6.92 0.00 5.48 8.25 27.95 0.44 7.77 6.80 0 00 0.00 6.51 4.59 6.66 0.00 0.00 7.09 0.00 6.45 0.00 4.98 6.94 6.90 10.28 5.97 000 0.00

TOTAL INTEREST
DUE 1995
10.33 0.00 10.69 9.36 0.00 9.38 0.00 0.00 19.10 10.69 0.00 9.43 10.69 0 00 3.02 11.78 10.54 0.00 0 00 11.02 3.05 9.19 000 41.75 9.37 31.58 10.65 0.00 12.32 10.68 9.60 9.41 8.16 0 00 0.00

TOTAL INTEREST
DUE 1996

TOTAL INTEREST
DUE

14.31 0.00 14.06 5.60 0.00 60S 0.00 0.00 0.00 16.22 0.56 7.00 11.77 0.00 1.52 9.18 14.70 000 0.00 15.35 2.16 9 91 0.00 0.00 12.73 0.00 14.92 0.00 12.17 16.19 15.88 7.80 9 90 0.00 0.00

45.23 39.84 44.33 40.15 57.53 33.80 56.41 11.99 21.71 51.49
0.56 33.69 44.54 40.04
6.12 42.58 38.01 12.13 11.11 51.60 17.68 32.13
8 56 42.58 42.82 42.15 39.94 31.12 53.90 47.13 43.89 29.78 35.99
4.69 18.52

DH3/D.C. XAOE RE8IDENTS INTEREST SUMMARY FOR THE PERIOD ENDING JUNE 1,1992 THRU DECEMBER 31,1998

LAST NAME
36 SCOTT 37 SCOTT 38 SCRIBERS 39 SEARS 40 SEASE 41 SENYARD 42 SETTLES 43 SHANKLIN 44 SHANNON 45 SHARROW 48 SHEEHY 47 SHELL 48 SHERRILL 49 SIMPKINS 50 SINGLETON 51 SKEETE 52 SLOCUM 53 SMITH 54 SMITH 55 SMITH 56 SMITH 57 SMITH 58 SMITH 59 SMITH 60 SMITH 61 SMITH 62 SMITH 63 SMITH 64 SMITH 65 SNEED 66 SNIDER 67 SOMERS 68 SOLOMON 69 SPEERS 70 SPENCER

FIRST NAME
RUTH SAMUEL FRANCIS VIRGINIA OTIS MARY WILLIAM JAMES THOMAS RUSSELL JANE MARY ETHEL RUFUS JOHNNY LOIS BARBARA ANNA BESSIE BOOKER CATHERINE JAMES JOHN NORMAN ROSA RAYMOND THELMA WILLIE YVONNE NELLINE TONY AGNES MAMIE ANNETTE MARSHALL

DCV#
10-12-20 10-25-38 10-16-33 10-22-83 10-16-54 10-20-55 10-16-34 10-04-97 10-23-54 10-23-74 10-23-25 10-19-51 10-23-60 10-24-06 10-14-72 10-24-78 10-20-18 10-16-91 10-07-09 10-24-41 10-22-80 10-20-21 10-15-97 10-21-15 10-23-94 10-25-33 10-18-91 10-22-69 10-18-18 10-25-43 10-21-02 10-22-81 10-23-44 10-15-51 10-15-98

TOTAL INTEREST
DUE 1992
2.07 000 0.00 000 0.60 6.10 5.14 36.46 0.00 0.92 6.03 72.88 0.00 0.00 24.32 1.30 6.10 3.48 5.70 75.79 6.37 000 5.92 2.08 5.09 0.00 5.14 6.13 4.16 0.00 6.10 6.04 0.19 4.86 540

TOTAl, INTEREST
DUE
1993
1.75 2.02 0.00 0.18 2.24 7.36 4.44 0.00 1.83 0.00 7.42 0.00 0.57 2.64 0.00 16.31 7.53 0.00 9.27 4.16 7.60 34.45 7.41 0.00 6.53 0.00 6.50 0.00 0.00 0.00 7.53 7.01 1.64 0.00 3.45

TOTAL INTEREST
DUE 1994
2.63 20.22
0.00 2.43 0.00 27.34 1.39 0.00 1.17 0.00 7.12 0.00 000 4.78 000 060 7.15 000 000 0.00 6.91 0.00 8.36 0.00 5.22 3.96 7.06 0.00 0.00 1.82 7.04 6.82 0.33 0.00 0.00

TOTAL INTEREST
DUE 1995
3.57 9.37 4.04 1.58 6.79 0.00 7.74 000 6.59 0.00 9.36 0.00 000 4.91 000 0.00 10.68 0.00 0.00 0.00 8.68 0.00 6.89 0.00 8 59 8.12 5.93 0.00 0.00 11.92 9.36 5.67 0.00 0.00 000

TOTAL INTEREST
DUE 1996
0 99 14.72
4.32 2.25 6.00 0.00 2.80 000 5.08 0.00 16.18 0.00 0.00 000 000 0.00 7.21 0.00 0.00 0.00 3.71 000 0.00 0.00 8.57 8 93 2.18 0.00 0.00 12.67 12.73 0.00 0.00 0 00 0.00

TOTAL INTEREST
DUE
11.01 46.33
B.36 6.44 15.63 4080 21.51 36.46 14.67 0.92 46.11 72.88 0.57 12.33 24.32 18.21 38.67 3.48 14.97 79.95 33.27 34.45 28.58 2.08 34.00 21.01 26.81 6.13 4.16 26.41
42.76 25.54
2.16 4.86 8.85

DH3/D.C. v.O RE8IDENT8 INTEREST 8UMMARY FOR THE PERIOD ENDING JUNE 1,1992 THRU DECEMBER 31,1996

LAST NAME
71 SPRATT 72 SPRIGGS 73 SPRINGS 74 STANFORD 75 STEVERSON 78 STEWART 77 STOKES 78 STRINGFELLOW 79 STURDIVANT 80 SUBER 81 SUMMERS 82 TAPLEY 83 TARRANT 84 TAYLOR 85 TEMPLES 86 THOMAS 87 THOMAS 88 THOMAS 89 THOMPSON 90 THOMPSON 91 TOLBERT 92 TOLBERT 93 TOLLIVER 94 TRAVIS 95 TRAVIS 96 TRUITT 97 TURNBOUGH 98 TURNER 99 TURNER 100 TUTSON 101 TWITTY 102 TYLER 103 UPSHUR 104 VALENTINE 105 VEASEY

FIRST NAME
ELIZABETH DIANA ANNIE LARRY ALODINE JAMES PRESTON LATHAN ROY GLADYS ALBERT KENNETH MARGARET AGNES BEATRICE CATHERINE CHARLES LUCY ETTA JAMES AUDREY JAMISA DOROTHY EDWARD HATTIE MATTIE BERTJA CRAVEN JAMES PEARL CHARLES FIDELLA SUSIE LOWRINE WILLIE

DCV#
0-22-91 0-16-25 0-12-14 0-21-06 10-05-33 10-12-91 10-12-54 10-24-89 10-21-47 10-17-72 10-15-52 10-17-97 10-23-84 10-23-84 10-05-51 10-11-54 10-05-55 10-21-37 10-20-55 10-18-69 10-24-45 10-25-21 10-20-84 10-16-01 10-20-20 10-21-83 10-21-74 10-22-27 10-25-00 10-25-40 10-21-16 10-24-04 10-19-48 10-23-39 10-23-72

TOTAL INTEREST
DUE 1992
3.70 0.00 6.10 0.76 26.28 14.36 5.19 0.81 4.91 25.84 0.00 0.00 15.32 4.47 3.58 10.56 0.00 5.30 0.00 0.27 3.58 0.00 5.16 1.27 0.57 3.00 4.24 5.65 0.00 0.00 7.20 0.00 0.57 0.19 0.00

TOTAL. INTEREST
DUE 1993
6.90 0.18 7.74 0.00 0.00 0.00 6.79 16.31 6.05 0.00 4.01 13.57 7.55 5.86 5.49 0.00 8.94 7.39 1.43 0.21 9.08 1.06 8.01 0.00 0.00 7.73 0.00 6.18 7.48 0.00 0.00 1.65 0.00 0.00 0.00

TOTAL INTERE8T . DUE
1994
6.91 2.46 0.00 0.00 000 0.00 7.26 7.14 6.15 0.00 3.34 0.00 6.39 0.00 8.18 0.00 000 7.26 0 00 0.00 6.21 7.42 6.45 0.19 054 6.43 0.00 6.18 6.45 10.15 0 00 0.00 0.00 000 0.00

TOTAL INTEREST
DUE 199S
10.35 5.03 0.00 0.00 0.00 0.00 3.43 2.56 10.64 0.00 0.68 0.00 8.56 0.00 9.65 0.00 0.00 10.68 0.00 2.29 6.87 12.30 11.03 0 00 15.00 10.69 32.81 10.38 10.96 5.04 0.00 0.00 0.00 0.00 0.25

TOTAL INTEREST
DUE 1996
13.41 2.31 000 0.00 0.00 0.00 000 0.00 14.35 0.00 000 000 0.93 0.00 10.09 0.00 0.00 13.66 0.00 7.31 0.00 7.04 7.01 000 6.83 14.61 0.00 13.58 14.99 0.00 0.00 0.00 0.00 0.00 0.00

TOTAL INTEREST
DUE
41.27
9.98 13.84 0.76 26.28 14.36 22.67 26.82 42.10 25.84
8.03 13.57 38.75 10.33 36.99 10.56
8.94 44.29
1.43 10.08 25.74 27.82 37.66
1.46 22.94 42.46 37.05 41.97 39.88 15.19
7.20 1.65 0.57 0.19 0.25

DHS/D.C. ...LAGE RESIDENTS INTERE8T 8UMMARY FOR THE PERIOD ENDING JUNE 1,1992 THRU DECEMBER 31,1996

\
LAST NAME
106 WET 107 WADDELL 108 WADDELL 109 WAINWRIGHT 110 WAITS 111 WALL 112 WANG 113 WARD 114 WARE 115 WASHINGTON 116 WASHINGTON 117 WASHINGTON 118 WATERS 119 WATERS 120 WATSON 121 WEBB 122 WELLS 123 WHEELER 124 WHITE 125 WHITE 126 WHITE 127 WHITE 128 WHITE 129 WHITEFIELD 130 WILKINS 131 WILLIAMS 132 WILLIAMS 133 WILLIAMS 134 WILLIAMS 135 WILLIAMS 136 WILLIAMS 137 WILLIAMS 138 WILLIAMS 139 WILLIAMS 140 WILLIAMS

FIRST NAME
WILLIAM HAZEL RONALD PAUL RONALD JAMES THOMAS JESSIE JAMES LAVERNE RAYMOND ROBERT HAZELG MARCO BEATRICE ROMAN ELMA NELDA MAE ANABELLE LURAY MARGARET MELVIN SARA ETHEL MAMIE BESSIE E CARL COLONEL CORA CYNTHIA DENISE ENORA JOHNEY LUCILLE MICHAEL

DCV#
0-22-97 0-23-63 0-17-54 10-21-51 10-24-23 1023-72 10-22-85 1045-82 10-15-56 10-20-39 10-21-07 10-11-20 10-18-36 12-23-68 10-22-71 10-22-31 10-18-40 10-22-71 10-17-91 10-17-11 10-13-53 10-21-13 10-25-13 10-24-45 10-23-14 10-19-70 10-23-85 10-21-31 10-24-46 10-24-35 10-21-01 10-15-61 10-24-64 10-12-49 10-18-15

TOTAL INTERE8T
DUE 1992
6.10 4.52 0.00 6.10 6.10 000 3.69 5.89 1.16 3.91 0.00 10.88 5.48 2.00 3.68 2.91 6.10 0.00 0.00 14.64 7.32 1.80 000 0.27 5.40 18.44 000 6.20 11.93 6.00 0.00 5.84 0.00 4.82 0.00

TOTAL INTEREST
DUE 1993
6.27 4.91 26.42 7.53 7.53 2.91 3.78 7.93 3.87 5.54 0.22 0.00 14.69 0.00 3.22 0.00 8.05 1.89 0.00 0.00 0.00 0.00 0.88 5.88 6.89 0.00 0.00 37.56 10.94 7.04 17.51 7.16 8.48 6.83 0.00

. TOTAL INTEREST -., DUE
1994
0.00 7.18 0.00 6.15 7.08 4.40 4.75 6.92 6.73 6.14 0.00 0.00 8.45 0.19 6.32 0.00 0.00 5.57 3.68 0.00 000 0.00 4.02 5.76 6.77 0.00 0.00 12.86 0.00 6.61 0.00 5.34 000 43.63 1.69

TOTAL INTEREST
DUE 1995
0.00 8.85 0.00 0.00 9.36 9.91 0.00 10.68 7.78 9.92 0.00 0.00 8.59 0.00 8.41 000 65.45 1.62 8.01 000 0.00 0.00 10.21 10.68 10.68 40.45 1.32 30.05 000 9.36 0.00 7.51 0.00 0.00 0.67

TOTAL , INTEREST
DUE 1996

.TOTAL INTEREST
DUE

0.00

12.22

0.00

0.00

12.71

7.70

000

9.63

5.78

10.89

0.00

000

11.76

0.00

14.57

0.00

0.00

0.00

7.96

000

000

0.00

7.20

13.39

12.74

0.00

0.00

0.00

0.00

7.94

0.00 000

—

0.00

0.00

0.00

12.37 37.68 26.42 19.78 42.78
24.92 12.22 41.05 25.32 36.40
0.22 10.88 48.97
2.19 36.20
2.91 79.60
9.08 19.85
14.64 7.32 1.80
22.31 35.98 42.48 58.89
1.32 86.67 22.87 36.95 17.51 25.85
8.48 55.28
2.36

DHS/D.C. AGE RESIDENT - .NTEREST SUMMARY FOR THE PERIOD ENDING JUNE 1,1992 THRU DECEMBER 31,1996

LAST NAME
141 WILLIAMS 142 WILLIAMS 143 WIILLIAMS 144 WILLIAMS 145 WILLIAMS 146 WILLIS 147 WILSON 148 WILSON 149 WILSON 150 WINFIELD 151 WINTHROP 152 WOODARD 153 WRIGHT 154 YOUNG 155 YOUNG 156 YOUNG 157 YOUNG

FIRST NAME
MINNIE PEARL RENEE WILLIAM VIRGINIA CLAYTON CARL CHARLES GROVER HELEN VALDEMAR ALLINE RAYMOND ALICE EDNA RUTH SAMUEL

DCV#
10-13-20 10-06 05 10-24-24 10-24-15 10-24-56 10-23-47 10-23-85 10-22-67 10-23-52 10-23-78 10-21-69 10-22-49 10-24-43 10-12-43 10-23-64 10-06-27 10-24-96

TOTAL INTEREST
DUE 1992
0.00 41.00 14.76 44.10
1.47 0.19 6.42 0.00 6.29 6.74 2.16 9.46 2.80 34.20 5.75 0.80 0.00

SUBTOTAL TOTAL Includes Rounding Differences

$1.037.52 3,436.10

TOTAL INTEREST
DUE
1993
29.27 0.00 0.00
35.47 10.55
0.00 6.69 2.28 9.13 7.84 0.00 2.36 0.00 0.00 12.24 0.00 1.63
$879.43
3171.53

TOTAL INTEREST
DUE 1994
0.00 0.00 0.00 0.00 5.26 4.31 16.56 0.23 4.97 6.85 0.00 27.12 0.00 0.00 1.26 0.00 0.00
$622.88
2090.63

TOTAL INTEREST
DUE 199S
0.00 0.00 0.00 0.00 7.90 0.00 6.64 0.35 10.00 10.68 0.00 0.00 0.00 0.00 0.00 47.56 0.00
$943.48
3173.84

TOTAL INTEREST
DUE 1996
000 0.00 0.00 0.00 5 48 0.00 0 00 0.00 16.20 1358 0 00 0.00 000 0.00 0.00 0.00 0 00

h
TOTAL 1 INTEREST 1
DUE |
29.27 41.00 14.76 79.57 30.66
4.50 36.31
2.86 4659 45.69
2.16 38.94
2.80 34.20 19.25 48.36
1.63

$622.26 2360.08

$4.10545 14232.18

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES,
Plaintiff, and M. ANNE HART, DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,

mini U.S. v. District of Columbia
NH DC-001-038

Plaintiff-Intervenor,

Civ. No. 95-948 (TFH)

v. DISTRICT OF COLUMBIA, & at,
Defendants.

ORDER

FILED
MAY j 4 ;997
Clerk. U S . District Court .District of Columbia

On February 21, 1997, the Court held a hearing to discuss the remaining matters in this case. At that hearing, all parties asked that the Court dismiss the case. With the submission of the Final Report of the Monitor, a copy of which is attached to this Order, and with the parties' consent order to remedy the violations outlined in the audit of patient accounts, the Court is satisfied that there are no remaining issues and will therefore dismiss the case.

I History of the Case This case originally came before the Court in May 1995, when the Department of Justice filed suit to require defendants to remedy conditions at the D.C. Village Nursing Home. Plaintiffs asserted a long list of violations of the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. §1997. On July 6. 1995. the parties signed and the Court approved a consent motion that

AO72A (Rev. 8/82)

obligated defendants to remedy these serious, sometimes inhuman, violations and to prevent further violations and retaliation against the residents of DC. Village. On August 1, 1995, the Court appointed a Monitor, Dr. Harriet Fields, to oversee the District's compliance with the remedial consent order. Besides entering remedial orders, the Court also ordered the creation of specialty consult teams to aid the Monitor in her task of ensuring that every resident received an appropriate and adequate services or outplacement.
Although the District had obligated itself to pursue and implement radical changes in the facility, its compliance with the consent order was poor at best. Faced with the District's noncompliance, the Court held defendants in contempt of its remedial order on December 22, 1995, and on February 23, 1996 '
In late August 1995, rather than comply with its own agreement, the District abruptly decided to close the facility and failed to produce a plan for the successful placement of the D.C. Village residents into other facilities. Instead, it embarked upon a system of transfer and placement which was both unsupervised and inappropriate for the task of moving residents, many of whom suffered from serious physical ailments. The District's placement was a disaster— some residents did not even survive the process— and in February 1996, the Court had to suspend the outplacement and ask the Monitor to supervise the placement of residents into new facilities and ensure the District's compliance with the Court's Order. In June 1996, the last resident was outplaced. The testimonials of former DC. Village residents, which are included in the Final
On May 10, 1996, the Court ordered defendants to pay each resident of D.C. Village $100.00 in compensatory damages and to pay $49,258.00 in compensatory damages to the District of Columbia Long Term care Ombudsman. Nine months later, the District has yet to comply with that order.
AO 72A (Rev 3/82)
-rw

Report, are clear proof that the Monitor accomplished her goal of ensuring that each resident received an appropriate placement into a new facility.
II Current Status The need for Court involvement in this case has come to a close. The Monitor has filed her Final Report,2 and has concluded that all former residents of DC. Village have been placed into facilities which are appropriate and adequate. The Final Report further assures the Court that those former residents are no longer subjected to illegal conditions or practices such as they experienced at DC. Village. Therefore, the Court is satisfied that its remedial orders have been carried out and that the CRIPA violations have been remedied. Furthermore, the parties have undertaken an audit of the patient accounts of the former D.C. Village residents. The audit reveals that the residents are owed outstanding interest on their accounts. Defendants have entered into a consent order to pay this interest. Therefore, it is hereby ORDERED that, pursuant to the Court's May 10, 1996, bench order, defendants shall pay as compensatory damages $100.00 to each person who was a resident of DC. Village on December 20, 1995, and $49,258.00 to the Office of the District of Columbia Long Term care Ombudsman. Defendants shall make such payments within 10 business days; it is further ORDERED that the consent order relating to interest payments to former residents of DC. Village shall be part of this final judgment; it is further
For the benefit of the public, the Court has attached to this order a copy of the main body of the Monitor's Final Report.
AO72A (Rev. 8/82)

ORDERED that the Complaints of plaintiff and plaintiff-intervenor are dismissed without prejudice as moot.

May i* . 1997

Thomas F. Hogan United States District

AO 72A (Rev. 8/821

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES,

, ».?;..v:.P.Lstrict of Columbia

Plaintiff,
M. ANNE HART, the DISTRICT OF COLUMBIA LONG TERM CARE OMBUDSMAN,

NH-DC-doi-O3c

Plaintiff-Intervenor, v. THE DISTRICT OF COLUMBIA el al,
Defendants.

CA. No. 95-0948 TFH
RLED
MAY t 4 J997
Clerk, U.S. Disinct Court District of Columbia

FINDINGS OF FACT AND CONCLUSIONS OF LAW

Plaintiff Intervenor M. Anne Hart has filed with the Court a motion for contempt

sanctions, accompanied by proposed findings of fact and conclusions of law. After having

reviewed the plaintiff intervenor's amended proposed findings of fact, the defendants' opposition

to these proposed findings, and the plaintiffs and plaintiff intervenor's replies, and after having

carefully considered the parties' oral arguments with respect to the plaintiff intervenor's

proposals, the Coua hereby enters the following findings of fact and conclusions of law to

supplement its previous ruling holding the defendants in contempt of court.

AO 72A (Rev. 8/82)

FINDINGS OF FACT

CLEAR AND CONVINCING EVIDENCE DEMONSTRATES THE DISTRICT'S

CONTEMPT OF COURT DUE TO NONPAYMENT OF VENDORS IN VIOLATION

OF THE STIPULATED

ORDER.

-

A. The Court's Previous Findings.

1. On December 20, 1995, in its oral findings from the bench in support of

its finding of contempt, the Court found that the District owed well in excess of $100,000 to

vendors in arrearages in excess of the 45 day time frame set forth in the July 6 Order and that

such arrearages had continued consistently throughout this Court's involvement in this matter

with the result of causing potential shortfalls in essential health care, and food and other needed

supplies. 12/20/95 Tr. 5, 11, Exhibit 1 to Intervenor's Motion for Contempt Sanctions

("Intervenor Exhibit"). These and other findings led the Court to conclude that "It's without

doubt that the District is in violation of the court order." Jd.., Tr. 8.

2. The Court's written opinion on December 22, 1995 further held that "By

the defendants' own admission, at least $161,000 in vendor payments are overdue beyond the

45-day period. This figure was provided by counsel during the status call on December 20,

1995, but the defendant's written submissions suggest an even higher indebtedness total of

$380,323.34. . . . The nonpayment has caused more than one threatened removal of contract

nurses and now threatens to deprive the residents of a physical therapist." 12/22/95

Memorandum and Opinion at 2.

AO 72A (Rev. 3/82)

B. The District's Admissions since December 20. 1995 3. On January 18, 1996, the District represented that two full-time
employees would spend 100 percent of their time processing invoices and purchase orders and "reduce the time lag for the payment of vendor invoices and to ensure the transmission of necessary documents to the financial management system and ultimately to the chief financial officer, as well as the city administrator for the issuance of a check." 1/18/96 Tr. 19-20, Intervenor Exhibit 2. Further, the District represented that, with respect to contracts requiring approval by the Finance Control Board, "Mr. Hawkins has addressed that situation by requesting that a contract officer for DHS set up and, administer all contracts involving DC. Village and to ensure that those contracts reach the financial responsibility of Management Assistance Authority Board so that they can be put in place on a permanent basis." Id.., Tr. 2021. In light of these and other developments, the District contended that "We think that at least the District should have the opportunity to purge itself of the contempt order." Id.., Tr. 22.
4. Subsequently, at the April 4, 1996 status conference, the District stated that as of April 2 "[w]e owe approximately . . . $672,000. Of that amount, $353,000 is beyond the 45-day requirement. Of the $353,000, $131,000 is beyond the 45-day requirement." 4/4/96 Tr. 18, Intervenor Exhibit 3. Jeanette Michael confirmed these figures as of April 2 at the April 29 contempt hearing. 4/29/96 Tr. 23.
5. At the April 4, 1996 status conference. Corporation Counsel stated to the Court "so in a technical sense, we understand that we are not in compliance" and "we are not in strict compliance with your order by any means." 4/4/96 Tr. 24, Intervenor Exhibit 3.
AO72A (Rev. 8/82)

6. According to an exhibit submitted by the District at the April 4, 1996 status conference, the District owed overdue amounts of $14,074 to American Therapeutic, $93,662.51 to National Nurses, $51,471.48 to Total Healthcare (a portion of which must be paid to the IRS as required by a tax lien), $47,861 to National Patient Care, and $14,917.47 to SRT Medical Staff. Intervenor Exhibit 4. This submission excluded numerous invoices referenced in the Monitor's Report.
7. The District admitted to the Court at the April 26, 1996 contempt hearing that "we are approximately $78,000 beyond the 45 days." 4/26/96 Tr. 11.
8. The DHS response to the Monitor's Vendor Payment Report dated April 28, 1996 (submitted to the Court on April 29, 1996) admitted the following amounts, in addition to others, were 45 days past due: $20,882.13 to CUP, $12,652.76 to SRT Premier, $202.84 to Abbott Lab, $47,861 to National Patient Care Systems.
9. The DHS response to the Monitor's Vendor Payment Report dated April 28, 1996 also listed numerous invoices that were over 45 days past due from the "Date Invoices Submitted," but not from the "Dates Invoice Rec'd DHS." The differences between these two dates in some cases was as much as two months. It is unclear whether, in all cases, DHS came into physical possession of the invoices only on the day marked as "Day Invoices Submitted," and not on some earlier date.
10. At the April 29, 1996 contempt hearing, the District admitted to the Court that there is "approximately $85,000 which is beyond the 45-day time line." 4/29/96 Tr. 4-5.

AO 72A (Rev. 8/82)

•"• irr

rrr

11. The District's May 9, 1996 report on vendor payments admitted that $69,238.81 in payments remained 45 days past due. This figure was attested to under oath by Jeanette Michael and Wayne Casey, respectively the consent decree coordinator and Deputy Director of the Department of-Human Services.
12. The District's May 15, 1996 report on vendor payments, also attested to under oath, stated that $60,000.41 in payments remained 45 days past due. This amount includes overdue invoices discovered after the May 9, 1996 report.
B. The Monitor's Reports.
13. The Monitor reported on April 25, 1996 that the District was in violation of the Stipulated Order with respect to overdue amounts, including $47,761 to National Patient Care System, $20,882.13 (March 5 invoice) to CUP, and $11,945 to Therapeutic Management Systems (February 13 and March 10 invoices).
14. The Monitor reported on May 9, 1996 that National Patient Care Systems invoice of $47, 761 remained outstanding. Monitor 5/9/96 Report at 5. Payment of this amount was approved by the Court on April 16, 1996.
II. CLEAR AND CONVINCING EVIDENCE DEMONSTRATES THE DISTRICT'S CONTEMPT OF COURT DUE TO MISREPRESENTATIONS TO THE COURT CONCERNING ITS COMPLIANCE WITH THE ORDERS OF THE COURT, 15. The Court stated in its December 22, 1995 Order that it would take
further action with respect to its concerns about misrepresentations to the Court if such conduct continued.
AO72A (Rev. 8/82)

A. Misrepresentations Concerning the Control Board,. 16. In its April 24 Opposition to the Motions for Contempt Sanctions, the
District stated, "As of April 18, 1996, the contracts for National Nurses and American Therapeutics were pending approval at the control board." District Opposition at 3. After the Monitor reported that this was inaccurate on April 25, the District admitted in a filing on April 29, 1996 that "this was an inadvertent error."
17. At the April 29 contempt hearing, counsel to the Finance Control Board, Daniel Rezneck, confirmed that the April 18 filing was false and that two contracts for National Nurses were approved respectively on February 28 and April 2, 1996 and two contracts for American Therapeutics on February 21 and March 28, 1996. 4/29/96 Tr. 31-34.
18. The misrepresentation stated in the District's April 24 Opposition was repeated throughout April.
a. The DC. Village payment report dated April 2, 1996, falsely stated that several vouchers for National Nurses and American Therapeutics are "waiting for CB approval."
b. The District falsely represented at the April 4, 1996 status conference: "In two cases, American Therapeutics, to whom we owe $14,000, and National Nurses, to whom we owe $93,000, we are awaiting Control Board approval on those contracts." 4/4/96 Tr. 18-19, Intervenor Exhibit 3.
19. In defending its "inadvertent error" and arguing it had not engaged in misrepresentations, the District reported in its April 29 submission that "The contracts referred
AO 72A (Rev. 8/82)

to in the monitor's April 25, 1996 letter for these two vendors are different from the contracts referred to by defendants." According to the District, this "different" contract for National Nurses was approved not on February 28 but on April 2, 1996 ~ albeit before the April 18, 1996 filing. The District stated on this basis at the April 29, 1996 status conference:
[Intervenor's] counsel has, has duplicated the position of the monitor and has identified the incorrect contracts. We stand by our prior executive summaries. We have not misrepresented to the Court those contracts identified by specific numbers. 4/29/96 Tr. 68-69. 20. The Control Board has confirmed that the National Nurses contract approved on April 2, 1996 covered services for the period January 26, 1996 to February 29, 1996. Letter from Daniel A. Rezneck, dated May 14, 1996. The invoices that the District maintained were pending pursuant to this the contract approved on April 2, 1996,however, were dated January 22, 1996 and February 3, 1996. District Executive Summary, April 2, 1996 at 3. These invoices thus did not -- as represented by the District ~ concern services for the period of the contract approved on April 2, 1996. These false representations were made by the District, moreover, in a hearing called by the Court to determine whether the District had made false representations. 21. The District's April 29, 1996 filing also admitted that the Finance Control Board was not responsible for some of the delay in paying vendors and stated "Defendants did not convey and did not intend to convey to anyone, the impression that the FRMAA or control board was responsible for delays in the payment of vendors."
AO72A (Rev. 8/82)

Counsel to the Finance Control Board also confirmed that no delays have ever been attributable to the Control Board. 4/29/96 Tr. 35.
22. The District previously represented to the Court on April 4, 1996 that the Control Board was responsible for delays and stated that "there has been a new process imposed. We have to now refer additional costs to the Control Board for approval, so it appears that some of the delay is the result of the implementation of the new procedure." 4/4/96 Tr. 19, Intervenor Exhibit 3. This representation was false.
B. Misrepresentations Concerning Vendor Payments. 23. The District's April 2, 1996 report on vendor payments concluded that:
"The District expects to resolve the problems associated with the late payments by April 18, 1996." Intervenor Exhibit 4. This did not take place.
24. At the status conference on April 4, 1996, the District stated that "we expect those checks to be cut by April 8." Tr. 18, Intervenor Exhibit 3. On April 12, 1996, the District again represented by its counsel that the District had mailed checks for overdue invoices. The District never complied with these representations to the Court and the steps it undertook do not indicate it intended compliance.
25. In its April 2, 1996 Executive Summary submitted to the Court, the recorded invoice date for Therapeutic Management Services is March 18 for $12,030. Based on the March 18 invoice date, the District represented that the invoice was not overdue.
AO72A (Rev. 3/82)

26. In actuality, two outstanding invoices from TMS were dated February 14 and March 11, and totaled $12,030. Intervenor Exhibit 5 to 4/29/96 Contempt Hearing. These are two separate invoices, on two separate dates, and neither is dated March 18. Contrary to the report submitted to the Court, both invoices were overdue over 45 days on April 2, 1996.
27. The District's April 24 Opposition stated that "Contrary to the arguments of plaintiff, there was never a threat to the health and safety of residents at D.C. Village. During the week of March 24, 1996, THR [Total Healthcare Resources]
* provided nurses through March 26, 1996 and assigned one treatment nurse on March 27, 1996." District Opposition at 4. The District omitted the highly material fact that Total Healthcare Resources suspended services of its nursing personnel on March 28, 1996. Monitor Report 4/3/96.
C. Misrepresentations Pertaining to Personal Needs Allowances ("PNA"). 28. The District told the Court on January 18 that "With respect to
patient accounts, as we've indicated, those accounts have been transferred to a private bank account, which will make the availability of patient funds quicker." 1/18/96 Tr. 16. Based on this representation, the Court stated at the January 18 hearing, "The Court is also pleased to see that the patients' monies have been recognized as their monies and have been put into separate, private accounts and trusts that in the past that all the
AO72A (Rev. 8/82)

monies that came in that were due to these patients have been credited to them as appropriate." 1/18/96 Tr. 29, Intervenor Exhibit 2.
29. The District's representation on January 18 was false. In actuality, all residents' PNA accounts remaining in the D.C. Treasury were not transferred to separate interest-bearing PNA accounts at Independence Federal Savings Bank until March 18, 1996 and only after the Monitor pursued this issue further. Monitor 4/3/96 Report at 5.
30. Prior to March 18, 1996, the therapeutic recreation staff reported in March, 1996 that five residents transferred on December 27 did not have their PNA. Monitor 4/3/96 Report at 7. At this time, the PNAs were being "Drawn down from the D.C. Treasury" and that "some monies are not totally transferred." Monitor 4/3/96 Report at 7.
31. Prior to the transfer of these monies to a private savings account, the District admitted that each resident's PNA was maintained in the District treasury and had to be obtained by requisition, leading to delays in payment. The Court was advised that each PNA "is accounted for separately, but all the District cash is kept in a pool cash arrangement, so that in order for [residents] to have access to this money, D.C. Village must requisition cash from our central treasury." 12/12/95 Tr. 20. "I believe the monies are accounted for separately, but now, when you need to get the cash, then that's a process that goes through the chief financial officer in order to get the
10
AO 72A (Rev. 8/82)

cash released." Id. "Ms. Fountain confirms what I was saying to you. And that, evidently, there has been some holdup there,... the paperwork has to arrive in the chief financial officer's office so he can approve it for the cash to be released, to be sent out to D.C. Village so that people can walk up to the window and get money." Id.
D. Misrepresentations Concerning the Outplacement of Residents with Mental Retardation.
32. The District considered outplacing certain residents with mental retardation to D.C. Family Services. The District told the Court on February 2, 1996 that with respect to D.C. Family Services, "We have an agreement on a tentative rate." 2/2/96 Tr. 8.
33. There was no agreed upon rate for the services of D.C. Family Service on February 2. Monitor 4/3/96 Report at 3 & Monitor 4/25/96 Report at 4. The District subsequently admitted on March 22 that "a proposed interim rate is anticipated in the near future." 3/22/96 Biweekly status report.
E. Misrepresentations Relating to Notices to the Ombudsman of Discharges. 34. In many cases, the District has failed to provide the Long Term
Care Ombudsman notices of the transfers and discharges from D.C. Village since the announcement of its closure. Exhibit 1 to Intervenor 12/11/95 Memorandum. At the status conference on December 4, 1995, the Court inquired to counsel for the District of Columbia about the notice issue. Counsel for the District of Columbia responded that
11
AO 72A (Rev. 8/82)

notice to the Long Term Care Ombudsman is not required by law where another person is designated as the resident representative. 12/4/95 Tr. 18-19, Exhibit 3 to Intervenor 12/11/95 Memo.
35. The statement of counsel to the District of Columbia at the status hearing is contrary to the law of the District as is confirmed by the prior filings of the Corporation Counsel's office in other cases. District of Columbia law provides that, even where the Ombudsman is not the resident representative, a nursing facility must in all cases provide a notice of transfer and discharge to the Long-Term Care Ombudsman. D.C. Code § 32-1432(e). Further, the Corporation Counsel's Office has previously confirmed its knowledge of this statutory requirement in other cases. Exhibit 3 to Intervenor 12/11/95 Memorandum, Exhibit 3 to Intervenor 12/11/95 Memorandum.
36. After concerns were raised about notices and care plans for hospitalized D.C. Village residents at the status conference on December 4, 1995, Corporation Counsel stated that "our policy is not to refuse the return of any patient who is sent to the hospital because of the need for acute medical care. We don't discharge patients to the hospital." 12/4/95 Tr. 32, Exhibit 3 to Intervenor 12/11/95 Memorandum.
37. That same month, two D.C. Village residents were discharged to new facilities from hospitals, one on December 1 ~ three days before the status conference — and one on December 15 — ten days after the status conference. The District's Response to the Inquiries of the Court dated January 30, 1996 at 1, 24. Both residents were discharged without

AO 72A (Rev. 8/82)

12
Tir

notice being provided to the Ombudsman or preparation of care plans and assessments required by law. Id.; Monitor 1/17/96 Report at 14.
38. At the January 18, 1996 status conference, Corporation Counsel, in response to questions from the Court, stated that notice was given to the Ombudsman of the ten discharged residents since December, 1995. 1/18/96 Tr. 27-28, Intervenor Exhibit 2.
39. On January 29, 1996, the District notified residents that a federal regulation "requires" DC. Village to "discharge" residents from the facility after a resident has been hospitalized for the 18 day period known as the "bed hold" period. Exhibit 1 to Intervenor's 2/1/96 Memo. The District informed residents that "If you are in a hospital when your bed hold period expires, the social services department of the hospital will assist you in obtaining services in another nursing facility." M- In January, five hospitalized residents of D.C. Village were as a result characterized in D.C. Village records as "Patients who are discharged from the census but remain in the hospital." Exhibit 4 to Intervenor 2/1/96 Memo.
40. On January 30, 1996, the District told the Court that two of the ten recently discharged residents had in fact been discharged without statutorily required notices being provided to the Ombudsman because they "were discharged directly from hospitals after being hospitalized and away from DCV more than eighteen days." District Response at 1 & Exhibit Y. Corporation Counsel admitted at the February 2 status conference that "The District was not initially involved in that decision" to discharge. 2/2/96 Tr. 8.
41. By notice dated February 5, 1996, the District rescinded its illegal January 29 directive and represented to the Court that the policy was issued by •"mistake." Affidavit of Alberta Brasfield, dated February 7, 1996.
13
AO72A (Rev. 8/82)

42. On January 30, 1996, D.C. Village issued four notices of discharge of individuals falsely stating that "Ms. Sarodel Childs [of the Ombudsman's office] agreed" to the transfer. Childs Dec, dated February 1, 1996. In each case, Ms. Childs and the Ombudsman's Office had not agreed to and was not asked to agree to the proposed transfer. Id-
14
AO72A (Rev. 8/82)

CONCLUSIONS OF LAW 1. Since the Court's first finding of Contempt on December 20, 1995, the District has repeatedly been in contempt of the Section C of the Stipulated Order requiring defendants to pay in full all outstanding debts to individuals and vendors who have supplied goods and/or provided services to or on behalf of DCV residents and thereafter to provide prompt payments in fvill to such individuals and vendors for goods supplied and/or services rendered not later than forth-five days from the date a legitimate invoice is received by the defendants. 2. The District has been in violation of Court orders as detailed in the Court's order of February 23, 1996. 3. The District has made misrepresentations to the Court with respect to its compliance with Court orders and other matters.
May
Thomas F. Ho. United States Dist
15
AO72A (Rev 8/82)

Richard James Farano/ Esq.
U.S. DEPARTMENT OF JUSTICE Suite 1708 950 Pennsylvania Avenue, NW Washington, DC 20530-0001

1:95-cv-00948

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, et al. )

Plaintiff

) Civil Action No. 95-0948 TFH

v.

)

FILED

DISTRICT OF COLUMBIA, et al. )

Defendants

)

ORDER

MAY 23 1997
CLERK. U.S.DISTRICT COURT DISTRICT OF COLUMBIA

Upon consideration of the motion of the District of Columbia

for an enlargement of time within which to comply with the court

order entered May 14, 1997, and^tha-,lack of opposition thereto, it

is by the Court t h i s ^ * 2 U > d a y of ^ - ^ ~-*-~T\^

, 1997,

ORDERED: That the motion be and is jfereby/granted; and it is

FURTHER ORDERED: That the time within which the District of

Columbia shall pay compensatory damages to each person who resided

at D.C. Village on December 20, 1995 and to the Office of the

District of Columbia Long Term Care Ombudsman is enlarged to 45

days from the date of entry of the Court order entered May 14,

1997, or not later than June 29,1997.

Copies to:

Barbara J. Mann
Assistant Corporation Counsel 441 Fourth Street, N.W., #680 Washington, D. C. 20001

II III

David Deutsch, Esq.

|| 11|

Richard J. Farano, Esq.

U.S. Department of Justice

Civil Rights Division

10th and Pennsylvania Ave., N.W., #1744

JUDGE
US. v . District of Columbia
NH-DC-001-04

-2-
Jonathan D. Schiller, Esq. William A. Isaacson, Esq. 901 15th Street, N.W., #1100 Washington, D.C. 20005

 
 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

FILED

UNITED STATES,
Plaintiff, and M. ANNE HART, DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN,
Plaintiff-Intervenor,

) )

MAY 23 t997

)

Clark. UiS. District Court

)

District of Columbia

)

)

)

Civ. NO. 95-948(TFH)

)

)

)

v.

U.S. v. District of Columbia

DISTRICT OF COLUMBIA, fit a l , Defendants.

HHH

«•

••

HH •

•

NH-DC-001-041

QREER,

On February 21, 1997, the Court held a hearing to discuss the remaining matters in this case. At that hearing, all parties asked that the Court dismiss the case. With the submission of the Final Report of the Monitor, a copy of which is attached to this Order, andwith the parties' consent order to remedy the violations outlined in the audit o f patient accounts, the Court is satisfied that there are no remaining issues and will therefore dismiss the case.

I History of the Case This case originally came before the Court in May 1995,when the Department of Justice filed suit to require defendants to remedy conditions at the D.C. Village Nursing Home. Plaintiffs asserted a long list of violations of the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. §1997. On July 6,1995, the parties signed and the Court approved a consent motion that

obligated defendants to remedy these serious, sometimes inhuman, violations and to prevent further violations and retaliation against the residents of D.C. Village. On August 1, 1995, the Court appointed a Monitor, Dr. Harriet Fields, to oversee the District's compliance with the remedial consent order. Besides entering remedial orders, the Court also ordered the creation of specialty consult teams to aid the Monitor in her task of ensuring that every resident received an appropriate and adequate services or outplacement.
Although the District had obligated itself to pursue and implement radical changes in the facility, its compliance with the consent order was poor at best. Faced with the District's noncompliance, the Court held defendants in contempt of its remedial order on December 22, 1995, and on February 23, 1996.1
In late August 1995, rather than comply with its own agreement, the District abruptly decided to close the facility and failed to produce a plan for the successful placement of the D.C. Village residents into other facilities. Instead, it embarked upon a system of transfer and placement which was both unsupervised and inappropriate for the task of moving residents, many of whom suffered from serious physical ailments. The District's placement was a disaster— some residents did not even survive the process— and in February 1996, the Court had to suspend the outplacement and ask the Monitor to supervise the placement of residents into new facilities and ensure the District's compliance with the Court's Order. In June 1996, the last resident was outplaced. The testimonials of former D.C. Village residents, which are included in the Final
On May 10, 1996, the Court ordered defendants to pay each resident of D.C. Village $100.00 in compensatory damages and to pay $49,258.00 in compensatory damages to the District of Columbia Long Term care Ombudsman. Nine months later, the District has yet to comply with that order.

Report, are clear proof that the Monitor accomplished her goal of ensuring that each resident received an appropriate placement into a new facility.
II Current Status The need for Court involvement in this case has come to a close. The Monitor has filed her Final Report,2 and has concluded that all former residents of D.C. Village have been placed into facilities which are appropriate and adequate. The Final Report further assures the Court that those former residents are no longer subjected to illegal conditions or practices such as they experienced at D.C. Village. Therefore, the Court is satisfied that its remedial orders have been carried out and that the CRIPA violations have been remedied. Furthermore, the parties have undertaken an audit of the patient accounts of the former D.C. Village residents. The audit reveals that the residents are owed outstanding interest on their accounts. Defendants have entered into a consent order to pay this interest. Therefore, it is hereby ORDERED that, pursuant to the Court's May 10, 1996, bench order, defendants shall pay as compensatory damages $100.00 to each person who was a resident of D.C. Village on December 20, 1995, and $49,258.00 to the Office of the District of Columbia Long Term care Ombudsman. Defendants shall make such payments within 10 business days; it is further ORDERED that the consent order relating to interest payments to former residents of D.C. Village shall be part of this final judgment; it is further
For the benefit of the public, the Court has attached to this order a copy of the main body of the Monitor's Final Report.

ORDERED that the Complaints of plaintifiFand plaintifF-intervenor are dismissed without prejudice as moot.

o 1997

Thomas F. Hogan United States District Judge

AO72A (Rev. 8/82)

 
 AEP:BPS:DD:CA:drb DJ 1 6 8 - 1 6 - 1 1

U.S. v. District of Columbia NH-DC-001-001
AUG , 9

REGISTERED MAIL RETURN RECEIPT REQUESTED
Honorable Sharon Pratt Dixon Mayor of the District of Columbia District Building 1350 Pennsylvania Avenue, N.W. Washington, D.C 20004
Re: District of Columbia Village Nursing Home CRIPA Investigation
Dear Mayor Dixon:
On August 20, 1990, we notified the Mayor's Office of our intention to investigate the District of Columbia Village Nursing Home (D.C. Village) pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. §1997 et seq. As contemplated by CRIPA, we are now writing to inform you of the findings of our investigation and to outline the minimum measures necessary to remedy the unconstitutional conditions at D.C. Village.
In connection with our investigation, attorneys from the Department of Justice toured D.C. Village on January 24-25, 1991, with two geriatric care specialists - a psychiatrist and a clinical nurse. In addition to touring the facility, each consultant observed residents, conducted interviews and reviewed care records and other documents. Throughout the investigation, District representatives were helpful and cooperative. We appreciate their efforts.
D.C. Village is licensed and designed as a long-term care nursing home for geriatric patients. However, the District has also chosen to place at the facility persons with acute and chronic mental illness, mental retardation, severe physical handicaps and children who are mentally ill, mentally retarded or both, or simply "boarder babies" — all placed at D.C. Village as overflow from other parts of the District's institutional care system. Thus, D.C. Village is being asked to function as a chronic care hospital, as an acute care psychiatric treatment facility and as a facility for the developmentally disabled,
cc: Records Chrono Peabody Schoen Deutsch Alford Hold

IT

- 2-
although it is organized, staffed, funded and licensed as a nursing home.
Our investigation found that D.C. Village is generally providing adequate nursing and medical care for its geriatric patients. Likewise, adequate custodial care is being provided for the children, including "boarder babies," residing at the facility. However, D.C. Village is simply not equipped to provide the specialized treatment and training required for its mentally ill and mentally retarded populations. Were these residents to be appropriately placed in care facilities designed and staffed to meet their specialized needs, the chances that they would receive appropriate training and treatment would be dramatically increased. Nevertheless, to the extent that mentally ill and mentally retarded individuals are confined at D.C. Village, the District is required to provide adequate psychiatric care and such training as would ensure that they are not exposed to unreasonable risks to their personal safety and are free from undue bodily and chemical restraint. See Youngbera v. Romeo, 457 U.S. 307, 324 (1982).
Although there have been improvements made at D.C. Village in recent months, our investigation identified several conditions which continue to pose health and safety risks to D.C. Village residents, thereby denying them their constitutional rights to adequate medical care and a reasonably safe environment. As detailed below, the deficiencies that have caused unconstitutional conditions include: D.C. Village's failure to provide minimally adequate training programs sufficient to ensure that residents are free from undue restraint; inadequate psychiatric care; insufficient numbers and training of staff; and inadequate recordkeeping.
I. Inadequate Training Programs
D.C. Village fails to provide professionally developed individualized training programs that are sufficient to ensure that residents are not subjected to unwarranted and unreasonable restraints. Following a careful review, our consultant psychiatrist concluded that physical and chemical restraints are both overused and dangerously misused by D.C. Village staff on residents because of the unavailability of trained and supervised professional and direct care staff, as well as the lack of essential training programs.
D.C. Village staff consistently fail to identify and eliminate circumstances which provoke problematic behaviors in residents, particularly those who are mentally retarded. Both of our consultants found that staff intervention focuses almost exclusively on restraint to control maladaptive or aggressive behavior, without resort to other recognized therapy methods. Throughout their tour, our consultants observed physical

|M| o _
restraints (posey vests) routinely fastened backwards which places residents at risk of strangulation.
Likewise, our consultants found current D.C. Village behavioral programs to be inadequate. For example, the records reviewed document that residents demonstrating self-injurious, physically abusive or other destructive behaviors are not being provided appropriate training to reduce or eliminate such behaviors.
In addition, the limited behavior programs that are provided are not data based and thereby fail to meet professional standards. D.C. Village lacks a facility-wide behavioral observation system that is used by all staff. Absent appropriate data, D.C. Village staff cannot evaluate whether behavior programs are effective.
Staff also fail to collect and provide behavioral data to the consulting psychiatrist for evaluation of the need for continued medication. The psychiatrist is thus limited in his ability to determine whether medication should be adjusted or withdrawn resulting in the risk of undue chemical restraint. D.C. Village also fails to provide adequate behavioral programming for residents taking psychotropic medication. The programming that does exist, moreover, is not integrated with the use of psychotropic medication.
Thus, D.C. Village's failure to provide professionally designed and implemented individualized training programs has resulted in residents being subjected to unreasonable physical and chemical restraints.
II. Inadequate Psychiatric Care «.
Our consultants concluded that D.C. Village's use and monitoring of psychoactive medications depart from accepted medical practice and fail to protect residents from serious risks of harm. ^Our consultants found that D.C. Village has inadequate procedures for monitoring the effectiveness of medications prescribed. As a result, residents are not treated for side effects or may continue to receive medications that are not effective and do not resolve their medical conditions. For example, high dosages of psychoactive medications are widely used, despite the absence of relevant clinical indications. Necessary evaluations of medications are not made nor is there evidence of attempts at "drug-holidays" or at gradual reduction after extended usage at the same dosage. Of equal concern is the frequent use of psychoactive drugs on a PRN ("as needed") basis. The use of psychotropic medications without appropriate monitoring by qualified professionals can result in serious harm to residents.

(?•:- =
- 4-
Our interviews with the nursing staff disclosed that D.C. Village's psychiatric consultant rarely comes to the facility to review resident records or speak to staff. Residents are often sent to the psychiatrist's office without their records. The exchange of behavioral data between the consulting psychiatrist and D.C. Village is minimal. Without such information, the psychiatrist's ability to determine whether medication should be adjusted or withdrawn completely is undermined. Residents taking such medication are placed at increased risk of being subjected to undue chemical restraint or harm from drug side-effects.
III. Insufficient Numbers and Training of Staff
Our investigation found that D.C. Village is generally providing adequate nursing and medical care for its geriatric and adolescent patients. However, D.C. Village is simply not equipped to provide the specialized treatment and training required for its mentally ill and mentally retarded populations.
Given the pressing needs of its residents, the most glaring personnel deficiency is the shortage of staff with specialized training. As noted, while D.C. Village is licensed as a nursing home, a significant number of residents there have serious psychiatric illnesses and/or are developmentally disabled, severely impaired and difficult to manage. Our consultants concluded that the current D.C. Village staff are inadequate to deal with the complex psychiatric and medical needs of these populations.
Both of our consultants concluded that D.C. Village has an insufficient number of psychiatric and psychology staff to provide adequate care and training and to render necessary professional judgments. Consequently, residents are not receiving the care and training necessary to protect them from unreasonable risks to their personal safety and to ensure freedom from, undue bodily restraint.
IV. Inadequate Recordkeeping
Inadequate recordkeeping practices have compromised D.C. Village's ability to provide adequate care to its residents. Our consultants found that D.C. Village lacks a record-keeping system sufficient to provide accurate, relevant and timely information upon which professional decisions may be based regarding the necessary care for residents. Our consultant concluded that, although resident records are well maintained by nursing staff, meaningful progress notes by other appropriate professionals are either absent or inadequate. Records lack sufficient information to justify orders for medications or changes in medication, thereby adding to the difficulty of providing continuity of care. The absence of such data undermines the ability to assess the interaction of drugs and

- 5-
behavioral intervention, a process necessary to evaluating treatment efficacy.
V. Minimal Remedial Measures
The aforementioned conditions deprive D.C. Village residents of their constitutional rights. To rectify these deficiencies and to ensure that constitutionally adequate conditions are established and maintained at D.C. Village, we propose to enter into a legally binding and judicially enforceable agreement with the District of Columbia that provides, at a minimum, for the following remedies:
1. D.C. Village must modify and/or implement medication practices to ensure that they comport with accepted professional medical standards;
2. D.C. Village must provide professionally designed training programs for those residents for whom such training can reduce or eliminate unreasonable risks to their personal safety and/or the use of undue bodily restraint. Residents with selfinjurious, physically abusive or other destructive behaviors must be identified immediately and provided training to reduce or eliminate such behaviors;
3. D.C. Village must hire and employ a sufficient number of qualified professional staff to provide adequate psychiatric care, as well as to design and implement the kind of training programs described in paragraph 2 above;
4. D.C. Village must train staff in behavior therapy and methodology sufficient to provide D.C. Village residents with minimally adequate training, as described- in paragraph 2 above;
5. D.C. Village must improve recordkeeping and administrative practices to enable qualified professionals to make judgments regarding resident treatment and training.
As we have noted, many of the above remedies would be rendered moot if the decision were made to appropriately place individuals in accordance with their specialized needs in other facilities able to meet such needs. Failing that, the above remedies are necessary in order to afford D.C. Village residents their constitutional rights.
Information about Federal financial assistance which may be available to assist with the remedial process can be obtained through the United States Department of Health and Human Services' Regional Office (Director, Intergovernmental and Congressional Affairs), and through appropriate officials of the United States Department of Education.

t •
— 6 ~*
Our attorneys will be contacting legal counsel for the District's Department of Human Resources shortly to arrange a meeting to discuss this matter in greater detail. In the meantime, should you or your staff have any questions regarding this matter, please feel free to call Arthur E. Peabody, Jr., Chief, Special Litigation Section, at (202) 514-6255. To date, we have been able to conduct this investigation in the spirit of cooperation intended by the Civil Rights of Institutionalized Persons Act, and look forward to continuing to work in the same manner with District officials toward an amicable resolution of this matter.
Sincerely,
John R. Dunne Assistant Attorney General
Civil Rights Division
cc: Honorable John Payton Corporation Counsel for the District of Columbia
Jay Stephens, Esquire United States Attorney for the District of Columbia
Mr. Terry Thomas Administrator D.C. Village

 
 U.S. Department of Justice Civil Rights Division

Office of lh<

r.; A::or-.; .

Washington. D.C. 20530

OCT BS4

The Honorable Sharon Pratt Kelly Mayor of the District of Columbia Office of the Mayor One Judiciary Square 441 4th Street, NW Washington, DC 20001

U.S. v. District of Columbia NH-DC-001-002

R: D.C. Village Nursing Home

Dear Mayor Kelly:

On August 20, 1990, we notified the Mayor of the District of Columbia, the Corporation Counsel for;4the District of Columbia, and the Administrator of D.C. Village ("DCV"), of our intention to investigate allegations of unconstitutional conditions at DCV pursuant to the Civil Rights of Institutionalized Persons Act ("CRIPA"), 42 U.S.C. § 1997 et. sea. In January 1991, we completed an investigative tour of the facility with two expert consultants. On August 19, 1991, we informed the then Mayor and other District officials that we had reasonable cause to believe that persons residing in or confined to DCV were being subjected to conditions that deprived them of rights, privileges, and
iimmmmiuiTniiiti-iieosc cseo^nrpn by the Constitution of tha United States. Younabera v. Romeo, 457 U.S. 307 (1982).

Attorneys from the District's Office of the Corporation Counsel, and the District's Department of Human Services indicated that remedial measures would be implemented at DCV to correct any constitutional deficiencies. To ensure that the necessary remedial action had been or would be undertaken, in April 19 92, we conducted a follow-up investigation at DCV with four expert consultants. Unfortunately, we found that constitutional deficiencies persisted at DCV. On October 22, 1992, we informed the Office of the Corporation Counsel that the persons residing in or confined to DCV continued to be subjected to conditions that deprived them of their constitutional rights. Again, the District's counsel indicated that steps had been or would be undertaken to correct any problems.

On April S, 1994, we notified the Office of the Corporation Counsel of our intention to conduct a follow-up investigative tour to assess current conditions at DCV. On June 6-7, 1994, we

.'

- 2

conducted our tour of the facility accompanied by four expert consultants: Rebecca Elon, M.D., a geriatric physician, Blaine Greenwaid, M.D., a geriatric psychiatrist, Richard Amado, Ph.D., a psychologist, and Mary..Ellen Anderson, R.N. Consistent with statutory requirements, we are now writing to advise you of our -findings. We regret to advise you that our investigative tour revealed that the residents at DCV are continuing to be subjected to conditions that deprive them of their constitutional and statutory rights.

DCV is organized, staffed, funded and licensed as a nursing home to care for elderly persons. Nonetheless, the District has inappropriately placed at the facility a disparate group of individuals including children, persons with mental illness, and persons with developmental disabilities, including mental retardation, simply because other parts of the District's care system lack available space and services to provide necessary care. Thus, the District has asked DCV to function as an acute and chronic care psychiatric treatment facility and as a developmental center even though DCV is not equipped to provide the specialized treatment and trainincr required for its mentally ill and mentally retarded populations.

As a result, DCV is not meeting the needs of its residents. In addition to providing inadequate care and services to its mentally ill and mentally retarded residents, DCV provides inadequate medical and nursing services to all its residents. DCV is unable to provide even adequate nursing home services to its geriatric population. All this has produced a host of serious problems including needless suffering and risk of harm, an excessive number of hospitalizations, and an unusually large number of deaths due to aspiration.

The District must reorganize DCV to permit the facility to fulfill -its lawful purpose, i.e., to provide nursing home and related services to the elderly. The District should place all children and individuals with mental illness or mental retardation in appropriate community based facilities and programs. Were these residents to be appropriately placed in care facilities designed and staffed to meet their specialized needs, the chances that they would receive appropriate training and treatment would be dramatically increased. Nonetheless, to the extent that mentally ill and mentally retarded individuals are confined at DCV, the District is required to provide them with adequate psychiatric care and/or training. Younabera, 4 57 U.S. 307; Preadmission Screening and Annual Review of Mentally 111 and Mentally Retarded Individuals ("PASSAR") 42 C.F.R. § 483.100 et. sea. (1994).

All residents of state operated institutional facilities, including nursing homes, have a fundamental Fourteenth Amendment due process right to adequate food, clothing, shelter, medical

care, reasonably safe conditions, and training. Younabera. 4 57 U.S. 307. As such, this right entitles residents to such care and training as to protect each residents' liberty interests and permit each resident an->.opportunity to function as independently as is reasonably possible. Individuals with disabilities have a right to programs to teach adaptive behaviors, self-help skills, communication, social skills, and skills necessary to enhance independence. See, e.g.. United States v. Tennessee, No. 922062, slip. op. (W.D. Tenn. Feb. 17, 1994); Thomas S. bv Brocks v. Flaherty, 699 F. Supp. 1178 (W.D.N.C. 1988}. See also 42 C.F.R. § 483.440 {Each institutionalized client is entitled :o a continuous and aggressive active treatment program that is directed towards the "acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible.").

The faces disclosed during the course of our investigation

supporting our findings of unlawful and unconstitutional

conditions at DCV are set forth below.

• • .-

X. MEDICAL CARS IS INADEQUATE.

DCV is failing to ensure that DQV residents receive adequate preventive, chronic, routine, acute, and emergency medical care in accordance with generally accepted standards of care.

The most pressing medical concern at DCV is that the medical staff routinely fails to assess and respond in a timely and appropriate fashion to individuals with aspiration pneumonia or risk of aspiration, dysphagia or swallowing difficulties, and decreased oral intake. As a result of this inadequate care, many DCV residents have died. A shockingly high number of DCV residents have died due to some form of aspiration, pneumonia or feeding dysfunction. Since June 1 / 1992, at a minimum, 19 individuals are listed as having died at least in part due to "aspiration"; at least 18 others have died due to some form of "pneumonia" {which could be related to aspiration). Many of these and other individuals have died in part because of a "feeding dysfunction." Many current DCV residents have beer. needlessly subjected to prolonged suffering and discomfort punctuated by repeated hospitalizations merely because the medical staff at DCV has been unable to adequately assess or respond to the residents' aspiration risk or dysphagia. The DCV staff has failed and is failing to determine what specialized medical services are required for these residents and to ensure that such services are timely obtained whenever necessary. The DCV primary physicians also fail to ensure adequate continuity of care for these residents with outside hospitals when hospitalized and with outside medical consultants when furnished with a specialty consult.

- 4-
Generally, the medical staff at DCV is failing to provide the residents with adequate medical assessment, diagnosis, treatment and monitoring of their conditions in keeping with generally accepted standards of medical care. For example, DCV primary care physicians fail to conduct comprehensive evaluations of all residents for whom"they are responsible. Even though a medical treatment plan is urgently needed for each resident, DCV fails to provide each resident with an adequate, individualized medical plan of care. Our consultants could find no integraced medical plan of care in any DCV resident's chart. The medical staff is also failing to respond to changes in an individual's medical condition in a timely and appropriate fashion. Finally, the DCV medical staff inadequately monitors the effectiveness of medications prescribed. DCV medical records lack sufficient information to justify orders for medications or changes in medication. The absence of such data undermines the ability to evaluate the efficacy of medication treatment. As a result, residents may continue to receive medications that are not effective and do not resolve their medical condition. This also unnecessarily exposes these individuals to the risks of medication side effects.
DCV is failing to provide adequate and appropriate routine, chronic, and emergency seizure management to all epileptic individuals at DCV in accordance with accepted professional standards of care. Individuals prone to seizures need regular and periodic medical review of their condition and care. However, at DCV, there is grossly deficient medical practice in this respect. DCV fails to provide individuals with epilepsy with a comprehensive neurological assessment of their condition; and there is no apparent neurology follow-up of residents with epilepsy either by a DCV physician or by an outside consultant neurologist. As a result, it is not clear whether many DCV residents still need to be taking anticonvulsant medication..
DCV fails to provide adequate staffing to meet residents' medical needs. As we first indicated to you in our 1991 findings letter, DCV does not have the expertise, and is simply not equipped to provide the specialized medical care and treatment required for its mentally ill and mentally retarded populations. To make matters worse, DCV fails to provide its medical staff with needed staff development and continuing medical educational opportunities that would help enable them to meet these needs. On our most recent visit, staff at the facility complained to us that there were endemic staff shortages at DCV. With respect to physician staffing levels, for example, Dr. Allin, a psychiatrist at DCV, has been pressed into duty as a surrogate internist because of staff shortages. Dr. Allin is trained as a psychiatrist, not as a primary care physician, so the individuals under his care are not being afforded the needed services of a general care medical doctor. In addition, there is a trend at DCV to hire contract physicians who, at least initially, will be

- 5-
largely unfamiliar with the needs of the DCV residents they are to care for. This is already a problem at DCV given the large number of contract/ agency nursing staff employed at the facility. In short, the, current DCV staff is quantitatively inadequate and qualitatively deficient to deal with the cornoiex medical needs of the DCV population.

DCV violates generally accepted practice by failing to maintain adequate and appropriate medical records with proper documentation. Interdisciplinary team notes in the individual residents' charts are grossly inadequate; meaningful progress notes are either absent or inadequate as physicians do not consistently make notes in the individuals' charts when appropriate; and medical forms in the charts are not up-to-date and often have inexplicably not been updated for months or even years. In short, DCV lacks a recordkeeping system that is sufficient to provide accurate, relevant and timely information upon which professional decisions tnay be based regarding the necessary care for residents. As we first indicated in 1991, inadequate recordkeeping practices have compromised D C V s ability to provide adequate care to its residents.

There are many other specific deficiencies in the provision of medical care and services at DCV including the DCV medical quality assurance system. In this regard, the staff fails to ensure that ordered services are actually rendered and that ordered medications are actually given to residents.

II. NURSING CARE IS INADEQUATE.

'

DCV is failing to ensure that its residents receive adequate nursing care, and that DCV nurses perform their responsibilities in keeping with accepted professional standards of care by adequately identifying health care problems, notifying physicians of health care problems, monitoring and intervening to ameliorate such problems, and keeping appropriate records of residents' health care status.

One of the most urgent problems at DCV is the facility's failure to provide each individual with adequate and appropriate nutritional management in accordance with accepted standards of care. This failure has placed many DCV residents at risk of aspirating which is an extremely dangerous, potentially life-threatening situation. DCV is failing to identify, assess and diagnose each individual who has a nutritional management problem, including difficulty swallowing, chewing, or retaining, assimilating or eliminating food and/or liquids. DCV is failing to ensure that residents are not fed improperly or while " improperly positioned in a wheelchair. The DCV staff does not provide adequate medical and nursing care services with respect to those individuals with dysphagia and other eating disorders. DCV has failed to develop screening indicators to identify

" .

- 6-

individuals who are aspirating, are at risk of aspirating, and/or who have symptoms of gastroesophageal reflux. DCV is failing to provide comprehensive, interdisciplinary evaluations and diagnoses for these individuals and is failing to identify medical, dietary, feeding ar.d positioning needs of each such individual. Even for those individuals so identified, DCV fails to regularly monitor the progress of the DCV residents at risk of aspirating ar.d to take whatever assessment, diagnostic, treatment, or supervision steps are necessary to ameliorate the individual's risk.

The nursing assessments at DCV are inadequate and are no: in keeping with accepted professional practices. DCV fails to conduct adequate comprehensive nursing assessments with quarceriy updates of the nursing care needs of the DCV residents. DCV also fails to develop and implement adequate and appropriate comprehensive nursing care plans to address each resident's health care needs in accordance with accepted professional practices. DCV also fails to develop and implement an appropriate nursing care plan to address any acute condition. Moreover, nursing staff should routinely monitor each individual's current condition and review treatment needs. However, DCV fails to routinely perform on-going monitoring of serious medical conditions, and to undertake such basic procedures as taking vital signs and monitoring other individualized health status information. For example, the DCV nursing staff routinely fails to monitor individual weights and respond to individual nutritional needs in a timely fashion. DCV needs an adequate quality assurance system to ensure that proper care and monitoring are being provided to the residents.

The current nursing staff is inadequate to meet the needs of the DCV residents. The clientele at DCV have very complex medical and nursing needs with many individuals having unique bathing -and/or toileting needs. Consequently, a sufficient nursing presence is crucial to their adequate care. The existing nursing staff has been forced to operate in a perpetual "crisis mode." As a result, nursing and medical care have greatly suffered. Nursing ratios must be increased generally to ensure the provision of basic nursing care, adequate supervision and therapeutic interaction for each resident.

There is currently a staffing problem given the widespread and common use of agency/contract nurses at DCV. Current nursing vacancies are not being filled, and according to the DCV Director of Nursing, agency/contract nursing staff now approaches fifty percent of total shift coverage within the facility. This is an extraordinarily high use of outside nurses and it is unacceptable. Such widespread use of agency/contract nurses presents serious risks to the health and safety of the DCV residents because the individual members of the contract staff often do not even know the names and identities of the residents

•

_7 _

•

.

•

to whom they are providing care and nursing services. As such,

the current practice at DOT is neither clinically appropriate nor

a safe means of providing nursing care to the DCV residents.

The DCV nursing staff needs to be inserviced to ensure that:

'"• they have been provided with the appropriate training to care for

the diverse and challenging DCV population. DCV nurses,

especially the contract nurses, are in urgent need of appropriate

inservice training on the specialized needs of the DCV

population, especially those with mental illness and those with

mental retardation.

.. .

There are other nursing deficiencies at DCV. For example, there is evidence of an excessive number of medication errors at DCV. The facility lacks adequate nursing protocols for certain problematic yet recurring conditions among the DCV residents: eating and swallowing disorders; non-ambulatory residents; residents with seizure disorders; residents with serious behavioral problems; residents with dementia and/or mental illness; residents with mental retardation; and residents prone to confusion, falling, bedwetting, etc. Nursing care rendered to immobile residents is inadequate. At DCV, they are bathed only every three days, they are provided w;Lth irregular and inadequate range of motion exercises, and they are not turned frequently enough, thus exposing them to the risk of decubiti. In addition, physical management is insufficient to meet the residents' needs.

There are also a number of basic care deficiencies at DCV.

For example, the facility fails to provide adequate pest control

throughout the institution. Our consultants frequently observed

ants at DCV on our most recent tour. On some units, there was a

foul odor akin to a urine smell. Finally, some residents

expressed concerns about missing and ill-fitting clothes, as well

as unappetizing foods.

•

III. PSYCHIATRIC CARE IS INADEQUATE.

The District is failing to provide DCV residents with adequate and appropriate psychiatric care and mental health services in accordance with accepted professional standards to residents who need such services.

DCV has an insufficient number of psychiatric staff to provide adequate care and training to meet generally accepted professional standards. In our 1991 letter, we notified you that one of the most glaring personnel deficiencies was the shortage of staff with specialized training in the care and treatment of mental illness. We indicated that the current DCV staff was inadequate to deal with the complex psychiatric and medical needs of the DCV population. Unfortunately, this is still true today. Even the staff at the facility complained to us on our most recent visit that there were endemic staff shortages at DCV and

"

-8 -

-""•

-

that this directly compromised the provision of psychiatric care and treatment. A recent example of the negative impact of the staffing shortage at DCV is the recent forced closure of Unit 3B which primarily served residents with mental illness. The staff is largely unfamiliar with the residents' individual psychiatric needs. This is especially true of the contract/agency staff at DCV. Because of the unavailability of trained and supervised professional and direct care staff, DCV both overuses and dangerously misuses chemical restraints on residents.

A psychiatrist working at a facility like DCV should not be

responsible for the primary medical care of any resident.

However, at DCV, Dr. Allin, a psychiatrist, has recently been

pressed into service as a surrogate internist because of staff

shortages. As a result, there is no qualified psychiatrist

working at DCV who is responsible solely for the coordination of

mental health services at the facility. Ever since Dr. Allin has

been saddled with inappropriate primary care responsibilities,

there has been a marked decrease in the quality of psychiatric

care rendered at DCV. Serving as a primary care physician has

kept Dr. Allin from providing psychiatric services to any

residents outside of those on his caseload, and has greatly

impaired his ability to tend to the psychiatric needs of his own

patients.

' ' '•'

It is generally accepted that individuals with mental illness, like those at DCV, are to be provided with adequate psychiatric assessment, diagnosis, treatment and monitoring of their condition. Specifically, they are to be afforded an initial comprehensive psychiatric assessment, a carefully considered psychiatric differential diagnosis based on DSM-IV criteria and objective behavioral data, a psychiatric treatment plan that is integrated with the individual'^ medical plan of care and with the individual's behavioral treatment programming, adequate psychiatric monitoring that includes quarterly updates of the psychiatric treatment plan, and at least a monthly psychotropic drug review to monitor drug efficacy, dosing and side effects. However, DCV does not afford this to its residents.

DCV is not providing its residents with a comprehensive psychiatric assessment including adequate behavioral data and with a functional analysis of the individual's behavior where appropriate. DCV also conducts no cognitive examinations or dementia work-ups of its residents. DCV is not providing its mentally ill residents with an integrated differential diagnosis and treatment plan which is signed by the psychiatrist. It is generally accepted in the field that a proper DSM-IV diagnosis be formulated and recorded before any institutionalized resident is provided psychotropic medication. However, the DCV medical staff is not familiar with and does not appropriately employ the DSM-IV criteria or terminology in formulating psychiatric diagnoses.

:

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-9 -

Many DCV residents have been placed on psychotropic medications without adequate documentation. This violates generally accepted practice.

With respect to psychiatric treatment at DCV, there is no effort made to integrate psychiatric care for the residents in a multidisciplinary fashion. Psychiatric notes are not integrated with the individual's overall medical plan of care or with behavioral treatment programs. Our consultant could not find a single integrated medical/ psychiatric/ psychosocial plan in any DCV resident's chart. It is generally accepted that prior toprescribing psychotropic medication for individuals with behavior problems, a facility is to specify that alternative non-pharmacological treatments have been systematically attempted and that they have been ineffective. However, this is not done at DCV. As we first indicated in our 1991 letter, DCV is failing to adequately integrate the use of psychotropic medication with behavioral programming. At DCV, there is no organized use of psychotropic medication in a carefully considered plan of care, and there is no rationale provided when medication dosages are changed. There is also no consistent correlation between medication order changes and progress note documentation of such changes. All this does not comport with accepted standards in the field. As a result, integrated psychiatric treatment plans are urgently needed for the DCV residents to ensure that programming options are exhausted before medications are perhaps needlessly employed.

Psychotropic medications are often used incorrectly at DCV. For example, medication dosing does not always conform to gsropsychiatric standards, dosing of antidepressants is inadequate or not properly titrated, depression is poorly documented (if at all), and there is widespread usage of PRN medication at DCV. There are also many individuals with the medication side effect of tardive dyskinesia ("TD") living at DCV. Yet, anticholinergic medications are improperly prescribed for TD, even though these agents will, in fact, worsen TD. The DCV physicians are confusing TD and extrapyramidal symptoms. This indicates a lack of basic neuro-chemical/ neuropharmacological understanding among medical providers at DCV and highlights the need for inservice training in psychopharmacology and geriatric psychopharmacology. Our consultant concluded that the DCV primary care doctors are not adequately trained in the field of psychiatry. 1/

]_/ DCV provides virtually no inservice training on mental health issues for its medical care staff, nursing staff or other direct care staff. As a result, psychiatric care at DCV has suffered on every level. A continuing education program in mental health issues and practices needs to be developed for the medical,
{continued...}

' •

'

- io -

.

It is generally accepted that the monitoring of an

individual's progress on a given psychiatric treatment should

include the collection of appropriate objective and behavioral

data so as to ensure that the individual is receiving benefit

from the treatment. However, at DCV, the staff fails to collect

and provide behavioral data to the physician or psychiatrist for

evaluation of the particular treatment. In fact, at DCV, there

is no evidence of follow-up by the psychiatrist or primary care

physician regarding a resident's progress on a given psychiatric

treatment.

, .

As we first indicated in 1991, the facility's monitoring of psychoactive medications departs from accepted medical practice and fails to protect residents from serious risks of harm. Because of the dearth of behavioral and other data collected at DCV, the physician or psychiatrist is limited in his ability to determine whether a particular medication regimen has been successful or not, and whether it should be adjusted or withdrawn. This produces the risk of undue chemical restraint. Psychotropic medications used without continual justification by objective, accurate, individualized behavioral data constitute restraint for behavioral control purposes.. In addition, necessary evaluations of medications tare not made at DCV, nor is there evidence of attempts at "drug holidays" or at gradual reduction after extended usage at the same dosage. Once DCV achieves stabilization of acute behavioral symptoms through medication, the staff no longer provides dynamic treatment; the treatment becomes static.

In addition, side effects of psychotropic medications are inadequately and improperly monitored at DCV. Vie first notified you in 1991 that DCV residents are not adequately monitored for drug side effects. For example, there currently is no regular review of prescribed psychotropic medications to integrate side effects with symptoms; DCV does not take postural blood pressure ratings on residents; and our consultant found that AIMS scores in residents' charts appeared to be perfunctory and did not correlate with his own observations.

IV. PSYCHOLOGICAL SERVICES ARE INADEQUATE.

The District is failing to provide the residents of DCV with that level of minimally adequate individualized behavioral programming to ensure and protect the DCV residents' liberty interests in personal safety and freedom from undue or unreasonable restraint.

i/(...continued) psychiatric, nursing and other staff. In addition, the pharmacy department should be inserviced on geriatric psychopharmacology.

- 11 -

Individuals living in an institution like DCV must be protected from physical injury and psychological harm stemming from behavior problems. An individualized behavioral treatment: program, devised and implemented according to currently accepted professional standards, can reduce and eliminate these ma1adaptive behaviors. However, the behavioral treatment programs currently utilized at DCV substantially depart from accepted professional standards. DCV fails to provide an adequate array of comprehensive individualized training programs developed by qualified professionals consistent with accepted professional standards to reduce or eliminate risks to personal safety, unreasonable use of bodily restraints, prevent regression, and facilitate the growth, development, and independence of every DCV resident. Our consultant psychologist found that DCV residents are being subjected to harm and unreasonable risk of injury due to major deficiencies in the assessment of residents and in the development, implementation and monitoring of resident behavioral programs. As a result, the District is failing to provide reasonably safe conditions and to ensure the reasonable safety and personal security of the DCV
resi nts.

All behavioral programs must be^based upon an adequate

assessment of resident need, including the need to develop

programs to address maladaptive behaviors. DCV residents have

evidenced quite a range of maladaptive behaviors, including

self-injurious behavior, pica, including ingesting feces and

drinking from the toilet, and aggression. At every stage of the .

assessment, analysis and treatment of an individual's behavioral

problems, DCV is failing to meet accepted professional practices.

The inadequacies in the development and implementation of

behavioral programs at DCV have deprived the residents of

effective treatment for their maladaptive behaviors and violated

their rights.

'

.

Residents demonstrating self-injurious, physically abusive or other destructive behaviors are not being provided appropriate training to reduce or eliminate such behaviors. The limited behavior programs that are provided are not data based and thereby fail to meet professional standards. DCV lacks a facility-wide behavioral observation system that is used by all staff. Absent appropriate data, DCV staff cannot evaluate whether behavior programs are effective.

The District is engaging in the use of chemical restraints by failing to ensure that psychotropic medications are prescribed and administered to DCV residents in keeping with accepted professional standards, and are not used in lieu of treatment, or for the convenience of staff. For those dually diagnosed individuals who need both behavioral programming and medication for their mental illness, it is extremely important that the two treatments are integrated properly. Accurate and reliable

- 12 -
behavioral data is particularly important when behavioral programs are combined with pharmacological treatment. In addition, written programs must show that the psychologist and physician have discussed the probable consequences of the combined treatments • However, at DCV, the level of integration of behavioral and pharmacological interventions is minimal. DCV fails to provide adequate behavioral programming for residents taking psychotropic medication. The programming that does exist, moreover, is not integrated with the use of psychotropic medication. •..
For those individuals on psychotropic medication, it is generally accepted that the treatment monitoring process is to involve continual reevaluation of the individual's existing behavior management program to determine whether it is appropriate and effective and whether the programs or interventions need to be developed or modified to address the resident's target behaviors so as to reduce or eliminate the need for psychotropic medication. However, DCV employs inadequate procedures for monitoring the effectiveness of behavioral programs and/or medications prescribed.
The District is failing to ensure that DCV residents are free from undue or unreasonable restraint, DCV fails to provide professionally developed individualized training programs that are sufficient to ensure that residents are not subjected to unwarranted and unreasonable restraints. For example, instead of programming, DCV routinely uses mitts to control the maladaptive behaviors of certain residents. The DCV staff consistently fails to identify and eliminate circumstances which provoke problematic behaviors in residents, particularly those who are mentally retarded. As a result, the staff intervention invariably focuses on restraint to control maladaptive or aggressive behavior, without resort to other recognized therapy methods. Physical and chemical restraints are both overused and dangerously misused by DCV staff on residents because of the lack of essential training programs.
Not all residents with behavior problems are being provided with a comprehensive interdisciplinary evaluation to determine the individual's need for training. As mentioned, there is no adequate behavior data collection system in place at DCV. For individuals with problem behaviors, DCV is failing to provide them with adequate functional analyses.
The District is also failing to provide DCV residents with that level of individualized training necessary to enhance functioning, and facilitate growth, development, and independence. In the absence of such programs, residents do not develop the skills necessary to exercise any degree of independence and they remain totally dependent on staff to meet all their needs.
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DCV residents' functional capabilities are deteriorating because of inadequate interaction, stimulation and treatment. Our consultants observed that the residents typically sit around all day with nothing to.-.po. Often this occurs while individual staff are in the room watching television. As a result, training programs at DCV are not implemented, revised or updated. In talking with staff on the units, it was not clear at all to our consultant that the residents who were sucoosed to be gettincr programming were actually getting it. Individual staff on the units were, for the most part, completely unfamiliar with the individuals' programming needs. In fact, the programming books that they are to use are located at a location far from the actual living units. Further, the training programs as written, focus on activities for the staff to do for the resident instead of for the resident to complete him or herself. This does not comport with generally accepted practices. The communication programs ir. place at DCV are inadequate in that they do not teach the residents to express their needs and wants. Activity programs and level of staff interaction are not adequate to even ensure maintenance of existing functional levels. Currently, activities of daily living and assistance with eating are considered activity therapy and are used to justify very limited provision of occupational and physical therapy.
We noticed a recurring problem at DCV in that there was a shortage or absence of needed adaptive equipment. For example, the speech therapist regularly noted that adaptive spoons or adaptive cups were not available for use with the residents. Even though this occurred repeatedly, DCV took no steps to remedy or even reference the problem in a quarterly or monthly review.
As we indicated in 1991, inadequate recordkeeping practices have compromised DCV's ability to provide behavioral treatment and training to its residents. DCV lacks a recordkeeping system sufficient to provide accurate, relevant and timely behavioral data upon which professional decisions may be based regarding the programming for its residents. The absence of such data undermines the ability to assess an individual's progress on a given treatment plan and the interaction of drugs and behavioral intervention.
DCV does not provide adequate psychology service hours to its residents. As we indicated in 1991, the most glaring personnel deficiency is the shortage of staff with specialized training. The current DCV staff is inadequate to deal with the complex psychiatric and psychological needs of the DCV population. Physical and chemical restraints are both overused and dangerously misused by DCV staff on residents because o£ the unavailability of trained and supervised professional and direct care staff.

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V . FEDERAL STATUTORY VIOLATIONS
Based upon our tours, we believe that the District is not in full compliance with a -number of federal statutes and regulations. For example, the District is not meeting the PASSAR requirements pursuant to "4 2 C.F.R. § 483.100 et sea. (1994). For those mentally retarded and mentally ill individuals confined at DCV, the District must provide them with adequate and appropriate specialized services. Fcr those with mental illness, this includes, for example, the continuous and aggressive implementation of an individualized plan of care that, among other things, works toward reducing the resident's behavioral symptoms and improving his or her level of independent functioning. For those individuals with mental retardation, it entails, for example, the aggressive and consistent implementation of a program'that works to enable the individual to acquire behaviors necessary for the individual to function with as much self-determination and independence as possible. However, the District fails to adequately provide and implement these services for its mentally ill and mentally retarded residents confined at DCV.
The District is also failing to 4meet the requirements of the Americans with Disabilities Act of 1990 ("ADA"), 42 U.S.C. § 12101 et. sec.. and the regulations promulgated pursuant thereto; and Section 504 of the Rehabilitation Act of 1973 ("Section 504"-), 29 U.S.C. § 794 et, sea. , and the regulations promulgated pursuant thereto with respect to many individuals, especially children and other individuals whose primary diagnosis is mental disability -- individuals with mental illness or developmental disabilities. DCV is an isolated, self-contained environment which necessarily separates its ^residents with disabilities from the rest of society. As a-result, the facility fails to provide its residents treatment in an environment that permits contacts with society and its mainstream social institutions, demands independent functioning and permits the exercise of judgment and contact with family members. The District must provide its residents with disabilities an opportunity to participate in or benefit from aids, benefits and services equal to that afforded to others outside the institution; more specifically, to those provided to other individuals with disabilities in the District's well established community-based programs. The residents are entitled to aids, benefits and services that are as effective in affording them the equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as those served in community-based programs. By confining residents with disabilities at DCV, the District is failing to provide such services in the least separate, most integrated setting as required by the ADA and Section 504.
mi

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Further, we are concerned that the District may not be providing its school-aged residents with an appropriate education in accordance with the requirements of the Individuals with ' Disabilities Education Act {"IDEA"), 20 U.S.C. § 1400 et sea. The DCV children are not being served in the least restrictive environment. Confined at -the facility, they are necessarily denied adequate involvement and interaction with other schoolaged children contrary to the IDEA.
In addition to the above statutory and regulatory violations, we note the many historical violations, cited by the Health Care Financing Administration, of the Medical Assistance Program (Medicaid) established under Title XIX of the Social Security Act, 42 U.S.C. § 1396r et se_g., and the regulations promulgated pursuant thereto, and of the Health Insurance Program for the Aged and Disabled (Medicare) established under Title XVIII of the Social Security Act, 42 U.S.C. § 1395i et sea., and the regulations promulgated pursuant thereto.
VI. MINIMAL REMEDIAL MEASURES
In addition to the remedial measures specified in our letter dated August 19, 1991, the following^additional measures, at a minimum, need to be implemented at DCV in order to protect the rights of residents and other individuals with disabilities currently confined there.
1. Facility Reorganization
a. Steps must be taken to ensure that the facility is operated as a nursing home consistent with currently accepted professional standards of care by, inter alia, placing all inappropriately placed1individuals, i.e., children and other individuals with a primary diagnosis of mental illness or mental retardation, in appropriate community based programs and facilities. Priority in placement should be given to children. No further children shall be admitted to the facility. All services developed to serve these individuals will be provided in the least separate or most integrated setting.
b. All residents of DCV with mental disabilities should be professionally evaluated to determine the residential, day program,, medical and other services needed to serve them in the community. Such programs should be established within a reasonable period of time and the residents placed in them. All placements should be monitored consistent with professionally based quality assurance standards and no person shall be placed in any program which cannot fully meet their needs.
C. All school-aged children should be evaluated to determine their individual needs with respect to educational services, related services and auxiliary aids to permit them to

- 16 -
be placed and receive appropriate educational services in the least restrictive environment.
d. To the extent ....that children and other individuals with disabilities remain at DCV for any period of time, services must be enhanced to meet their -specialized needs, including requirements for adequate treatment and training.
2. Medical C=re
The District shall ensure that DCV residents receive adequate preventive, chronic, routine, acute, and emergency medical care ir. accordance with generally accepted standards of care. To this end, DCV primary care physicians shall:
a. Conduct comprehensive evaluations of all residents for whom they are responsible;
b. Determine what specialized medical services are required for the residents for whom they are responsible and ensure that such services are timely obtained whenever necessary to evaluate or treat the individual's medical problems;
c. Ensure that each individual'has an integrated medical plan of care to address any chronic medical problem;
d. Ensure that each individual's medical status and progress in response to the individual's medical plan of care is fully and adequately reviewed.
DCV shall provide adequate medical care for those individuals at risk of aspirating. . To this vend, DCV shall: •
a. Identify individuals who are at risk of aspirating;
b. Take any appropriate medical steps to ameliorate the individual's aspiration risk and develop and implement an individualized feeding and positioning plan for each individual identified as at risk of serious illness, injury, or death due to aspiration;
c. Develop and implement a system to regularly monitor the progress of the DCV residents who are at risk of aspirating to ensure that the staff is continually taking whatever assessment, diagnostic, supervision and treatment steps are necessary to ameliorate the individual's risk.
The District shall provide adequate and appropriate routine, chronic, and emergency seizure management to all individuals with epilepsy at DCV in accordance with accepted professional standards of care . *,

> " - 17 -

3. Nursing Care

.

•

The District shall ensure that residents receive adequate nursing care, and that D.CV nurses perform their responsibilities in keeping with accepted professional standards of care by :-adequately identifying health care problems, notifying physicians of health care problems, monitoring and intervening to ameliorate such problems, and keeping appropriate records of residents' health care status. To this end, DCV nurses shall:

a. Conduct adequate, comprehensive assessments;

b. Develop and implement adequate and appropriate

comprehensive nursing care plans to address each resident's

health care needs;

• -

' •

C. Routinely perform on-going monitoring of serious medical conditions, including such basic procedures as taking vital signs and measuring weights;

d. Develop and implement a system for recording important information about a resident's status to monitor changes;

e. Ensure that all DCV residents receive adequate and appropriate food, shelter, and clothing.

The District shall provide e-ach individual"" at DCV "with adequate and appropriate nutritional management in accordance with accepted standards of care. To this end, DCV shall:

a. Identify each individual who has a nutritional

management problem, including dysphagia, difficulty swallowing,

chewing, or retaining, food and/or liquids; * •

;

b. Have an interdisciplinary team of oral motor specialists comprehensively assess each such individual to identify the causes for the nutritional management problems;

C« Take necessary medical steps to ameliorate the problem;

cl. Develop and implement a system to regularly monitor the progress of the DCV residents with nutritional management difficulties to ensure that staff is continually taking whatever assessment, diagnostic, supervision and treatment steps are necessary to ameliorate the individual's difficulties.

The District shall provide each individual at DCV with adequate and appropriate physical management in accordance with accented standards of care.

4. Psychiatric Care

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' ;

The District shall provide adequate and appropriate routine and emergency psychiatric and mental health services in accordance wicn accepted professional standards to residents vho need such services. Psychotropic medication shall only be used in accordance with accepted professional standards and shall not be used as punishment, in lieu of a training program, for behavior control, in lieu of a psychiatric or neuropsychiatric diagnosis, or for the convenience of staff. DCV shall:

a. Conduct a comprehensive assessment of each DCV resident receiving psychotropic medication;

b. Develop an overall treatment plan for each resident with a diagnosis of mental illness with a description of clear, objective and measurable short-term, intermediate and long range goals and objectives for each resident including time frames for the achievement of each, and provide on-going monitoring of the treatment;
c. Document that, prior to using the psychotropic medication for behavior modification,^ other, less restrictive techniques have been systematically tried as part of a training program and have been demonstrated to be ineffective.

DCV must develop and implement an adequate system for detecting, reporting, and responding to any drug-induced side effects of psychotropic medication.

5. Psychological Services

The District shall provide an adequate'array of comprehensive individualized training programs at DCV developed by qualified professionals consistent with accepted professional standards to reduce or eliminate risks to personal safety, unreasonable use of bodily restraints, prevent regression, and facilitate the growth, development, and independence of every DCV resident. To this end, DCV shall:
a. Conduct a comprehensive interdisciplinary evaluation of each DO/ resident with special needs to determine the individual's need for training;

b. Develop and implement a professionally based, individually appropriate data collection system to measure relevant information about maladaptive behaviors and the conditions under which they occur, including, where appropriate, the frequency, intensity, and duration of the behaviors;

c. Have a qualified professional develop and implement a professionally based, individualized training program for each

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resident and provide each individual with an adequate number of hours of training.
The District shall-.'-ensure that bodily restraints, including emergency restraints and time out, are used only pursuant to accepted professional standards and that they are never used as punishment, ir. lieu of training programs, or for the convenience of staff.
6. Recordkeeoina and Staffing
The District shall establish and maintain an adequate record for each individual that comports with accepted professional standards that shall include current information with respect to his/her care, medical treatment, and training and shall require staff to utilize such records in making care, medical treatment and training decisions.
The District shall ensure that a sufficient number of professional and non-professional staff are employed to fully meet the needs of the DCV residents.
Pursuant to CRIPA, the Attorney .Qenezral may .initiate a lawsuit to correct deficiencies at an institution or otherwise to protect the rights of its residents 49 days after appropriate officials have been advised of the relevant violations of law. 42 U.S.C. § 1997b(a)(l). Therefore, we anticipate hearing from you as soon as possible but no later than 49 days after the date of this letter with any response you may have taken or intend to take to implement each of the remedies described above. If you do not respond within the stated time period, we will consider initiating an action against your jurisdiction to remedy the unconstitutional and unlawful conditions we nave identified. In your response/ please address your willingness to enter into a judicially enforceable agreement to memorialize any agreement we may subsequently reach regarding this matter.

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;

We look forward to working with you to resolve this matter in a reasonable and practical manner. If you or your staff has any questions, please feel free to contact Richard Farano at 202 307-3116, or David Deutsch at 202-514-6270.

Deval L. Patrick

;

'

Assistant Attorney General

Civil Rights Division

cc : Melvin Bolden, Esq. Assistant Deputy Corporation Counsel Office of the Corporation Counsel Government of the District of Columbia

T. Britt Reynolds, Esq. General Counsel Department of Human Services Government of the District of Columbia

Ms. Alberta Brasfield Executive Director D.C. Village Nursing Home

The Honorable Eric H. Holder, Jr. United States Attorney District of Columbia

 
 U.S. v. District of Columbia

NH-DC-001-008
IN THZ UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA
UNITED STATES OF AMERICA,

v.

) Civ . No . S5 - 945 771-1

i'lB A A , 5

1

• —

•

/

GRDSR deration of the United States' Motion for ~ n^unction to Enjoin Dsnc^erous and Lif e-Trr— -,L~~~ : ~cr ?racticss a r. cto Ensure Basic Care, Services and Treatment, it is herebv ORDEP.ED that the Preliminary Ir.junction is GRANTZD. •a, it is hereby ORDERED that Defendants shall take the follow!: actions: A. Me: :ai and Nursina _C^a_re_ I. Care of Decubitus Ulcers 'endants shall immediately cease the use of Eiase and .rasite c= . inappropriately for treatment of decubitus ulcers. JO. De:Pendants shall immediately ensure that all D.C. Village ("DC1 '") residents receive appropriate and adequate preventive r.i-di.cai and nursing care and timely treatment for decubitus ul;:ers and/or other skin breakdown sufficient to maintain the:.r good health. To this end, Defendants shall assess all resident,> for risk of skin breakdown within two days from the date of entr;- of this Order, and shall develop and implement within five • iays thereafter, for each resident identified as at

risk, a treatment plan fully adequate to prevent skin breakdown and/or to treat existing skin breakdown.
2. Care of Incontinent Residents Defendants shall immediately ensure that all incontinent DCV residents receive appropriate, adequate and timely nursing r=re in accordance with generally accepted nursing standards. F:r residents whc have been identified as subject to becoming
individual ccndition at least once every two hours. Nurses shall take ail appropriate steps to care for and clean these residents who need nursing attention due to their incontinence. Nurses shall take special care to clean and treat ulcerated areas zhat may have beccme soiled due to incontinenee.
3. Adequate and Appropriate Nursing Staff a• Defendants shall immediately ensure that continuity of
on all DCV living units• b. 3y no later than September l, 1955, Defendants shall
ensure that there is a sufficient permanent nursing staff a: !CV to eliminate the need for contract nursing staff except in unexpected emergency situations.
4. Medication Errors • a. Defendants shall ensure, within fifteen days f rorr. the date of entry of this Order, that all nursing staff on duty are trained in proper medication administration practices, and are adequately inserviced on and/or are sufficiently aware of the
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TWI

individual needs of the residents to whom they are adninisteri:

b. Defendants shall ensure, within fifteen days f rtr. the date of entry of this Order, that all medication errors are recorded, thaz adequate procedures are established to crack al medication errors, that any causes for medication errors are identified and remedied, and that any other needed corrective

acti.cn is a-ien in s. timely

r:s.< to

v- p = i H .=

B . Measures Needed to Remedy Short acres

1. Food and Drink

Defendants shall immediately ensure that sufficient supclie.

maintained a: DCV and that e3.cc, resident daily receives adecru= well-balanced, nutritious and appropriate food and drink according to their individual nutritional needs.
2. Medications, Medical Supplies and Ecruioment a. Defendants shall ensure that adequate and appropriate supplies of necessary medications/ that meet the individual r.of the DCV residents, are consistently maintained at DCV no 1; than two days from the date of entry of this Order. b. Defendants shall ensure that an adequate and appropr quantity of medical supplies and equipment, that meet the individual needs of the DCV residents, are available for use, as needed, no later than five days from the date of entry of thi Order.
- 3-

T mi7i

)~zendancs shall maintain the plumbing and heacinc SV3CS..I 3.~ J.,' „ o ensure that adequate amounts of hot wac~r, safe terr.jera-.uras, are available for use by residents wit hi:. cwo days from che dace of entry of this Order. Defendants shal! also ensure chac chare is sufficient hoc water to properly sar.ic. ze and clean esc ing utensils, places and other meal related ic-
3. Personal Care Items
supplies of personal care items, including but not limited ' toothbrushes, COTTCOS , brushes, soap, lot ion and caper co:.ve 1 s available zz- '-35 by residencs within two days from the d~zentry of this Order.
bv no lacer char, forcy-five days from, the date of er.:r, this Order, Defendants shall pay in full ail outstanding de;
services to cr en behalf of DCV residents. Defendancs shal" thereafter provide prompt paymer.es in full co such individu: and venders for goods supplied and/or services rendered no . than forty-five days from the date the individual or var.ccr a legitimate invoice to Defendants. Defendants shall ensur: needed goods and/or services procured for the benefit of th- DCV residencs shall not be terminated due to Defendants' non-pa; or deiinauenc payment of individuals or vendors.
T -mit

'or Individuals with Mental ?.•

1.. Defe ndants shall place all DCV residents with :

IT =: i_di d a . ^.^..

prograrr.s which fully meet their individual needs as iden

appropriate in terdisciplinary assessmer.zs, no later char.

1995. Defendants shall ensure that the placements are a

to cee: each individual's needs.

2. In t he interi™, Defendants shal1 extend the ex

contract wi~h Georgetown University to ensure uninterrup

clinical se rvices 13.0iiics-ior., ar.G ozner services z

residents w mental retardation. The contract with

University shall re~ain in effect ntil all

"esicer.t = are

^orooriat e corr.~ur.itv settings in accor dan ce

th e above vision.

.enta.i- retarcazion snaii.

A Monitor shall be appointed with full authority to c

the Defendants' compliance vith this Order and the remedie:

imposed by the Court in this proceeding. The United State.

submit within seven days the names and curricula vitae of

recommended candidates for the Monitor. Defendants shall '

all costs of the Monitor.

F . Protective Order

Pursuant to the Civil Rights of Institutionalized Per

Act, no persons, be they residents, staff, District employ

or

- 5-

otherwise, re orting conditions wnich nay constitute a violati*

ur.der chis A : shall be subverted to retaliation in anvrr.ar.r.er

zor so r eoo x* c

G. P.icrr." cf Access

The U request, i

d Scales ar.d "s agents sr.an nave tr.eright. cc, review ar. . copy facility records, reside:

chartsar.d er documents, conduce interviews with reside:

S.£L;
accivities r.av be con

cond

at DCV. Such

ed without pricr notification.

Ii IS SZ ORDi^£D, this n

Thonas F. Hocrar.

- 6"mi

NOTIFICATION OF ENTRY OF ORDER
Pursuant to D.D.C. R. 108(k), notification of the entry of an order in this case shall be made to:
For the United States:
Richard J. Farano David Deutsch Attorneys Special Litigation Section Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035-64 00 (202) 307-3116 D.C. BAR # 424225
For the Defendants:
Melvin W. Bolden, Jr. Acting Special Counsel
to the Corporation Counsel Office of the Corporation Counsel Government of the District of Columbia 441 4th Street, NW, 6th Floor Washington, DC 20001 (202) 727-3885

 
 EXHIBITS

Exhibit 1 a.
b. c. d. e. f.
h.
1.
j • k. 1. m. n.
o. Pq. r. s . t. u. v. w.
-- X.

Declaration of Ellen Anderson, B.S.N., M.A., J.D. Curriculum Vitae of Ellen Anderson Declaration ,of Saundra Baugh Declaration of Charles Burgess Declaration of Robert Dorr Declaration of Linda K. Duval, R.N. Declaration of Rebecca Elon, M.D., M.P.H. Curriculum Vitae of Rebecca Elon Declaration of Curmet Forte Declaration of Blaine S. Greenwald Curriculum Vitae of Blaine Greenwald Declaration of M. Anne Hart Declaration of Charlease Hatchett Declaration of Andrew Hawkins Declaration of Joseph Haynes Declaration of Maria Laurence Supplemental Declaration of Maria Laurence Letter from Karen Clay to Frances Bowie Declaration of Ronald L. Messenheimer Declaration of John Mogenson Declaration of Maria Morton Declaration of Jack H. Robinson Declaration of Alan I. Roomberg Declaration of Lamont Royster Declaration of Ted Schimpff Declaration of Laura Scott Declaration of Willie Veasey Declaration of Marco Waters Declaration of Pernell J. Williams

Exhibit 2

Past Amounts Due DCV Vendors

U.S. v. District of Columbia

NH-DC-001-009

-•m

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES 0? AMERICA,

)

)

Plaintiff,

)

)
) )

i

THE DISTP.ICT 07 COLUMBIA, et. a_l . , )

)

Defendants.

)

Civ. No. 95-94 3 TFH

DECLARATION OF ELLEN ANDERSON, B.S.N., M.A., J.D. I, Eiier. Anderson, B.S.N., M.A., J.D., the United Stages' nursing consultant in this case, pursuant to the provisions of 28 U.S.C. § 1746 and D.D.C. R. 106(h), do hereby declare: 1. I am a registered nurse with twenty-three years cf experience in the health care field. My experience and background encompass serving as a nurse clinician, a clinical and staff nurse, to serving as the deputy director for the State of •Maryland's Department of Health and Hygiene, Mental Hygiene Administration. In that capacity I was responsible for the programmatic management of over 110 community-based programs and the fourteen facilities administered by the Mental Hygiene Administration. More recently, I served as the senior administrator responsible for the direction and operation of the University cf Maryland, School of Medicine, Departments of Anesthesiology and Psychiatry. I have also served as a faculty

- 2associate c: "he University of Maryland, School of Medicine. Most recently, 1 have served as a consultant evaluating nursing and health care and working with state and local governments and private corporations regarding health care delivery systems for tnousancis cz patients.
2. 7c acquaint the Court with my specific qualifications, I provide a copy of my curriculum vitae, which is attached :c my Declaration, which contains further details about my experience and quaiincaiions .
3. I have served as an expert consultant in cases involving professional nursing standards for long-term care. I have worked with the United States Department of Justice since 19SS in the Department's investigation and enforcement activities under the Civil Rights of Institutionalized Persons Act ("CRIPA"). In this capacity, I have been involved with CRI?A investigations in several states including New York, Maine, Virginia, Massachusetts, California and the one CRIPA investigation in the District of Columbia. INVOLVEMENT WITH THIS CASE AND FAMILIARITY WITH D.C. VILLAGE NURSING HOME
4. In April 1S94, I was asked by the Department of Justice to serve as an expert consultant to assess the care and treatment of residents at the D.C. Village Nursing Home in Washington, D.C. I first toured D.C. Village on June 6-7, 1994. Prior to the tour, I reviewed numerous documents provided by D.C. Village, including policies and procedures of the facility, internal

- 3reports and summaries, consultations and treatment protocols, staffing p?.::arr.s and sign-in sheets, incident reporcs and hospitalizazicr. records. During the investigative tour, I observed, arr.cr.g other things, routine nursing and health care, routine management, training and treatment of residents on zheir living units, as well as meal times on the living uni~s. In addition, I reviewed numerous records, including medical re::rds, Interdisciplinary Team ("IDT") notes, nurse progress notes and assessments, physician notes, and hospitalization records. I also interviewed residents and multiple staff members. In addition, I observed the care and treatment of decubitus ulcers.
5. My review of the care and treatment of D.C. Village vaci na^"c ~ *~* oci rev^a^ed a number of c^it^cal d°^~ic*'rir''~'''~~ The nursing care and related treatment provided to the residents was significantly below accepted professional standards. Cf rr.osr immediate concern was the facility's failure to provide each resident with adequate and appropriate nutritional management in accordance with accepted standards of care.
6. In addition, I found inadequate nursing care and treatment for the care, prevention and treatment of decubicus pressure ulcers and an excessive number of medication errors.
7. I also found that the nursing staff complement, comprised of almost 50% temporary contract nurses, failed zo meet the needs of the D.C. Village residents. Nursing staff was being forced to function in a perpetual "crisis mode." As a resul",
i ri"

- 4residents were placed at risk of harm due to the resultina inadequate nursing and medical care.
8. I re-toured D.C. Village on May 25-25, 1995 and again on May 3C, 1595. Again, I observed the routine medical and clinical care, management and treatment of residents and sc:-:e with a number of staff. I conducted interviews with direct care staff, various Registered Nurses ("RN"s) and Licensed Practical Nurses ("L?N"s> , and the newly appointed Director of Nursing. I-also spoke with a number of residents. I directly observed the care and treatment of residents with decubitus pressure ulcers feeding of residents, and medication administration. During the tour, I reviewed more documents, including individual resident medical records, medication logs, nursing and physician notes and orders.
9. I found that the deficiencies I identified in the crior year had not been corrected by the District. I was especially concerned to find that in many instances conditions had deteriorated, placing residents at further increased risk of significant harm.
10. In my opinion, nursing care and treatment at D.C. Village are inadequate and pose a serious, immediate risk of harm to D.C. Village residents. Nursing Care For Residents' Decubitus Ulcers is Inadequate
11. A major concern at D.C. Village is the high incidence of decubitus ulcers (i.e., pressure sore ulcers involving skin tissue wounds and destruction). Decubitus ulcers are routinely

-5 classified ir. four stages: Stage I (superficial wound); Stare II (partial-thickness wound); Stage III (full-thickness wound and Stage IV (deep tissue destruction).
12. It is generally accepted that most incidents of decubitus ulcers are preventable and all are treatable if identified at an early stage. The key is identifying the at-risk patient and, where a risk is identified, taking appropriate preventive r.easures.
13 . Prime candidates for pressure ulcers include the elderly, the chronically ill, the immobile, weak and debilitated individuals, nutritionally compromised individuals, residents with altered mental status or who are incontinent, and persons who have decreased sensation and accompanying paralysis. lue to

L:I-

(JTC v a l e : . - - OL LUCSC i-^iiuiLiijiiO o.^. LJ . ^, . V l i x a ^ c , a. i a _ - r

segment of I.C. Village's population are prime candidates ftr

decubitus pressure ulcers.

14. Preventive measures include repositioning patients

regularly every two hours to take the pressure off any single

area, introducing pressure-relieving devices, keeping the skin

clear of urine and feces, assessing nutritional and fluid needs, gently cleaning and drying potential skin breakdown areas,

massaging around the area with appropriate ointments to imp rove circulation, and recording site and treatment interventions.

15. During my investigation, I asked the charge nurse on

each unit to identify residents with decubitus ulcers and the

stage of their skin breakdown. Facility-wide, over 30 residents

with decubitus ulcers were identified. This means that with a total census of 279, more than I out of every 10 D.C. Village residents suffers from this condition that is largely preventable. Several of the residents had recurrincr decubiti and many had multiple decubitus ulcers.
16. In rr.y opinion, D.C. Village residents continue tc suffer unnecessary skin breakdowns that are not being assessed, evaluated and treated properly. The neglect and improper care of decubitus ulcers at D.C. Village has had dire consequences for a number of residents.
17. For example, I observed Claude 3. in the surgical clinic after he had been sent there for the treatment of his decubitus ulcers. Claude has a stage IV decubitus ulcer on his right hie and a skin flap closure on his left hip. He also has two "new" stage II decubiti on his left foot which the treating physician described as resulting from Claude having been left on his left side for prolonged periods. Claude B.'s decubitus ulcer on his hip is one of the worst I have seen in my professional career. It was deep, red and raw with the skin completely eaten away. It was sickening and hard to view such sores on the body of another human being. Claude kept squirming and crying out from pain while the treating physician manipulated the skitissue to examine the wound. Claude had to be restrained by the nurse. I have seen some pretty hideous bedsores over my 23 years of nursing practice but this particular sore was horrible and one of the worst I have ever seen. In my opinion, given the
~m

- 7 -
inadequate care and treatment, further skin breakdown is ir.-ir.enc for Claude unless corrective action is taken immediately.
IS. Claude was in the surgical unit for the treatment cf :wo new scare II decubiti chat had developed on his left fccc. I watched the physician pull off the layer of skin tissue en ccp of che decubitus ulcers. Claude continued to cry out in pain. The skin was red. raw and bruised inside.
19. I also observed the decubiti of resident Lamonc ~.. who is paralyzed from the neck down. Lament has no feeling or sensation below the neck. Ke has a decubitus ulcer on his left ankle that he believes developed when he fell out of bed. .-. second decubicus ulcer on the ball of his left foot is now borderlire stage III/IV. In my ooinion, it looks infected. The decubitus ulcer on his foot was initially detected this past February and has not yet healed. Lament indicates that he noticed urine flowing out of his tennis shoe. The urine had spilled out of Lamont's catheter tubing, down his pants leg and into his shoe. Upon having his shoe removed by staff, the sore was noticed. He described the sore as initially being the size of the tic of a pencil eraser. The decubitus ulcer I observed looked infected, was raw and deep and had increased to the size of a quarter.
20. Another resident, William S., has suffered from decubitus bedsores that were allowed to deteriorate resulting in the recent amputation of William's leg on April 28, 1S95. William's medical record documented improper delayed notification
TT

- s-
by nursing staff of signs of infection to the physician. The result was the amputation of William's leg that could have been avoided and prevented. William currently suffers from tw; decubitus ulcers. He has a large hole on his right hip that has eaten into the muscle that is reported by D.C. Village as a stage III ulcer. William also suffers from a decubitus ulcer on his right butted-: that is raw, red and beginning to eat into muscle tissue. This indicates further breakdown of the skin. The wounds could easily be infected. I asked the D.C. Village nurse if a culture had been taken to see if either of the wounds were infected. The nurse informed me that none had been ordered. It is accepted nursing practice that a culture should be taken anytime a wcuno. LOOKS suspicious.
21. y.v review of William's medical record also indicated significant lapses in his care and treatment. William was 4 5 pounds below his ideal body weight prior to his amputation. I saw no evidence in his record that a nutritional assessment had been performed. Even now, William is still 10 pounds under his appropriate body weight. Still, no nutritional assessment has been performed. In addition, according to William's record, he failed to receive his supplemental feeding or physician-ordered water bolus (a procedure in which water is injected to insure proper hydration) the day before I commenced my tour at D.C. Village on May 24, 1995. Given his low weight, such neglect can have dire consequences unless appropriate nursing care is begun immediately.

_ 522. Mcses D. is another recent amputee, having had 'r..s right leg amputated on October 17, 19 94 and his left leg en February 14, 1995. Moses currently suffers frocr. two decubitus ulcers. I asked the charge nurse to remove Moses' dressinr so "hat I could examine the decubitus ulcer by the base of his spine. I observed that the dressing was saturated with urine. The entire dressing, large portions of his body and the bed linens were scaked. The best way to describe what I saw was a pool of urine. Around the edges, the urine had dried, leaving huge stains. This indicates to me that Moses had been left laying in his own urine for hours without being checked. .-.= a professional nurse, I was appalled by seeing that. A resident reauiring total care who is bed-ridden should never be left for long periods of time without supervision. A bed-ridden resident should be offered a urinal regularly and checked, at a rr.ir.i~u~, every two hours. After the charge nurse removed the dressing, I observed that Moses' urine had seeped through and was laying directly on the wound contaminating the decubitus ulcer. When I asked the charge nurse how often Moses' dressing was changed, I was informed once per day. In tr.y opinion, this is inadequate. The wound I observed by his spine, near the tailbone, can be described as a borderline stage II/III decubitus ulcer. The entire top layer of skin was missing over the entire area. The ulcerated area was over 3 inches in diameter and the skin breakdown was complete to the muscle. I returned a second time to review Moses' care four days later on May 30, 1995, and was
-IT

- 10 utterly appalled to find almost the exact same situation. Moses was again laying in his bed with a urine soaked dressing over his decubitus ulcers. The bed was soaking wet. It appeared chat Moses had beer, neglected again for hours.
23. My review of Moses' medical chare gives further indication cf improper and inadequate care. The medication administration record ("MAR") documents that nursing staff had twice failed to provide Moses, within the prior week cf my May 1995 tour, with his physician-ordered water bolus injeccicn deemed necessary to insure adequate hydration. This failure serves to exacerbate Moses' skin breakdown as well as places him at risk of dehydration.
24. During my tour, staff and residents reported a lazk of core essential supplies normally used to treat decubitus ulcers includinc duoderm taoe, 4x4 cads and Silvadene ointment crem.e. One evening charge nurse reported that the shortages were as recent as the prior week. When asked about possible shortages, another nurse stated: "things have gotten better this week." The nurse indicated the belief that residents are at risk. A third nurse claimed that there had been numerous food, medication and supply shortages and that they have been short for so long, that staff have lost track of what is and is not available. Numerous other nurses and aides confided in me that supplies ware an onagain/off-again proposition. A physician indicated that shortages of medications, especially antibiotics, had become
~rr

- II commonplace ar.d that: the physician was forced, or. occasion, tc substitute alternative medications. Assessing and Monitoring the Nutritional and Feeding N'eeds cf Residents is Inadequate
25. ~.C. Village residents' nutritional needs are net being adequately monitored. For example, Houston J. had a documented weight loss of 24 ocunds in less than three weeks yet no r-.utritior.al/-edical assessment had been performed. Significant weight loss such as this can greatly compromise an individual's health and well-being. My review of medical records indicated that even residents identified at .risk (e.g., William S. and Lament R.) had not received nutritional assessments. Other residents, who had physician-ordered supplemental feedings e . c., Richard G. and Catherine S.) had documented missed feedings therebv compromising their nutritional well-being. Moreover, m.v review of recent hospitalization records reveals four residents (Houston J., George A., Jeff C , and Thomas B.) being hospitalized between February 1595 and May 1995 with a listed diagnosis of dehydration.
25. Despite the fact that I had identified the failure to properly and adequately assess individuals at risk for swallowing problems during the prior year's tour, I observed minimal corrective action. In fact, I observed a poster in the lobby of the facility which announced that a "Dysphagia Clinic" was just being kicked off the first day of my investigative tour -- nearly a full year after my prior tour. During my investigation, I

- 12 observed a significant failure to adequately monitor residents during meal times. This failure places many D.C. Village residents at risk of aspirating which is an extremely dangerrus, potentially life-threatening situation. Risk of Medication Errors is Excessive at D.C. Village
27. During my investigative tour, I found evidence cf many medication errors. On one unit, (Unit 3A) , a review of the medication administration record ("MAR") and the corresponding medication blister packs revealed huge discrepancies. Medications were being documented as having been given when it was clear that they had not been administered. For chat cr.^ unit, encompassing over 30 residents, the medication count was off for every single resident reviewed. While on the same unit, the record of one resident, Charles L., indicated that he was to be given a dose of Dilantin elixir (a medication to control seizures) twice a day. The record indicated that Charles hai already received one dosage that day and was scheduled to receive a second dosage at 5:00 that afternoon. I asked to see the supply of the afternoon's medication. I was informed that they were out of the medication and that pharmacy would be supplying the medication later that day. Later that evening, I returned to the unit to ascertain whether the medication had indeed come in and had been administered. I was informed that the medication had not as yet arrived. However, upon reviewing the MAR, the medication had been marked as having already been administered to Charles. When confronted, the medication nurse admitted that the

- 13 -
record was indeed inaccurate and that the medication had net been given. This type of nursing practice grossly violates accepted nursing standards and is professionally unjustifiable.
28. Cn another unit, I found a discrepancy in the administration of Houston J.'s Dilantin (seizure medication between May 12, 1995 and May 25, 1995. I personally verified three missed dosacres of Dilantin bv counting t^e m^dic—.- io~s i~ Houston's blisterpack which revealed an excess number. In face, the medical record indicates that the treating physician, after documenting an inappropriate blood level, was forced to order a one-time increased level dosage to compensate for the blood level.
29. Another example cf the frequent medication errors is Edward S. whe has an order for phenobarbital (a medication often used to control seizures). My review of the MAR indicated thac Edward had not been given his anti-seizure medication twice in the prior week, on May 12 and again on May 18th.
30. I found medication errors to be a systemic, on-going problem exacerbated by a nursing staff that is understaffed, over-burdened and confronted with the prevalent use of temporary agency/contract nurses who are not adequately familiar with the needs of D.C. Village residents. Nurse Staffing at D.C. Village is Inadequate
31. I continue to find nurse staffing at D.C. Village to be professionally unsound and dangerous. In my opinion, the

- 14 existing nurse staffing at D.C. Village continues to operate in a perpetual "crisis mode."
32. I fcund the problems to be exacerbated by the crevalent use of agency,'contracc nurses at D.C. Village. Agency/contract nursing staff remains at just under 50 percent of total shift coverage within the facility. I found such widespread use cf acrencv''contract nurses to cresent serious risks to t'^^ ^ —s" ~'~ a^d safety of che D.C. residents because several individual members of the contract staff did not know the naT.es and identities tf the residents to whom they were providing care and nursing services and administering medications.
33. For example, on one unit I toured, both nurses on duty were temporary agency/contract nurses who were not able t answe basic questions about che residents without looking at the records. Specifically, neither nurse could identify che residents when asked. Neither could identify any of the residents' needs, treatment, or medication regimen. Every question was responded to with "let me look it up." This cverreliance on temporary staff is inappropriate and dangerous in a facility such as D.C. Village where continuity of care and familiarity with residents are critical to ensure adequate safety and treatment.
34. Staff must be acutely aware of residents' needs and alert and responsive to often subtle changes requiring intervention. Inadequate and inappropriate staffing has resulted in residents not receiving the care and attention they require.

- 15 35. Nursing staff, overburdened, short-staffed, ar.d czzer. unfamiliar wi~h zhe individuals' needs have and continue :: fail to meet the basic needs of D.C. Village residents. For exa-.cle, bed-ridden residents are reportedly bathed only every three days at bas~. Moreover, as indicated earlier, bed-ridden residents are not turned on a regular basis to prevent or minimize incidewi~s o ~ de^ ub ^ tu s ulca'y*s. L)ue to i-Vt^ "! a^k of s^~ a ~*~ b—"~ "n numbers and training, residents are ofcen not provided v/izh needed therapy despite orders for such in the individuals' records. For example, Byrd A. had not received her prescribed skin care regimen twice during the week prior to my 'tour. Dressings are changed infrequently and, as personally observed, are often urine-soaked by the time they are changed. Nursing staff roucineiy fail to monitor individual weights and respond to individual nutritional needs in a timely fashion. 36. During my three-day tour, I never saw a single resident being given appropriate range of motion exercises. In face, what I did observe was residents routinely being left unattended. For examcle, I observed Catherine S. left in a posey vest (a restraint used to prevent falling). I was concerned whether residents were being released periodically for range of motion exercises. My review of Catherine's record was quite remarkable. The record verified that the entire evening shift the day before had gone by with no charted restraint release by staff. What was more remarkable, however, was that the night shift, which had not yet begun, had already documented in Catherine's record that she

- 16 id been periodically released from the posey vest restr= •.roughout the night. This is a significant departure f: :ofessior.al cractice standards.
I declare under penalty of perjury that the foregoi: 1
:rue and accurate. Signed this ,' ^ ~r>day of June, 195:
Mary Ellen Anderson, B.S.N., M.A.; J.Z

MARY ELLEN ANDERSON 2427 Stanwick Road
Phoenix. Maryland 21131 Telephone: (410) 628-8020

EDUCATION:

Juris Doctor. 1994 University of' Maryland School of Law, Baltimore. Maryland
Coursework in Master of Administrative Science Program. The Johns Hopkins University. Baltimore, Maryland, 1976-1979
Master of Arts. Major in Psychology, 1976 Towson State University, Towson. Maryland
Bachelor of Science. Major in Nursing. 1973 University of Maryland, Baltimore. Maryland
Associate of Arts in Nursing. 1971 Essex Community College. Baltimore. Maryland

BAR .ADMISSION: The Bar of Maryland. June, 1994

EMPLOYMENT: 1/94 -

Assistant Professor Towson State University Health Science Department Towson, Maryland

Responsible for preparing technical proposals and feasibility and policyrelated analyses for mental health and substance abuse managed care initiatives related to national, state and local government accounts and academic medical centers in collaboration with a national managed care organization. Provide consultation and technical assistance on health care administration and management to government agencies and private organizations. Teach graduate and undergraduate level courses on health care administration and policy and related issues.

1 92 - 12 93

Senior Administrator Universit> of Maryland School ot Medicine Department of Psychiatry Baltimore. Maryland

Responsible tor direction of all administrative matters rela'.rc to the Department of Psychiatry and its activities within the I'::;-, ersity or Maryland Medicai Center, which encompasses the School of Medicine, the University of" Maryland Medical System, and University P'r.ysicians. Inc. Responsible for the preparation and financial managerner.: ot the Department's budgets from all sources, which total approxima:e'.> $28.5 million annually. Managed the administrative aspects of the pr.. i'.ization of a State-operated clinic system, with total annualized revenues of S3.1 million. Responsible for the provision of administrative supper: services for approximately one hundred (100) faculty and eighty (80* trainees and for direct supervision of five (5) management staff and the cersight of approximately six hundred (600) management, technical and support staff within the Department. Manage personnel, procurement, and grant/contract management functions for research and clinical service programs within the Department. Direct planning activities and functions within the Department and participate on various institutional committees within the Medicai Center.

4/91 - 7/92

Senior Administrator University of Maryland School of Medicine Department of Anesthesiology Baltimore, Maryland

Responsible for direction of all administrative matters related to the Department of Anesthesiology and its activities within the University of Maryland Medical Center, which encompasses the School o: Medicine, the University of Maryland Medical System, and University Physicians, Inc. Responsible for the preparation and financial management of the Department's budgets from all sources, which total approximately S17 million annually. Responsible for the provision of administrative support services for approximately forty-two (42) faculty and thirty-four (34) trainees and for direct supervision of five (5) management staff and the oversight of approximately twenty-five (25) management, technical and support staff within the Department. Managed personnel, procurement, and grant/contract management functions within the Department. Directed planning activities and functions within the Department and participated on various institutional committees within the Medical Center.

5 '88 - 4 Qi

Faculty Associate Mental Health Policy Studies Program University of Maryland School of Medicine Department of Psychiatn. Baltimore. Marvland

Responsible for preparation of short term plans related to sigr.iricanc departmental service expansion, both inpatient and outpatier.:. Conducted feasibility analyses related to capital and program expansion, including expense and revenue projections, staffing requirements. a~.c cost containment initiatives. Prepared federal planning documents, finding proposals, and issue papers for State and local governments and private agencies. Investigated alternatives for organizing and providing mental health services to high priority populations (e.g. children, the eide'i> and severely mentally ill patients). Participated in evaluation of innovative service delivery systems.

7/89 - 7/90

Director of Inpatient Services Giass Mental Health Centers. Inc. Baltimore. Maryland

Responsible for the management of a private psychiatric hospital for adolescent and adult patients. Supervised clinical department heads and administrative staff. Responsible for negotiating and monitoring service and space contracts. Responsible for managing transition to two hospital sites and development of an inpatient psychiatric program for adolescents during period of facility expansion from thirty-seven to eighty-five beds. Participated in Executive Committee meetings at the corporate level which determine strategic planning objectives and policy development for all operations, including outpatient, inpatient. and specialty mental health and substance abuse services.

5/86 - 5/88

Deputy Director Mental Hygiene Administration Department of Health and Mental Hygiene Baltimore, Maryland

Responsible for the budgeting process and fiscal and programmatic management for over 110 community-based programs and the fourteen facilities administered by the Mental Hygiene Administration with annual budgets exceeding S250 million and an employee base of approximately 7500 full time equivalents. Directed the planning and management

information system functions for the Administration and the development and management of special initiatives including collaborative error's with general hospitals, long-term care facilities. State health regulator^ commissions, and other State departments and agencies. Supervised personnel, procurement, and grant'contract management functions of Maryland's publicly funded mental health system. Supervised the Assistant Directors for Administration and Management. Qua!it\ Assurance. Special Projects. Planning and Management Information Systems. Regional Offices, and facility-based programs. Developed and negotiated contracts and service agreements featuring innovative financing mechanisms for service alternatives with hospitals and other health care providers. Represented the Administration and the Department before the Legislature and at public and professional meetings.

8 '85 - 5 '86

Acting Director of Special Projects Office (On assignment from the Mental Hygiene Administration) Office of Financial Planning and Management Analysis Department of Health and Mental Hygiene Baltimore. Maryland

Responsible for the development and operation of a newly created unit to analyze the fiscal and administrative feasibility of various management initiatives impacting on the Department of Health and Mental Hygiene, a major State Department with a budget of Si.4 billion in F.Y. 1986 and 4,000 employees. Analyzed and studied Federal funding programs and submitted recommendations for program prioritization and implementation to senior management. Supervised professional staff in analyzing utilization and fiscal data and in preparing financial impact statements and feasibility reports. Participated in focused management studies, including the reorganization of the Juvenile Services Administration, and recommended changes and improvements in operating procedures and program policies.

11/84 - 5/85

Acting Director of Mental Health and Mental Retardation (On assignment from the Mental Hygiene Administration) Baltimore City Health Department Baltimore, Maryland

Directed publicly funded mental health, mental retardation, and employee assistance programs with annual budgets of $21 million. Responsible for overseeing the development and monitoring of thirty grant programs.

Supervised a staff of seven professionals. Developed policies rela::ng to the development and provision of mental health and retardation s l i c e s . Represented the Division and the Department at communitv. '.rv.e'agencv and legislative meetings
Program Administrator Mental Hygiene Administration Department of Health and Mental Hvgiere Baltimore. Maryland
Directed fiscal and programmatic aspects of State hospital and community mental health programs in Centra! Maryland jurisdictions. Managed annual grant budget of S10 million. Directed regional initiatives including the development of a pilot psychiatric inpatient unit for State hospital patients in a community-based general hospital and community psychiatric rehabilitation and housing programs. Developed short-term and long range plans. Responsible for regional office coordination o; State psychiatric facilities in Baltimore City with total budgets o: S~8 million in F.Y. 1986. Assisted these facilities in maintaining Medicare certification and gaining JCAHO accreditation and in the resolution of budgetary, personnel, and programmatic problems. Provided technical assistance to health officials and planners. Represented the Mental Hygiene Administration at community and policy development meetings involving health professionals, legislators, agency representatives, and citizen advocacy groups.

11/76 - 5'19

Nurse Clinician Walter P. Carter Center Department of Health and Mental Hygiene Baltimore, Maryland

Responsible for provision of individual, group, family, and play therapy. Screened and evaluated cases. Consulted with educational, medical, and community agencies. Developed, implemented, and evaluated therapeutic programs and the in-service training program for Children's Services. Supervised staff and graduate students. Represented the Ouroatient Clinic and Nursing Department in inter-Departmental meetings.

6/76 - 976

School Psychology Intern Roanoke City Public Schools Roanoke. Virginia

Responsible for psychological testing and evaluation of public school students. Consulted with parents and teachers regarding educational

remediation and psychiatric treatment recommendations, mor.-saiaried. degree requirement)

74 - 6 76

Clinical Nurse University ot Maryland Hospital Baltimore. Maryland

Responsible forpro%ision of clinical care to critically ill infants, children. and adolescents in an intensive care setting in a teaching hospital. Supervised professional staff and students. Worked as par: of an interdisciplinary team with medical and other clinical professions.

8/71 - 9 7-

Staff Nurse Greater Baltimore Medical Center Towson. Maryland

Responsible for provision of professional nursing care to ped:a:ric and adult patients on all tours of duty in a private community genera: hospital. Supervised professional and non-professional nursing personnel.

1970 - 1971

Nursing Assistant II Greater Baltimore Medical Center Towson. Maryland

Responsible for provision of semi-skilled and auxiliary nursi g care to pediatric adult patients.

CONSULTANT CONTRACTS:

1994 - Present

1993 - Present

1989 - Present

Howard County Government Howard County, Maryland Core Service Agency Project
Green Spring Health Services, Inc. Technical Assistance and Professional Writing related to Mental Health and Substance Abuse Services and Managed Care
United States Department of Justice Expert Witness for Civil Rights of Institutionalized Persons Act (CRIPA) Cases

1992 - 1993 1992 1991 1989 1939 1989

Liberty Institute of Community Ps>ch:a:r> and Behavioral Sciences Baltimore. Maryland Comprehensive Mental Health Plan for Fiscal Years [993 - 1996
Washington County Mental Health Author:-:?. Washington County. Maryland Comprehensive Mental Health Plan for Fiscal Years 1992 - 1995
The National Institute of Mental Health Program Evaluations and Site Visits or' McKmne> Act Mental Health Demonstration Programs for the Homeless Mentally 111
Franklin County Mental Health Board Franklin County, Ohio Options for Development and Implementation or Legislatively Mandated Utilization Review and Quality Assurance Standards
The North Baltimore Center, inc. Baltimore. Maryland Management and Organizational Analysis of Community Menial Health Center
Washington County Health Department Washington County, Maryland Core Service Agency Project

PROFESSIONAL AND CIVIC
AFFILIATIONS:

1994 - Present

1982 - Present

1984 - Present

1988 - 1990

1989 - 1990

Member, The Maryland State Bar Association. Inc.
Member. Greater Baltimore Board of Realtors
Member, Credit Committee, State Employees' Credit Union
Vice President. Hunter's Run Homeowner's Association
Member, Board of Directors, Transitional Living Council, Inc.

19S4 - 1986 1983 - 1984

Treasurer. Maryland Women's Hea'.:':'. C-v.'.;:ioii Chair. Fundraising Committee
Chairperson. Mental Health Coaliii.v.. Centra! Maryland Health Systems Agency

REFERENCES: Available upon request

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES 0? AMERICA, Plaintiff,
v. THE DISTRi: 0? COLUMBIA, et.
Defendants.

C i v . N o . 9 5 - 9 4 3 TFI-1
DECLARATION OF SAUNDRA BAUGH

Pursuar.- to the provisions of 25 U.S.C. § 1745 and L.Z.Z. ?.. 10S(h), I, Saundra Baugh, do hereby declare:
1. I have been a resident of the D.C. Village Nursing Home ("DCV") for the past fourteen years. I presently live en "Jnii 23 in a small room with two elderly women.
2. I am currently 42 years old. I require nursing care because at acre 20, I suffered an injury that caused mv seine to be partially severed, leaving me paralyzed frorr. the waist down. The injury also left me unable to use rr.y fingers. I a- now confined :o a wheelchair, and arr. largely dependent on staff zc meet my basic care needs. I must live at DCV because I have no where else to go.
3. In recent months, basic care services for the residents have deteriorated at DCV. There have been severe shortages of food and drink, hot water, medications, and medical supplies. Ms. Brasfield, the DCV facility director, has told me that the city's budget crisis has put DCV in a "difficult situation" and has caused many of these shortages. As a result, the DCV staff

have had tc do the best they can. Yet, in spite of their efforts, the residents have suffered because of the shortages.
4. Because individuals fror, the Department of Justice and other outside surveyors were present at the facility during the week of May 23-30, 1995, basic services to residents were enhanced ar.i increased to make it appear to the outsiders as if there were no basic care shortages. However, this is misleading. For example, the meals served to us that week were of better quality and greater quantity than they had been for months. The facility alv.-ays puts on a good show for the surveyors, yet poor services alv;ays return once the outsiders leave. I fully anticipate this happening again.
5. In 1995, food shortages have adversely affected resident care and residents' quality of life. As a substitute for meat, the staff have repeatedly served us peanut butter sandwiches for dinner and lunch. With the peanut butter, we are served only vater to drink, not juice. Before the surveyors arrived last week, we had not been served salad or fresh vegetables for months. In fact, on the day the outsiders first arrived, we were given salt, pepper, sugar and juice at lunch and dinner for the first tins in months.
6. Last year, neals were tolerable. This year, meals are extremely unappetizing and practically inedible. Sometimes, I can't even figure out what's been served. When a hot meal is attempted, the food is usually either undercooked or overcooked, leaving it too hard, or soggy and watery. This year, I have
- 2-

often beer, u.-.able to eat what's been served and am left to buy my own food.
7. Iz is quite often the case that staff either forget to bring me ny real tray, or they bring roe a meal which I simply cannot eat. I am unable to drink milk or eat certain kinds of fish. If I eat salmon, for example, I will usually vomit. I'm pretty sure I'm allergic to such foods, but I've never been tested. Nonetheless, I'n continually served such inappropriate foods. When I alert the staff of this, they have either brought me back just a sandwich, cr they have left me with nothing to eat. I have told my dietician repeatedly about my individual feeding needs, yet nothing ever seens to come of it. I know this happens to ether residents as well.
S. There have beer, medication shortages this year that directly affect resident health and welfare. I have been left without needed medication simply because the facility did not have it. For example, a few weeks ago, the pharmacy did not have my prescribed allergy medicine for about two weeks. Because the medicine was not available, the doctor changed my prescription to an inappropriate sinus medicine until the allergy medicine was again available. During this time, I awoke most mornings congested and stopped up, unable to speak clearly for awhile. The pharmacy also recently ran out of the medication I need in order to control my muscle spasms. I was without this important medication for a few days.
- 3-

9. There are also severe shortages of medical supplies. For example, I, along with many other DCV residents, suffer from bed or pressure sores called decubiti. I currently have such sores on my buttocks. In properly treating these sores in the past, DCV staff have used duoderm tape. The duoderm tape works well at protecting the sore and helping it heal faster. However, in recent r.onths, there has been no duoderm tape available at DCV. The staff are left to improvise, treating sores with a combination of gauze, ointment and four by four's. This treatment is not sufficient. The make-shift patch used on my sores often becomes dislodged, leaving the sensitive sore exposed and subject to further irritation. Without the duoderm tape, the patch never stays in place properly. As an aside, I've learned that some are claiming that decubiti only develops at the outside hospitals ar.d not at DCV; this is simply not true. I've beehospitalized often, and yet I've never developed decubiti anywhere but at DCV.
10. There are shortages of other needed supplies. Currently, there are few if any toothbrushes, combs, brushes, soap, lotion, paper towels, and regular sized cups made available to the residents. I have seen staff bring in soap from the outside, buying it with their own money, simply because the facility had run out. We are forced to use very small cups that simply don't hold enough liquid. I have been able to get myself over to the dentist's office to obtain a new toothbrush, but other residents who do not have that ability are left to use
- 4-

their old toothbrushes for too long. In addition, blood pressure cuffs are our of date, so the nurses bring in their own for use with the residents. DCV also has a shortage of light bulbs and fluorescent lights. I noticed replacement fluorescent lighcs installed only upon the outside surveyors' arrival.
11. We are never guaranteed to receive adequate hot water for bathing at DCV. About a month ago, we were without hot water on my unit for an entire week. The facility had put up sigr.s on some units warning the residents that the hot water was net available to them. During that tine, it was too cold for anyone on my unit to bathe or to take a shower. I was forced to not take a shower or a bath at all that week. At other tines, the water is merely warm. Sor.etimes, we are forced to take a sponge bath because the water is not hot enough. As an aside, I'supposed to be bathed at least twice a week, but I'm usually only bathed once a week.
12. The lack of adequate hot water has rendered the facility unable to wash and properly sanitize dishes and eating utensils. As a result, in 1995, we have used plastic utensils and paper plates more often than we have used silverware and dishes. It is very important that silverware be available for the DCV residents. Some elderly and medically infirm individuals cannot eat or be fed properly with the plastic "sporks" used at DCV. The "spork" is a combination spoon and fork with sharp plastic prongs at the end. I've seen DCV residents poked in the mouth, tongue and chin when these "sporks" are used. I've even
- 5-

heard the staff say aloud that they can't feed the residents with the plastic utensils.
13. Clothes often cone back from the laundry still stained and shrunken. Tovels look dirty; diapers return stained ar.d shrunken with rusted snaps. The diapers given to me have beco-e so shrunken, that the staff have had to double-up the width of what's left just to meet my needs. This doubling is uncomfortable and inadequate. In addition, residents' clothing . is often stolen or lost when sent out to the laundry.
14. A few weeks ago, ny wheelchair was in need of repair. It was taken to the repair shop for an entire week. I had had an alternate wheelchair to use for such occasions, but it was stolen a few months ago while I was at an outside hospital. Thus, while my chair was being fixed, I was left without the use of a wheelchair altogether. As a result, I was confined to bed for the whole week while I waited for my wheelchair to be returned.
15. During the time I was forced to remain in bed while my wheelchair was being repaired, the nursing and direct care staff failed to attend to my basic needs. For example, while in bed, I'm dependent on staff to help me go to the bathroom. However, during that week, staff regularly left me in bed wet with urine for 10-12 hours at a time after I had been incontinent. Needless to sav, it is very uncomfortable, unhealthy and embarrassing to be left wet for such a long time. I know it can't have helped my bed sores.
- 6-

16. I've noticed such neglect affecting other DCV residents. Just recently, I noticed residents with Alzheir.er's disease left: in fecal matter for hours simply because the staff neglected to check on them. Typically, incontinent residents are left to sir in their own feces from 1:00 in the afternoon until after 6:00 a~ night. This has happened quite regularly during my stay here at DCV. Nurses are supposed to be monitoring the residents, bu- many of thsr. sit at the nursing station all day talking. Sor.e take pride in their work, but others could care less.
17. The nurses do not tend to our other basic care needs. As I indicated, I an unable to use my fingers, so I can't brush my own teeth. Nonetheless, no staff person or nurse had brushed my teeth for the entire week before the outside surveyors arrived. The evening of their arrival, however, a staff person brushed my teeth. The last time my teeth had been brushed was at the dentist's office a week earlier.
IS. The nurses who work at DCV on a part-time, contract basis, lack familiarity with the residents and our needs. This has a real impact on resident care. For example, I never know who's going to be here and when. Because the contract nurses are not familiar with us, they improperly treat residents' decubiti. They have improperly treated mine. Contract nurses also constantly make medication errors. I invariably have to tell the nurses what medications I take and when I take them. Often I have to correct the nurses after they hand me the wrong pills at
- 7-

the wrong time. Even after I correct their mistake, if it's just a timing error, the contract nurses often encourage me to take the pills that they've given me at the time anyway. The permanent nurses regularly make mistakes as well. They often try to dispense r.edications by memory, which can certainly lead to errors. Both contract and permanent nurses pass out medications by hand instead of using a small paper cup as they are supposed to. They also do not wash "heir hands when, moving from person to person providing services.
19. For nurses ar DCV, paperwork is core important than the residents. Nurses often write entries in the record without interacting with or saying a word to the residents. Many rir.es, they will write in the record that they have done something, like change a dressing for a bed sore, yet they will have not dene anything at all. I typically have to ask the nurses to do things for ne that are supposed to be done routinely anyway.
20. Generally, the staff treat us in a disrespectful manner. They often do not talk to us at all or if they do, they will talk to us as children. They've made degrading c0-.-sr.-5 to me such as "Move, so I can get that junk off your table." In dealing with other residents, I've heard staff comment aloud, "I can't stand [resident's name]." The staff will do as little for you as possible, and they will only do something for you if they are your assigned nurse. I've asked other nurses to help ne, and I've been rebuffed because the person was not assigned to r.e.
- S-

The staff tend to holler loudly at one another. This just adds to the stress and frustration level at the facility.
21. Staff routinely call in sick and/or take annual leave, leaving the units short staffed. I believe absenteeism nay be so high because each nurse's caseload is so heavy. I would estimate that over half the time we do not have enough nurses on the unit. The nurse shortage means that they cannot attend to the needs of the full care residents. There always seems to be a shortage of nurses and staff on the weekends. Even when we do have cur full complement, the nurses are invariably pulled from other units. That means they are not familiar with us or our needs.
22. I do net receive sufficient physical therapy a~ DC'.'. I had only been receiving range of notion therapy three times a week. I understand that ultrasound and massage have just been cancelled. I've lost a lot of mobility since I arrived at BCV.
23. The doctors do not coma around to check up on us regularly. My doctor never cones around to see me on his ovr. initiative; he only comes by when asked. Upon my return to DCV from a recent hospitalization, my doctor merely took my vital signs and did not talk to me or ask me about my needs or past care.
24. In my chart, it indicates that I'm currently involved in a "fall prevention" program. However, I have never been told this by staff and do not know what my program is. It also indicates that my dietician had conducted a quarterly assessment
- S-

of ir.y nutritional needs. However, the dietician never spcke with

ne about ny needs or desires. She simply made a record en~ry.

25. I nave recently discovered that our personal funds

accounts r.ay be in jeopardy, or are at least tied up. We are

entitled tc seventy dollars a month as a "personal needs

allowance." I have learned that residents' money is being ried

up somehow, and that to get it in the future will require going

through aiot of red tape. If this is true, this will effectively

keep many DC* residents, especially those who are less alert, and

aware from accessing their ov/n money. The personal funds appear

to be another casualty of the city's budget crisis.

I certify under penalty of perjury that the foregoing is

true and correct. Executed this

day of June, 1995.

Saundra Baugh

- 10 -

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES Or AMERICA,

)

)

Plaintiff,

)

)

v.

)

)

THE DISTRICT OF COLUMBIA, e_t a_l., )

)

Defendants .

)

)

Civ. No. 95-948 T?H
DECLARATION* 0? CHARLES BURGESS

Pursuar.- to the provisions of 28 U.S.C. § 1745 ana u.lD.Z. R. 105(h), I, Charles Burgess, do hereby declare:
1. I a ~ the son of Willie Burgess, who was a reside-- at D.C. Village ("DCV") for about three years before his death or. August 20, 1994.
2. My father had Alzheimer's disease and he needed tccai and complete basic care services. I tried to care for hirr. myself at nay home, but after a year, I found I was ultimately unable to juggle work and meec his needs adequately. He needed 24-hour care.
3. I was very dissatisfied with the care my father received at DCV. As soon as I placed him at DCV, his health deteriorated rapidly. When I would visit him, I often found that my father had been sitting in his own feces or laying in bed full of his own feces. The smell was awful. The nursing staff had completely neglected to meet his needs. I was left to clean him up and change him myself. The staff would only act when I would complain. In fact, care always got worse the longer I stayed

away from the facility. Only when I spoke up all the tine, did the staff ever act to provide anything to my father. I was told that unless I visited DCV every single day, the care would not be adequate to meet my father's needs; otherwise, he would be ignored. That was true.
4. Before my father entered DCV, he was able to walk well. However, the DCV staff stopped walking him and he gradually lost the ability -co walk entirely. Eventually, he couldn't walk at all. By the tine of his death, his legs were completely drawn up to his chest in a fetal position. He couldn't straighten them out any more. I attribute this deterioration solely to the neglect of the DCV staff. In fact, every single time I visited my father, he was sitting doing nothing. The staff never interacted with him.
5. At the time of his death, my father had become afflicted with severe bed sores. Before entering DCV, r.y father had never suffered with bed sores. The sores started appearing a few months after placement at DCV. They kept getting worse. At first, the bed sores were just large; then they became deep too. By the time he had reached the hospital just prior to his death, the hospital doctor showed me that the sores on his buttocks were so deep, he could put his hand in them. I saw these sores personally, and I can attest that the sores were humongous.
6. At DCV, my father had been left to develop deep bed sores on his back and his legs. Given the size of the leg sores and the potential for infection, it was decided that the best
- 2-

course of action would be to have both his legs amputated. This was done at the hospital. Given my father's frail health, he died a few days later. The sores developed in the first place because the DCV staff had failed to keep my father walking and active and because they failed to properly turn my father while he was on the bed.
6. Whenever I visited ny father, his clothes were always missing. I had bought him a lot of new clothes -- pants, shoes, socks, underwear. I spent about $500 on the clothing. However, the next tir.e I visited, it was all gone. I never saw r.y father's clothing again. Vihar>. I visited him, he always seerr.ed to be dressed in a raggedy pair of pants that were two or three sizes too big for him.
I certify under penalty of perjury that the foregoing is true and correct. Executed this _*7*J2-day of June, 1995.
0LJu
Charles Burgess
- 3-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES 0? AMERICA,

)

)

Plaintiff,

)

)

v.

)

)

THE DISTRICT 07 COLUMBIA, et al. , )

)

Defendants.

)

)

Civ. No. 95-94S TFH
DECLARATION 0? P.03SP.T DO P.?.

Pursuant to the provisions of 28 U.S.C. § 1746 and D.2.C. R. 105(h), I, Robert Dorr, do hereby declare:
1. I a: the President of Central Armature Works, Inc. 2. Central Armature provides electrical contractor services, makes repairs and sells parts for electrical equipment. 3. In June 1994, we were called to provide an esti~=ze for an anticipated repair of a boiler cotor at the D.C. Village Nursing Home ("DCV") . A boiler motor and pump circulate hot water for use in other parts of a building. Over the course of three days, we surveyed the job and concluded that the motor in question was burned up and not able to be repaired. We provided DCV with an estimate on the cost of repairing the hot water unit, however, we did not hear back from them to repair it. Finally, in late January or early February 1995, we were called back to DCV to do the work as originally quoted. By this time, the boiler pump had become completely locked from having sat idle for so long. We repaired the boiler pump, checked it for leaks and replaced the boiler motor with a new Toshiba 15 horsepower motor.

4. On February 28, 1995, we billed the District $4,440.33

for the repair of the hot water boiler, yet to this day, vs have

still not been paid. If you include other unpaid invoices, the

District currently owes our company almost $5,000.00 for parts

and labor supplied to DCV. Specifically, the District also owes

us for services we rendered in April 1995 in the anount of

$165.00, and for parts supplied in May 1995 in the anount cf

$313.56.

I certify under penalty of perjury that the foregoina is

f true and correct. Executed this

day of June, 1935.

Robert Dorr

- 2-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA,

)

)

Plaintiff,

)

)

v.

)

)

THE DISTRICT 0? COLUMBIA, e_t al., )

)

Defendants.

)

)

Civ. No. 95-S4 8 7FH
DECLARATION OF LINDA K. DUVAL, ?.. >:

Pursuar.: to the provisions of 23 U.S.C. § 174 S and D.Z.C. R. 106(h), I, Linda K. Duval, R.N., do hereby declare:
1. I a~ the Chief Operating Officer for Premier Nurse Staffing, Inc., dba SRT MedStaff ("SRT"). Generally, SRT provides supplemental nurse staffing and other health rela-ei services for hospitals, nursing homes and private individuals.
2. Pursuant to a contract with the District of Coluriia, SRT has provided nurses for D.C. Village ("DCV") on an as-needed basis for the past several years.
3. As of June 1, 1995, the District owes SRT at lease $251,401.89 in past due amounts for services we have rendered at DCV. Some outstanding invoices date back to 1994. I have attached a letter sent to Ms. Alberta Brasfield, the DCV Executive Director, and a computer printout detailing the monies past due.
4. Because of the District's failure to pay us, we have had to cancel all contract nursing services with DCV. We

officially stopped furnishing nurses to DCV at 11:00 p.m. or. Friday, June 2, 199 5.
5. Since we stopped supplying DCV with nurses, I have spoken with Mr. Vernon Hawkins, the Interim Director of the District's Department of Human Services. He said his Department was working on getting us the money we are owed, but he was not ultimately able to furnish me with a time when, in fact, we would get paid.
6. SRT pays in full the nurses who work at DCV shortly after they complete their work there. We continue to bill the District for these services, but we do not receive payment. As a result, SRT is forced to assume the financial burden of paying its employees without reimbursement from the District Government. If the District doesn't pay us, we are simply not able to continue to provide services. Our banking relationships will not finance receivables aged over ninety days. Thus, our financial situation and our banks simply will not tolerate the District's indefinite non-payment.
7. On many different occasions, I had alerted District officials that if they did not pay us, our company would be forced to terminate our services to DCV. In fact, I have spent much of my time the last three weeks simply trying to get payment from the District for services rendered at DCV. I have called everyone I know to call to try to obtain payment. In the attached letter, I have partially detailed the individuals I've spoken with in attempting to resolve this matter. Unfortunately,
- 2-

some individuals would not return my calls until I left a r.essage with the nagic words that we were threatening to terminate services. Ozher District officials actually argued with r.s that we would not be paid because we were not working under a valid contract. I can attest that our company only provided services at DCV pursuant to valid and existing contracts with the District.
I certify under penalty of perjury that the foregoincr is
true and correct. Executed this n day of June, 1995.
Lihda K. Duval, R.N.

•06;0S'93

0J:2S

® ' O 3 236 3377

PRDIIER SRT

Premier Medical Services, Inc.

June 5,

Premier Cerifisd Home Health Pnrr.is' Nurse Staffing SRTMedStaff
1995

Ms. Alberta Srasfield, Executive Director D.C. Village #2 D.C. Village Lane, S.V. Washington, D.C. 2 0032

Dear Ms. Brasfield:

It is vith much frustration and regret that Premier Nurse Staffing, Inc., dba SRT Med-Staff, discontinue providing R.V's and LPN's to DC village as contractor for contract nuiaber JA/S57C7 due to NON-PAYMENT of Premier's invoices for services dating bacK as far as 12/1/94 to present. SRT Med-Staff has been a primary provider of nurse staffing services under contracts numbered JA 93677 and JA 390704.

Listed belov are the overdue invoices which have been presented for payment following each month of services:

December 1994 Services January 1995 Services February 1995 Services February 17 - May 15, 1955 Services March 17 - March 31, 19S5 Services April 1 - April IS, 1S95 Services

$35,580.79 $33,5 63.30 $38,165.4 4 $27,266.51 $29,326.93 $25,034.62

May 1995 Services have been submitted for payment weekly instead of monthly over the last several weeks. Also, Hr. Tony siler and/or myself have placed numerous phone calls to several people, including but not limited to the folloving individuals requesting processing and payment for Premier's services:
Ms. Gladys Fountain - LTC Ms. Queen - LTC Mr. Ronald Collens Ms. Anne Wilson Mr. Atley - several messages left - no return calls Mr. Robert Taylor - Comptroller's Office Ms. Delores Stiephard - Comptroller's Office Mr. George Hemaingway - Comptroller's Office Ms. Posa Doyle - Comptroller's Office Ms. Eunice Weldon - Comptroller's Office

5501 Backfick Road, Suite 220 • Springfield. VA 22151 • (703)341-8600 • FAX (703) 256-3577

'• !•

06/0S'9o 03:29 © 7 0 3 256 357"

PREMIER SRT

Premier Medical Services, Inc.

Ms. Alberta Brasfield, Executive Director D.C. Village *2 June 5, 1995 Page 2

©003
Premier Csrtfisd Home Heaiv. Prsr.ier Nurse Stsftr,-; SRTMsdSt3-

The current status of this receivable is unacceptable to Premier Banking relationships with $35,530.73 over 120 days aged; $69,144.5S over 90 days aged; $134,579.54 over S5 days aged.
In order for Premier to reinstate services $69,144.55 -ust be paid in full and remaining invoices must be paid promptly. Frecier pays the nurses wages weekly. We cannot continue this relationship without timely payment of our invoices.
We look forward to your cooperation in rectifying this situation. It is our intent to continue providing the much needed nursing services required by DC Village to care for your patients as soon as payment is received.
If there is anything that we need to do to facilitate your payment please contact me at (703) 941-1001.

Linda K. Duval, RS* Chief Operating Officer Preaier Nurse Staffing, dba SRT Ked-Staff

cc: Gladys Fountain

5501 Backlick Road, Suite 220 • Springfield, VA 22151 • (703)941-8500 • FAX (703) 255-3577

, 0'6--0S'95 03:31

© 7 0 3 256 3377

PREMIER SRT

CITS- fas 5.

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-s.su.s;

i s . i : - 5 -.

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,
V. THE DISTRICT 0? COLUMBIA, e_t al.,
Defendants.

)
)
) ) ) Civ. No. 95-94S )
) ) )

DECLARATION OF REBECCA D. ELON, M.D., M.P.H. I, Rebecca D. Elon, M.D., M.P.K., the United States' geriatric/r.edical consultant in this case, pursuant to the provisions of 28 U.S.C. § 1746 and D.D.C. R. 105(h), do herebv declare: 1. I am both a practicing and academic physician specializing in geriatric medicine and gerontology. My professional career has been devoted to treating elderly patients in long-term care settings as well as teaching, writing, and studying about the provision of long-term care for the geriatric population. 2. To acquaint the Court with my specific qualifications, I provide a summary of my background below. My curriculum vitae, which is attached to my Declaration, provides further details about my experiences and qualifications. BACKGROUND, EXPERIENCE AND EDUCATION 3. Educational background: I received my medical degree from Baylor College of Medicine in 1931 and my Master's Degree in

Public Health from the University of Texas in 1991. My residency was ir. internal medicine and I served a fellowship specializing in geriatrics a; the Baylor College of Medicine.
4. Academic experience: I am an Associate Professor cf Medicine, Division of Geriatric Medicine and Gerontology, at -he Johns Hopkins University School of Medicine.
5. Administrative and clinical experience: In Ju1v 15 94, I was appointed and currently hold the position of Medical Director at the Johns Hopkins Geriatric Center. In this capacity, - am. responsible for overseeing the medical care and treatment fcr the residents of the Geriatric Center, a lor.~-term care facility affiliated with the Johns Hopkins Health System. Prior to my appointment, I served as Associate Medical Director, first at the Lorien Frankford Nursing and Rehabilitation Center
Center. 6. Professional Activities: I am board certified in the
field of internal medicine and have a specialty certification in geriatrics. I have also been granted the status of "Fellow" by the American College of Physicians. I am an active member in the American Geriatrics Society, the American Medical Directors' Association and the Gerontologicai Society of America.
7. Publications: I have published extensively on a variety of topics in the field of geriatric medicine, including articles, book chapters, monographs, manuals, and other publications in respected professional journals and treatises in
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the field cf gerontology. Recent: articles and book reviews

include: The Current and Future Role of the Medical Director,-

N'ursinc Home Medicine; Abuse and Neglect of Elderlv Persons

Living in Nursing Homes.- Prevention and Intervention, and Medical Practice in Cursing Facilities: Assessing the Impact cf OB?-1.. In

addition, I have been an invited speaker at numerous symposiums,

grand rounds and annual meetings cf medical associations. My

publications and presentations have focused extensively on long-

term care and treatment.

S

Zvc6rt Witness activities aird exo~iV*ionc-n i77 ~ .^ ~^ t ~ r—

care related litigation: I have served as an expert consultant

and witness in cases involving professional standards for long

term care. I have worked for both defendants and plaintiffs and

for the federal government. In addition, I have been qualified

as an expert witness in court on matters involving appropriate

medical care and on geriatrics and long term care. I have worked with t1r"e United States Department of Justice since 3.990 in the

rjonjrhrnanr's investigation and enforcement activities under the

Civil Rights of Institutionalized Persons Act ("CRIPA"). In this

caoacity, I have been involved with CRIPA investigations in

several states including Mew York and Virginia and the one CRIPA

investigation in the District of Columbia.

INVOLVEMENT WITH THIS CASE AND FAMILIARITY WITH D.C. VILLAGE

NURSING HOMS

9. In April 1994, I was asked by the Department of Justice

to serve as an expert consultant to assess the care and treatment

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of residents at the D.C. Village Nursing Home in Washington, D.C. I first toured D.C. Village on June 6-7, 1994. Prior to the tour, I reviewed numerous documents provided by D.C. Viilare, including policies and procedures of the facility, internal reports and summaries, consultations, treatment protocols, and injury, hospicalization and death records. During the investigative tour, I observed, among other things, routine medical and health care, routine management, training and treatment of residents within their living units, as well as meals on che living units. In addition, I reviewed resident charts and interviewed multiple staff members.
10. Mv assessment of the care and treatment of ^D.C^. Village residents in 1994 revealed a number of critical deficiencies. The medical care and related treatment provided to the residents were far below accepted professional standards. Of most immediate concern, because of the continual risk of death to the residents, were the deficiencies noted in feeding residents and care and treatment of residents with increased risk of aspiration (i.e., inhaling food or fluids into the lungs). I found that D.C. Village residents had been needlessly subjected to prolonged suffering and discomfort punctuated by repeated hospitaiizations merely because the medical staff was unable to adequately assess or respond to the residents' aspiration risk or dysphagia (difficulty in swallowing). I found a shockingly high number of D.C. Village residents having died due to some form of aspiration, pneumonia or feeding dysfunction.
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11. _ ccured D.C. Village agair. or. Tuesday, May 30, 1 — 5 . Again, I observed the routine medical ar.d health care, the management ar.d treatment of resider.cs, feeding practices a: mealtimes ar.d the care and treatment provided to residents wich decubitus pressure ulcers. I reviewed individual medical records, spcke with a number of staff and residents, and reviewed the death reccrds of a number of residents who had died during the past year.
12. I determined that the deficiencies I had idert"^i—d las- year had not been corrected by the District. I was distressed tc find that conditions had deteriorated even further, placing residents at increased risk of significant harm. Inadequate Care of Decubitus Ulcers Jeopardizes the Health and Lives of D.C. Village Residents
13 . Durincr rav recent investicative tour I found ru^^r^u3 examples of inadequate care of decubiti (pressure sore ulcers involving skin tissue wounds and destruction). D.C. Village residents continue to suffer unnecessary skin breakdowns that are not being assessed, evaluated and treated properly.
14. In order to assist the Court, I will briefly describe the various szages typically ascribed to decubitus ulcers. Decubitus ulcers are routinely classified in four stages ranging from stage I (superficial wound, reddened skin), stage II (partial-thickness wound, broken skin) , stage III (full-thickness wound, damage has extended beyond superficial tissue to the deep tissues below and may involve drainage) to stage IV (deep tissue
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destruction extending to the muscle or bone). Once skin is broken, infection often sets in. Extensive infection can lead to sepsis (overwhelming infection of the body) which, in turn, tften leads to death especially in this population.
15. It is generally accepted that most decubitus ulcers are preventable and ail are treatable if identified at an early stage. The key is identifying the at-risk patient and caking appropriate preventive measures where an incident might occur.
ic 2-~-*~roor^a~e o re v^"~ ~*^ v^ measures ^ ^c' ud^ v"^r)O=:^~''~""*"~cr patients on a regular basis, introducing pressure-relieving devices (e.c., air mattress properly inflated, gel pads, special beds, elbow and/or heel protectors), assessing nutritional and fluid needs, gently cleaning and drying potential areas of skin breakdown, massaging around the reddened area for at least 2 1 seconds and recording site and treatment interventions.
17. As a result of my investigative tour, I find a general systemic failure by D.C. Village to adequately assess residents at risk, as well as a systemic failure to take appropriate preventive measures. Moreover, the neglect and improper care of decubitus ulcers at D.C. Village has had dire consequences fcr a number of residents.
18. The pervasiveness and seriousness of decubitus ulcers at D.C. Village and the facility's inability to prevent and treat them are apparent from statistics provided by D.C. Village. There are at least 3 0 D.C. Village residents, or more than one out of every ten people who live there, who currently have
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decubitus ulcers.1 The tragic consequences of the facility's failure to prevent decubiti ir. the first instance and tc adequately treat it or.ce it emerges are also apparent fro- recent hospitaiizations of D.C. Village residents for serious complications fro— decubiti.
19. For example, on February IS, 1935, George A. had tc be hospitalized for two weeks due to dehydration and a possible infected decubitus ulcer. On March 24, 1995, Marie D. had tc be hospitalized for amputation of her left leg due, reportedly, due to infected decubitus ulcers. On April 13, 1995, William S. had to be hosoitaiized for two weeks due to a septic right knee. On April 23, 1995, William's leg was amputated above the knee due to necrosis and gangrene. Within the past year, at least seven different D.C. Village residents (William S., Marco W., Otis S., James M., Violet F., Stanley L. and Marie D.) had to have limbs
ated. 20. The life-threatening consequences of decubitus ulcers among D.C. Village residents are equally apparent. For example, D.C. Village lists "multiple decubitus ulcers" as a cause of death for John B. on March 9, 1995. Similarly, D.C. Village identifies "multiple decubitus ulcers" as one of the causes of the May 5, 1995 death of Marie D. who, as mentioned previously,

1

In addition to the 30 individuals identified by D.C.

Village, I personally observed at least one other resident,

Lamont R., not identified by D.C. Village, who had multiple

decubitus ulcers.

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was hospitalized in March for amputation of her left leg due :o ir.fecced decubitus ulcers.
21. Many of the recent D.C. Village hospitaiizatior.s ar.d deaths are listed as sepsis. Sepsis is the body's response tc overwhelming infection. A decubitus ulcer can and often 1= a major contributing factor to the resulting sepsis. In the recent two month period, alone, between March 10, 1995 and May 5, 1?95, three different D.C. Village residents were hospitalized with a diagnosis of sepsis. In the cwo month period between March 22, 1995 and May 23, 1995, seven other D.C. Village residents were hospitalized to rule out a diagnosis of sepsis.
22. Mv observations and review of individual records verified the inadequate care of decubiti at D.C. Village. .-_r. example is Claude 3. who I observed on the surgical unit. Claude's decubitus ulcer on his hip is dusty blue and red, with unhealthy tissue. If I were to describe the wound to a lay person, I would say it looks like old hamburger. Ke has a hole in his right hip that is approximately 6 centimeters. Below that opening, beneath the surface the wound extends for another ten centimeters, through the muscle and down to the bone. The entire decubitus ulcer is, in actuality, about fiffteen to eighteen centimeters. Ke has two other decubitus ulcers on his foot.
23. Claude was in the surgical unit for the treatment of the two decubitus ulcers on his left foot. I observed the physician pull off the dead skin revealing a stage III wound with dead tissue down to the muscle. The physician then treated the
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foot ulcer with Che ointment Elase. Elase, used to debride dead tissue, is rarely used or.foot ulcers because of the danger of having the ointment spread to adjacent healthy tissue. The physician spread the Eiase liberally beyond the r.ecrocic/dead tissue of the ulcer onto healthy skin. If extended beyond the necrotic area, the result is that healthy adjacent tissue may be damaged, resulting in extending the decubitus ulcers. The result was that the I.C. Village "cure" could actually exacerbate the problem. Due to the inadequate care being rendered, Claude is now at high risk ot having his v/cuncis becoming infected and is m danger of potentially losing his leg unless corrective action is taken immediately.
24. I also observed the decubitus ulcers of Lamont R., who is quadriplegic, totally paralyzed from the neck down. Lament has two decubitus ulcers on his left foot. Lamont's medical record indicates two inappropriate physician orders. First, there is a SC-day order for Eiase, which is inappropriate for a foot ulcer. Second, there is an order for Intrasite on the dead tissue. Intrasite is an gel product normally used to enhance granulation tissue growth. It is totally ineffective and inappropriate to be ordered to treat necrotic/dead skin. Such orders are a significant departure from professional standards and place Lamont at risk of imminent harm. I am very concerned that the inadequate treatment has led to a progression of Lamont's wounds and predisposes him to potentially losing a limb unnecessarily.
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25. Another resident that I am quite concerned about is Houston J. Houston currently has two decubitus ulcers, one on his left foot and one on his right heel. The right heel wound is a stage III decubitus ulcer that has significant dead/necrctic tissue that needs surgical attention for debridemer.t. My review of his record shows no request for a surgical consult. The failure to properly debride such a wound of dead tissue is a departure from professional standards and places Houston at imminent risk that the wound will get larger and get infected. Potentially, Houston if not adequately treated imminently, risks a potential loss of limb, sepsis, and even possibly death.
25. Another example of the inadequate care being rendered at D.C. Village is William S. who, after suffering from decubitus be.d sores that were allowed to deteriorate, had to have his leg amputated in April 1995. The amputation was a direct result of inadequate care and neglect coupled with improper delayed notification by nursing staff of signs of infection. The result was the amputation of a resident's leg that could have been prevented.
27. William's medical record reveals that on March 17, 1995, nursing staff documented that William's knee was warm to the touch and that he was running a fever. Blood tests indicated a high white blood count. The physician was not notified. Three days later, on March 20th, medical records document William's temperature at 102 degrees and an elevated pulse rate of 125. The nurse's notes indicate that William was "flushed ...
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dehydrated." Ke was cher. transferred to the hospital, still r.ot having seer, a D.C. Village physician. William was diagnosed at the hospital as suffering from celiulitis with drainage of infected pus from the knee ar.d returned to D.C. Village. Cr. Aprii 4, 1955, William's progress notes states "the ulcers are getting worse." Ke was not admitted again to the hospital until April 13th, seme nine days later where his leg was amputated above the knee due to necrosis and gangrene.
23. I personally observed William's current care and treatment during my tour. William currently suffers from two stage III/IV decubitus ulcers on his hip and buttock. I found him lying on an air mattress that was improperly inflated, thus offering no pressure relief. The ulcer on his hip was oozing green pus. In my opinion, this indicates that the wound is likely to be infected. The ulcer on his hip was a hole in the skin approximately 4 x 6 centimeters in size. The wound was red with tissue coming through. In my professional opinion, William is in imminent danger of infection due to the inadequate Treatment of the wound by D.C. Village staff.
29. Another example of the inadequate care being given is Moses D., who has had to have portions of both of his legs amputated. On October 17, 1994, Moses underwent below-the-knee amputation due to gangrene of the right foot. His record indicates that on December 15, 1994, the attending physician notes that "the ulcers of the L [left] leg not healing well." On December 2Sth, thirteen days later, a progress note documents
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chat Moses still suffered from multiple leg ulcers and r.ecr::;: tissue. The note identifies a moderate amount of drainage and ' "^^C 3 L a s t~ a~ t)"* -* ulcer is "fou"' sm-1 ^l^ncr " *-• ^^~^•• ^ ~ ~^ —- — surgical clinic was forwarded. On January 3, 1995, the same physician who examined Moses on December 15th, notes the decubitus ulcers on his left leg and states that the patient has a surgery clinic appointment. On January 15, 1995, a month after the physician's note of improper healing, the monthly nursing note states "Leg ulcers doesn't look good. Consult for the surgical unit was sent." It is not until January 24th that the record indicates that Moses was seen in the surgical clinic and not until February 7, 1995, almost two months after the severity of the problem was initially noted, that surgical treatment at the clinic was obtained. A week later, en February 13, 1935, Moses was admitted to the hospital with gangrene and ulcers tf the left foot and leg. The following day, February 14, 1995, Moses' remaining left leg was amputated above-the-knee.
30. On May 30, 1995 I entered Moses' room to find him lyinc in his own urine and feces. Moses was lying ir.appropriatelv on an inverted egg crate donut which not only failed to provide any pressure relief but, in fact, may serve to increases pressure in other decubiti prone areas. Moses currently suffers from :v: decubitus ulcers. The wound by the base of his spine had an opening that was approximately 4 x 5 centimeters. 1 asked the nurse to probe the wound with an applicator tip so that I could gauge the size of the underlying wound. It was evident that the
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wound was quite deep as the nurse was able to place the rr:be three inches into the wound. The ulcerated area was duskv and dry due to the inappropriate dry dressing ordered by the physician. Such wounds need to be kept hydrated to increase circulation. In my opinion, Moses is at imminent risk, of infection due to his inadequate treatment.
31. My review of Moses D.'s record also reveals that he has a recently documented (May 22n.d) penile ulceration due to the improper use of a condom catheter by the nursing staff.
32. Marco W. is another resident at D.C. Village wh: recently lest a limb after a long history of deteriorating decubitus ulcers that became infected and gangrene. While in Marco's case the deterioration was exacerbated by poor circulation due to peripheral vascular disease, the inadequate care and neglect by D.C. Village was a significant contributing
i. a c •_ o r .
33. A review of the medical record of George A. who was hospitalized the day before our tour, May 23, 1995, is further reflective of the inadequate care at D.C. Village. George .-.. was rehospitalized (he had been hospitalized several times during the past year for infected multiple decubiti) with a fever and with a listed diagnosis of multiple stage III and IV decubiti that were septic and gangrene (dead tissue due to lack of blood supply). My review of George's medical record reveals that on May 13, 1995, the nursing progress note stated "AM reported to supervisor -- decubitus stage IV has no written orders for specific
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treatment." It was not until May 17, 1995, four days later, chat the record reflects that George was examined by a physician and specific treatment ordered. His decubicus ulcer was classified by che D.C. Village physician as "deep to the muscle and bcr.e." The physician referred George to the surgical clinic for debridemenc removal of dead skin) and reevaluation. George was then not seen by the surgical clinic physician until May 23, 1995, another six days later. Ke was immediately hospitalized with a diagnosis that the hip area had become septic and gangrene. He remained hospitalized during the time of my ccur.
34. My review of hospitalizations since January 1, 1995 reveal numerous residents being hospitalized due to infecced decubiti. Examples include the hospitalizations of Willie V. (January 2, 19 95 - flap closure), Claude B. (January 9, 19 9 5 flap closure', , George A. (February 16, 1995 - infected decubitis), Houston J. (February 17, 1995 - surgical flap, left hip), William S. (March 19, 1995 - cellulitis, right knee), Marie D. (March 24, 1995 - amputation, left leg), Milton B. (March 30, 1995 - celiulitis, right leg), William S. (April 13, 1995 septic right knee, subsequent amputation), James T. (April 21, 1995 - cellulitis), and George A. (May 23, 1995 - multiple decubitus ulcers, septic and gangrene).
35. My review of death records highlights the tragic consequences of the inadequate care being rendered at D.C. Village. For example, during the past nine months, D.C. Village lists "multiple decubitus ulcers" as a cause of death for Willie
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5. (died or. August 20, 1994) , Savir.a C. (died on September
1 5 3 4 ) , John 3. (died on March 5, 1995) and Marie D. (died en MaaTy
5, 1935) . 3€. Medical and nursing staff throughout the faciiizv
report shortages of essential medical supplies normally use :o treat decubizus ulcers. In particular, shortages of duoder '2na and 4x4 pads were continually reported. I personally observeedd a medical doczcr forced to do a debridement of dead skin tis= using improper equipment (a suture removal kit) because of of adequate supplies. In addition, this same doctor used = improper oir.zment because he thought the facility still ha: shortage of zhe appropriate Silvadine ointment. In sum, th^ r* ^ • and treatment of decubitus pressure ulcers at D.C. Village is inadequate and jeopardizes the health and well-being of r e s ** den~s Inappropriate Feeding and Medical Care of D.C. Village r.esidenzs Poses Life-Threatening Risks
37. Many D.C. Village residents have eating disorders. Further, many of these residents have difficulty breathing and swallowing. Improper feeding techniques and inappropriate positioning of the residents during feeding can cause acuze and chronic aspiration problems in persons with these disorders. A.spiration of large amounts of food or liquid may result in asphyxiation; aspiration of smaller amounts will compromise breathing and lung functioning and chronically damage lung tissue through repeated or chronic infection. Medically fragile
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individuals with weak respiratory systems, compressed chest cavities frcrr. scoliosis or poor positioning, and decreased r.uscle tone and lung capacity have greater difficulty coughing and clearing cheir lungs, conditions which contribute to both choking and gagging. Repeated aspirations damage the lungs and car. lead to a spectrum of chronic respiratory problems, including asthr.a, aspiration pneumonia, chronic lung disease and even sepsis, all of which can be fatal.
33. Turing my most recent investigation, I learned that D.C. Village residents continue to suffer from aspiration and chat several more aspiration-related deaths (e.g. , Jessie '-.. , Elsie E., John B., Agnes S., John S., and Charles H.) had occurred since my last tour in June 1994.
35. These deaths are described in D.C. Village records as either directly related to aspiration or as a contributing cause of death. It is my opinion that at least some of these deaths may have been prevented if appropriate practices had been followed by trained staff.
40. Despite the fact that last year I had indicated a need to properly and adequately assess individuals at risk for swallowing problems, I saw little evidence that any suchevaluations had been conducted at D.C. Village. Upon our arrival this year, the facility was initiating its "Dysphagia Clinic" to assess residents with swallowing disorders including feeding/aspiration issues. However, it is important to note that this clinic had not been commenced until May 25, 1995, the first
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day of the -apartment of Justice's investigative tour and almosone year after we had toured in 1934. During my investigation, I observed a general failure to adequately monitor resider.-s during meal times :: identify those with swallowing problems. Medical Diagnosis and the Management and Treatment of Residents with Aspiration and P.elated Medical Problems are Inadequate
41. It is also my opinion that the medical diagnosis, management, and treatment of aspiration and related medical problems are inadequate and place the health of residents at C.C. Village at risk.
42. The lack of appropriate identification of residents at risk of aspiration and insufficient care thereafter is documented in individual charts. Medical reviews are not conducted until che individual circumstances of residents become extreme.
43. P.elevant information regarding the identification, care ana treatment of residents' feeding problems and related disorders is not sufficiently communicated between the direct care staff, therapists, nurses and doctors. To the extent that symptoms are observed at the direct care staff level, this information often does not appear to be communicated adequately to medical personnel or, if so, is often not translated by the physicians into appropriate directions for assessment or treatment. In my review of residents' charts, I identified instances where nursing and/or direct care progress notes report symptoms of aspiration that are not discussed in physician notes and are not followed up with appropriate evaluation. Similarly,
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when appropriate occupational therapy or dietary consults are obtained, there is often little indication of implementation cf recommended interventions or follow-up by nursing or direct care staff .
44. 2.Z. Village's physicians also do not routinely prcvide standard medical assessment and treatment for residents ac risk for chronic aspiration. D.C. Village's medical and nursing scarf are not identifying and acting upon the clinical symotoms cf chronic aspiration and related illnesses. Because staff are not carrying out chis critical function, illness, aspiration and injury are occurring which otherwise could be prevented chrcugh early detection and intervention. Delayed Medical Response
45. A review of death records revealed several cases cf respiratory distress in which nursing staff documented buz failed to notify the physician, or where the physician failed tc promptly respond until the resident was in extreme respiratory
or ce a 45. An example is the death record of Jessie K., who died on April 27, 1995. The record reflects failed/delayed notification and appears to have been altered so as to indicate a quicker notification and response time. An initial note that day states that Jessie "doesn't look good." The note looks like it was initially written at 7:30 a.m. but was rewritten to indicate 8:30. A second note at 8:45 reports that Jessie was congested full of mucus. A third note, also appearing altered, states
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"looks not :: [sic] good." The note continues to state "P.eccrted . . . (HN) that pt. congested i needed to be suction." A 1C:ZZ a.m. note indicates that Jessie was in distress and taken tt his room. C?R wa= commenced at l":05. Jessie was pronounced dead at 10:2C that mcrning. The failed and delayed notification in this instance is a significant departure from professional standards. If Jessie had been assessed promptly and adequately and then given proper treatment, he may have survived.
47. Ancth.er example is Agnes S. who died on February 2 3, 1935. On February 11, 1995, Agnes was hospitalized with an unexplained hand fracture and placed in a cast. The next day, February 12, 1395, the record reflects that the "resident verycongested and wheezing both lung sound congested (sic) ." Zr. February 15th there is documentation of thick yellow mucus. Later that day, Agnes began to run a fever. The next day, February IS, 1995, the nurse's note indicates that Agnes continued to run a fever (1C1.4) and states that Agnes "is observed to be coughing, having labored breathing, wheezing most times during the night." Later that day, the physician was finally notified and an x-ray taken. At 12:45 p.m., Agnes was finally examined by a physician and hospitalized with possible pneumonia and sepsis. Agnes died four days later on February 2G, 1995. The delayed notification is a significant departure from professional standards. With earlier notification and proper intervention by the physician, this death could have been prevented.
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43 . I: conclusion, an overriding concern which e: he f ir.dir.c :f inadequate medical care and treatment si s che inad: ruate assessments, evaluations and diagnose o exist at: l.C Village. The result is that medical
= and treatment are often inadequate and ir 1 declare under penalty of perjury that the forego:
D. Elon, M.D
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CURRICULUM YITAE REBECCA DAMS ELON, M.D., M.P.H.

CURRENT .APPOINTMENTS: University;
OFFICE .ADDRESS:
HOME ADDRESS: DATE OF BIRTH: PLACE OF BIRTH: SOCIAL SECURITY NUMBER: EDUCATION AND TRAINING:
Hish School
P.tssarch Assistant

Associate Professor of Medicine Division of Geriatric Medicine and Ger: Johns Hopkins Uriversity School of Mi

Stiff Physician Johns Hopkins Bayview Medical Czr.:z:

Johns Hopkins Bawiew Medical Cer.:::

Johns Hopkins Geriatrics Ceai=r

5505 Hopkins Bawiew Circle

3al:unore, MD 21224

Telephone: (-10) 55O-O5SS

FAX:

(410)550-1190

9109 Covered Brides Road Baltimore, Maryland 21234 ' — " •"'! 65S-S753

J'j^y 6,

MU-.vaukee,

Bro^r. Deer High Schoc'. Milwaukee, Wisconsin
Rice Universit>Kous:on, Texas ("B.A., cun Icude, 1976)
Barnard Celiezs Ccli^mbia Urivcrsirv New York Ciry
Co-ell Medical School New York Hospital New York Citv

4

Rebecca D. Elor.. MD., M.P.H. Midi;al School R=si-d=:vcv

PROFESSIONAL EXPERIENCE:

3

.

Asso:i?.:e Professor

Baylor College of Houston. Texas (M.D., 19SL)
Internal Medicir.e Baylor Affiliated Hospitals Houston. Texas
Geriatrics Baylor Ccilece of Medicin; Houston. Texas
Universiiy of Texas School of Public Health Houston, Texas (M P.H., 1951)

?zzc 2 .977- 19S1 '•?£!. - 195 I?'i4 - 19S5 l ? i ? - 199:

e:<=j Medical Ceare: Hospice
Bayior College cf Medicine
Deparxie-; cf btcrr.il Medicir.s Baylor College of V.;dicir.e
Bavlor College of Medicb.e
Division of Geriairic Medicine Departmen: of Health C^s Sciences George Washington Urdv;rs:ty Medical Washington, DC
Division of Geriatric Medicine and Gerontology Jours Horkxs Univ-rsi:v School of M:
Division of Geriarric Mecicin. and Gerontology Johns Hockins Urjvs7s:r%- School of M:

C o - ' Q»

Rebecca D. Elcn, M.D.. M.P.H

CERTIFICATION AND LICENSURE
Soe-ciilry Ci~if:c Geriatrics Medical Director

Ir.s-iai Medicine

;r'.i~.be:

Miryia-d Lice-sure D:s:::c: cf Columbia Licensure

Texas L::r:\5u:e Federal Licer.str.s Exam

)scs-bc-r. '.912 -Mav. 199^-

AW.AJRDS .VND HONORS 197;

Brown Cciiese Service Award, Rice Uruver>i".v Coctt:=:;tion on Azizs:

on Aiir.a sr>cr.scrcd bv the N'aticr.til Id>:ir_te or. .-.gir.z zs.d the .--T.ericar. Ger;ctrt:5 Socie'.'-', 3i.t;~:ori. N'ac"-';arui
Selected as on; ct fovir physiciar.s to represer.t Th; M-cthodist Ko^oiia. Houston a: ar awards cerarn^-v i~ Gua:s~ali Citv. Guatemala, durir.g which a surgeon frcrr. Houston received Guatem-la's higheit civiiian honor

Srudy Exchange sponsored by the Rotary Irtter::it::nil Foundation
rirs: piace award, America- Mtdical D.:;c:ots' Assrciatioz, Mid Car; Evaluation Srudv Cor-redtioa
Keliosr Na:iona2 Feilowshuo Prosram Award

4 - _—^

Rebecca D. Elon, M.D.. M.P-K.

PliC -i

PROFESSIONAL ACTIVITIES:

Americas Medical Directors Association

1939-1991 199L1992 -present 1992 - present 1993, 1994 1993 - present

Chair, Public Policy Committee Representative ;o Senaca Aging Ccr Co-Chair, Education CcTurdT.it Merr.ber, Certification Council Member. Annual Meeting Program. Ms-be:. House cf Delegates

Maryland Medical Directors Association

1992 - present

Founding Board Membsr

H^al:h Cire Financing Adrrbisira:::•;:

1990 1991 -

Expert Adviser/ Par.::1, Case-Mix D=~or. Expert Advisory Par.: I, Quality Indicatio

United S:?.u? Justice Depart-—c~;

- press;:

instituticnslized elderly livise in s'-a'.t instir

Institute cf Medicine

1995 - i594

;ber. Corr.-rJi:ee to Evilui-e Ombuds-m Prcg: Oide; Americans Act

1994

Choir, Symposium on Onibuds:naa Prvgri-r.

Uriversir/ cf Minr.esoca Schoc! cf Medicine

1990 - present

Instructor for Medic;; Director iriining Co_:is. Cnice o: Co~tin. Educztion, (Progra~i has been presented in Mi.viesr.a. Ne-« Vc:l<
City. Cleveland, Baltimore, Houston, San Fr^icisc;-}

Cniversir.- cf Cincinnaii Schj..-.! of Medicine

1993

Consultant to Dr. Robert Luke. Chai —2T.. Dzzn-.rr.t-: cf Lv.i-r.zl

Mtdicine, recarduac ar. academic affil ;aticn azreemin: v.rj a !ons-

term care institution, Drake Center

Expert Advisory Panel?

1991 - press.-.:

of Maryland, Robert Weed jchr.sor. Feuniaticn Project tg Ciini:aJ Pn::ice Guidelines for Lon£-

4''

Rebecca D. Elon. M.D.. M.P.H.

Paee 5

1990 - 1993

George Washington University. National Institute :~ Agir.g Project. "National Evaluation of Alzheimer's Sr^cia! Care L'mts"

In^'ir^.'icr.Al Administrative Acroinmer.ts

July 1994

Mrdical Director. Johns Hopkins Geriatrics Center

1993 - 1991991 - 1993

Associate Medical Director. Johns Hopkins Geriatrics Center Associate Medicai Director, Lorien FrarJcbrd Nuritr.s and Rehabilitation Center

19*3 - -resent

Co-direcccr. Annual Geriatrics CME Rivii^- Course Member. Johns Kopidns Health System, Goriatrtcs Nef-c-rkin

199> - rresen: Edi:?r:a; Acti-.-ities: 199- - r;risen:

Member, Francis Scon Key Medici Cen:e: TQM C ; ~m t t e ; cr. Cost Efreciivc Care Member, Subacu:e Care Oversigh: Ccmmiv.=e Member. PACE cccicnsvration Feisibilitv S'."-dv •.'•."::?tir
Cc-edi:cr, Gcrictncs Reviev Sylizbus; A C:~e C---tr-.'.\:-, The Arr.sr::=r. Geriatrics Socisr.-, Third Edi:ic=. D - - : : R-.bt- and Tern

Cc-edi:c:, Surging Hens A;sessr.c>:: (John 3 ; : : : i: Dar: Os:er-e:J. editors)

1990 - 1993

Member, Editorial Advisory Board. The Jcurtcai : : Medical D:rec:ors

AriT.a:5 of ln;e~al Medicine Joiiirrrr-il of the A-T-friccT. Geriatrics Socie Johns Hopkins Universir/ Press Public Health Reports. United States Pub Health Professionals Press Association for Geror.tolog>p in Hishe: E Oxford Universir>- Press The Gerontolocis:
Expent V,'i-_-.ess, long-um care related lidgation, experience in cases for both defendants ar.d clainciffs

••*
"ITT

Rebecca D. Elcn, M.D.. M.P.H.

Pase

TEACHING RESPONSIBILITIES

1. Course Director, Growth Development and Aging, Year n medical student curric la.- '.worked with the Curriculum. Commirtee and representatives from pharmacology, pathology. pe iatrics, geriatrics t develop and implement a new 21-hour course), 1993.
2. Smalt Group Facilitator. Physician and Society Course <2 hours pe: week fcr 2S-w;;k. curriculum developed fcr Year n medical students), 1993-1954..
3. General Medicine.Geriatrics Hospi:ii Vs'ard amending (1 c: 2 ison^s per yea:, s ising team or" reside;u-L-.:err_5-saideui5) with didactic ceaching rounds 5 days per we.j«;.

- . ?re;sp:or : ; : Year El and Year IV r.edical srudsr.ts and physician assistant y.ii-zrM durir^g my •-aekly geriatrics outpatient clinic.

5. S-iper»"ise ger:arric assessrntn: cii.-.ic vith fellers, residencs and srudents one mcn'.h a yeir. 6. Teach introduction :o ireriaLric medicine :o cere medical students czz mcr.ch each vear.

". Dt'-i\cy:z -:edical director curriculum (in conj-unccicn -'iih Susan J. Denrr-nt
re.iC ws.

in fellows' jou~al ciub schedule.

5. Give one lecture per moath in A-4-v.'est geriatrics lecture series.

10. Weekly teaching rounds with multidisciplinaxy team on 54-bed chronic hcscital --'• 11. Par.icipa'.i in divisional weekly conference schedule.

12. Teach seminar in Introduction to Gerontology Course for stuc-nt;

-•_-.

<;.•

13. Teach manaeemen: module in Faculty Development Course

.•

,.->.•_•

14. Teach rh.vsical diagnosis to vea: II srudents

PROEESSIO.N.U. MEMBERSHIPS Americar: Cclleze of Physicians

Member 19S1 - oresev

America,-. Geriatrics Society .-jr.erican Medical Directors' Associat Geronrolosical Sociers- of America

Member 19S1 - present Member 19S9 - orcjenc Member 19S1 - cresent

4

Rebecca D. Elon, M.D.. M.P.H.

Pase

PUBLICATIONS
Journal Articles
1. E'.cr. R. Urinary Tract Infections Asymptomatic Bacteriuria: Treatment c: the Positive Vr:ne Culture. A Nodical Care Evaluation Srudy. Journal cf the America.*! Medical Directors A=?:••:::::::- ! 52-39. 1990.
2. Winters WL. Mclntosh KD, Cheitlm MD, E'.cn R, e: al. The Relationship cf Cardic-v^dar Specials: to Patients, ether Physicians and Physician O-Tied Organizations: Report cf Task Fcr:e =2. Ethics ir. Cardiovascular Medicine. Position Paps: of the Americar. College cf Cardiology. JACC 15(1):! l-'.6. 1590.
3. Eior. R. ?a--:.-cn LG. The L~pa:t of OERA S T or. Medical Practice within N'virsir.z Facilities. J A™. Gsria~ Sec 4C". 95S-963, 1592..
4. E ! " R. Abuse and Nsglcct cf Elderly Persons Livi::e in Nursinj Korres: Prsve-ticr. ;r.d l-rervemio-. Jc_nal cf the American Medical Directors Association, 2: 76-S0, 1952.
Eion R. The Nursing Home Medical Director Role in Transition J Ar.: Geriat: 5:-c -^-1:131-135. 1993
Elon R. The Current and Future Role cf the Medical Director. Nursinr Home Medict.-.: .'-. press;
Other Publications
Elon R. "Urhtary Incontinence in the Elderly." Audio-Digest for Family Practice 3 j . l i ; . March 5.

2. ticn R. Reducing Chemical Restraints: Lea-ning by Example. In: Proceedings cf a Symposium cf the Senate Special Committee on Aging. Government Printing Office. 1991.
3. Elon R. Ccmmencary on Federal Nursing Home Regulations. In: Long-Tcrtra Care Administration Manual: Standards and Guidelines for Lor.g-Term Cara Facilities. National Health Publishing, Baitimc: Maryland. 1990, 1991.
4. Elcn R. Letter to the editor regarding "Geriatric Fellowship Training: A rtvisicru.il Proposal." by *C\":''iir~ Kazzard J Am Geriacr See 41:575, 1993
5. E'.:-. R. Le".'.--r :o the Editor regarding American Geriatrics Society Medical Studin1. Ini.titive. J Am Grria-- Sec-2:355, 1994.
Book Chapters
I. Eior. R. Approaches to Assessment: Ourpatieni Evaluation for Nursing Hone AdL-jjsicn. In: Yoshika-. T. Co'^bs E. Brummel-Scnifh K, ecs. IN An±ula:orj Gt>r:z:r:c Cera. St. Louis: Mosey Year Bock. Charter 16. ru. 142-145, 1992.

Rebecca D. E!o=. M.D.. M.P.H.

Page S

2 Elcr. R. FLial Placements: Hccr.e or Nursing Hc-e° Li: Kane RA and Capias A l . szs IN Mcncgirg Ccrzpcssicr.: Tc->crd en Ethic for Case Xzr.zg err.er.t Cere cf the Elderly, Ne~ Ycric: Sprlr.cer Publishing Cr.. pp. 137-142. 1993.
3. E'.c-n R and L_cco AJ. Long-term Care Fba-cLag arid Sysrems. In: Levsr_soc S., ci. Medical Direct:"., in Long-term Cars, IN LfC: /I Guidebookfor :ks Fur.ire. 2nd edition. D-rharr. NC: Carolina Acacs-ic Press, p? 7S-93, 1993.
-. Elcr. R. Medical Pracrice i:i N-rsir.g ?ac:l:::c-s: Assessing -he tnpact of O33_\. IN Ai'-'ar-ces Li Lo.ig;e:m Cars. P.R. Katz. R.L. Kane, & M.D. Mezey (eds). S:;i-ge: Publishing. N s - V::> •:.-: press}.
5. Elen R. 03RA 57 and I:s Inipiicaiic^i : : : -J-.e Mecical Dre;:cr. Li Cixics in Geria:::: N.'eiicir.e, J.G. Gus!a."dir s_"C E. Tar.galos (-ds). (^i priii)
6. Fi-uca^; TE. Elcn R. Kscr.ar. JM. The Medic-I Dirsc-or in N*:-i.L-j^7-:icr.a; Lc-£-Te— Care • P.-c-grar-:s. I~ Ciirics in G;:ia:ric Msdicine. JG Ouslarider ard E Taagaics (id<;-. (ir. pre-55;
Book Reviews
1. Eicn R. Bock Revise cr; Adding Life to Y-zin: Organized.Ckr.z-r.cs ScrAzcs ir. C^cz: 3-.:zir. cr.d ["•.p'.ici'.iorj f:r :r.c Ur.i:ed S:z:-:sb> WiliiiX Haiiey Baktr. Geronijiogis: 2S \l:: -15. I f i i .
2. Eicr. R. 3^1< Rtvisw or. 77:* G S ^ ^ ' C J . ^ V : ^ 5v;;-3to-. I A n Gtria:: <cc 4v: : 191-1 Ir2, 1992.
3. Elcr. R. The Scr.clarsri? cf Gerii::ics: ?::cr:::=s Reconsidered. J Acr. Gsria:: Sec -2: . 1 9 9 - .
Abstraas
1. Tarfe: G. tier: R. Teascalt T, Mallsr.e L, Ludii R. Eleva:ed parathyroid hcrmor.e ir. •siierly nu.es. J A.T. Ge:ia:r Soc 34:9G6A. 19S6.
2. Elon R. Malle-c Lf Luchi R, Pirozzcio F. Lt-ry J. Taffe: G. K;.per?ara"j:y:c-idis--. and ccerduve r_r.c:icr. in ihc elderly. The Gercntolczis: 29:1J~A. 19S6.
3. Eicn R, Kcipakchi A. The ia:srra:i cf psy:hia*j~/ and micicine ir. the care c: £er:a::ic rav.enis: psych:a:ric problerns seen in a £tria:r;c — ^iicine clinic. The Gtroruclogis: 2 7 : 2 " 2 A . ISS".
4. Teasdais TA; Wilscu NL, Eloa R, LLCTU RJ: L C - C:S: ir^or~i:ioa n a ~ 2 ^ t - ; n : in z try cen:er. Th^ Gercntolcgis:2S:167A, 1938.
5. Wiisc-n NL: Teasdale TA. Eicn R, Fiaugher J. The Gero-clcgis:. Dev-lo-rr.en: and \ise of an Lnl:~-r.a:icn system for a dementia day center. The Gerontclogisr 25:221 A, 19Si.
6. MilvLi T, Elc-n R. House calls in geriarric medicine. The Gercn;ciocisc 2S:5A. 193S.
7. Kclpakchi A. Eiou R. Teasdale T, Wilscn N. Eviluaeion of dementia in elderly oun:i::?n:s in a ccrr_—'irurv hcspital general cedizins cliric J .Am Geriarr Sec 36:6~OA. 19Sj.

Rebecca D. Elcr.. M.D.. M.P.H.

Pace

S. Auerbach H, Elcn R, Finucar.e T. Developing public policy; a scholarly activity, i he Jobs.s Hopkins University School of Medicine Department of Medicine Research Repeat. $A, 1933.

9. Auerbach H. El:- R, Finucar.e T. Fei;C«'sh:p retiring in public policy. Ss'-^i"ti. Arrurican Geriatrics Sccierv. 19?-.

GRANTS:
19S9 - 1992
Jur.e. 195r June, 1933

Authored KcLloge Fdlc-ship Gran: Proposal.
Co-author, Program Evaluation of ar. Alzheimer's Day Ct funded bv i e Hos? Foundation.

July, 19'

funded bv the Vete-ans' \dr~diiist'-r'"r>

SELECTED PRESENTATIONS

ihe Geriatric Continuum of Family Medicine. A Texas Consortium of Geriatric Ed.:iti;n Centers symposium for Family Medicine Faculty fro~ reaching hospitals frorr: 2 f Ja-uarv ^c;57" and 198S.

2. Kujnar. Rights Considerations in the Care of che Dsrnsited Elderly. .Arr_"esr.' Iztert^i'.ij-ai Regional Conference. Hcuston. Texas, March, 195".

5. The Physician's Role in Long-Term Care. S}Tr,poi;um on long-'.erm care -A-ith Dr 7. PrarJ-Lin '^"iiiiami. •'isi'-ing professor, Houston, Texas, March, 19S^.
-. The D:fft:sn'.:.al Diagnosis of the Dementias. Invited preser.ta'ior. to the First Nit:::.a". C:n£:;s5 c: Grrii^-ic Medicine in Guatemala City, Cczoc?-, 1>37.

5. Thi I-:srfa:s of Psychiatry and Medicine in Lie Cars cf Geriatric Patients. Ge:?r.::'.:si:ai Society of America annual meeting, WashL'itoa DC, November, i9j7.

6. Thi Texas Medical Center; An Historical Ovsr/iew. Presented in German to the Franlccr., Hornbe:: Gicsscn. ar.d Korbach. West Germany Roury Ciubs. May. 19£s.

7. Lons-Ter~ Care in Vs'cs: German;-: Repon frr.n the Rotary Group Study Ex-chanre. Hcustcn. Texas September. 19SS.

S. Demc-graphy. Health Care, and Economics. Symposium on Ethical Issues in Geriatric Health Care Delivery '-ith Drs. Christine Casssl and R o t e - Binstock, Houston. Texas, October. 19SS.

9. Should Active Euthanasia be Legalized? A debate with Don Murphy. M.D., Geer=; Wasl'unr.on University. September. 19S9.

10. Ethical and Social Implications oi Chronic Illness. Invited presentation for (r.-z N';:ional Hea'.± Polic Fcrucn workshop on Chronic Illness and Lcnj-Term Cire. Washington. DC. Oc:c-ber. 1959.

Rebecca D. Elon. M.D.. M.P.H.

Pa.cs

11. The Role of the Nursing Hone Medical Director: Three Perspectives. Poster ss*s::-r it :he Geror.ro'.cgical Society cf America annual meeting, Minneapolis, NfN, November, 195.-.
12. Residents' Rights and Safer.-- Finding the Balance: Symposium on Quality Asi-rir..-. .md Residents' Rights in Long-Terx Care. Houston, Texas, March, 1990.
13. Uririzry Trac: Infections'Asymptomatic Bacceriuria: Treatment of the Positive L'rir.e C_ir_:e. A Medical Care Evaluation Scucy. American Medical Directors' Association and Ar.t:::ir. Coliece of H e £ ± Cire Adr™iris:ra:ors cnnual meeting joir.t s>—pesiurr., Toronto, Canada. .Vay. 199:.
14. Legal arid Epical Issues in N'utrhionil Support. Maryland Society of En:era'. ar.d r^rer.tarz'. Nu:ri:ior.. Brlhssda, Miryland. March, 1991.
15. Dea'J: a: i-.e E_".ical Edge. Plenary Session. Natiomil Cc^nci: cr. die Asii-.s. Mia—!. r.:::ii. Ma1-. 1991.
16. NursLig Home Medical Directors and the OBRA Rer-iarioni. Anerioar: Gerii..-i:> Sc:ie:y. May.

17. Reducxa die Use of Cr.Exicai Restraints in Nursing Horr.es. Learrinj bv E.xamr-e Nursing Hcmes. Ir.vitec presentation. Forum of ± s U.S. Ssr.ate Special Ccmrrir.ir v.-ish:.;"r-on. D.C., July, 1991
IS. Career Or:::ni in Lcng-cerrr: Care for Geriatrics Felloes. American G=ria:r:;s S: DC, N:vi.T.bs:, 1992.
19. Dii;ncer.:i'--es for Physician Pra:tice ir: Lons-term Care. .American Giriairios S:-c:e:v. ''i-»'aihin.2ton. D e""b*r 1992
20. Nutriricc as 2 Quality Indicator in Nursing Kocnes. Annual Syrr.pos;-jrr: of -Jzt J:-hr.s H:-r«dns Universi: Division of Geriatric Medicine and Geron:olog>, Baltimore, Febraar/, 1993.
21. Nursing Home Medical Directors as Expert Witnesses: Defining the Standard of Car=. Annual Meetin; of the American Medical Director's Association, Phcenix, March, 1993.
22. Education in the Nursing Home. Annual Meeting of the Amtrioan Medical Directtr-' A3?::ia:ijn. ?:.otrl?.. March. 1993.
23. Linking Acute and Chronic Care: D3constructing the Dichotomy. Arm-al S^mooiium on Medical Cart in the Nursing Home, sponsored by the Western Ne*- York Geriatric Educa:::.- Cer.::r and Nfonroe Commur.:-.- Hospital, September, 1993.
24. Invited presentation :s the 200th Anniversary Celebration of the University Kosrital Civil de Guadalajara. Guadalajara, Mexico, May, 1994.

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF C0LUM3IA

UNITED STATES OF AMERICA, Plaintiff,
v. 7KZ DISTRICT 07 COLUMBIA, et, al . ,
Defendants.

Civ. No. 95-943 TFI-I CUR-MET FOF.TZ

Pursuant co the provisions of 2S U.S.C. § 1745 and ~.D.C. R. I06(h), I, Curmet Forte, do hereby declare:
1. I have been a resident of the D.C. Village Nursing Home ("DCV") since 1986. I presently live on Unit 3A. I am alsz che Presidenc of che DCV Residents' Association. In this job, I regularly tall-: to the other residents abou- things chat are currently affecting them at the facility. I then talk, to the DCV administrators, including the facility director, Ms. Brasfield, abouc the residents' concerns. I try to get a solution for whatever problem nay come up.
2. I appreciate the job Ms. Brasfield is trying to dc here a: DCV. She is responsive to my concerns and the concerns of the residents' association. Nonetheless, resident care and services have suffered in recent months due to the District's budget crisis. Ms. Brasfield has told me that some DCV vendors haven't been paid. This has created shortages of food, medical supplies and other things residents need. Even though the city's budget problems are not her fault, and even though she has done the best

she can, the financial crisis has caused real problems for residents at the facility.
3. Ir. the past few months, there have been food shortages at all meals. Once the outsiders arrived last week, cor.ditirr.s improved and we had everything we needed. We were fed chicken and pork chops and other good foods. Before they arrived, the meals were bad. We were often served peanut butter sandwiches as a meal. The cooked food was usually net served to us hot. There were no lids to keep individual hot iterr.s warn. Until the outside surveyors arrived, we had not received juice at lur.ch or dinner for a long tine. Now that the outsiders are gone, conditions are worsening again.
4. We typically have to eat our r.eals with plastic utensils. On nost occasions, we are not provided with plastic knives. Needless to say, this makes eating difficult.
5. There have also been shortages of needed supplies and medicine at DCV. I've noticed that staff have run short of medical supplies needed to treat residents on a daily basis such as gauze, four by fours, and duoderr. tape. There has also been a shortage of cups here.
6. There have been recent hot water problems as well. It's my understanding that the vendor who had been under contract to repair the plumbing had not been paid. As a result, he stopped coning out to service the plumbing to ensure that we all had adequate hot water. Many units were without hot water for a week. The residents could not bathe or take showers.
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7. There are other sanitation problems here including roaches and -ice. I've often heard mice running above ne ir. the ceiling while I'm trying to go to sleep. I've also heard them running down the heating pipe. Roaches are often seen in residents' rooms if there's food around.
8. Some contract nurses have been a problem at DCV. They pass medications with their hands dirty and they have committed a lot of medication errors. Or, -any occasions, I've beer, har.ied the wrong medication by a contract nurse, forcing me to correct her mistake. They simply don't know the residents very veil.
9. I've often noticed nurses writing in the record that they perform certain duties and yet I know they don't. A let of residents have gotten what I call a "pencil bath" where the nurses write in the record that they bathed the person, but in fact, they had not. Many residents don't get turned in their beds as they should. I've also seen residents left wet for prolonged periods of time. You can smell the urine. I noticed this just a few days ago.
10. The staff also sometimes become impatient with the residents and holler at us. This may result from the shortage of staff I always notice on the units. We're usually short-staffed all the time. Some staff are forced to work two shifts in a row. This makes them irritable. These shortages continue today.
11. I've noticed that residents' clothes are often stolen when they are sent out to the laundry. I don't even send my clothes to the laundry any more.
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12. I've recently noticed a problem with our personal needs funds. We are entitled to certain personal monies from Medicaid. These funds are to be deposited directly into our own accounts. However, it sser.s that because of the budget crisis, the District is putting all our money into an account in the District's Department cf the Treasury. They are supposed to give us the money we are entitled to from Medicaid directly, not keep it for themselves ur.til we ask. I've been able to get rr.y ir.cr.ey, but that's because I can speak up for myself. Other residents have recently ccrr.e to me upset because they were told that their money was tied up. I approached Mr. Brown here at DCV and he agreed to pay the residents who requested funds. I still worry about those other residents who cannot speak about their concerns or come to me and ask for help.
13. I think the best way to resolve the problems here at DCV would be to place the operation of the facility under federal control or under the control of a receiver.
I certify under penalty of perjury that the foregoing is true and correct. Executed this '•• day cf June, 1995.
_ . / J: .-
Curmet Forte
- e.-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES Or AMERICA, Plaintiff,
v. THE DISTRICT 07 COLUMBIA, ec al.,
Defendants.

) ) ) Civ. No. 95-945 T7K ) )

DECLARATION OF BLAINE S. GREENWALD, M.D.

1. Elaine S. Greenwald, M.D., the United States'

psychiatric consultant in this case, pursuant to the

provisions cf 28 U.S.C. § 1746 and D.D.C. R. 106(h), do hereby

declare:

"

" ~— both a IDractic-.r*cr ar*d acader^ic D'nvs^cia*^

specializing in geriatric psychiatry. I have focused primarily

on treating elderly patients, including in long-term care

settings, as well as teaching, writing, and studying about -he

provision cf appropriate psychiatric care for the geriatric

population.

2. 7c acquaint the Court with nry specific qualifications,

I provide a summary of my background below. My curriculum vitae,

which is attached to my Declaration, provides further details

about my experiences ana qualifications.

BACKGROUND, EXPERIENCE AND EDUCATION

3. Educational backaround: I received my medical degree

from New York Medical College in 1981. I completed a medical

TTT r

internship at Metropolitan Hospital Center in New York Citv. Xv residency was in psychiatry and I served a fellowship specializing in geriatric psychiatry both at Mount Sinai S::.:;l of Medicine in New York.
4. Academic experience: I am the Associate Chairman cf Department cf Psychiatry at the Long Island Jewish Medical Center, and an Associate Professor, Department of Psychiatry at the Albert Einstein College of Medicine in New York. I am s.l = c the Program Director for one of the largest accredited felltv/shic traininc prc~rams in geriatric psvchiatrv in the countr*.*.
5. Administrative and clinical experience: Currentlv, I hold the positions of Director, Geriatric Psvchiatrv Divisitn, and Attending Psychiatrist for the Hillside Kospital-Lonr Island Jewish Medical Center; Gero-Psychiatric Consultant for the Kecrev Home of the Acred (a 700-bed nursin— home) • ard Prc'sc" ~ir— r for an affiliation between Long Island Jewish Medical Center and the Central Islio Psychiatric Center, a chronic state hospital for geriatric patients. In these capacities, I am involved in overseemcr tne psychiatric care anc treatment j_or more tnan a thousand individuals, including a significant proportion who reside in a variety of long-term care facilities.
6. Professional Activities: I am board certified in psychiatry by the American Board of Psychiatry and Neurology. I have been granted the status of "Diplomate" by the National Board of Medical Examiners and the American College of Physicians. The American Board of Psychiatry and Neurology has
- 2-

also grar.ted me the status of "Added Qualification in Geriatric

Psychiatry." I have also received awards for excellence ir.

psychiatry, research ir. psychiatry and by the Northwest Brcnx

council on Aging, the Outstanding Gerontologist Award. In

addition, I recently received a clinical mental health academic

award in geriatric psychiatry from the National Institute of

Mental Health ("NIMH").

I am an active member of the American Psychiatric

Association ("APA") and serve on the APA's Council on Aging's

Committee or. Access Effectiveness of Psychiatric Services fcr the

Elderly. I am also a member of the American Association for

Geriatric Psychiatry and the Gerontological Societv of America,

and have made numerous presentations before these groups en

issues related to geriatric psychiatry.

T

^"'bl~'cat"'on3t I nave published sxt£nsivs'* v o ^ ^

variety of topics in the field of geriatric psychiatry, including

articles, book chapters, monographs, and abstracts in respected

professional journals. P.ecent publications and presentations

include: Geriatric Depression With and Without Reversible

Cognitive Impairment: Clinical Comparison; Psvchotrooics and

Hispanic Nursing Home Residents; Impact Of A Nursing Home

Geriatric Psvchooharmacoloav Education Program On Prescribing

Practices; and Tailoring Adult Psychiatric Practices To The Field

Of Geriatrics. In addition, I have been an invited speaker at

numerous symposiums, grand rounds and annual meetings of medical

- 3 -

associations. Many of my publications ana presentations have focus^d on 1 cnc term care and treatment
S . Excert Witness activities ana experience in Ion- term care related litigation: I have served as an expert consultant in cases ir.vdving professional standards for geriatric psychiatry. I have worked with the United States Department of Justice since 1993 in the Department's investigation and enforcement activities under the Civil Rights of Institutionalized Persons Ace ("CRIPA"). In this capacity, I have been involved with CRIPA investigations in Virginia and -he instant action here in the District of Columbia. INVOLVEMENT WITH THIS CASE AND FAMILIARITY WITH D.C. VILLAGE NURSING HOME
9. In April 1994, I was asked by the Department of Justice to serve as an expert consultant to assess the psychiacric care and treatment of residents at the D.C. Village Nursing Home in Washington, 2.C. I first toured D.C. Village on June c-7, 1594. Prior to the tour, I reviewed numerous documents provided by D.C. Village, including policies and procedures of the facility, internal reports and summaries, consultations and treatment protocols. During the investigative tour, I observed, among other things, routine medical and psychiatric care and treatment of residents within their living units. In addition, resident charts were reviewed and multiple staff members interviewed.
10. I toured D.C. Village again on Tuesday, May 30, IS35. Again, I observed the routine medical and psychiatric care and
TT

treatment of residents and spoke with multiple staff tr.err.bers . During the tcur, I reviewed more documents, including additional individual resident medical records.
11. During the more recent investigative tour last week, I saw that the deficiencies I had identified last year had .-.:: bee: corrected by the District, and that D.C. Village residents rerr.ai: at serious risk of harm. In my opinion, D.C. Village is failing to provide residents with adequate and appropriate psychiatric care and mental health services in accordance with accepted
Shortages at D.C. Village Have Led to Inadequate Basis Care 12. Before I address psychiatry issues, there are severs.!
areas of more general but immediate concern that I noted during the recent investigative tour. Multiple staff I talked with reported that there were staff shortages, particularly among nurses and nurse's aides and that there were supply shortages. Some staff commented that the consequences of these shortages included: "not enough nurse's aides to feed peoole;" "not enough nurse's aides to bathe people,-" that the requirements of tube feedings, nebulizer treatments, and medication administration overwhelmed the nursing manpower and "there's gotta be mistakes; "inadequate food on trays;" and "medication shortages." In addition, several physicians told me in confidence that because of medication and staff shortages, they believed nursing staff would either mark in the record that the drug had been giver., even if it had not been given, or indicate that the resident
- 5-

refused the dedication. The physicians further indicated zheir belief thai lew drug blood levels are a consequence of medications :.:; being given because of either medication shortages or lack of nursing manpower. Inadequate rsvehiatric Assessment of D.C. Village Residents
13. The principles underlying modern psychiatric care are sympzom-based diagnosis and diagnosis-based treatment. These basic premises are undermined regularly at D.C. Village. In both discussions wi~h staff and review of medical records, I found little documentary evidence that residents are adequately diagnosed via the traditional organized process of (a) collecting historical information, (b) interviewing the resident and significant others, (c) conducting a. comprehensive mental status exami1^a^iC'" including a cocrnxtive examz.n3.tion (esoecia"' lv i~" "he elderly or in those individuals with underlying brain disease;, (d) colleccin- additional necessarv coroiiarv information, (e.c., neurological examination, blood tests, neuroimaging scans, neuropsychological testing), and (e) integrating these data into a diagnostic formulation and/or differential diagnosis that conforms with the generally accepted standard diagnostic nomenclature cf American psychiatry as articulated in the Diagnostic and Statistical Manual ("DSM-IV") published by the American Psychiatric Association.
14. D.C. Village is not providing its residents with a comprehensive psychiatric assessment including adequate behavioral data and analysis where appropriate. The notion that

a potentially reversible medical or neurological problem r.;r'r.: be expressed as a behavioral disturbance seems alien.
15. D.C. Village also appears to conduct no cognitive examinations or dementia work-ups of its residents. I found little evidence that mentally ill residents are provided with an integrated differential diagnosis and treatment plan signed zy the psychiatrist.
16. It is generally accepted in the field that a proper DSM-IV diagnosis be formulated and recorded as part of the process of institutionalized residents receiving psychotrorio medication. However, the D.C. Village medical staff is net familiar with and does not appropriately employ the DSM-IV criteria or terminology in formulating psychiatric diagnoses. Furthermore, reevaluation and revision of psychiatric diagnoses do not aooear to occur ir. any regular or organize^, manner. Psychiatric Treatment at D.C. Village is Inadequate
17. It is generally accepted that psychiatric treatment should be an amalgam of psychosocial, psychopharmacolcgical, and psychiatric rehabilitative efforts that are organized into a coherent, multidisciplinary "treatment plan" that is regularly revisited to determine whether such treatment has been effective in ameliorating the psychiatric symptomology and disorders.
18. I found little evidence that such a process occurs at D.C. Village. There is no effort made to integrate psychiatric care for the residents in a nuiltidisciplinary fashion. Furthermore, psychiatric notes are not integrated into the
- 7-
TWI 1 W

individual's overall medical plan of care or with behavioral treatment programs. I could not find a single integrated ~edical/psychiatric/psychosocial plan in any D.C. Village resident's chart that I reviewed.
19. In addition, I found no organized use of psychctrceic medication in a carefully considered plan of care. For examele, for residents on antipsychotic medications, forms seem tc have supplanted the traditional psychiatric note that incorporates the various aspects of symptoms, treatment, side effects, and ether information (e.g., nursing notes/input), and ends with a conciusion/ir.pressions and a carefully considered plan.
20. I found no consistent correlation between medicatien order changes and progress note documentation of such changes. In face, there is no rationale provided when medication dosages are changed. Furthermore, examples of inaccuracies are apparent in psychiatric notes: e.g., a resident is titrated down and off of a particular neuroieptic and the psychiatric note indicates that neuroieptics have been discontinued and are not indicated, while in fact, the resident actually continues to receive another neuroieptic medication.
21. Psychotropic medications are often used incorrectly at D.C. Village. For example, I found medication dosing does net always conform to geropsychiatric standards, and the dosing of antidepressants to be inadequate and/or not properly titrated.
22. There are also many individuals with the medication side effect of tardive dyskinesia ("TD") living at D.C. Village.
- 8-

TD is an untoward, usually irreversible effect, appearing after long term use of antipsychocic drugs, involving involuntarv muscle involvement, spasms, and speech disturbances. Yet, I found evidence that antichoiinergic/dopaminergic medications (medications given to control/influence nervous system activity) being improperly prescribed for TD, even though these agentwill, in fact, worsen TD. The D.C. Village physicians are confusing 71 and extrapyramidai symptoms. This indicates a lack of basic neuro-chemical/neurc-pharmacoiogical understanding among medical providers at D.C. Village and highlights the need f:r inservice training in psychopharmacoiogy and geriatric psychopharmacoiogy.
23. Fsychopharmacclogical treatment does not appear tc be clearly tied tc target symptoms, i.e., if the target symptoms are not improved, the treatment should then be modified (dosage increased, decreased, or drug changed). Side effect monitoring is erratic and potentially dangerous (e.c., not monitoring postural bleed pressure in elderly residents on psychotropic drugs that can provoke postural hypotension and consequent falls). In addition, there currently is no regular review of prescribed psychotropic medications to integrate side effects with symptoms. The side effects testing that I observed in the records appeared to be perfunctory and did not in several cases correlate with my personal observations of residents.
24. Psychosocial and psychiatric rehabilitative treatments do not exist for the majority of the patients and are not part of
- 9-

an integrated treatment plan that has defined goals and cbjectives.
25. Ir. su~, in my opinion, D.C. Village is failing :c provide residents with adequate and appropriate psychiatric care and mental health services in accordance with accepted professional standards to residents who are in need of such services. Inappropriate Placement of D.C. Village Residents With Mental Illness
25. It is my opinion that -any of the residents at T.C. Village with a psychiatric diagnosis are inappropriately placed and need not be in a nursing home setting.
27. Several staff commented to me that D.C. Village has been a "dumping ground" for Saint Elizabeth's overflow of schizophrenic patients. I was informed by a D.C. Village physician that "plenty of people are here who should not be here. "
28. It is generally accepted that individuals with a primary psychiatric diagnosis should not be placed in a nursing home setting. One physician reported to me that the prior 2.Z. Village Medical Director explicitly instructed staff to "net list psychiatric illness as the primary diagnosis." If true, this is a dramatic departure from generally accepted professional standards.
29. My own review of medical charts suggests that the medical needs of many of the D.C. Village residents
- 10 -

classified wi:h a secondary diagnosis of mental illness do :.;;, ir. face, necessitate placement in a nursing home.
30. .-." a minimum, everyone with a psychiatric diagnosis at D.C. Village should be re-evaluated, and for those who are determined to have a primary psychiatric diagnosis, they shculd be outplaced to a more appropriate setting. I found the process of complying with federal statutory nursing home regulations a:
admissions and a lack of review/outplacement of inappropriate residents. These regulations are part of the Nursing Home Reform Law ("QBRA legislation") and include a Pre-Admission Screening and Annual Resident Review ("PA3ARR") for mental illness.
31. In addition, even if residents with orimarv osvehiazric diagnoses are considered to have secondary psychiatric diagnoses with medical or dementia qualifiers for nursing home placemen", D.C. Village is still obligated, pursuant to federal nursing home law and generally accepted professional standards, to provide adeauate osychiatric services. I find that D.C. Village fails to provide such services. For example, when I queried the D.C. Village psychiatrist about a work-up to rule out whether a resident with dementia may have a reversible component to their cognitive decline, he replied, "We don't do a dementia work-up."
I declare under penalty of perjury that the foregoing is true and accurate. Signed this '5 "" day of June, 1S55.
Blaine S. Greenwald, M.D. - 11 -

BLAINE S. GREEXWALD, M.D.

Date of Birth: Place of Birth: Address:

12/5/52 New York City (W) Hillside Hospital - Long Island Jewish Medical Center. PO Box 38. Glen Oaks. New York 11004 (H) 2 Lafayette Road Larchmont. New York 10538

Phone #: Marital Status: Children:

(718) 470-8159 (W) / (914) 833-0521 (H) Married to Jayne Doreen Weiner - 4/8/79 Rebecca Kate Greenwald - born 10/18/81 Dorothy Hana Greenwald - born 4/8/8 Charles Evan Greenwald - born 3/2/91

Professional Experience:

Director. Geriatric Psychiatry Division, Hillside Hospital-Long Island Jewish Medical Cer.:er. Glen Oaks. NY. January 1989 -

Associate Chairman. Department of Psychiatry. Long Island Jewish Medical Center. G'.en Oaks. NY. February 1994 -

Attending Psychiatrist, Long Island Jewish - Hillside Medical Center, Glen Oaks. NY. January 19S9 -

Associate Professor. Department of Psychiatry. Albert Einstein College of Medicine. Bror.x. New York. July 1989 -

Consultant Geriatric Psychiatrist. Hebrew Home for the Aged. Riverdale, New York. 198" -

Director, Division of Geriatric Psychiatry, Department of Psychiatry, Mount Sinai School o: Medicine. New York, NY. December 1984 - December 1988.

Director, Clinical/Recruitment Core. Alzheimer's Disease Center, Mount Sinai School o: Medicine, New York, NY. July 1987 - December 1988.

Assistant Professor, Department of Psychiatry, Mount Sinai School of Medicine, New York. NY. July 1985 - December 1988.

Assistant Attending Physician, Mount Sinai Hospital. New York, NY. January 1985 -"December 1988.

Medical Director, Day Hospital Program, Broax VA Medical Center, Broax. New York. July 1983 - June 1985.

Instructor, Department of Psychiatry, Mount Sinai School of Medicine, New York. NY. July 1982 - June 1985.

Fellow in Geriatric Psychiatry (Division of Extended Care - VA Central Office), Bronx YA Medical Center / Mount Sinai School of Medicine, New York, NY. July 1982 - June 1983.

Blaine S. Greenwald. M.D.
Chief Resident in Psychiatry. Special Treatment Unit, Bronx VA Medical Center Psychiatry Service. Mount Sinai Schoo! of Medicine. New York. NY. July 1981 - June 1982.
Resident in Psychiatry. Mount Sinai Medical Center. New York. NY. July 1979 - June 19S1.
Intern in Internal Medicine. Metropolitan Hospital Center, New York. NY. Julv 1978 - June 1979.

Education: M.D., 1978. New York Medical College. Valhalla. New York. B.S., 1974. summa cum laude. State University of New York. College at New Paltz.

Awards:

M. Ralph Kaufman Award for Excellence in Psychiatry. Mount Sinai Medical Center. 1982
Marcel Heiman Memorial Award for Research in Psychiatry, Mount Sinai Medical Center, 1982
Northwest Bronx Council on Aging Outstanding Gerontologist Award. 1990.

Licensure:

New Y'ork State Dtplomate, National Board of Medical Examiners
Diplomate, American Board of Psychiatry and Neurology, 19S3
Diplomate, American Board of Psychiatry and Neurology Added Qualification in Geriatric Psychiatry. 1991

Membership:

American Psychiatric .Association American Association for Geriatric Psychiatry Gerontolosical Society of America

Consultant - American Psychiatric Association (APA) Work Group: Practice Guidelines for the Treatment of Major Depression, 1991-1992
Past Member: American Association for Geriatric Psychiatry (AAGP). Committee on Fellowship and Residency Training

Blaine S. Greenwald. M.D.
Member: American Psychiatric Association (APA) Council on Agi.-.t's Committee on Access and EfTectiveness of Psvchiatric Services for the Eiderh. s ^3-

Grants:

NVS OMH. Central Islip Psychiatric Center-Lonsz Island Jewish Medical Center .Affiliation Contract 4/91-6/91, SS.000.00 (B. Greenwald. Project Director) Renewal 7/91 - 6/92, $32,000 Renewal 7/92 - 6/93. S32.000 Renewal 7/9? - 6/94, S33.OOO
Bristol-Myers Squibb Pharmaceutical Research Institute. "A Mu:::cer.:er Placebo Controlled Comparison of Nefazodone and Fluoxetine in the Treatment of Elderlv Patients with Major Depressive Illness" 3/92 -9/93. $142,000 (B. Greenwald. site P.I.)
National Institute of Mental Health (NIMH). Clinical Mental He;:l:n Academic Award (CMHAA) in Geriatric Psychiatry: "Brain Morphometr. in Geriatric Depression" 4/94-3/99, S721,478.00 (BS Greenwald. PI) .

Publications:
1. Nurnberg. H.G.. Greenwald. B.: Stuttering: an unusual side effect ofphenothiazir.es. American Journal of Psychratry 138: 3S6-3S7, 19S1.
2. Rosenberg. G.S.. Greenwald. B., Davis. K.L.: Pharmacological treatment of Alzheimer's disease. In: Alzheimer's Disease. The Standard Reference. Editor, B. Reisberg. The Free Press. MacMillar. Publishing Co., 1983.
3. Greenwald, B.S. and Davis. K.L.: Experimental Pharmacology of Alzheimer's Disease. In: The Dementias: (Advances in Neurology, Vol. 38). Edited by R. Mayeux and W.G. Rosen. Raven Press. New York, 1983.
4. Greenwald, B.S., Mohs. R.C. and Davis, K.L.: Neurotransmitter deficits in Alzheimer's disease: Criteria for significance. Journal of the American Geriatrics Society 31: 310-316, 19S3.
5. Davis, K.L., Mohs, R.C, Rosen, W.G., Greenwald, B.S., Levy, M.L., Horvath, T.B.: Letter: Memory enhancement in Alzheimer's disease with oral physostigmine. New England Journal of Medicine 30S: 721, 1983.
6. Johns, C.A., Levy, M.L, Greenwald, B.S., Rosen, W.G., Horvath, T.B., Davis, B.M., Mohs, R.C, Davis. K.L.: Studies of cholinergic mechanisms in Alzheimer's disease. In: Biological Aspects of Alzheimer's Disease (Banbury Report 15); Cold Spring Harbor Laboratory Press, 19S3, pp. 435-449.
7. Johns, C.A., Greenwald, B.S., Mohs, R.C. Davis, K.L.: The cholinergic treatment strategv in aging and senile dementia. Psychopharm. Bulletin .19:2. 185-197, 19S3.

Blaine S. Greenwald. M.D.

S. Davis. K.L.. Mohs. R.C.. Davis, B.M.. Horvath. T.B., Greenwald. B.S., Rosen. W.G.. Levy. M.I., Johns. C.A.: Oral Physosrigmine in Alzheimer's disease. Psychopharm. Bulletin 19: 451-453. 19S3.

9. Davis. K.L., Johns. C.A.. Mohs, R.C., and Greenwald, B.S. Reply to letter. Re: Chotinesterase inhibitors and opiate antagonists in patients with Alzheimer's disease. New England Journal of Medicine. _309: 555-556. 19S3.

10. Mohs. R.C.? Rosen. W.G.. Greenwald, B.S., Davis, K.L.: Neuropathologically validated scales for Alzheirner's disease. In: Assessment in Geriatric Psychopharmacology. Edited by T. Crook. S. Ferris. R. Bartus. Mark Powley Assoe, New Canaan, Connecticut, 19S3.

11. Greenwald, B.S.. Denicoff, K., Meyerson, A.T. Treatment Planning: Chronic patient has numerous changes in drugs, therapists; Makes only limited gains. Hospital and Community Psychiatry 3<v 233-235, 19S5. "

12. Mohs, R.C., Davis. B.M.. Johns. C.A., Mathe. A.A., Greenwald. B.S., Horvath. T.B.. Davis. K.L. Oral physostigmine treatment of patients with Alzheimer's disease. American Journal of Psychiatry. 142: 28-33, 1985.

13. Greenwald, B.S.. Edasery, J., Mohs, R.C., Shah, N., Trigos, G.G., Davis, K.L. RBC and plasma choline in Alzheimer's disease. Biological Psychiatry. 20: 367-374, 1985.

14. Kanof. P.D., Greenwald. B.S.. Mohs. R.C.. Davis, K.L. Red blood cell choline uptake kinetics in Alzheimer's disease. Biological Psvchiatrv _20: 375-383, 1955.

15. Johns, C.A., Haroutunian. B.. Greenwald, B.S., Mohs, R.C., Davis, B.M.. Kanof, P.. Horvath, T.B.. Davis, K.L. Development of cholinergic drags for the treatment of Alzheimer's disease. Drug Development Research. _5:1, 77-96, 19S5.

16. Davis, B.M., Mohs, R.C., Greenwald, B.S., Johns, C.A., Horvath, T.B., Dans, K.L. Clinical studies of the cholinergic deficit in Alzheimer's disease: I. Neurochemicai and Neuroendocrine Studies. J. American Geriatrics Society, 33:741-748, 1985.

17. Mohs, R.C., Davis, B.M., Greenwald, B.S., Johns, C.A., Horvath, T.B., Davis, K.L. Clinical studies of the cholinergic deficit in Alzheimer's disease: II. Psychopharmacological Studies. J. American Geriatrics Society. 33:749-757, 1985.

IS. Mohs RC, Davis BM, Mathe AA, Rosen \VG, Johns CA, Greenwald BS, Horvath TB, Davis KL.

Intravenous and oral physostigmine in Alzheimer's

disease. In: Interdisciplinary Topics in

Gerontology Vol 20: Modern Approaches to the Dementias. Part II. F.C. Rose (editor). S. Karger,

Basel, 1985.

19. Davis, K.L., Davis, B.M., Greenwald, B.S., Mohs, R.C., Mathe, A.S.,-Johns. C.A., Horvath, T.B. Cortisol in Alzheimer's disease I: Basal Studies. American Journal of Psvchiatrv. 143:300-305. 19S6.

Blaine S. Greenwald. M.D.
20. Greenwald. B.S.. Mathe. A.A.. Mohs. R.C.. Levy. M.I.. Johns, C.A.. Davis. K.L. Corciso! in .Alzheimer's disease II: Dexamethasone suppression, dementia severity, and affective symptoms. American Journal of Psvchiatrv. 143: 442-4-16, 19S6.
21. Greenwald. B.S.. Marin. D.B., Silverman, S.N1. Serotoninergic treatment of screaming and banging in dementia. Lancet 2: 1464-1465. 1986.
22. Greenwald, B.S., Mohs. R.C.. Davis, K.L. Reply to letter, re: Cortisol and Alzheimer's Disease. American Journal of Psychiatry. 144: 534-535, 19S7.
23. Greenwald. B.S. &.Kramer-Ginsberg, E. Age at onset in geriatric depression: Relationship to clinical variables. J. Affective Disorders 15: 61-68, 19SS.
24. Kramer-Ginsberg. E.. Greenwald, B.S.. Aisen. P.S., Brod-Milier, C. Hypochondriasis in the elderly depressed. J Am"Geriatr Soc, 37: 507-510, 19S9.
25. Marin. D.B. & Greenwald. B.S. Carbamazepine in aggressive agitation during nursing care in dementia. American Journal of Psychiatry. 146: 805, 1989.
26. Greenwald. B.S.. Kramer-Ginsberg. E.. Marin, D.B., Laitman, L.B.. Hermann, C . Mohs. R.C., Davis. K.L. Dementia with coexistent major depression. American Journal of Psychiatry. 146: 1472-8, 1989.
27. Greenwald BS, Reingold E (eds.): Late Life Psychoses: Biopsvchosocial Considerations for Practice. A Monograph. Samuels Foundation, New York, 1990.
2S. Greenwald BS. Overview of late life psychoses, in Late Life Psychoses: Biopsvchosocial Considerations for Practice. A Monograph. Edited by Greenwald BS, Reingold E. Samuels Foundation, New York, 1990.
29. Davis KL, Greenwald BS. Biology- of schizophrenia, in Foundations of Psychiatry. Edited by Davis KL, Klar H, Coyle JT. W.B. Saunde'rs Co., Philadelphia, PA, 1991.
30. Greenwald BS, Kremen N, Aupperle P. Tailoring adult psychiatric practices to the field of geriatrics. Psychiatr Quart 63: 343-366, 1992.
31. Greenwald BS. Depression in Alzheimer's Disease, in: Behavioral Complications in Alzheimer's Disease: New Approaches Relevant for Clinical Practice. Edited by BA Lawlor. APA Press, Washington (in press).
32. Greenwald BS, Grossman H, Bloom HG, Kramer E, Teresi J, Holmes D. Impact of a nursing home geriatric psychopharmacology education program on prescribing practices, (in review - J Mental Health Administration)

Blaine S. Greenwald. M.D.
33. Greenwald BS. Kramer-Ginsberg E, Bogerts B, Ashtari M, Aupperle P, Allen L. Zerr.an D, Wu H. Patel M. Qualitative MRI Findings in Geriatric Depression. Possible Link Between a Late-Onset Depression Subgroup and Alzheimer's disease? (Manuscript in preparation). (Presented in part at New Research forum at American Psychiatric Association {APA}. May 19^4. Philadelphia.
.34. Greenwald BS, Kramer-Ginsberg E, Krishnan KRR. .Ashtari M. Aupperle P. Patel M. MRI Signal Hyperintensities in Geriatric Depression (Manuscript in preparation). (Presented a: New Research forum at American Psychiatric Association {APA}, May 1995, Miami).
Recent Presentations:
Greenwald BS, Kramer E. Reingold J, Jacks EB, Staum S, Foley C. Aggressive/disruptive behaviors in nursing homes, (presented at APA meeting, New York. 1990)
Greenwald BS & Kramer E. Incessant screaming in advanced dementia, (presented a: APA meeting. New York. 1990)
Greenwald BS, Grossman H, Bloom HG, Kramer E, Teresi J. Holmes D. Impact of a nursing home geriatric psychopharmacology education program on prescribing practices, (presented at GSA meetings. Boston, 1990.)
Kramer E, Greenwald BS. Aisen PS. Depression in the "old-old." (presented at GSA meetings, Boston. 1990).
Kramer E, Greenwald BS. Abraham S, Reingold J, Grossman H. Physical restraints in dementia with agitation, (presented at APA meeting, New Orleans, 1991)
Greenwald BS, Kramer E. Major depression in severe dementia, (presented at APA meeting, New Orleans, 1991).
Greenwald BS, Kramer-Ginsberg E, Abraham S, Hodder RA. Tricyclic antidepressar/.s. orthostatic monitoring and falls in nursing homes. (presented at APA meeting, Washington, D.C., 1992).
Vince M, Greenwald BS, Kramer-Ginsberg E, Lennon A, Corcoran R. Psychotropics and Hispanic nursing home residents, (presented at APA meeting, Washington, D.C., 1992).
Hasan N, Kramer-Ginsberg E, Greenwald BS, Ramos-Lorenzi J, Aupperle P, Kremen N. Treatment of older depressives in a geropsychiatry versus general psychiatry clinic: A comparison study, (presented at APA meeting, Washington, D.C., 1992).

Blaine S. Greenwald. M.D.
Mildener B, Kramer-Ginsberg E, Greenwald BS. Kremen N. Aupperle P, Leipzig R. Fluoxetine and bupropion in old-old depressives. (presented at APA meeting, Washington, D.C.. 1992).
Kramer-Ginsberg E. Greenwald BS, Abraham S. Hodder RA. Reingold J. Do severe behaviors predict death in advanced dementia? (presented at GSA meeting, Washington. D.C.. 1992)
Greenwald BS. Gemson DH. Kramer-Ginsberg E. A survey of mental health services in nursing homes, (presented at APA meeting. San Francisco, 1993).
Kramer-Ginsberg E. Greenwald BS. Depressive pseudodementia: 6-7 year follow-up, (presented at APA meeting. San Francisco. 1993).
Greenwald BS, Kramer E. Bogerts B, Ashtari M, Aupperle P, Allen LG, Zeman D, Patel M. Qualitative assessment of brain morphology in geriatric depression. APA New Research Abstracts. Washington, 1994.
Allen LG, Greenwald BS. Brenner R. Hodder R. Risbrook A. Mental disorders in Black nursing home residents. .APA New Research Abstracts, Washington 1994.

DECLARATION OF M. ANNE HART
c _i=T 9

— i^v---. *•""•" a"d a •1'ras~'5r3 m P u b l i c — c-~ir*is~ra~i' ndrus Gercntologv Center at the University of Sout'

Term
•r-9
residents; 2) to investigate and resolve cor.plaints made

J3"/ or o"" .ce cualitv cf :are, services provided and quality of ii
s to ensure tnat tn~ cars

a.net ssrvices a.re m accorcance witn. apoiicaoie uio.iri-'

federal laws; 4} to analyze, co~.rr.~r-t on and monitor z'r.

devaloo".er.t and iir.pieT.entation of federal, State, and

laws,

regulations and governmental policy and actions that p to .*._,,„ k-

tine health, safety, welfare and rights of nursing faci

residents; and 5} to reoresent the interests of reside nts ceiore

T.rr.er.ta_ agencies ana see.-: administrative, lecral and " h e : Lies tt protect their health, safety, welfare and rights.
erscnai kr.cwledae of D . C . ViIIacre :."ursmcr
- = T - ^ .'I
e rased uccr. thac kr.owledge. Based or. rr.y personal kr.cv/le .d cbservaiions as the District of Columbia Long Ter~ "are buds~ar., I have concluded that the level of care is so adequate at D.C. Village that health, safety and welfare t f its
- . x have verified from medics.! records tha~ ~"" ing crovided to residents at D.C. Village is inadequate a = ^^.v-Q- 7^3 their health, safetv and welfare. I have also
coor based on complaints and my investigation of those
c. For example, one B.C. Village resident was hospitalized on February 11, 1995 with a broken arm after s'r.e wa found with a swollen arm, her bedside curtain full of stool, and blood on the floor. This was not the first such incident, incident reports show that she suffered contusions and

t ne r-=5 ic-sn _ w a s
) u t s L c. a •_ o w a — t ~ •
Wltn Yf.i ]fS 5 ICwf.t
.5 54 with pneu~onia, stage III decubitus ulcers iected with staph and strep, septicerr.ia and ar.arr.ia. ient was previously hospitalized only in Septerier
i a U i v ' f l v j ' i_ni 3 *~ d ri ^ ^ " " ' •". ' ~ ' ' 5 ' ' " ~ *"
.s again hospitalized on May 19 of this year .nfectlon ana stage IV decubitus ulcers. 7r.
A resident of D.C. Village was senr to the -co.10, 1595 wich dehydration and decubitus
.r.s resj.vj.en™ w a s
ie~?z wr.icr. was m t e c t teo. to ce rr.amounsneo anct •dsnyo.r'S.tsG . —y zr.s :cond hoscitaiization, the ulcer went to the j oint The resident's lower leg below the knee was ne rsalter a rr.stated.
Another resident was sent to the hospital cr. A ^-2 1534 with severe dehydration, multiple decubitus

; 3O S- ^

: r.e resia.ent r.a.

1 ™ Ar O t ~~-e ^ ^~e s br.s wss ta.<sr. ~o a f.osp
have uroseosis an~ siaqe II decubi"us ulcers

•v- ^ •— • ' v - v - •
A review

.r.g serious injury and hospitaiization, yet the;. :aii after they return to D.C. Village. For ex= :ii six 11n~.es m tour montr^ sustaining j.a^.erat isnt fell five tirr.es in three mor.c.is. Anotr.er . four tirr.es m two months, twice coiner to ch-= once fallina twice on the same day. ~T'his indi a snorta-e c t
orts also show a pattern of unexplained injuries tha'

12. A resident was hospitalized on April 12, 1535 with a fractured bone from a fail. She was diagnosed upon hosoitalizacion with sepsis from a urinary tract infeoticn, and S t a a e III d e c u b i t u s ulcers. The resident died or. A p r i l 2 3 , 1 9 9 5 .

r.euroleci i t = which were prescribed because cf chronic mental 11_r_e53. .-._ -r.oucrr. t r.e res icier.t was az nij.i r13K , sr.e cz.z. not r e — e i v e e n e s " s i * m.on_ •_ o r —. .cr v^r — n•_ ~ r~v ^n _ .^ o n ri*c65 35.rv t ~ c r ev e nt '•"-2>v~ ~~"""o — S ' ' ^ " — "1!^. — r.'CT s o Tar".*/ rr."i_*i.~ 2.o^s ir."^ u n s s
1 - A r e s i d e r . " o f D . C . V i l l a c r e h a d h i s c h v s i c " =•*. reo"j.es~ c _ a s s e s t o r r.z_rr. or. r e o r u a r v l o , 1 ? ^ D . &y Msy , _ rr - , cr.e resicer.- r.3.5 scij.^. r.oz oeer. Sliced tor classes s.r.i a 56C3T.3.
glasses. 15. I receive r.ar.y corr.claincs about; the shcria~e cz
ir."s511—aticr. ar_^* personal observation tnat various ur.113 5.1 u . L. • Village have been without diapers, bibs, clean sheets, ducderrr. cape forchanging dress ings fordacabitus ulcers, drinking cups, "iuice r~ilk Procardia, X3.nt.ax, A ic D Ointment, andall~anner ovitaTiins that are prescribed to assist in the healing of
16. The quantity and quality of food provided residents at D.C. Village is insufficient. Residents frerrgently tell me and my observations have confirmed that they are hungry, the portions of food are too small, substitutions andsnazksare

- - , .'.

ve-e~ac-.es.

r a r e J- V, _ r.ave ^cc.-c-r. ~o a d i e t i c i a n a : - . «

not rscsivir.1-! sr.cu-.". e u s e o - spor.-cs" a t '•— . _

iir,*c z.3
r= O — U — . - - 3 '- '

eat with a spork and, a

.:er.: tooa In response to -v c

C V? =

1?. On May 10, 1935, residents on unit 33 were eating

T. that date, there were no cups available fo
=. -r- £i T,/ ^1 '
tr.at azter ea ting their food with their fingers, resident. covered with re5idual fcod. Resider.t s m tne aav
room were crying and very distressed that they had no uter.siis with which to eat.

T

r

rss 1c.6r.~3 were s~rv—3. = c^;-;
• — r ,->
S _cil _

z~ or foca eerause tr.ere is a sr.ortaae o: "•

ere;

srs ...

- ao is co sal solid food.

ir \_n-s...

'C a*J — '
on. co c'nsir

23. As a resu_: or cr.e= e prooier.s, rr.any rssider."= ar suffering dramatic weigh" loss. 0r.~ res ice."t o.i unit 3 3 wzr.z from 193crur.ds in Augus~ 1994 to 140pounds ir. ecembeer, 1
24. Based on rr.y review of medical records, I have s." so ~o"'"™d "'"a" a very mcrn cercenta^e o~ residents at ^ . C. Village are dehydrated. Residents are often dehydrated because thev are not being given sufficient quantities of water each day The conseauenees of dehydration, particularly in the vulnerable copulation at D.C. Village, can be severe. If residents do not drink lieuids they are crone to urinary tract infectionsand

4 1 2 U 1533

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. . . me cav roc~ on ur.i

• J . ; 3 J . S — e n _ j- v

= roowsri .- srr.eii o . u n n i wr-icr. nass ~~oo~~5.^5_jj.y sa~u.r5.~ ~ i.i~,^*sriS£ ana r s s i d s r . t s or. c'r.a- uniti

iri"satn9 and ssk for f r s s h aiX".

ai^6 v-"t=arir.- 3J.O•.r.23

co

J.1. "I-- -^. _ lothes are "issir.g butcons and have holes Ll.C.,1- heir shoes are often too small and hanging o
cr.ev crv co

2 9. • I have been or.3 i te at D.C. Villa' £. = ree~~eennccv_vaas last week and have reviewed case histories and records of residents during this week. The statements made in this affidavit are thus true as of the date of this affidavit. 3a; on my experience at D.C. Village, absent court action, I also

IN THE UNITED STATES DISTRICT COURT FOR THS DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,
v. THE DISTRICT C7 COLUMBIA, e^_ 5_1
Defendants.

Civ. No. 95-948 C HA?.I. EAS E H A T C HHI

Pursuant to the provisions of 25 G . S . C . § 174c and Z.Z.Z. R. 10o(h), I, Chariease Hatchett, do hereby declare:
1. I a~ the great-granddaughter of Kazie Edwards, whc was a resident at D.C. Village ("DC"/") for about two years before her death on Decertb-sr 10, 1593. A few months before she died, ~y grandfather asked me to loo-: after try great-grandmother if Z could.
2. When I visited rr.y great-grandmother at DC" in August 1993, I was shocked at the conditions there. The roocr.s smelled like urine. There were no staff around as far as 1 could see. Every resident on the unit was herded in front of the TV wi"h no staff present. There were no scheduled activities. S'r.e va = dressed in a hospital gown, not real clothes. In fact, there were no clothes in her closet or in her furniture. All of her clothes were r.issing.
3. I a" a certified therapeutic recreation specialist, so I'm familiar with elderly patients' therapy needs. When I looked through my great-grandmother's record, I was surprised to

Til

discover that she had been given no therapy whatsoever at DCV. There was no current therapy plan of care in her chart with goals and objectives, and there was no indication in the chart I reviewed thac therapy or stimulation had been provided to her at all. She was just left ir. bed all day. In fact, when I visited DCV, no one cane in to provide any forn of service for or therapy to her.
4. Wher. I called up the relevant professional at DCV to ask why such needed services were not being furnished, I was given a harsh, abrupt and arrogant response. It was completely unprofessional. He made it seem as if I was at fault somehow for merely inquiring about my relative's health and welfare. I also spoke with r.y great-grandmother's physician at DCV, and he blar.sd conditions on the budget and the agency nurses -- anyone else but him.
5. My great-grandncther died of a fractured skull. At the hospital, the doctors believed that she must have been dropped to have sustained this type of injury. They didn't see how an elderly person with severe contractures in her upper and lover limbs could have sustained such a traumatic fracture.
6. Even though this was a serious injury and eventually led to her death, DCV had failed to fill out an incident report on the matter within 24 hours. Only when I brought this to their attention did they take steps to have the matter investigated. Even then, no one could really pinpoint exactly what happened to
- 2-
TWIT

her. None of the staff see-.ed to have any hard information abouwhy she sustained the fracture.
I certify under penalty cf perjury that the foregoing is true and correct. Executed this " day of June, 1995.
.Charlease Hatchett
- 3-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF C0LUM3IA
UNITED STATES OF1 AMERICA,

V.
Tl^E DISTRICT C? COLUMBIA, e^ al.,
Ljenenciancs

Civ. No. 95-94 3 TTr.
DECLARATION O; ANDREW HAWK IN;

Pursua" co the provisions of 23 L'.S.C. § 1745 and 2.2 .Z. P.. 106(h), I, Andrew Hawkins, do hereby declare:
1. I am the brother of Charles Hawkins, who was a residenc at D.C. Village ("DCV") for about two years before his death on January 3, 15 55.
2. A few years ago, at age 59, my brother suffered brain darr.a.cj'e thai causeci him to recruire specialized attention an— ca-3. My brother had lived with rr.e and my wife for a few years, buo he needed more services than we were able to provide for hirr.. Vie decided to clace hin at DCV. I visited hi^ as ofuen as I could. Sometimes I would see hir. twice a week; other times I would see him three or four times a rr.cnth.
1 3. Every time I visited my brother at DCV, I became upset over the deplorable conditions. The longer I stayed, the more it got to me. I found myself needing to leave earlier than I had planned, because if I didn't, I would have confronted people and gotten myself in trouble. Yet, I found that talking to staff was

always a useless exercise. I couldn't trust anyone thereall banded together to tell r.e half-truths.
4. I' - overcome with guilt sometimes because I left r.y brother there and he ended up dying. It's been very difficult for me to 1ive with. I wish the place could be shut down s: that no one else will have to suffer like ny brother did. I'm afraid alot of other people will die needlessly. It's a national disgrace.
5. While he was alive, the DCV staff did not take care of my brother adequately; they didn'r provide for his basic care needs. It was a crime the way they treated him. They just ignored him. They would leave hin and the other residents in front of the TV unattended. The staff were very unprofessional; in fact, they were a disgrace to their profession. Whenever I visited hir., I found him needing a shave and needing to be cleaned up. I couldn't even find staff to help me take care cf him when I visited. I would have to find my own razor ar.3 shave him myself. I would also do my best to clean him up myself. I never saw staff around to help. I think this was outrageous _ neglect.
6. I was always surprised to find that my brother had been left poorly dressed in clothes that were three sizes too lares for hin. None of the clothes he wore were ever his. Thay weren't really clothes, they were more like rags. That never made sense to me because I made sure that my brother had enough to wear when I first left him at DCV. In fact, he had quite an
- 2-

extensive wardrobe. But it seer.s that whenever my brother's clothes were sent to the laundry, certain items would becor.s lost forever. I could never find any clothes in his closet or in his drawers. As a result, he v/as always dressed like a raganuf t in. It was just criminal.
7. I think rcy brother's death was suspicious and mysterious. He died after having choked on a very large piece of meat. He had never had any eating problems or choking episodes in the past. I think the r.sat may have been forced down his throat, but I can't prove it. In telling rce about his dea-h, the hospital doctors looked at themselves as if something was grossly wrong. When I talked to staff at DCV about the circumstances surrounding his death, they all looked scared to death. No one would talk to me about it.
I certify under penalty of perjury that the foregoing is true and correct. Executed this V in dzy of June, 1995.
\U*t/tA CK Andrew Hawkins
-3 -

06 15'95 11:23 © 2 0 2 514 6273 '

CRT SPEC LIT

IN THE UNITED STATSS DISTRICT COURT FOR TEE DISTRICT OF COLUMBIA

UNITED STATES OF AiMSHICA,

)

Plaintiff,

)

v.

)

THE DISTRICT OF COLUMBIA, £t a!. , )

Defendants.

j

Civ. A. No. 35 -S i3 DECLARATION O?

Fursuar.: to the provisions of 23 U.S.C. § 1746 and D. Z . Z . P.. 106(h), I, Joseph Kaynes, do hereby declare:
1. I currently work for the Kill-Rom Company, Inc. as a credit rcar.ager. Hill-Rom provides hospital beds and therapy beds to nursing homes, hospitals and others nationwide. Some ot our bsds ar= used for the prevention and treatment, of decubit-is ulcers or pressure sores.
2. For at least the past seven years or so, Hiil-P.DTi has provided rental therapy beds to D.C. Village ("DCV"}. Our arrangement with DCV is for rental of the beds on a day to day basis.
3. We are currently owed $16,667.50 in past due ar,:ur.;s frorr. the District of Columbia for the rental therapy beds usgd at DCV. We received our last payment Erom the District in late March 1295 in the amount: of $3,925.00. This was only a partial payment and did not meet all past dus amounts owed us at that time. Traditionally, the District has been slow in paying- our

O6'15'95 H : 2 4 ^ 2 0 2 514 6273

CRT SPEC L [ T

'004

invoices. However, the current delay is much longer than the

normal delay.

:

4. At the present time, we have removed all of our rental

therapy beds from DCV.

I certify ur.dar penalty of perjury that the foregoing is

true ar.d ccrrect. Executed this |ja ' 3ay on June, 1995.

• 1

/ ••->//

Joseph. Kaynes

- 2-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF C0LUM3IA

UNITED STATIS C7 AMERICA,

-iii. ,

V.
I DISTRICT

COLUMBIA, e_t_ a_i . , )

)

Defendants.

)

Civ. No. 95-943 ;:H
DECLARATION 07 MA?. IA LAUR ENCE

Pursuant to the provisions of 23 U.S.C. § 174=5 and _ . _ . Z. R. 1 0 5 ( h ) , I, Maria Laurence, do hereby declare:
1. I am. the Supervisor of Volunteer Advocacy Services at the District of Columbia A r c , Inc. ("DC A r c " ) . As part of our many duties and responsibilities, DC Arc serves as the courtappointed Menicor for the class of approximately S3j individuals with developmental disabilities known as the Pratt class, whe have been out-placed into the community from Forest Haver., a District-run institution that was forced to close under court order in 1351. We routinely visit the class members at their .residences and day programs to ensure that they are provided with adequate habilitaticn, care and other support services to m.eet their needs pursuant to a series of consent decree provisions that govern their outplacement.
2. Upon the closure of Forest Kaven, 23 individuals with mental retardation were placed at D.C. Village ("DCV"). At the time, DC Arc voiced opposition to these placements because we considered DCV to be an inappropriate institutional setting that

was overly restrictive and that would fail to meet the needs of the class -er.bers. In fact, the class members have not fared well at DCV. Of the 23 class members who were initially placed there in 199 0-91, 10 have since died. Many class members' health deteriorated rapidly and they died shortly after placement a~ DCV. For example, Rsnee W., Anna Hay H., and Linda T. all died within two months of placement at DCV; Russell S. died within five months of placement; Willie P.. died within nine months of placement; Donna C. died within thirteen months of placemenz; and Maxwell E. died fourteen months after placement, at DCV. Other class members, Joseph M., Deborah K. and Earl V., also have died while under the care cf DCV.
3. In order to monitor conditions and services provided to the remaining class members at DCV, I have visited the facility on many different occasions over the years. In 1995, I have visited DCV about once or twice a month.
4. I have noticed that in response to cited problems and pressure from DC Arc and other outside groups, DCV has put a lot of new processes in place. However, during my visits, I have not found that these new processes resulted in significant improvements for the residents. The facility director, Ms. Brasfield, and the District administrators seem to have good intentions, but their initiatives, like total quality management and peer review, seem to have had little real impact on resident care and services. For example, in several recent conversations with DCV staff, in meetings and on the residential units, the
- 2-

staff have indicated that certain activities related to the care of the class members and of the other residents do not occur in the manner they are supposed to because of a lack of necessary equipment, s:affing or training.
§. Generally, my observations at DCV have led me tc conclude that there are not an adequate number of staff to meet the needs of the class members and of the other residents, especially individuals with mental retardation. The staff often do not interact appropriately -with the residents. For exar.ple, in April of this year, I stood in a dayroom on Unit 5A for about thirty minutes. Nine residents were present, but no staff were in the room. After a few minutes, two staff then entered the room and began talking to and tending to the needs of some of the people. On several occasions, I have observed the staff sitting in the dayroom at a table talking to one another with class members and other persons sitting idle while the TV is on in the background. I have never seen a supervisor tell the staff that this type of behavior is unacceptable. As a result, there is a total lack of habilitation provided to the class members and residents who need it. At times, when I have identified r.yself as being f ror; the Monitoring program, staff have increased their interaction with the class members and the other residents. The residents are usually all lined up in their wheelchairs in the dayroom or they are in bed and receive minimal interaction from the DCV staff.
-i _

6. It appears that the food served to the people living at

DCV is a concern. While I observed a r.eal a few weeks ago, I

heard one staff member comment on the poor quality of the food,

saying to the individual she was feeding, "I 'in surprised you can

eat it, it's so hard."

7. While reviewing resident charts a few months ago, I

noticed that DCV did not have a sufficient supply of Jevity, a

liquid nutrient used for tu!

ings, for one of the class

members, Franklin M. In the chart, the nutritionist wrote ~hat

the food could not be given "because of unavailability." Jevity

had been carefully selected by a DCV physician as the food that

best ir.et Franklin/s individual nutritional needs. In fact, the

doctor wrote a prescription for the Jevity. Because the Jevity

was not available, the facility was forced to substitute it with

Complent, a liquid food wizh a different nutritional value.

8. When I observe p.eais, I usually notice that the DCV

staff do not follow the written feeding protocols specifically

tailored for the residents. As a result, the staff often feed

the residents incorrectly. This is dangerous because many of

these individuals have swallowing problems or other medical

concerns requiring careful feeding.

9. At a recent neal, I found that a shortage of staff led

to long delays in feeding certain residents. While the

individuals who live at DCV waited, the staff left the trays of

food uncovered so that the food became cold by the time it was

fed to the residents. As a result, the residents became clearly

uncomfortable. The individuals with mental retardation resorted to crying and whining to get the attention of the staff.
10. Certain individuals with mental retardation require close supervision. However, whenever I visit DCV, I invariably notice staff rot doing anything to intervene when a person with mental retardation begins to engage in inappropriate behaviors. Just last north, I noticed that Arnethia R., a resident with mental retardation, had become agitated. DCV has provided her with virtually no meaningful activity in which to be involved. Typically, she ends up playing with tin cans by herself. In addition, the poor staff ratio usually leaves her confined to the dayroom where the few staff on duty can keep an eye on her. Arnethia seer.s to enjoy being active. On this particular cay, she was walking out into the hallway trying to leave the dayroom. Initially, in response to her agitation, staff yelled at her but did not r.ove away frorr. their table to intervene. Eventuailv, they F.oved to physically stop her. In response, Arnethia resorted to sitting on the floor, rocking back and forth, j flapping her hands and banging her hands on the floor. Eventually, she even approached me and tried to get me to escort her off the unit. It was clear the DCV staff did not know what to do. They definitely did not refer to Arnethia's behavior program to determine what they should do. Fortunately, a Georgetown University staff person who is contracted to provide clinical services to persons with mental retardation, came by and intervened by implementing her behavior management program. The

- 5-

:

Wit

residents with mental retardation are fortunate that the independent contractors from Georgetown are there to intervene appropriately whenever they can. When intervention is left to the DCV staff alone, the residents have suffered.
11. Generally, program plans are not implemented by DCV staff. For example, instead of following the behavior plar. for Cynthia W., a resident with mental retardation who excessively rubs her ear until it becomes raw, staff will apply restraint mitts instead. According to her Individual Habilitation Plan ("IK?"), Carla L., a resident with nental retardation, is to receive training to use a soft glove to wash herself. However, the Georgetown staff have told ir.e that this has never happened. Generally, DCV staff have not demonstrated knowledge of the residents' IK?'s to properly implement them. In fact, it is never clear to me that the residents' IHP's are even kept on the given living units. This makes implementing the written plans very difficult.
12. In response to repeated concerns expressed by DC Arc, the Long Term Care Ombudsman, and the U.S. Department of Justice, the District has recently begun taking steps to place in the community ail remaining class members and any other individuals with mental retardation who currently reside at DCV. We applaud this decision because DCV is and will remain an inappropriate institutional setting for individuals with mental retardation. We have been working closely with facility administrators and the designated community vendors to ensure that the placements are

- 6-

•

.

'

Tl!

appropriate and will meet the specialized needs of these

individuals with developmental disabilities. Outplacement

efforts should continue and new admissions to DCV of people vith

mental retardation should be prohibited.

,:

I certify under penalty of perjury that the foregoing is

true and correct. Executed this - day of June, 1995.

Maria Laurence

- 7-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES Or AMERICA,

riaiu.ii ,

v.

'

)

THE DISiRIC- Or" COLUMBIA,, e t 5.^. ,

)

Defer.dar.tis.

)

)

Civ. No. 95-94 5
SUPPLEMENTAL DECLARATION 0? MA?. IA LAURENCE

Pursuant to the previsions of 23 U.S.C. § 1745 and r.r.C. E. 105(h), I, Maria Laurence, do hereby declare:
1. Since signing rr.y previous declaration, I visited Z.Z. Village ("DCV"} on two separate occasions, Monday, June 12, 1995 and Friday, June IS, 1995. This supplemental declaration details observations I m.ade on these two visits.
2. Or. each day, there wss no adapti*/e equipment available at mealtimes for the use of residents who need it. No staff seemed to knew where it was. The unit staff called the kitchen to look for it, but they could not find it either. For som.e individuals with severe disabilities, adaptive equipment is critical to allow them to feed themselves, or to be fed safely and effectively. When it is not available, these individuals struggle and often are ur.able to take in sufficient amounts of food to meet their nutritional needs.
3. Because of the lack of the adaptive scoop plate she needs, I noticed that Shirley A. was unable to feed herself properly. As a result, food was flying off the plate onto her

'• •'!

bench. I noticed her eating the fallen food off the bench, staff intervened to help her.
4. I observed Patricia A. eat only about one tench o r.eal on Mor.dav because the adaptive cuo and other adaptive equipment s'r.e needs was not available. I asked the Geor-e: contract staff about her. I learned that Patricia has lest pounds, which places her below her ideal body weight. I understand -hat her dramatic weight loss is attributable di to the lack of proper feeding equipment at DCV.
5, A= a result, tracking Patricia's weight is exceed important to her health and well-being. However, in an interdisciplinary team meeting for Patricia on June 16, 19r DCV nurse indicated that Patricia could not be weighed prep at DCV because the unit scale was broken. The nurse admit" that the vendor who normally comes out no repair the scale not come out to DCV because he had not been paid past due a-ount for ssrvices he had rendsred.
6. On Monday, while observing activity in the dayrccm on unit 5A, I observed a large puddle of liquid on the floor bv DCV resident Franklin M. It turned out to be a cuddle of Jevi cy, the liquid nutrient provided to Franklin through a feeding tube. The Jevity was spilling on the floor because Franklin's tube had become dislodged. I immediately notified staff who then reconnected the tube without sterilizing it. Throughout my 45 minute stay in the dayroom, no staff had interacted with cr checked on Franklin. Had I not been present, noticed the p uddie,
- 2-
TTBT

and alerted the staff, Franklin may have continued to si- wi~h his feeding tube disconnected and leaking for a much longer t irr.e. I learned later that Franklin has suffered with many different infections at his tube site. My understanding is that this could be due to the fact that his tube repeatedly becomes dislodged, and yet the staff reconnects it without sterilizing it fir=:.
7. On Fridav, I observed Pierce L., a DCV resident,
He started coucrh.in.cj and soittir.cr up mucus. I immediat~lv £.l~rted. the staff in the dayroom who alerted the registered nurse. She intervened by stopping the flow into Pierce's feeding tube. Fierce's condition seemed to improve, however, it was clear that the nursir.cr staff had not been r.onitorin-cr his condition closely enough to prevent him from suffering such discomfort.
8. I have recently learned that for a variety of reasons, the District will not r.esc its stated goal of cutplacing into the community ail DCV residents with mental retardation by June 3C, 19S5. I have also learned that Georgetown University/ the contractor who currently provides the DCV residents with r.entai retardation with needed clinical services, habilitation, and other services, will not provide such services at DCV without a formal contract with the District. District officials have indicated to DC Arc that they intend to extend the contract, but given that the contract has not yet been drafted or signed, there remains a real danger that needed services may not be available for the DCV residents with mental retardation as of July 1, 1995.
- 3-
T m -ITF n -irrm—r

•»

•

*

I certify under penalty of perjury that the forego.

S : E : SUN 22^05
Arc District of Columbia
rOC Vc"V-~ 3"ei". N ~ v,c " ~s"c". DC 2IC17

Frances Bow it Aenng Admini.-,:^::: Mental Retardation &. Development
Dliabilities Adu;:~isiracton ^29 O Street. N.W. Vt*a?hinutor., DC 20001

June 19. 1995

Dear Ms. Bowie:
I am wriiinc to you to con fin*1, mir ;.!'jp!v:!c Lunver:>iiii"n on Friday, J\inc 16.1 regarding the need u» extend the Gecr^eio--. M Uuiwrsiis Lontr.n:: foi" sei'vicc.^ p;o-,U!c_ : Pratt cla.ss m e m b e r s and other persons with mental L-cuLrd^Eioc ar. D C Vi-Ia^u A> •-discussed, ii has be-crr.tf apparent over ihe past several weeks that ali 22 ir...i.*..ci.;-.ls - : ir.or.rai reiardaiion ^ h o 'A-ere scheduled to be ouiplaced to I C I ' V M R by J'JIIC .VJL:. will :. rao^cd to Lhe coraiiiunity by this deadline. My convcriations wiih Gcorje'.owi; ?.dinimstrators md;c:-::e that ihcy will nor continue to provide services at D C \'ii)^ge p.-.;: ?Oth, the dare o:i wiiich their contract expires, unio^.s thc> receive u r i a c n uonfirinac^.r. r District's intent ro exrend their coiKraer :,«: .\ yiven period cf cirne.
After spe.tkir.^ with >c?u on Friday. ii i> m \ u-vJtr.iL-ind:"^ th,-: M R D D A :s i'.i a g r e s m e m that [he Georgetown contract n e c S {•-.< be o.\Landed in order to cr^t.:re tha:.i b ; m e m b e r s and other persons with mental i\ji:iidaik>ii a; DC V*il!.i»o receive the clini-.v.!. hjbiiuarion and other services which the> :v.juir.- j::tt!,; en^ui'e tlm;[he u a : b i : i c ; ; p:'r?^r for these individuals occurs in,a safe and ef'.eLii'.c ni,'.;uier \ o u i;:die;-ued ihat >'ju arc : process of working out the details of ?. \-~\^: whi<ji would <^\:cv.d the G c o r ^ c c o ^ n cont:?.
As we discussed, rhe DC Arc Pi'itU M-.tiiitorin^ Program strongly recoimrer.ds I'. er actioii necessary be c;iken ro eniurj V.YJ-A the Geurgerown climciiins and other -. in place at DC Village until nl! chiss incinbcrs and other persons with rner.ral tno. are tr:in?i::Diied s.itcly ro ctMi-i::K;niL> pkicemcm^. Thank. y:>j in «0va:xe U r

'ez '•"., '-'z-z?1 ~2~"~t

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES •F AMERICA, Plaintiff,
v. Tr-IS DI STP.ICT COLUMBIA, et_ al

Civ. Mo. 95-945
DECLARATION 07 RONALD L. MESS I

Pursuant :o the provisions of 25 U.S.C. § 1745 and D.D.C. R. 105 (h) , I, Ronald L. Massenheimer, do hereby declare:
X. I am the President of National Nurses Service ("National";, a division of ATLIS Health Services, Inc. National provides nurses on a part-time contractual basis for hospitals, nursing horr.es, and private individuals.
2. For about the last four or five years, National has furnished -he D.C. Village Nursing Home ("DCV") with agency nurses pursuant to a contractual arrangement with the District cf Columbia.
3. Until recently, our arrangement with the District had been a positive one. Although payments were often delaved, the District eventually paid us for the services we had rendered at DCV. However, last Fall, we stopped receiving payment altogether for our contract nursing services. As a result, we were forced to call repeatedly various District officials in an atter.pt to obtain the funds we were due. Many times, our phonecalls were not returned. Whenever we were finally successful in talking to

someone, we were often asy.edto re-fax the invoices we had already submitted causing further delay. In response to our pleas, the District made numerous promises and assurances to us that we would be paid in a week or ten days, yet we never received pay—ent.
4. In March or April 1995, we finally received partial payment for -he months of October, November and December 19 9 4. As is obvious, this payment was long overdue. We are still owed money for services we've rendered at DCV for the months of January through Hay 1995.
5. On May 23, 1995, I sent the attached letter to Vernon Hawkins, the Interim Director of the District's Department of Human Services ("DKS"), expressing my extreme concern about the overdue amounts owed us totalling $134,964.56. As I indicated in the letter, some of the invoices dated back seven months. I alerted Mr. Hawkins that we would be forced to discontinue service to DCV if we were not paid.
6. On June 6, 1935, I sent another letter to Mr. Hawkins advising him that we still had not received payment for services rendered at DCV. I told him that we would be unable to continue service at DCV after the evening of June 9, 1995 unless we received payment for the past due amounts. I have also attached a partial list of overdue amounts stemming from work performed at DCV primarily in March, April and May 1995. Some of the overdue amounts involve invoices submitted as far back as October 1994.
- 2-

7. Since February of this year, we have been providing services to DCV in good faith based upon the professional and official representations of Mr. Hawkins, who expressly told ny organization and other DCV providers that our contracts were being verbally extended by the District. He asked us to work with the District daring its fiscal crisis. We agreed to do so, but we have reached the point now where we cannot continue to provide service en the representations of the District alone, which in the past have proven empty.
I certify under penalty c: perjury that the foregoing is true and correct. Executed this 9th day of June, 1995.
j -
P.onald ' L. Messenheimer
_ 3_

THj 12:=^ ID:331557136£

TEL NO: 3315571376

NATIONAL NURSES SERVICE
AQiv'aio- 3(ATL!S Haslin Ssrv;css, inc.

June 6, 1995

Vernon E. Hawkins

Interim Director

Department of Human Services

Building 801 East, Second Floor

2700 Martin L. King Avenue, S.E.

- '.

Washington, D.C. 20032

Re: JA/90701 -D.C. Village J A/93941 - D.C, Village Quantum Merit - D.C. Village

Dear Mr. Hawkins:

Since our May23, 1995letter to you (copy attached) wehave had many discussions with various representatives of the D.C. Government and received payments under Contract JA/90746, however we have received no payments for services at D.C, Village.

We regret to advise you that we will be unable to continue service at D.C. Village after the evening shift on Friday, June 9, 1995 unless we receive payment for these seriously past due invoices.

Thank you for your assistance in th.is matter.

Sincerely,
I

Ronald L. Messenheimer President

RLM:ejf Enclosure

cc: Alberta Brasrleld Gladys Fountain Annie Wilson

SJI.VFR SPRING MARYLAND 20910 • (301) 535-7890 • (301) 587-1073 FAX

IT W T TWTf T •

...

j / * ' J U N - G £ - ' S 5 THU 1 2 : 5 5 I D : 3 3 i 5 S 7 : 3 6 3

TEL NQ:3215371S75

NATIONAL NURSES SERVICE
A Oivinon ot AT'JS H n i m Sarvicas, inc.

May 23, 1995

Vernon E. Hawlrins Interim Director Department of Human Services Building 801 East, Second Floor 2700 Martin L, King Avenue, S.E. Washington, D.C. 20032

Re: JA7907Q1 - D.C. Village JA/93941 -D.C. VUlagc Quantum Merit - D.C. Viliagc JA/90746 - Forest Haven

Dear Mr. Hawkins:

„- :

V/e are extremely concerned about overdue Invoices which total S184.964,56. These invoices date back seven months (see attachments). Despite repeated assurances, we are simply not being paid. It is vital that we obtain payment immediately or we will be forced to discontinue service.

PI«y. advise us by Thursday, May 25, 1995, with respect to when we will receive payment. Your personal assistance in this urgent matter is greatly appreciated.

Sincerely,
JAM
Rcmald L. Messenheimer President

RLM;ejf cc: Peggy Butler
Gladys Fountain Annie Wilson

HIT l " 7 i r r t f

H.UXf=JiO

Sip/.tR ITSwPP&Rr IN"tGff.

MMARYLAND
r •

2Q910

•

(301)

555-7890

•

(301)

587-1073

FAX

0 b ' 0 9 9.)

CKI"

LIT

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,
v. THE DISTRICT OF COLUMBIA, et al.
Defendants.

Civ. A. No. 5 D - C 9 4 ~ T?H
DECLARATION D JOHN M O G E N S O N

Fursuar.: to the provisions of 2S U.S.C. § 1746 and E.D.C. R. 2 05(c), I, John Mogenson, do hereby declare:
1. I work as a credit analyst, for the Sandoz Nuti i tion Corporation.
2. Sandoz supplies tube feeding products and ot'mi dietary and medical-related products to nursing homes, hospitali and private individuals.
3 . Pursuant to an arrangement with the District <-i Columbia, Sandoz has supplied the D.C. Village Nursing Kc-r.("DCV") with such products for the past few years.
4 . The District currently owes Sandoz past di.e anounts totaling about $9,QQ0. Specifically, we are owed $;,12o 00 for a Navenbsr S, 1994 invoice; $5,670.00 for an April IS,- IS'*:; invoice; and $1,300.00 for a May 19, 1995 invoice. Ths ..ast paynent we received from the District was or. May 24,, 19 >.i for an invoice we had submitted on February 12, 1995, three; mo.v:hs earlier. The District has regularly withheld payments Long past the due date. Certain invoices seen to be tied up .:..n t u system.

Od 0 y y i

1U; 33

^UZ 3 L 4

CKt 3t'[X LIT

D 0.!

I cer-ify under penalty of perjury that the foregoing is true and correct. Executed this ^_j% day of June, 1395.
r

John M

Qr

1- 2 -
I T

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT O? COLUMBIA

V.

Civ. No. 95 -94S T?K

COLUMBIA, ~ - a ^ .

MAR. I A. MO ?.T0M

Fursuar.: to t h e p r o v i s i o n s of 23 U.S . C. § 1/45 a n d 2.2. 1 0 5 ( h ) , I, Xaria M o r t o n , c : h e r e b y d e c l a r e :
1. I have bee" a resident of the D.C. Village ^ursinr ("DCV") for the past four y e a r s . I a~ 41 years old and pres l i v e or. Cr.it 2A ir. a roorr. w i c h two o t h e r wo~e":.
2 . The food s e r v e - tc us ir. the last few ".onths 'c.z.s 'z h o r r i b l e . It is r.o: adequate ar.d cfter. ir.edibie. It is ser to u s all dried up ar.d blar.d. P o t a t o e s are overcooked ar.d h T h e rr.eals are r.ot h o t . We haver.'t hear, served s=a l•>a d --? -.-•Last week, I vas happy because I kr.ew the food would improve while the outside surveyors were here. In fact, the food d; improve while they were here. Upcr their arrival, we were provided with better meals, and with salt, pepper, sugar ar; juice at lunch and dinner tor the first time in months. We to get juice all the time last year.
3. I can't eat certain foods like seafood. However, tr.ev still keep sending me fish tc eat. Even after I remind sta that I cannot eat fish, they still get it wrong. For exarr.p

when I've r.-r.zior.ed that I can't eat the salmon served r.e, thsv will replace i~ with tunafish. It's still fish so I'm left unable cc ea~ it. This type of sarvice continues today. As recently as a week ago, they served me fish inappropriately ar.d I was left wi-h nothing to eat. The dietician knows about ail this, but the problem still keeps recurring.
4. I have difficulty hearing, yet DCV doesn't provide rr.e with hearing or speech therapy. I'm not given any formal sign language instruction. Without such training, I'm not able to move out of DCV ana. into a r.ora appropriate community setting. I'm only 44 years old, and yet without proper training, I'r. stuck at DCV. DC' doesn't even provide r.e with a proper battery for my hearing aid. I need to use r.y own money to buy the batteries.
On r.y unit, we were entirely without hot water r a day about a r.or.th ago. ihey pu~ up signs telling us that hot water was r.-t available to us. This made bathing difficult.
6. Tha staff and nurses often don't groon the residents properly. I've seen residents in need of such services left with their hair not co-bed and nappy all day long. Sometimes staff do not bathe residents for months. The nurses typically don't respond when you press the service button near your bed.
I certify under penalty of perjury that the foregoing is true and correct. Executed this . <> day of June, 1995.
Maria Morton
2 -

a , '

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UtflTED STATES OF AMERICA, Plaintiff,
IfTHE DISTRICT OF COLUMBIA, ez a_I,
Defendants,

Civ. A. Ko. 95-C94S TFK
DECLARATION OF JACK H.

Pursuant to the provisions cf 2S U.S.C. § 1746 and C.D.C. R. 105(h), I, Jack H. Robinson, 60 hereby declare:
1. I am the President and CEO of Nurech Laundry ;rd Textiles, Inc.
2. Nutech provides commercial laundry services fcr such itens as sheets, pi 1 lev cases, towels and other personal ite-.s.
3. Nu-ech has provided service to the D.C. Vi Llacs Nursing Home ("DCV") since December 1992. We have alvays provided service through a purchase order arrangement with ths District of Columbia. In the beginning, we v/ere used spcradically, however, frora October 1993 through February 1S95, we laundered DCV iterr.s on a somewhat regular basis. The last service we provided DCV was in late February 1995.
4. The individuals at DCV have always been pleased vith our work. Mike Pantazis of DCV wrote us a few months ace indicating that we provided a "quality linen service ... [t^he work was always very well done and always returned in a timely fashion ... you always responded to energencies in accordance to

cur needs and for this we ars truly grateful. You have an operation that you shculd be proud of." See attache.! letter.
..<&. A S the attached letter indicates, even though they were very pleased with our work, DCV officials "terminated" their use of Nutech because "budgetary restraints have forced us tc ta>s this action." Mr. Pantaeis indicated that he would be concentrating his efforts on paying us the outstanding irvcicss we were du=.
6. Currently, the District cv/ss Nutech $90,827.se for services rendered at CCV. As the attached invoice anali sis report reveals, we are still cued monies for services v;e provided at DCV as far back as May 1994.
7- In trying to obtain the monies Nutech is due, v.e have beer, forced to speaX with many different District officials. Working vith the D.C. Government has been an administrative nightmare.
S. It seeir.s that DCV has called upon my business cnly when they are facing an emergency need for service. They wait until their nachines, or the machines at St. Elisabeth's hospital, break down before contacting us. Naturally, the cost fcr emergency work is higher than it would fce if we had a relationship established where there was sortie semblance cf continuity in service. We hare tried repeatedly to tell District officials that they are wasting their resources by procuring laundry services in this manner. However, we have been unable to succeed in creating a nore orderly and reliable working

relationship with the District. Without better planning and

foresight, the District will continue to obtain emergency

services vay over market prices whether froai Hutech or froir. s:ne

other vender. Nutsch remains willing to quote lower prices for

services ir. return for a Bcrs orderly and reliable workirg

relationship with the District.

9- The District recently put out an invitation fc: bids

for laundry services at ccv, yet our conpany declined tc bid on

the work. Ever, though we are actively seeking addit icrw.]

contracts, we declined tc bid on the job because cf the j:<as~

anounts we are due fro;n the District and because there :.< no one

in the District Government who we can daal with on a. reiji.lar

basis who we can count en. As we recently indicated in Lhe

attached letter to tre District's Department cf Hurce.n Services,

"[vlhen cpen and accurate cor-nunicatior. can be institute'., tiutsch

will be ready to respond."

:

.

I certify under penalty of perjurv that the foregoing is true and correct. Executed this /*• day of June, 1995.

•"

,;*-

&S/12/1995 13:11 7228211173

JACK H ROBINSON

PAGE 01

GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMEYT 0 ?HUMAN SERVICES WASHINGTON, O.C.2CCC2
Mr. Jim Quayle Nutech Laundry and Textiles 5214 Mor.roe Avenue Hyattsville, Maryland 20781
Dear Mr. Quayle:
Please be advised that effective Friday, February 24, 1995, we will be terminating our use of Nutech Laundry and Textiles-to process the D.C. Village laundry. We have now reached the point where budgetary restraints have forced us to take this action.
Our efforts now will be concentrated on trying to get those outstanding Nutech invoices paid and satisfied.
I can make no quarantees but I will do all that I can to effectuate payment. I would suggest that you submit all outstanding invoices as soon as passible.
Please allow rr.e to personally thank you firstly for providing a quality linen service. The work was always very well done and always returned in a timely fashion. Secondly, you always responded to emergencies in accordance to our needs and for this we are truly grateful. You have an operation that you should be proud of. Again, thank you.
If you have any questions or comments concerning this matter, please feel free to contact me on (202) 645-4466.
-Sincerely;
Kike" Panta2is, Chief Facility Support Services Division/ D.C. Village

3S/12/1935 13:11 7238211173

JACK H ROBrNSON

02

IMUTECH LAUNDRY AND TEXTILES, INC.

17 April 1995

Claudia Booker Contracting Officer Department Of Human Services 801 East BuiLdir.g/St. Elizabeth Campus 2700 Martin Luther King Jr. Ave. S.E. Washington, D.C. 20032-4047
.He: Invitation For Bid: JA/95928

Ms. Booker:
I regret to inform you that Nutech Laundry and Textiles declines from entering a bid relating to D.C. Village. Currently, D.C. Village has an unpaid debt to Nutech Laundry in the amount of $80/926.96. This outstanding obligation dates back to May, 1994.

Even though Nutech is actively seeking additional contracts, without having some formal agreement as to when payment would be received on previous or future contracts, we at Nutech- feel that it is prudent not to submit a bid at this time.

As stated above, Nutech is actively looking for new business. Nutech has on numerous occasions proven its abilities by providing the peace of mind associated only with a quality linen service. Nutech has never failed to be there in time of need for D.C. Village or St. Elizabeth.

When open and accurate communication car. be instituted, Nutech

will be* ready to respond.

.,

cc. Jack Robinson/ President and CEO

Sincerely,
Timothy Sutphin Vice President

06/eS/l9S5 17:05 HUTECH

301 277 7496

F.23

NUTffCH

LAUMbftY

4

TEXTILES

01. 1995 17i2Qi37

•SHORT KANF' T*V * INV CUTE

PC VILLAGE
j

8 Q U O9/C5/34 8042 03/13/94 8072 00/20/94 8103 09/27/94.

I N V O K E ANALYSIS 86P0ST

ANOUtfT

4*L£S TAX AKOUfT

ltlVfllCS *YT//O4C

HH0U1T

DATE

PAYKEKT

4723 .63 4949 .65 J029.17 7211.4?

.00 .00 .00 ' .00

4723 -6B 1U/Q5/91 4iM9 .65 10/06/91 2023 .17 10/06/91 7211 .«-» IQTAL >
I ! 12/23/94
T : 11/10/94

472 3 .63
.65 2029 .17 2?9: * "
837 .91 2155 .14

8132 09/03/94 9162 09/L0/94 S194 O9/W/34 8223 09/24/94 9314 10/15/94 8343 10/22/94 B40l 11/05/S4 8463 11/19/94 8504 11726/94 871S Ot/07/95 8752 01/14/95 87^7 01/21/95 3323 Cl/23/95 8$S? 02/04/95 6335 02/11/95 3>'3i 02/U/S5 3963 02/25/95

' 4S9 3 .0 3 6130.41 6532.39 6792.63 65S3.ZC 4635.93 1489.68 2309.97 l?23.48 2S25 .25
11350.55 »413 ,11 6574.46 '6680.31 "8535.76 J3J5.Q4 60*1 .10

ACCOUNT TOTAL 222010.12

.00 4533 -03 12/19/94

.UQ

6130 .11 12/24/94]

.00

ft S 3 2-tlJ 12/23/94

.00 6792 .53 12/19/9*

.00 6593 .20 01 /13 / y 5

.00 1035 .33 OL/24/35

.00 443^ .56 01/24/33

.00

2303 .9 7 03/23/95

.CO 192'i .13

.00 2525 .25

.00 U31Q .35 U6/C5/95

.00 9413 • 1 1

.00 6 6 M .46

.53 6&3O .31

.00

H335 .76

.00 9*35 .01

.00 6011 .10

4393 .03 4553 .51 43S/ .fi 1V31* .03 5533 .20 4»3^ .fi 44SJ .b3 230? .97
.UU .00
Hi.00
.50 .OU .00 .00
.GO
.UU

.00 222030 .12

141202 .16

OSC

DUE

.CO

.03

.00

.00

'.00

.uu

'.00 4213..54

<•

,-uo .o:
..03 .00 ".00 .00 -Uli
-CO
.rJ0 '.DO ,00 .00 »C3 .CD
»<30
,oc

.tftf 1571 .90 IS 7 5.10 Hb'j .S5
.03 .00 .(JO .00 i523 .43 .25
11251 .55 Sil3 .11
6S74 .46 .Ji
8S3S .76
J33S .0«
6041 .10

;oo 80327 ,95

;Q~-'09/95 13:29 ©202 514 6273

CRT SPEC I.I.T

©003

IN THE UNITED STATES DISTRICT COCRT TOR THE DISTRICT OF COLUMBIA

UNITED STATHS OF AMERICA, Plaintiff,

THE DISTRICT OF COLUMBIA, e

•

*.,

•

Defendants.

Civ. A. No. 95-CS4S TFH
DECLARATION OF ALAN I. ROOMBERO

Pursuant to the provisions of 28 U.S.C. % 1746 and C.D.C. R. 205(0), I, Alan I. Roomberg, Co hereby declare:
1. I 2m the Chief Financial Officer of National !•« tisnt Care Systans, Inc. ("NPCS"). NPCS supplies hospitals, ru.rsing homes and private individuals with health care supper" r.ystems and products that aid in the prevention and treatwert or bed sores. Bed sores are a terrible problem for people who c.re immobile. If these individuals are not cared for ar.d t*:<;ated properly, they will likely develop skin breakdown ar.d ini'ections.
2. Specifically, we provide nattress overlay systems which. mitigate the formation of bed sores and aid in their he-ii.ing. This is accomplished by a series of bubble tubes in whir;h air is pumped through the nattress overlay. NPCS provides not only the mattress overlays but also the support staff to service -:he equipment and to inservice the consumers and their care ijivers on how to use the product most effectively.

13:29 ©202 514 6273

CRT SPEC LIT

$004

3. Since the Spring of 1934, NPCS has had a formal

arrangement with the District of Columbia tc provide the services

described above at the D-C. Village Nursing Hone ("DCV"). We

have provided mattress overlay systems and support to DCV for a

nunber of residents on an as-needed basis. We charge tire

District twenty-five dollars per day per unit for our ssstezis and

service.

:

.A. As of May 31, 1995, the District owes NPCS $66,535.00

in past dus amounts for goods and services supplied tc iCV. We

have not received any payment at all for services rendered sines

October 1994. The last check ws received from the District

arrived to us in December 1394 for services rendered at L'CV in

September 1994.

5, We have made repeated telephone calls to Ks. ;..'berta

Brasfield, the DCV facility director, and to Mr. Silas m.tler,

also of DCV, in an attempt to obtain payrtent. We are a..vays

promised payment, but it never arrives.

6. Despite the non-payment, NPCS has continued to honor

its agreement with the District because we believe it i-.s against

public policy to stop service to the medically fragile ucv

residents who are using our products. W* fully und^rst-nd that

in many cases, their lives nay be at stake. This attiti'Ie has

forced us to incur the nany additional expenses associazid with

non-payment. While we are not yet at the point of heinj forced

to terminate services at DCV completely, I can envission i day

when that would be the case.

:

- 2 -

"TWIT

6 0 9 / 9 3 13-30 © 2 0 2 51.-4 S271

CRT SPEC LIT

.00 3

I certify under penalty of perjury that the foragoing 1 5 true and correct. Executed this J ' day of June, 1595
Alan I - Koomberg

- 3-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,
v. THE DISTRICT 0? COLUMBIA, e_t al . ,
Defendants.

Civ. No. 95-945 TrH
DECLARATION OF LAMONT RQYSTER

Pursuar.t to the provisions of 28 U.S.C. § 1745 and D.Z.C. R. 106(h), I, Lamont Royster, do hereby declare:
1. I have been a resident of the D.C. Village Nursing Horr.e ("DCV") for the past six years. I presently live on Unit 2.-. in a small room with three other men. I'm 33 years old, but I need nursing care because I'm paralyzed from the neck down.
2 . Recently, the facility has been running cut cf r.-eeded supplies. A couple of weeks ago, the staff didn't have gauze to treat my sores. This shortage lasted for a few days. A week ago, they ran out of stretch/cling wrap for my foot. The facility has also run out of catheters for me. In fact, I've had to pay for a catheter myself. They have also run out of duoderm tape.
' 3. Overall, there is a shortage of basic care supplies such as toothbrushes, toothpaste, combs, brushes, soap, lotion, paper towels and cups. I've noticed these items in short supply and I've had this confirmed by unit nurses. As a result, I've had to buy some supplies, like toothpaste, on my own.

*-&*
4. Not too long ago, my unit was without hot water for a week to a week and a half. With no hot water, I was not provided with my normal tub baths during that time; I only had my face washed for the entire period.
5. We have had to use plastic utensils instead of silverware alot recently. I would estimate that this year we have used the plastic about half of the time. It's my understanding that the silverware cannot be washed properly so we have to use the plastic. The plastic utensils are a combination of a spoon and a fork, called a "spork." It is difficult for me to eat with the plastic "sporks" they give to us. I've noticed other residents having difficulty eating with the "sporks" as well.
6. The food served to us here is terrible and inadequate. It has gotten worse in recent months because there have besri food shortages. I understand that there is no money to buy enough food for us. The portions we've been served recently have been smaller than in the past. I haven't been served a salad in very long time. We haven't been served juice for lunch or dinner in about three months. In addition, the food we get is often overcooked and mushy with no taste. I can't eat it. Just about every day I leave most of the food I've been served without eating it. As a result, I'm left hungry, so I order food from outside vendors like the local Chinese restaurant. I do this three or four times a week. Sometimes, my brother will bring me food. This is how I get by.
- 2-

7. While the outside surveyors were here last week, we were provided with juice at all meals for the first time in months. The meals improved during that time as Wall, Kovsvsr, I fully expect the quality of the meals to go down again once they're gone. This is always the pattern.
8. Sons of the staff are disrespectful of our condition. Nurses and staff have directed hurtful comments to me such as "at least I'm walking and you're not I" They have told me to "shut up." Some have treated me like a child; when I objected, I was told, "At least my children can do for themselves." They often use profanity.
9. Last year, my wheelchair was in need of repair. Instead of furnishing me with a replacement wheelchair, I was left in bed for four to five months.
10. There are not enough activities to keep me occupied during the day. I wish I could socialize with others to keep my mind active. However, DCV provides me with little such stimulation.
I certify under penalty of perjury that the foregoing is true and correct. Executed this '-^-v day of June, 1995.
Lamont Royster
- 3-

08/14/95 10:50

©003

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES 0? AMERICA, Plaintiff,
v. THE DISTRICT OF COLUMBIA, et al.
Defendants.

Civ. A. NO. 95-0943 TFH
DECLARATION OF TED SCHIMpFF

4-
Pursuant to the provisions of 28 U.S.C. § 17^6 and D.D.C. R.

106(h), 1/ Ted Schimpff, do hereby declare:

1. I am the President of National Creative Growth

j

Incfustries, Inc. We do business under the trade name Healrh care

Laundry Services ("HLS").

; ;

2. KLS provides personal and institutional laundering1 }

services. We primarily launder sheets, pillow ses, towels.

adult diapers, bed pads and patient gowns.

3. We have been providing such•laundry services far the

i

i

!

!

D.C. Village Nursing Home ("DCV") twice a day, every day fortthe

past eight months.

)

•; ;

4. As of June 9, 1995, the District owes KlA $103,255^50 |

for services rendered at DCV. A few days ago, we had been owed'

•i

II

s$u5b0s,t6a0n0t.i0a0llfyormotrene tohrantwtehlvaet,pabsut douneJDuCnVe 5i,nv1o9i9ce5s,.weMwaenryeofpaitdhe

payments we receive now are only partial payment;. We still are

7* *%
06/14/95

10:51

8004

owed monies.from invoices submitted to the District in February
1995.
5. Despite the financial hardship delayed payments cause us, KLS will do its best not to discontinue services to DCV. We do not want to leave the residents "in the lurch.
I certify under penalty of perjury that the foregoing is true and correct. Executed this f" day of June, A995-
—4 Ted Schimpff

- 2-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES 07 AMERICA, Plaintiff,
v. THE DISTRICT OF COLUMBIA, et aJL.
Defendants.

Civ. No. 95-948 TFK
DECLARATION" OF SCOTT

Pursuant to the provisions of 28 U.S.C. § 1746 and D.D.C. R. 106(h), I, Laura Scott; do hereby declare:
1. I am 72 years old. I am a resident of the D.C. Village Nursing Home ("DCV"). I presently live on Unit 3A in a small room with two other women.
2. While I've lived at DCV, items of my clothing have been lost or taken from my room. I've lost forever many such personal items. I have to keep clothing on the bed and not in the closet. My name is now on all my clothing.
3. I don't like the food I'm served here at DCV. The food is nasty. Because it is not adequate, I can't eat many of the meals served to me. As a result, I'm repeatedly forced to make my way down to the kitchen to see if they'11 prepare something else for me. In addition, my niece has to bring in fruit for me to eat. DCV doesn't provide fresh fruit for me.

4. Last week, when the outside surveyors were here, the food was positively beautiful. This always happens when outsiders are visiting. However, the food is not to my liking once they go.
5. A few weeks ago, we had no hot water on my unit. Because the water was too cold, I was not able to be bathed as I normally an. I had to be washed up at the sink in cold, cold water.
I certify under penalty of perjury that the foregoing is true and correct. Executed this 5- <'-. day of June, 1995.
'. Laura Scott
- 2-

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,

v. THE DISTRI:

0? COLUMBIA, et al., Defendants.

Civ. No. 95-94S
DECLARATION OF WILLIE VEASEY

Pursuant to the provisions of 28 U.S.C. § 1745 and D.C.C. R. 106(h), I, Willie Veasey, do hereby declare:
1. I have been a resident of the D.C. Village Nursing Home ("DCV") for about the past fifteen years. I presently live on Unit 5A in a room with one other man. I need nursing care because I'm dependent on staff for bathing, dressing, and toileting.
2. Recently, there have been shortages of needed medical supplies at DCV. For example, I need to use a urine bag every day. In the past, after the bag had become soiled, I had been able to replace it every day. In recent months however, there aren't enough bags available at DCV. I've had to re-use the same dirty bag two to three days in a row. This creates a sanitation and health problem. I recently suffered from a urinary tract infection which I believe was caused by my having to re-use the urine bag. I had to go to the hospital to get treatment for the infection and I had to take antibiotics. As far as I can

remember, I had never had a urinary tract infection when I was able to change my bag everyday.
3. I've had two different pressure sores on my buttocks and feet. When staff come in to dress my sore, I've noticed recently that they often lack tape, gauze and bandages.
4. About three or four months ago, the meals served to us started getting bad. The food they serve us now is terrible. The meals have been unappetizing, they're not nutritious, and they're usually not hot. In addition, the meal portions have been greatly reduced. My three meals together now equal one regular meal. The kitchen workers have told me that they haven't had anything to serve us. The meals used to be much better last year. At that time, we were served vegetables, meat and pasta.
5. We haven't been served fresh vegetables in about three months. We are also served very little meat. I'm given peanut butter sandwiches alot. We are routinely not given anything to drink for lunch and dinner except water. We are also not provided with little things like sugar, salt or pepper.
6. Many times, I don't eat the meal served and I'm left hungry. Since December 1934, I've lost about fourteen pounds. This is certainly not due to any positive intervention fron my dietician; as far as I can tell, I'm still on a "regular" diet, Hy weight loss has resulted simply because I end up not eating the bad food they serve me.

fi -TV

7. The facility always improves conditions and services

when outsiders tour DCV. Other than when the outside surveyors

were here last week, we had not had juice for months. In fact,

last week when the surveyors were here, food quality improved

greatly. I ate virtually all food served to ne for the first

time in a long time. However, once the surveyors leave, things

always revert back to the way they had been. I expect this to

happen again now.

.

;

8. There are staff problems at DCV that are affecting

resident care right now. Recently, there have been alot of

forced retirements and lay-offs, resulting in not enough scaff to

meet our needs.

9. There is also a problem with contract nurses. They

don't want to pay attention to us. They don't know who we are.

As a result, they have made quite a few mistakes in dispensing

medications to me. I know what I'm supposed to be taking, and

when I tell the nurses that they've made a mistake, they don't

like it.

10. I would have complained about conditions to someone,

but I've realized over the years that complaining doesn't do any

good.

I certify under penalty of perjury that the foregoing is

true and correct. Executed this t-L~~Y- day of June, 1995.

Willie Veasey

—/

- 3-

*•*

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES Or AMERICA, Plaintiff,
v. THE DISTRICT Or COLUMBIA, et, al . ,
Defendants.

Civ. No. S5-S48 T?:-:
DECLARATION Or MARCO WATERS

Pursuant: to the provisions of 28 U.S.C. § 1745 and D.D.C. P.. 105(h), I, Marco Waters, do hereby declare:
1. I have been a resident of the D.C. Village Nursing Home ("DCV") for the past five years. I presently live on Unit 2A in a small room with three other men. I don't like living at DO/, but I have nowhere else to go. I have no choice but to stay.
2. I had my lower leg amputated in December 1994 afcer my foot had become infected from a sore that had developed here at DCV. At firsu, the sore was limited to the top of my foot. In the course of the next few months, the sore became infected and spread to the rest of my foot and to my lower leg. My doctor at DCV told me it would heal, but it never did. It kept getting worse. Throughout the worsening of the infection, my doctor came to see me personally only a very few times. Instead of visually inspecting me and my foot, he would rely on the written reports of the nurses. This is true even though his office was right around the corner from me. I'm bitter about the lack of medical

attention hs gave r,e during this period. This doctor still works

at DCV.

.

3 . When the infection becane more pronounced and iny foot

turned completely black, I was eventually sent to Hadley

Hospital. The doctors and nurses there were shocked at the

condition of ny foot and leg. They said that my condition should

have been caught long ago. I was told that my leg would need to

be cut off so that the infection wouldn't spread to the rest: of

my body and kill me. The lower part of my right leg and foot

were amputated.

4. After I was returned to DCV, at times, the nurses,

especially the contract nurses, wouldn't give me medicine to

alleviate the pain even though the pain was excruciating. The

contract nurses corae in and out; we don't know them and they

don't know us. In fact, the nurses got mad at me for asking for

the medication I was entitled to. Ms. Brasfield never came to

see me after I returned.

5. I used to be able to walk with a walker. Now, I can't

walk at all. I'm trying to learn how to walk with crutches. I

spend most of my day in a wheelchair.

6. A few weeks ago, my unit was without hot water for a

full day. I certify under penalty of perjury that the foregoing is

true and correct. Executed this 5 day of June, 1995.

Marco Waters - 2-

r . O S U 95 16:34

2O2 5 L 4 6*273

CRT SPEC L I T

IN THE UNITED STATES DISTRICT COURT TOR THE DISTRICT OF COLUMBIA

UNITED STATES OF AMERICA, Plaintiff,

v.

•

••.

THE DISTRICT Of COLUH3IA, et a_l.

Defendants.

Civ. A. No. 95-C943 TFK
DECLARATION OF PERNELL J. WILLIAMS

Pursuant to the provisions of 2S U.S.C. § 1746 m d C.D.c. R.

106(h), I, Pernell J. Williams, do hereby declare:

. .

1. I am the President of District Healthcare and

Janitorial Supply, Inc. ("DHJS")

!

2. DHJS distributes radical products and supplies such as

duoderm tape, four-by-four's, ointment, gauze, catheters, tongue

depressors, needles, syringes, bedpans and specimen sups. We

also provide textiles, linens and janitorial supplies such as

toilet paper, trash bags, cleanser and laundry bags.

3. DKJS has been providing such goods to the D.C. Village

Nursing Home ("DCV"), pursuant to an agreement with che Eistrict

of Columbia, since February 1993. Since that time, DCV ras

placed an order with us about once or twice a week every week for

medical or cleaning supplies.

.

4. Currently, the District owes DHJS $59,152.17 ir past

due amounts related to DCV. There are about twenty-five invoices

outstanding for goods we have already provided to DCV. The last

payment we received arrived in February 1995, and yet it was only

n i

13 95 L6:34

2O2 5£4 6273

CRT SPEC LIT

©004

for a total of $257.20. Nonetheless, DCV continues to crder goods from us. We most recently supplied them with products in early May 1S95. However, without payment of the pas: due amounts, we von't be able to supply the- with goods In the future simply because we can't afford to do business indefinitely without getting paid. We hope tc be able to resuir.e .2 gccd business relationship with the District where they will pay us in a timely fashion for ths goods they order for use at DC'v .
I certify under penalty of perjury that the fcrsgoirg is true and correct. Executed this /^TJ day of June, 1395.

- 2-

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 HARRIET A. FIELDS, Ed.D., R.N. #604
1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
U.S. v. District of Columbia

The Honorable Thomas F. Hogan U.S. District Court Judge U.S. District Court for the District of Columbia 333 Constitution Avenue, Nw, 4th Floor Washington, DC 20001

NH-DC-001-012

Re: Stipulated Order entered on July 6, 1995, in the matter United States v. District of Columbia, et al..Civ. No. 95-948.

Dear Judge Hogan:
The following is an initial estimated budget for the monitoring activities for D.C. Village.
These figures were derived after much thought, consultation, and careful consideration. Throughout, I tried to tailor the budget to include only those items that are essential to enable me to effectively monitor the terms of the Stipulated Order. In arriving at the reimbursement rates and the budget as a whole, I took pains to consult with local colleagues who do similar work to ensure that the quoted hourly and other rates were reasonable. Because this case involves a public facility, I have endeavored to begin negotiating rates less than the market rates for required consultants and myself and those figures are reflected in the proposed budget. Further, my initial investigation and review of the Court papers leads me to conclude that lower time commitments than reflected in this budget would jeopardize the abilities of the Monitor to comply with the Court Order or report on the needs of the over 270 residents of the D.C. Village nursing facility.
Given the size of the task ahead of me, I have devoted a substantial amount of time thus far in identifying and developing a local network of expert consultants to draw upon on an ad hoc basis as I deem it necessary in monitoring the Order. When at all possible monitoring activities will build on local expert consultants who have a commitment to the District of Columbia and to the improvement of the quality of care and quality of life of its long term care residents. (It will also keep expenses for consultants to a minimum.) I am gratified to report that I have received an overwhelming positive and heartwarming response from local professionals with expertise in such areas decubitus ulcer care, care of incontinent residents, medication administration, staffing and basic care issues.
Given that there is no fixed termination date in the Stipulated Order, I have simply estimated the budget for a one year period, although I believe monitoring activities will take longer. I have estimated that monitoring activities in the first year will involve a commitment of up to threefourths of my time. This includes on-site reviews, review of documents, writing reports, and

TT

consultation with experts, all to help ensure compliance with the Order. This estimate will be reassessed after six months.
Certain deadlines in the Stipulated Order which directly relate to residents' quality of care, quality of life and residents' rights are imminent or have already passed. Therefore, I respectfully request consideration by the Court of the enclosed at your earliest possible convenience so that the resources reflected in the budget may be employed as soon as possible.
So that monitoring activities can be continually and consistently delivered, I respectfully request the Court to ensure that the District of Columbia pay into a Court escrow account immediately and monthly a sum to be maintained at $50,000.1 request that the Court created escrow account in turn pay to the Monitor upon invoicing within seven days for monitoring related services and expenses. I will submit my first invoice for work already performed upon approval of the budget and for subsequent work at the end of every month. In my conversations with the Center for the Study of Social Policy, the court monitors for the D.C. child welfare system, I know that there is precedent for this arrangement in other cases before this Court. Thank you for your attention to this matter.
I look forward to working with the Court and the parties on this challenging matter.
Sincerely,
Harriet A. Fields, Ed.D.,R.N.
cc. ^ M r . Richard J. Farano Mr. David Deutsch U.S. Department of Justice Civil Rights Division 10th Street and Pennsylvania Avenue, NW, Suite 1744 Washington, DC 20530
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann Assistant Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

Harriet A. Fields, Ed.D., R.N.
#604 1722 19th Street, N.W.Washington, D.C. 20009
Phone (202) 234-7142
Budget for Court Monitoring Activities United States of America v. The District of Columbia et ai. Civ. No. 95-948 TFH Re: D. C. Village Nursing Home July 28,1995 - June 30,1996
I. Court Monitoring Functions
The major function of the Court Monitor is to assure that the performance requirements as set forth in the "Stipulated Order to Remedy the US and the Ombudsman's Motions for a Preliminary Injunction (Civ. No. 85-948 TFH of July 6, 1995 are hereby met by the defendant. The Court Monitor will hereby assess for the court the performance of the following measures:
A. Medical and Nursing Care
1. Care of Decubitus Ulcers
a. Assess whether or not the Defendant has ceased the use of Elase Intrasite gel inappropriately for treatment of decubitus ulcers.
b. Review the the adequacy of assessment of the Defendant identification of high risk patients for decubitus ulcers.
c. Review adequacy of decubitus ulcer care plans of high risk patients identified by the Defendant as stipulated within 20 days of July 6, 1995 of high risk patients.
d. Review adequacy of on-going care of decubitus ulcer care.
2. Care of Incontinent Residents
a. Assess timely treatment of patients with incontinence, assure that such conditions are checked every two hours.
b. Evaluate the appropriateness and efficacy of steps taken by nursing staff for the care of incontinence.
c. Identify adequate standards of care for incontinence and share such standards with the Defendant.
d. Assess adequacy of steps taken to clean ulcerated areas that are soiled by incontinence.

Page two
3. Adequate and Appropriate Nursing Staff
a. Assess compliance with nursing staff requirements. b. Assess reasonable reduction of contract staff.
4. Medication
a. Assess and evaluate training of nursing staff in proper medication administration practices (On-going and within 15 days of July 6, 1995).
b. Assess on-going in-service of nursing staff of individual needs of patients with respect to administering their medications.
c. Assess the procedures outlined by the Defended for the identification, tracking and correction of medication errors.
B. Remediation of Shortages
1. Assess the Defendant adequate supply of nutritious food and drink. 2. Assess the DCV's provision of nutritional needs for residents. 3. Assess the adequate supply of medications as stipulated two days after July 6, 1995 4. Assess the adequate supply of medical supplies and equipment as stipulated five days
following July 6, 1995. 5. Assess adequacy and safety of the heating and plumbing system as stipulated within 2
days of July 6, 1995. 6. Assess adequacy of hot water for sanitization of eating utensils, plates and meals
related items. 7. Coordinate appropriate regulating agencies to assure compliance of e and f. 8. Assess the adequacy of the provision of personal care items to residents.
C. Payment of Vendors
1. Assess financial payment of all outstanding debts by the Defended to vendors and individuals wihin 45 days of July 6, 1995.
2. Assess on-going payment system to meet vendor payments within a 45 day cycle.
D. Services for individuals with Mental Retardation
1. Assess the placement of DCV residents with mental retardation into appropriate community-based residential and day-programs to take place within 45 days of July 6, 1995.
2. Assess the provision of uninterrupted services to residents with mental retardation. 3. Identify and immediately report to the court any admittance of a new resident with
mental retardation.

Page three

E. Review of Monthly Compliance Reports
1. Assess the accuracy and validity of monthly compliance reports submitted by the Defendent to the Court commencing August 15, 1995.
2. Conduct random checks of resident records to assure that items 1-7 of pages seven and eight of the Court Order are validly reported.

II. THE BUDGET: PERSONNEL COSTS

A. Court Monitor
1. Development of assessment and performance tracking system to assure the adequate performance of functions A-E cited in this budget (20 hours @ $75 per hour = $1,500)
2. On-going assessment of Defendant compliance with functions (A-D) (20 hours per week @ 75 per hour x 46 weeks = $69,000)
3. Monthly review of Defendant Compliance Report to the Court (E) (16 hours @ $75 per hour x 11 monthly reports = $13,200)

Sub-Total

$83,700

B. Expert Consults
A by-product of this function will be to create an interdisciplinary group of local experts who can provide on-going consults to the Nursing Staff to assure quality of care after the completion of this Court Order.
1. Decubitus Ulcer Expert (A.I) Geriatrician : Review of patient records, develop assessment protocol for court monitor, conduct ongoing assessment of patient records August 1995 through 6/30/96 (10 days @ $300 per day = $3,000)
2. Incontinence Expert (A.2) Geriatric Nurse Practitioner: Review of patient records, develop assessment protocol for court monitor, conduct ongoing assessment of patient records. (5 days @$300 per day = $1,500)
3. Nursing Home Systems Expert Assist with development of assessment protocol and a tracking system for items A(3), B, C, D, and E cited in this budget, conduct on-site reviews (30 days @ $300 per day = $9,000)

Page four

Expert Consults (continued)

4. Geriatric Pharmacologist Review training of nursing staff on medication administration, develop assessment techniques for (A.4) of this budget (5 days @ $300 per day = $1,500)

Sub-Total

$14,000

C. Support Staff

1. Faculty/Nursing Students of Howard University Students will work under the direction of the Court Monitor and University nursing faculty to track the performance of the assessment measures (A through E of this budget) and the tracking measures for the Monthly Compliance Report. (9 months, 8 days a month = $14,000)

2. Clerical Support (Average of 6 hrs. per week @$15 per hr. x 46 wks = $4,140)

Sub-TotaL

$17,940

GRAND TOTAL PERSONNEL COSTS.

$115,640

NON-PERSONNEL COSTS

1. Travel: Consultant airfare, lodging, travel reimbursement to and from nursing home, rates would be paid as per the Federal Government Travel Book) (Estimate not to exceed projected amount of $5,500)

2. Phone: Local calls and long distance ($100 month x 1 lmonths = $1,100) 3. Copying/Fax ($75 month x 11 months = $825) 4. Postage ($50 month x 11 months = $550) 5. Supplies (General desk supplies @$50 month x 11 months = $550) 6. Liability Insurance ($350)

Sub-Total Non-Personnel Costs.

$8,875

GRAND TOTAL OF BUDGET

$124,515

 
 SEP 21 '95 02:59PM DC VILLAGE

_-

P.2

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Sfreet, N.W. Washington, DC 20009 Menage: (202) 234-7142
September 21, 1995

Washington, DC
«"Dear Judge Hogan:

U.S. v. District of Columbia
ii NH-DC-OOI-014

Re: Civ. No. 95-948 TFH, D.C. Village Nursing Home

I am writing you to inform you of two situations relating to my Court monitoring activities.

The first is as of today at 1:00pm, I have not received the Court ordered payment of Friday, September 15, 1995.

The second area is that I support the United States motion to expand the duties of the Court Monitor to include the transfer and outplacement of residents. This would include, among other activities, attending outplacement meetings and monitoring individual care plans, placement of residents, and ability of the proposed facilities to meet the needs and care for the D.C. Village (DCV) residents.

Some of my concerns with transfer and outplacement of residents are the following.
(1) Transfer trauma mentioned in my Preliminary Status Report.
(2) At least four of the facilities which have a policy of receiving District of Columbia medicaid payments for residents and are listed as possible transfer and outplacement sites are according to my consultants "substandard" to care given at DCV. For example, one nursing facility has an activities staff of two for a resident population of 250. According to my consultants, the staff morale in these facilities is low, the staff is not generally spirited and motivated to care for residents, the opposite of what I am generally finding at DCV;
(3) In a meeting on Monday morning, September 18, 1995, with Dr. Harvey Sloane, Commissioner of Public Health, and other District of Columbia government

SEP 21 '95 02:59PM DC VILLAGE

-

P.3

officials as well as D.C. Village administration, I raised some of my concerns listed above as well as my serious concerns about one in particular outplacement facility. Although, I need further in-depth assessments in this area, apparently many of the decubitus ulcers at DCV either originate at this hospital or further develop and multiply while DCV residents are admitted. Dr. Sloane suggested that I visit this local hospital to oversee the staff knowledge and competence in the area of care of decubitus ulcers.
(4) I have now attended three of the "Outplacement Meetings for Residents with Mental Illness." It is generally agreed upon at these meetings, that there are not sufficient nor existent at present appropriate placements for these residents needs. Careful and sensitive oversight is necessary. I believe the same situation maybe true for the residents with Mental Retardation, although further assessments are necessary.
I believe a formal expansion of Court Monitoring activities to include the transfer and outplacement of DCV residents will facilitate my ability to monitor in the best interests of the long term care residents of the District of Columbia and make it clear to staff at all facilities what my role is.
Again, Judge Hogan, I look forward to serving the Court and working with all concerned parties for the best interests of the long term care residents of the District of Columbia.

Sincerely,

Harriet A.. Fields, Ed.D., R.N. Court Monitor

cc: Mr. Richard Farano Mr. David Deutsch Civil Rights Division u. s. Department of Justice Washington, DC
Mr. William Isaacson Kaye, Scholar Washington, DC
Ms. Barbara Mann Assistant Corporation Counsel District of Columbia

_ SEP 21 '95 02:59PM DC VILLAGE

P.I

HARRIET A. FIELDS, Ed.D., R.N.
1722 19th Street, NW
Suite 604
Waihmgtoo, DC 20009 PHONE: (202) 234-7142

FAX TO.

COMPANY NAME: C i V/L.

FAX NO:

ClU —

(Phone)

v ^ ^- ". ? / / (+

SENT BY:

DR. HARPTFT A

DATE:

^ \ ^-V \ C

# of Page*

Cover Page):

NOTES:

TIM

 
 HARRIET A. FIELDS, Ed.D., R.N.
#604 1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

The Honorable Thomas F. Hogan U. S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

U S v. District of Columbia
11 III I
NH-DC-001-015

Dear Judge Hogan:
Re: Civ. No. 95-948 TFH, D.C. Village Nursing Home
Enclosed is the first Status Report of the Court Monitor subsequent to the Preliminary Status Report submitted in September. On October 16, 1995,1 submitted Section HI. D. Services for Individuals with Mental Retardation.
I look forward to serving the Court and all concerned parties for the best interests of the long term care residents of the District of Columbia.

Sincerely,

Harriet A. Fields, Ed.D., R.N. Court Monitor

end.
cc. J Mr. Richard Farano Mr. David Deutsch U.S. Department of Justice Civil Rights Division Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15 Street, NW, Suite 1100 Washington, DC 20035

Ms. Barbara Mann
Assistant Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 690 Washington, DC 20001

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by: Court Monitor
Harriet A. Fields, Ed.D., R.N. Date:
October 16, 1995

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by: Harriet A. Fields, EdD., R.N.
Court Monitor Date:
October 16, 1995

I. INTRODUCTION

1

H. OVERVIEW OF SYSTEMS

2

A. Physical Restraints

3

B. Dining

3

C. Health Care Financing Administration (HCFA) Survey

4

D. Physical Therapy, Occupational Therapy

4

E. Nursing

;

5

F. Staff Development

6

G. Infection Control

6

H. Housekeeping

7

I. Therapeutic Activities

8

J. Medicine

9

Request to the Court

11

m. STATUS OF COMPLIANCE WITH COURT ORDER

12

A. Medical and Nursing Care

12

1. Care of Decubitus Ulcers

12

a. Defendants shall immediately cease the use of Elase

and Intrasite gel

12

b. Defendants shall immediately ensure mat all DCV residents

receive appropriate and adequate preventive medical

and nursing care

12

Concerns

13

2. Care of Incontinent Residents

15

Immediate Remedies Needed

16

3. Adequate and Appropriate Nursing Staff

17

4. Medication Errors

19

B. Measures Needed to Remedy Shortages

20

1. Food and Drink

20

2. Medications, Medical Supplies and Equipment

21

3. Personal Care Items

21

C. Payment of Vendors

22

Request to the Court

22

D. Services for Individuals with Mental Retardation

23

1. Defendants shall place all DCV residents with

mental retardation in appropriate community-based

residential and day programs

23

Assessment Data

23

Concerns

26

Concerns Re: Transfer, Outplacement, and Discharge

ofAU DCV Residents

27

2. Defendants shall ensure uninterrupted clinical services, habitation,

and other services

30

Assessment Data

30

3. No individuals with mental retardation shall be admitted to DCV . . 31

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home L Submitted by:
Harriet A. Fields, Ed.D., R.N. Court Monitor Date:
October 16, 1995
I. INTRODUCTION Hundreds of hours of the Court Monitor and consultants time have been devoted to assessing D.C. Village (DCV) and developing and helping implement a tracking system so mat compliance with the Court Order could be measured. The Court Monitor was appointed by the Court on August 1,1995. The budget for monitoring activities was approved by the Court on September 6, 1995. The Court Mom'tor and the nursing home systems expert consultant first entered DCV on August 28, 1995. At that time it was apparent mat there were no clear systems in place to determine compliance with the Court Order or other indicators of quality of care. Therefore, a systematic assessment was immediately implemented. This assessment consisted of meeting with all department heads and as many staff as possible and continuous touring of the units where DCV residents live. The Court Monitor met with all department heads as a group and then met with each department and staff separately, hi order to report to the Court regularly and accurately on compliance with the Court Order, systems assessment of DCV is ongoing as well as touring the units on all three shifts, day, evening, and night.
The Court Monitor met with the following DCV departments: therapeutic activities,

nutrition/dietary, nursing, medicine, pharmacy, housekeeping, facility services, physical therapy, occupational therapy, speech therapy, social service, administration. The purpose of these meetings was to clarify the role of the court monitor, the content of the Court Order, the role of each individual department in complying with the Court Order, the integral relationship of the Court Order to the quality of care and the quality of life of the residents of DCV, identify and clarify the tracking system to be implemented in order to monitor facility compliance with the Court Order, and to assess the role and function of each department in resident care. Along with the Executive Director of DCV, the Court Monitor met with all nursing staff on all three shifts, day, evening, and night.
On numerous occasions at DCV, the Court Monitor has met with and toured the resident units with the Commissioner of Public Health for the District of Columbia, the Interim Administrator for Long Term Care for the District of Columbia as well as many other District of Columbia government officials. It is a tribute to the Court that the Monitor has been openly received and has been told by the District of Columbia officials as well as the Executive Director of DCV mat the Court Monitor's presence has been a positive influence in helping to facilitate compliance with federal and District law and regulations and the Court Order. It is a privilege to serve the Court for the best interests of the residents of DCV.
This Status Report not only serves to inform the Court on a regular basis regarding compliance with the Court Order, but hopefully it will also serve as a guidepost for staff at DCV to facilitate improvement in care. No one area in the Court Order can be separated from the entire life of the institution and from how residents receive care, therefore, in order to give the Court a picture of the systems within DCV, and the relationship to the Court Order, a systems overview follows.
H. OVERVIEW OF SYSTEMS

A. Physical Restraints Perhaps the most profound impact the presence of the Court has had at DCV to date is the reduction in the use of physical restraints. The use of physical restraints directly relates to the Court Order in the areas of pressure sores and incontinence by immobilizing residents and affording no opportunity for turning of position and toileting. The Nursing Home Reform Law of 1987 stipulated that nursing home residents have a right to be free from physical and chemical restraints. This has had a profound impact on long term care in this country, so much so that now the acute care settings are looking to nursing homes for guidance in "untying the elderly". When the Court Monitor and consultant first entered DCV at the end of August, there were 59 physical restraints in use at DCV, approximately 25 percent of the resident population, well above the national norm. At present, there are less than 10 physical restraints in use.
Hopefully the process implemented to reduce physical restraints will be utilized to improve other care areas, especially those identified in the Court Order. The process is the interdisciplinary care approach utilizing all systems or departments, for one goal of quality resident care. The newly hired physical therapists as well as the occupational therapists working with facility services, housekeeping, nursing, medicine, therapeutic activities along with the resident as a team achieved this result.
B. Dining Another impact the presence of the Court has had at DCV is the engagement of the therapeutic activities department in the residents dining experience. Most of the resident dining areas on the units now have table clothes, flowers on the tables, and tables separated much as in a restaurant style. This can have the potential to add to residents improved nutrition by making dining more of a home event than an institutional routine.
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C. Health Care Financing Administration (HCFA^ Survey As mentioned in my Preliminary Status Report to the Court, HCFA did return at the end of September to re-survey DCV. The surveyor's findings were that there were no level A deficiencies outstanding and, therefore, the intent to close and terminate federal funding were set aside. Two deficiencies were cited in care planning and pest control. At the exit conference, Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia acknowledged among others, the positive role of the Court Monitor and consultants in advising the facility on how to comply with federal regulations.
DCV must focus on an interdisciplinary systems approach to improve resident care as reflected in compliance with the Court Order. When the Court Monitor and nursing home systems expert consultant first entered DCV, the care plans and care planning process in place did not meet the minimum standards of care requirements reflected in the federal regulations. Part of the tracking system implemented to monitor compliance with the Court Order is a new care planning system which merely reflects the federal regulations.
Pest control continues to be a problem at DCV. According to outside, independent pest control experts who know DCV and the District of Columbia government, roaches, etc., can be eliminated or greatly reduced by utilizing a variety of products and proper application.
D. Physical Therapy. Occupational Therapy A recent and very positive force at DCV is the new physical therapists and occupational therapists. They are contract staff but committed to DCV. The physical therapists are consummate professionals and can serve as a model to all other departments in their focus on interdisciplinary approaches to resident care.
The remaining overview reflects a systems breakdown at DCV and is directly related to the

ability of DCV to comply with the Court Order. It is my sincere hope that recommendations will be acted upon for the best interests of resident care.
E. Nursing Intensive in-service sessions on the tracking systems for assessing compliance with the Court Order and care planning have been given to the licensed nursing staff by the Court Monitor's consultants. In addition, follow-up advice has been given on the units. These sessions merely reflect advice on how to comply with minimum standards of care as reflected in the federal regulations. I find an admirable and unanimous commitment to learning how to improve resident care. Nursing staff have come in on their days off and off shifts to attend. However, until two weeks ago with the hiring of a new Director of Nursing and an Associate Director of Nursing, there was no leadership from the nursing office.
I am very hopeful that this new administrative team will bring the direction that is needed. Both the new administrators are doctorally prepared. The Director of Nursing is a seasoned administrator from Howard University Hospital and the new Associate is a former Director of Nursing in a nursing home in the District and has a working knowledge of the minimum standards of care as reflected in the federal regulations. At the initiation of the new Director of Nursing (DoN), and commencing Thursday, October 12,1995, weekly Thursday morning meetings will take place between the DoN and the Court Monitor for the shared purpose of improving resident care.
Policies and procedures must be updated, some are more than 20 years old. On-going and daily supervision from the nursing office of the unit clinical coordinators on all three shifts must commence immediately. The clinical coordinators on each of the eight care units are well intentioned, caring but floundering with no direction from nursing administration. Basic care practices are not part of daily and routine resident care which is a violation of

professional standards of practice. These absent routine care practices that directly relate to me Court Order are the following: daily range of motion; re-positioning at least every two hours; daily skin checks of the entire body to prevent the development, spread and worsening of decubitus ulcers; hydration; and restorative bowel and bladder programs for incontinent residents. The sections of this Status Report mat address the appropriate sections of the Court Order will provide assessment data. I am hopeful that with the new nursing administration leadership, all future Status Reports to the Court will profile progress in these care areas.
F. Staff Development Staff development at DCV is very weak. There is currently one staff development person at DCV. The section of this Status Report addressing nurse staffing will address recent new staff, one of whom has been assigned, as of the week of October 9, 1995, to the Staff Development department. This new contract staff apparently is knowledgeable of the minimum standards of care as reflected in the federal regulations. There has not been the on-going in-service and continuing education at the unit level that is necessary for the staff to become knowledgeable of and know how to maintain practice standards required for compliance with the Court Order. It is my hope that the new nursing administration will implement systems to immediately address this deficit.
G. Infection Control Infection control is weak. There appears to be little to no follow-up when infections are discovered. Follow-up should consist of identification of a pattern if any, and appropriate and immediate in-service and training for staff involved. The Court Monitor consultants have shared with the staff a system that is clear and list the steps necessary to take for an accountable infection control program in a nursing facility. The HCFA surveyor team leader commended DCV for implementing mis new infection control program. However, to date,

it is unclear which staff person, if any, at DCV is taking responsibility for appropriate follow through. This is very serious and directly relates to the Court Order in the areas of decubitus ulcers, incontinence, and nutrition of the residents. Frail nursing home residents are at great risk of infections and resultant hospitalizations as evidence in the x30 Day Compliance Report'.
H. Housekeeping There are numerous housekeeping staff. I have found them to be open and courteous, yet not always present on the units. What is needed is for housekeeping to take ownership and pride in the operations of the units to which they are assigned. It has been suggested by surveyors and consultants to the Court Monitor that the housekeeping department make permanent assignments of staff to each of the units. Further, it has been advised that housekeeping staff assigned to the units work closely with the unit clinical coordinator regarding the maintenance of a clean and healthy living environment for the residents "home".
Housekeeping is an important and integral part of the interdisciplinary team. A sense of pride and ownership of the units and the hallways and public spaces at DCV would result in consistent proactive initiatives for the health and safety of all. This vital department directly relates to the Court Order and to infection control activities profiled above. Frail, compromised residents with open wounds, such as, decubitus ulcers, are prone to infections as listed in the "30 Day Compliance Report'. Hand-washing is essential for limiting the spread of infection from resident to resident and from staff to resident. Soap is the most important element in prevention of infections. And yet, on numerous occasions I have observed no soap in residents' rooms. This seems to be an especially chronic problem on Unit 5B. For the entire weekend of September 29, 1995, the majority of rooms on Unit 5B were without soap, yet the Facility Supplies Chief told me there were "152 cartons of soap" on hand. It is alanning to me that this situation existed, that staff did not report it, which

means proper Hand-washing technique was not being done, and that the situation was not rectified immediately.
I. Therapeutic Activities There are eighteen therapeutic activities staff at DCV. For the first week of court monitoring activities, staff were nowhere present - absent from public rooms, the units, and resident rooms. After meeting with the therapeutic activities staff and advising them on how to comply with federal regulations, the dining areas on many of the units were transformed into the positive environments described in the Dining section above. The staff has been very open since this first meeting. In fact, the Director of the Therapeutic Activities Department told the Court Monitor mat "at first we thought you were the enemy, now we know you are here to help us." Another staff member, who has taken great pride and effort in creating a home like environment in me dining area on his assigned Unit 4A, has specifically expressed openness to any suggestions for improving care.
The D.C. Village Residents Choir performed during Resident Rights Week on October 4, 1995. Residents who are normally not engaged in their environment nor particularly present to time and place, sang solos. This event was organized by the therapeutic activities staff and tile residents.
Therapeutic activity is crucial to the life of frail, institutionalized people. Activities department staff must continually be present in the life of all the residents of DCV, including working with nursing department staff and teaching nurse aides how to meaningfully engaged all the residents. The challenge is to provide purposeful activities to total care residents from shift to shift, instead of, for example, putting residents to bed directly after dinner, as I so often observe at DCV. Total care residents at DCV are a neglected group. This will be described more fully under the sections addressing the Court Order and
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decubitus ulcer, incontinence, and nutrition care.
J. Medicine The Medical Director is a positive presence at DCV and a role model of professional behavior. The Medical Director has been in the position for one year.
There are four full-time medical doctors, including the psychiatrist, and one part-time medical doctor on staff at DCV. In addition, a fee for service medical doctor has recently been brought in to provide medical coverage for the unit previously covered by Dr. Barnes, who died suddenly in September. DCV likely has more medical doctors on staff than most nursing home in this country.
I believe the medical doctors at DCV are committed and care. However, they are currently organized in such a way as to prevent them from functioning as team members within the Department of Medicine. The DCV medical staffs belong to the Doctors Council union.
On September 7,1995, the Doctors Council staff representative met with Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia. Dr. Sloane asked the Court Monitor to attend. Also attending the meeting were Ms. Gladys Fountain, Interim Administrator for Long Term Care for the District of Columbia, the Executive Director of DCV, the medical doctors on staff at DCV, the Medical Director, and a labor representative from the Department of Human Services of the District of Columbia.
The Doctors Council staff representative described the medical staff as "labor" and the Medical Director as "management". Dr. Sloane, who is also a medical doctor, stated that in all his experience he has never known attending medical staff and psychiatrists to be unionized and defining themselves as "labor". Apparently, in the District of Columbia, only medical doctors who work in public facilities are unionized. Historically in other east coast

cities doctors unions were formed and needed for interns and residents to protect their working conditions while still formally learning within institutions, not for attending physicians and psychiatrists.
In the somewhat small meeting on September 7, the Doctors Council staff representative spoke for the DCV medical staff (all of whom were present) to the medical director and to the rest of the attendees. Not once did any of the medical staff address the Medical Director directly. There appeared to be near anger and hostility toward the Medical Director from the union representative, who expressed negative input she received from medical staff with no effort to validate the input.
The staff representative of the Doctors Union is not knowledgeable of the Nursing Home Reform Law and, thus, of its minimum standards of care for nursing facility residents identified in the federal regulations. The Doctors Union staff representative is not a health professional and, thus, does not have the professional focus on the resident centered care required in long term care. The focus seems to be on maintaining the artificial dichotomy between five medical doctors and one medical director and the administration.
A non-collegial and unprofessional relationship currently exists at DCV between the medical staff and the Medical Director. The medical staff alliance with the Doctors Council instead of the Medical Director creates an inherent tension within the medical department at DCV where there should be collaboration for the good of resident care. The current structure has fueled a malaise and a lack of motivation within the medical staff to continually upgrade their education, which is manifested in the low level of knowledge of the federal regulations mat are the minimum standards of care for nursing facility residents. This directly relates to the Court Order in the areas of care of decubitus ulcers, nutrition, and medications which will be addressed in this Status Report under the appropriate sections of the Court Order.
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The medical staff virtually ignore all recommendations by the Medical Director for attendance at continuing education programs (offered locally) that directly relate to resident care issues at DCV and care areas identified in the Court Order. For example, on October 11,1995, a nationally recognized expert on pressure ulcers (a medical doctor) spoke locally on the latest treatment modalities for the care of decubitus ulcers. The medical staff, treatment nurses, and the Court Monitor were informed of the meeting and invited. The two day-treatment nurses and the Court Monitor attended, but no medical staff from DCV were present At the September 7, meeting the psychiatrist commented that "if DCV is going to close why should we upgrade our continuing education".
A number of the medical staff are dedicated and concerned professionals, but their alliance with the Doctors Council creates the pervasive attitude of mistrust and defensiveness to constructive input and feedback from the Medical Director and is obstructing the ability of the medical department to participate fully as an interdisciplinary team in the care of residents at DCV. These attitudes and practices then permeate to the rest of the institution.
The Doctors Council staff representative is the only presence associated with DCV whose primary goal is not focused on improving resident care. This is a reflection on the nature of the position and not the person. Much of the Medical Director's time is spent responding to communications from the Doctors Council. The relationship is destructive to the process of improved resident care, and impedes the ability of DCV to comply with the Court Order.
Request to the Court I, therefore, respectfully request that the Court advise the medical staff at DCV to suspend their relationship with the Doctors Council staff representative for as long as DCV remains open. And, further, to communicate and relate directly to the Medical Director in all areas related to resident care and to follow the Medical Director's direction, especially in her
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recommendations for continuing education, which are always based on the best interests of the residents of DCV.
IIL STATUS OF COMPLIANCE WITH COURT ORDER
Future monthly status reports will address each of the areas in the Court Order. In order to commence monitoring and responsibly assess data, the above systems assessment was required. Updates on systems functions will be given in future status reports when applicable to compliance with the specific areas of the Court Order.
A. Medical and Nursing Care 1. Care of Decubitus Ulcers a. Defendants shall immediately cease the use of Elase and Intrasite gel
inappropriately for treatment of decubitus ulcers. b. Defendants shall immediately ensure that all DCV residents receive
appropriate and adequate preventive medical and nursing care and timely treatment for decubitus ulcers and/or other skin breakdown sufficient to maintain their good health. To this end, Defendants shall assess all residents for risk of skin breakdown within two days from the date of entry of this Stipulated Order, and shall develop and implement within twenty days thereafter, for each resident identified as at risk, a treatment plan fully adequate to prevent skin breakdown and/or to treat existing skin breakdown.
Status Re: Court Order Partial Compliance
Elase is not being used for the treatment of decubitus ulcers. Intrasite gel is prescribed and is used. The treatment nurses have been interviewed and observed and they are appropriately applying intrasite gel. Further monitoring is required to determine the current level and source of knowledge of the medical staff prescribing intrasite gel.
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There are four treatment nurses, two on the day shift and two on the evening. On each shift one nurse covers Units 5A, 5B, 4A, 4B, and the second treatment nurse covers Units 3A, 3B, 2A, IB. The treatment nurses treat identified decubitus ulcers. One treatment nurse is a DCV employee and has known the residents for many years. The three other treatment nurses are contract nurses but are permanently assigned. The treatment nurses have been observed to use appropriate sterile technique. At present there is still lack of coverage for the care of decubitus ulcers on the weekends.
Concerns I have a number of serious concerns regarding the care of residents with decubitus ulcers, which require further and on-going monitoring. I am hopeful the new leadership in nursing administration will tend to these concerns immediately. They are the following:
(1) There are no systematic and daily assessments to check for skin breakdown and to give early warning signs of the development of decubitus ulcers. On several occasions in the past month, decubiti were first observed at Level m. This means that the wound is deep and possibly draining. It is alarming that these wounds were not discovered earlier at Level II which means broken skin, at Level I superficial wound, or preventive measures implemented. It is not clear how decubiti are discovered and get on the treatment nurses list.
Daily nursing skin check rounds would discover possible pressure sores. It is hopeful that with the new nursing administration, unit coordinators will receive proper supervision, and in turn properly supervise the nurse aides on their units. On-going continuing education is needed for all staff.
(2) The treatment nurses know the residents decubitus ulcers but not the total care of the residents. This can lead to communications breakdown and delay in the timely sharing of information necessary for an up-to-date interdisciplinary care plan and continuity of care.
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(3) When the treatment nurses are not present on the units, including weekends, decubiti care and skin care are not part of nursing practice. This violates general standards of nursing practice.
On Sunday evening, September 24, 1995, the Court Monitor was touring the units with a nursing home systems expert consultant From the hallway on unit 3A came a distinct odor the odor of decubiti and urine. Upon entering the resident room which was the source of the odor, Mr. J.B. was found lying on his Level IV stage decubitus ulcer and soaked with urine. The nurse on duty did not seem to notice. I have no doubt that the nurse on duty, who has been on the unit for years, has affection for Mr. J.B., who had also been on the unit for years. In 1990 he was walking, on September 24, he was totally contracted in his bed, so much so that decubiti were developing on his knuckles which were contracted up under his chin. Mr. J.B. was scheduled on Tuesday of that week to enter a hospital in the District for a surgical procedure for the decubiti on his hip. The Medical Director was notified on Monday, September 25, as well as the physical therapist who assessed Mr. B. and noted that there was no range of motion or rehabilitation plan of care in his chart. The Medical Director had Mr. B. transferred that morning to the subacute unit of the hospital to receive the care he was not receiving at DCV. On Monday afternoon, the HCFA surveyors arrived.
(4) Decubitus ulcer care and prevention especially for frail, institutionalized people require an interdisciplinary approach including all departments. Currently, this is lacking at DCV.
I believe, if medicine more fully participates in the interdisciplinary team and upgrades it continuing education; nursing administration provides leadership to nursing which will really provide direction for the entire facility; nutrition and dietary become proactive; housekeeping
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keeps and maintains clean living spaces; pharmacy becomes proactive; while the physical therapy and occupational therapy departments are already fully participating as interdisciplinary team members, residents rights will be protected. However, it will take nothing less man the full commitment of all departments.
2. Care of Incontinent Residents Defendants shall immediately ensure that all incontinent DCV residents
receive appropriate, adequate and timely nursing care in accordance with generally accepted nursing standards. For residents who have been identified as subject to becoming incontinent, nursing staff shall make rounds to check on their individual condition at least once every two hours. Nursing staff shall take all appropriate steps to care for and clean those residents who need nursing attention due to their incontinence. Nursing staff shall take special care to clean and treat ulcerated areas that may have become soiled due to incontinence.
Status Re: Court Order Partial Compliance
The best way to assess compliance in this area is to periodically assess the residents. At times residents are clean and dry and, therefore, there is partial compliance. However, on other occasions, I have found residents to be sitting in urine for quite some time, that is, time enough for an odor to develop.
On-going continuing education is necessary for all staff including certified nurse aides and the treatment nurses.
In all due respect, the position charts which are placed at the end of resident beds and which make the '30 Day Compliance Report' so voluminous, are meaningless. On numerous occasions I have observed residents in urine for several hours on a shift and yet the position chart has been neatly checked and initialed. On the evening of October 4,1995,1 observed a resident, Ms. M.H. at 7pm, 8pm, and at 9:30pm-at that time with the evening nurse
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supervisors. At all those times, Ms. B. was in the same position and she and her bed clothing were wet At 7pm, the position chart intended to document turning every two hours had not been completed since 3pm. At 8pm the chart had been filled in, and at 9:30pm Ms. B's bed clothing was soiled with feces. Check-off charts often lead to slovenly practices and not necessarily with deliberate intent.
Immediate Remedies Needed (1) Leadership from the nursing office by developing and providing a role description
for unit coordinators outlining basic care practices, supervisory requirements and techniques for nursing assistants, and daily reporting procedures to nursing administration. In this way, the unit coordinators take ownership and responsibility for the care status of the residents on their units, and nursing administration becomes accountable for the care being given on the units. Nursing administration must be a constant presence on the units.
(2) Interdisciplinary team approach to resident care as described above in the decubitus ulcers section under Concerns (4). Housekeeping and the ever presence of soap to prevent spreading infections from one incontinent resident to another are especially vital.
(3) There are procedures for a restorative bowel and bladder training program now on each unit. With the assistance of nursing administration and staff development, this should be systematically implemented.
I have come to realize a pattern at DCV which saddens me. Residents who cannot advocate for themselves are victims of passive neglect. These are residents who for the most part cannot communicate; have restricted mobility; need nearly total care; have decubitus ulcers; are incontinent; have severe contracture; and are dehydrated. Many of these conditions are often preventable, or are susceptible to improvement. A definition of passive neglect is the
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"deprivation of goods or services which are necessary to maintain physical or mental health, without a conscious attempt to inflict physical or emotional distress (for example, abandonment or denial of services because of inadequate knowledge.)" Persistent neglectful practices result in abuse.
I stand by my statement at the end of the Preliminary Status Report, submitted in September. That is, I find the staff at DCV to be caring and motivated, but there is an immediate need for on-going continuing education. Neglect and abuse occur when staff are poorly trained and poorly supervised Frail, institutionalized residents present care challenges which require sensitivity and daily support to the staff to prevent neglect and abuse of the residents.
Recommendations in this Report do not cost money, they do cost in a priceless commodity - time, commitment, and caring.
3. Adequate and Appropriate Nursing Staff a. Defendants shall ensure that continuity of nursing staff is maintained
to the maximum extent feasible during all shifts, seven days a week, on all DCV living units.
b. By no later than January 1,1996, Defendants shall ensure that there is a sufficient permanent nursing staff at DCV to ensure that DCV does not routinely rely on contract nurses. Nothing herein prevents the use of contract nurses in emergency situations or to ensure that adequate nursing staff is available to care for DCV residents.
Status Re: Court Order Partial Compliance
With the announced closure of DCV in August 1995, this section will probably never achieve full compliance. Many staff are resigning or opting for early retirement offers, and it is difficult to attract new staff. However, there are efforts to stabilize the staffing.
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In the first week in October, seven contract nurses were hired under a special arrangement with one of the vendors, National Nurses, Inc. These contract nurses will be permanently assigned to DCV, forty hours per week and apparently have many years experience in long term care. Three will be placed as unit coordinators on three of the units. Two are planned to be placed in the Staff Development Department One will be placed in quality assurance,
In terms of numbers of licensed nursing staff and certified nurse aides (CNAs), DCV is not understaffed. In fact, it likely has one of the lowest staff to resident ratios in the country. The problem is the utilization of staff and continuity of care with the use of contract nurses. For example, on the night shift of October 5,1995, at 12:30AM, I observed the licensed Nurse on duty (a contract nurse) and four nurses aides sitting in the day room with the television on. One nurse aide was with a resident who has a nurse aide solely assigned to him. One nurse aide did not have her uniform on, I asked the CNA where it was and she pointed to a chair with her bags in it.
The new Director of Nursing (DoN) in the first of weekly meetings with the Court Monitor on October 12, indicated that one of her priorities is to "get a handle on contract nurses," which, I must admit, is difficult to do. I asked a nursing administrator - who does the nurse staffing and the response was "anyone who can get their hands on the book". At any one time I have observed three to four nurses in the nursing office who claimed to be doing staffing for the day. These particular nurses are former DCV nursing administrators who took early retirement and are now employees of the contract nurse staffing vendors which supply the contract nurses to DCV. There are approximately six vendors. In addition, there is also a DCV non nurse employee who solely does staffing.
A daily staffing form has been implemented to track nurse staffing for court monitoring. This form includes daily data for each unit listing the census, numbers of licensed staff,
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numbers of contract agency nurse staff, and numbers of CNAs. Future status reports will provide an analysis of this data.
4. Medication Errors a. Defendants shall ensure, within fifteen days from the date of entry of
this Stipulated Order, that all nursing staff on duty are trained in proper medication administration practices, and are adequately in serviced on and/or are sufficiently aware of the individual needs of the residents to whom they are administering medications.
b. Defendants shall ensure, within fifteen days from the date of entry of this Stipulated Order, that all medication errors are recorded, that adequate procedures are established to track all medication errors, that any causes for medication errors are identified and remedied, and that any other needed corrective action is taken in a timely manner to minimize medication error risk to the DCV residents.
Status Re: Court Order Further monitoring required
The next Status Report to the Court will provide in-depth data in this area. Random medication pass reviews conducted on September 27,1995, identified two medication errors by a contract nurse - eye drops prescribed for the left eye and administered in the right eye. Random medication pass review conducted on October 10, 1995, found six medication pass errors.
A profile of me Pharmacy Department and the medications prescribed for DCV residents will be given in an upcoming status report. There are five pharmacists on staff at DCV. The national norm for the number of prescribed medications a nursing home resident takes is five to six. The average number of prescribed medications DCV residents are taking is eight to thirteen.
In a meeting with the Department of Medicine on September 12, 1995, the psychiatrist indicated a lack of clarity regarding the appropriate use of prescribed psychotropic
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medications as indicated in the federal regulations.
Assessing medication errors cannot be separated from a medication review to identify possible unnecessary drug use.
B. Measures Needed to Remedy Shortages 1. Food and Drink Defendants shall immediately ensure that sufficient supplies of nutritious
and appropriate food and drink are consistently maintained at DCV and that each resident daily receives adequate, well-balanced, nutritious and appropriate food and drink according to their individual nutritional needs.
Status Re: Court Order Further monitoring required
The next Status Report to the Court will provide a profile of the Nutrition/Dietary Department. The Court Monitor has met with the Chair and a faculty member of the Department of Nutritional Services at Howard University. This meeting took place at DCV. I expect to have by the next report, and analysis of residents nutritional needs and a daily nutritional intake profile.
Monthly weight logs have been instituted on each unit. This should be a clear tool for quality assurance activities and monitoring nutritional status. The Dietary Department must assume a critical role in taking responsibility for calculating monthly weight loss or gain and initiating proper assessment and care planning if indicated. The interdisciplinary team plays a vital role in appropriate nutrition. Meal observation is also important in ensuring daily nutrition.
Dehydration is a reason given for several hospital admissions. When asked her opinion about dehydration as a reason for hospital admission a nursing administrator said, "it is embarrassing." Proper hydration for nursing home residents, including those with gastric
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tubes, requires vigilance and routine offering of liquids and flushing of gastric tubes with
water.
2. Medications, Medical Supplies and Equipment
a. Defendants shall ensure that adequate and appropriate supplies of necessary medications, that meet the individual needs of the DCV residents, are consistently maintained at DCV no later than two days from the date of entry of this Stipulated Order.

Further monitoring required

See A. 4. above

b. Defendants shall ensure that an adequate and appropriate quantity of medical supplies and equipment, that meet the individual needs of the DCV residents, are available for use, as needed, no later than five days from the date of entry of this Stipulated Order.
Data will be presented in next Status Report.

c Defendants shall maintain the plumbing and heating system at DCV to ensure that adequate amounts of hot water, at safe temperatures, are available for use by residents within two days from the date of entry of this Stipulated Order. Defendants shall also ensure that there is sufficient hot water to properly sanitize and clean eating utensils, plates and meal-related items.
Status Re: Court Order Compliance

The Facility Services Department conducts regular random checks and charts findings. On two occasions temperatures in resident bathrooms and common bath areas were validated by the Court Monitor and consultant to be within the mandated temperatures required in D.C. regulations (100 to 110 degrees f.) The actual readings observed were 104 degrees and 105 degrees.

3. Personal Care Items

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Data will be presented in next Status Report
C. Payment of Vendors
Request to the Court I respectfully request mat the Court advise me Corporation Counsel on behalf of the District of Columbia to supply the Court Monitor with contact names and phone numbers for the vendors listed. I am unable to validate the data in the '30 Day Compliance Report' and to monitor compliance with this area of the Court Order without this information.
For weeks I have asked for this information from administration within DCV and from various District of Columbia government officials. I have witnessed bureaucratic groupthink - a pattern of thinking which stifles the potentially competent into inertia.
Data is presented for the following vendors whose names and numbers were supplied to me by the Department of Justice.
Status Re: Court Order As of October 3, 1995 Out of Compliance
NUTECH Laundry is owed $3535.90 from February 1995. NUTECH no longer has a contract with DCV.
Health Care Laundry Services is owed $24,962.93 for services from July 14-28,1995. Health Care Laundry is not planning to suspend service.
Central Armature Works is paid in full.
Hill Rom supplier of specialty beds has referred back payment of approximately $20,000 to a collection agency, and with no response forwarded the case to an attorney.
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As of October 12, 1995: National Patient Care Systems supplier of specialty beds has $8110 outstanding from March 1995. Outstanding: for June - $9030; for July - $9300; for August 1995 - $9400. National Patient Care Systems does not intend to suspend services.
D. Services for Individuals with Mental Retardation 1. Defendants shall place all DCV residents with mental retardation in
appropriate community-based residential and day programs which fully meet their individual needs as identified by appropriate interdisciplinary assessments, no later than October 31,1995. Defendants shall ensure that the placements are adequate to meet each individual's needs.
Status Re: Court Order Non-Compliance
Assessment Data Data have been obtained primarily from the Georgetown University Child Development Center staff at DCV and the Social Services staff person from DCV assigned to the majority of the residents with mental retardation (M.R.).
Since the filing of the Court Order on July 6, 1995, two residents have been transferred out of DCV, they are the two people listed in the '30 Day Compliance Report*. As far as can be determined, mere has been no assessment of the adequacy of current care to meet their needs. Four residents were outplaced on June 30,1995. One resident, Mr. D.H., deceased, July 13, 1995. Currently, there are 15 individuals identified with mental retardation at DCV.
According to the Social Service staff person at DCV, the interdisciplinary assessment team involved with planning the outplacements of the M.R. residents consist of the following:
23

DCV Social Service social worker; case manager from the Bureau of Case Management, Mental Retardation and Developmental Disability Administration (MRDDA), Commission on Social Services, Department of Human Services, District of Columbia; Georgetown University Child Development Center (GUCDC) staff consisting of psychologist, nutritionist, speech therapist, therapeutic activities; the clinical nurse coordinator for the DCV Unit; M.R. resident's attorney if any; and family members) if any.
The case manager from the District of Columbia identifies the placement sites usually after the interdisciplinary team meeting. The placement sites are all under the jurisdiction of MRDDA.
Of the 15 residents identified with mental retardation at DCV, four are identified to be outplaced to the Kennedy Institute. According to the Georgetown University Child Development Center (GUCDC) staff and the Social Service staff from DCV, no date has been given for outplacement because of "contract/budget considerations" a definition of which is not known by either source.
Five residents are scheduled to be outplaced to CARECO. This outplacement is of great concern to the DCV Social Services Department social worker handling the majority of the mental retardation resident outplacements. The four residents identified to be outplaced to CARECO are wheelchair bound. These residents would be placed on the second and third floors of the residence. The concern is fire safety hazards. Currently, CARECO is remodeling and no date is given for outplacement. Further monitoring is needed to determine what are the remodeling plans in relation to residents needs.
Four M.R. residents are scheduled to be outplaced to Wholistic Habilitative Services. Attorneys for two of the residents oppose this outplacement because they believe the medical
24

needs of these residents require nursing home care beyond the capabilities of the identified Intermediate Care Facility/Mental Retardation (ICF/MR).
Another resident is scheduled to be outplaced to METRO, Inc. Again this is being delayed because of the residents "medical needs".
One resident scheduled to be outplaced to D.C. Family Services is currently hospitalized.
The Hearing Commission for a Pratt decree MR. resident is concerned that his physical health problems may worsen upon discharge from the DCV nursing home care setting, where under the guidance of GUCDC staff his health problems improved. The concern is that in outplacement into the lower level care setting, he may revert to the worse health problems with which he came to DCV. The social worker at DCV is concerned about the ability of some of the identified placements to care for the physical needs of the residents, such as, the two residents with tracheotomies, hi addition the majority of the M.R. residents have gastrostomy tubes for feeding. Some of the residents scheduled to be outplaced have compromising medical conditions which leave their transfer in question at present. There is concern that their medical conditions may be beyond the capabilities of the staff at the MRDDA identified sites.
Georgetown University Child Development Center staff provides training for the staff of the identified outplacement sites. This training takes place at DCV. The District of Columbia assesses the outplacement site physical plant. The social worker from DCV usually visits the identified outplacement site before the resident is discharged.
According to the DCV social worker, at this point in time, it is not known if there are community based day programs available and appropriate for the needs of the M.R.
25

residents. Further assessment and monitoring are needed to determine mis.
I have a number of concerns regarding the outplacement process for residents with mental retardation which require further monitoring, they are the following:
fa) Outplacement planning process and match of outplacement sites with individual needs Given the assessment data obtained above, I am very concerned about the decision making process and rationale for the identification and match of the outplacement sites with the individual needs of the MR. residents. The Court Monitor will gather information from the Bureau of Case Management, MRDDA, DHS, District of Columbia.
(b) On-going supervision of placement site staff From my discussions with staff and observations of the M.R. residents at DCV, I am particularly concerned about the adequacy, on-going assessment and evaluation, and appropriate and effective supervision of the staff of the MRDDA identified outplacement facilities. The MR. residents at DCV have complex physical, emotional, and behavioral needs. Staff training off site is one thing, but the implementation and 'how to* of the training in the actual care-giving setting is another. The current planning process for the outplacement of the M.R. residents identifies the case manager from the Bureau of Case Management, MRDDA to do this follow-up.
© On-eoing evaluation of outplacement site in meeting individual needs I am particularly concerned about the on-going assessments of the individual resident and the adequacy of the outplacement sites to continue to meet care needs. Seven of the residents with mental retardation at DCV do not come under the Pratt decree. The case manager from the Bureau of Case Management, MRDDA is identified as the monitor for this activity.
26

My concerns listed above are validated by the semi-annual report to the U.S. District Court for the District of Columbia, Evans v. Barry, et al., and the Pratt decrees. In the report submitted by the Court Monitor in this matter, the District of Columbia ARC, dated September 30, 1995, data is given on the limited capacity of the Bureau of Case Management, MRDDA to assess, evaluate, supervise, and monitor the adequacy of care for residents with mental retardation.
Further monitoring necessitates and will include contact with the outplacement vendors and MRDDA.
Concerns Re: Transfer. Outplacement and Discharge of All DCV Residents My concerns regarding the adequacy of outplacement of DCVM.R residents also apply to the DCV resident population as a whole. The GUCDC staff have described the discharge planning process for the M.R. residents as "bumpy" without a "smooth flow of information among" all parties involved. In fact, GUCDC staff mentioned that there have been instances when they have gone to the unit and found that the M.R. resident has been discharged without their knowledge, yet the GUCDC are the primary caregivers for the residents with mental retardation. Some of my concerns are outlined in my September 21,1995, letter to the Court The patterns I have been able to assess to date regarding the outplacement process for residents with mental retardation as outlined above, can be generalized to the planning process for the remainder of the residents at DCV. Recent responses the Residents Council has received from the Mayor add to my concern that the discharge planning process is based on fiscal considerations and the meeting of arbitrary time deadlines not residents' health and welfare.
As Court Monitor, I am a bit surprised and disappointed in the response of the Office of Corporation Counsel on behalf of the District of Columbia to my September 21, letter to the
27

Court outlining some of my concerns with transfer and outplacement of residents. On numerous instances the Court Monitor has received feedback from the Executive Director of DCV, from department heads, from staff, from the interim administrator for Long Term Care in Department of Human Services of the District of Columbia, and from the Commissioner of Public Health for the District of Columbia that the presence of the Court Monitor at DCV has been a "positive" influence in advising DCV how to comply with minimum standards of care as outlined in the federal and district law and regulations and the Court Order. My concerns regarding the transfer and discharge of DCV residents are shared in the same spirit of constructive communication and advice for the best interests of the residents of DCV and the long term care residents of the District of Columbia.
In addition to my concerns relating to transfer trauma which is well documented in the literature, my continued concern regarding the transfer and discharge of the residents of DCV relates to the following data:
(1) Social services department staff at DCV has described the outplacement process as "chaotic". The social worker (s.w.) estimates that it will take "at least a year" to outplace all residents and that many residents no one may accept, especially the residents with mental illness. In addition, the s.w. mentioned that the transfer search will probably have to go beyond the 50 mile radius planned. An interesting point shared by the s.w. is that historically DCV has accepted hard to place residents, that is, "a dumping ground for residents no one else wanted." Therefore, closing of DCV may lead to increased homelessness of the helpless in the District of Columbia.
(2) Many nursing homes do not admit medicaid residents with the severe decubitus ulcers unfortunately many of the DCV residents still have.
28

(3) As gleaned from the 'Outplacement Meetings for Residents with Mental Illness' to date there are not adequate numbers of appropriate placements for these residents. In the planning meetings, DCV position is to transfer these residents to a nursing home and then within a year or so, when and if adequate placements may develop, transfer them to the appropriate setting. This disruption in environment is detrimental to any older person, but especially to those with mental illness whose care needs for a sense of autonomy, security, and control of the environment are critical.
(4) m a meeting on Monday, September 18,1995, at DCV with Dr. Harvey Sloane, Commissioner Public Health for the District of Columbia, Ms. Gladys Fountain, Interim Administrator for Long Term Care for the District of Columbia and other District of Columbia government officials, as well as DCV administration, Dr. Sloane suggested I visit a local hospital which is an identified outplacement site. Dr. Sloane suggested I visit this site to oversee the staff knowledge of and competence in the care of decubitus ulcers. Many of the decubitus ulcers at DCV either originate at this designated outplacement site or further develop and multiply there while DCV residents are admitted. In fact, one resident returned to DCV on Thursday, October 13,1995, from this outplacement site with four new decubiti.
(5) The president of the Residents' Council at DCV, Mr. C.F., attended an interfaith ministers meeting last week in which the Mayor was also present. Mr. C.F. introduced himself and told the mayor of his concerns regarding closure of DCV, upon hearing this the Mayor told Mr. C.F. that he did not have time to speak with him and walked away. The mayor did meet with a few residents of DCV on October 11,1995, at City Hall. The Mayor spent a few minutes with the residents and said that DCV costs "$30,000,000 a year to run" and it is closing.
29

There is enormous financial waste in the operation of DCV. In a future status report to the Court, I will present a profile of how DCV can be competently operated and at a savings of significant millions of dollars per year. This profile will reflect the input of health professionals in me District of Columbia who have a commitment to the District, a concern for the long term care residents of the District of Columbia, and expertise in long term care practice, education, research, and in the operations of cost effective and quality care giving facilities.
2. Defendants shall ensure uninterrupted clinical services, habilitation, and other services to all DCV residents with mental retardation. Such services shall remain in effect until all DCV residents with mental retardation are outplaced into appropriate community settings in accordance with the above provision.
Status Re: Court Order Partial Compliance Further monitoring required
Assessment Data The Georgetown University Child Development Center staff provide habilitation services to the residents with mental retardation. GUCDC hours are primarily 9AM to 5PM, with some overlap into the evening hours, Monday through Friday. Currently the contract for the GUCDC is due to expire on December 31,1995.
Further monitoring is required to more fully assess the staff on duty on the evening, night, and weekend shifts. Observations of M.R. residents and staff and interviews with DCV staff indicate that on hours, shifts, and days that GUCDC staff are not present on the unit, habilitation and clinical services are not performed. During the evening, night, and weekend shifts when contract nurses are on duty this is even more problematic because of the lack of knowledge of the residents, which leads to lack of continuity of care.
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3. No individuals with mental retardation shall be admitted to DCV in the future except where this Court specifically approves the proposed admission.
States Re: Court Order Full Compliance
31

 
 HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

U.S. v. District of Columbia
11
NH-DC-001-016

Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Order Modifying Stipulated Order of July 6, 1995
Dear Judge Hogan:
Enclosed is the Court Monitor's second Status Report to the Court. It follows the October Status Report, and submission of the Preliminary Status Report in September.
This is the first Status Report since the November 7 expansion of the monitor's duties to oversee the outplacement process. Since there was an acute and critical need to assess and advise the facility, the majority of the Court Monitor's time and the majority of this report is devoted to the discharge process.
It is a privilege to serve the Court and work with all concerned parties for the best interests of the long term care residents of the District of Columbia.

Sincerely,

Harriet A. Fields, Ed.D., R.N. Court Monitor
encl.

cc: * Mr. Richard J. Farano / Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann Assistant Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home Submitted by:
Harriet A. Fields, Ed.D., R.N. Court Monitor
November 30, 1995

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by: Harriet A. Fields, Ed.D., R.N.
Court Monitor Date:
November 30,1995

INTRODUCTION

1

I. ORDER MODIFYING STIPULATED ORDER OF JULY 6,1995

2

1. ASSESSMENT

4

a. ASSESSMENT DATA

4

2. RECOMMENDATIONS

7

3. ACTION STEPS

9

4. PROFILE AND BRIEF CASE STUDY

15

a. RECOMMENDATIONS

17

5. OUTPLACEMENT OF RESIDENTS WITH MENTAL ILLNESS 19

a. ASSESSMENT DATA

20

b. ACTION STEPS

21

6. REQUEST TO THE COURT

22

II. UPDATE OF SYSTEMS

23

A. MEDICINE

23

B. NURSING

24

C. INFECTION CONTROL

25

III. STIPULATED COURT ORDER, JULY 6, 1995

25

A. MEDICAL AND NURSING CARE

25

1. CARE OF DECUBITUS ULCERS

26

2. CARE OF INCONTINENT RESIDENTS

26

3. ADEQUATE AND APPROPRIATE NURSING STAFF

27

4. MEDICATION ERRORS

28

B. MEASURES NEEDED TO REMEDY SHORTAGES

29

1. FOOD AND DRINK

29

2. MEDICATIONS, MEDICAL SUPPLIES AND EQUIPMENT

31

3. PERSONAL CARE ITEMS

32

a. STATUS RE: COURT ORDER

32

C. PAYMENT OF VENDORS

33

a. STATUS RE: COURT ORDER

34

D. SERVICES FOR INDIVIDUALS WITH MENTAL RETARDATION

34

a. STATUS RE: COURT ORDER

35

1. APPROPRIATE PLACEMENT

35

a. RECOMMENDATIONS

39

2. UNINTERRUPTED CLINICAL SERVICES

39

a. STATUS RE: COURT ORDER

39

3. NO FUTURE ADMITTANCE

40

a. STATUS RE: COURT ORDER

40

federal and District law and regulations, and the Court Orders, including Stipulated Order of July 6, 1995. The Court Order of July 6, pertains to the establishment and maintenance of residents rights and the status of compliance will be directly reflected in the quality of the outplacement plans and the transfer of residents. It will also be a measure of the humanity of the District of Columbia. The transfer of the residents literally can be a life or death determining factor for the residents of DCV. The outplacement of the residents, the planning surrounding it and the transfer of residents to new homes is the most important activity to take place now until closing.
Nothing less than a full commitment on the part of every single employee at DCV is vital to making the outplacement process a humane one for the residents. I am confident DCV can rise to the occasion.
This Status Report is divided into three main sections. The first addresses the outplacement process and the November 7, 1995 Order Modifying Stipulated Order of July 6. 1995. The second section gives an update of systems as a follow-up to the Overview of Systems in the October Status Report. The third section addresses the Stipulated Court Order of July 6, 1995.
I. NOVEMBER 7,1995, ORDER MODIFYING STIPULATED ORDER OF JULY 6,1995 B. The Monitor shall have authority to review and advise on Defendants'
compliance with District and federal law. C. Review compliance with provisions of discharge plan to ensure the safe and
orderly removal of the residents and to protect their health, safety, welfare, and rights, including the residents' rights to an opportunity for participation in their discharge process.

This section of the first Status Report after the expansion of the Court Monitor's duties will address the November 7, 1995, Order Modifying Stipulated Order of July 6. 1995 in the following areas:
1. Assessment of the outplacement process to date, before and since the November 7 modification of duties;
2. Recommendations based on assessment data; 3. Action Steps put in place by DCV to address the concerns regarding the outplacement process; 4. A profile of one unit and a brief case study of one resident which can be generalized to all the residents at DCV, profiling life at DCV, how it impacts some residents now, and how with the implementation of the recommendations of a humane outplacement process, life could improve for the residents and also provide a discharge outplacement plan that would give direction to the receiving facilities at the residents new home; 5. Outplacement of residents with mental illness, assessment and recommendations and action steps to be implemented by Dr. Mary Alice Crockett, the Medical Director, who is charged by Mr. Silas Butler to oversee the outplacement of the residents with mental illness. This section ends with a Request to the Court
The outplacement of the residents with mental retardation is addressed in this Report under the July 6, 1995 Stipulated Court Order Section D. Residents with Mental Retardation;

1. ASSESSMENT The Court Monitor first began attending the weekly outplacement meetings on October 25, 1995. These meeting are chaired by Mr. Silas Butler, Deputy Administrator, DCV. In attendance are the social services department, usually the department head; the long term care ombuds person for the District of Columbia; Ms. Corrie Kemp, Chief, Central Referral Bureau for the District; and now the Court Monitor.
The following is assessment data the Court Monitor has gleaned from attendance at outplacement meetings, discussions with staff, conversations with all concerned parties to the Court Order, and most important from the residents on the units and at the bedside.
I want to assure the Court, that the assessment data listed has lead to the remedies recommended by the Court Monitor that follow, and which I am happy to report are in the process of being implemented. It is a tribute to the Executive Director of DCV, Ms. Alberta Brasfield, that she had the wisdom to appoint Mr. Silas Butler, Deputy Administrator to oversee the outplacement process for the residents. I find Mr. Butler to be a professional genuinely concerned about improving the life of the residents, proactive in improving the outplacement process, and completely open to and not defensive about recommendations and advice on how to comply with federal and district law and regulations and the Court Orders. Mr. Butler is rising to the occasion and has emerged as a constructive leader.
Assessment Data Early on it became evident to the Court Monitor, despite the pronouncements and assurances from within DCV and District of Columbia government officials, that:
- there were no interdisciplinary care plans for the residents;

- DCV was relying on the receiving facilities to develop these plans, despite the fact it is the caregivers at DCV who know the residents, in some instances for decades;
- the pre-placement packages to be shared with potential outplacement sites developed by the social services department were sparse at best and did not present a clear picture of the individual, the resident;
- if this process was left to continue, the residents would be at a supreme disadvantage and likely to suffer transfer trauma and possible early death;
- the outplacement of residents was not cohesive and in fact was disorganized; - the outplacement process was beyond the ability of one department (social services) to handle, that in fact all departments relevant to the life of the residents had to be involved in order to present a clear and relevant view of the resident to the outplacing facility; - residents were not being systematically informed of their transfer and given choices; - no resident was receiving any type of counseling whatsoever to decrease the anxiety and trauma associated with moving to a new home. The professional literature associates this lack of counseling with adverse consequences which in many instances leads to early and unnecessary death.
All of the above findings were in violation of residents rights, federal and District law and regulations, and the Court Order. Indeed several residents outplaced to date have suffered. One Ms. E.W. outplaced on October 9, died two and one half weeks later. At time of transfer Ms. E.W.'s health condition in no way indicated imminent death. One resident outplaced on October 17, Ms. M.T., stopped eating and was hospitalized, another resident outplaced October 20, Ms. D.L., stopped talking. A fourth resident, Ms. E.B., on the morning of outplacement, October 23, became so anxious that she began roaming the

halls and running into offices and rooms, seeking solace. Furthermore, she was unable to identify to which nursing home she was moving. Staff knowledge of transfer trauma phenomenon would have indicated a plan of action for Ms. E.B. which would have resulted in her not moving out that day, and not until her anxiety was diminished by therapeutic interventions such as counseling by a supportive staff. In addition, the Residents Council is actively campaigning through calling press conferences and letter writing to public officials to keep DCV open.
Two residents have been outplaced from the hospital where they were transferred. These residents were outplaced with no input from DCV describing their life and care needs gleaned from years of knowledge from living with these individuals at DCV. One resident with mental retardation, Mr. L.S., was outplaced from the hospital with both arms and legs restrained. Mr. L was never restrained at DCV. Clearly Mr. L.'s Individual Habilitation Plan was not communicated. Recommendations indicated by this event are listed in this Status Report under the July 6, 1995, Stipulated Court Order. Section D. Residents with Mental Retardation.
Since August 1995, 24 residents have been discharged. According to District of Columbia Law, the Long-Term Care Ombuds person is to receive written notice of intent to discharge. The Long-Term Care Ombuds person did not receive notice for 11 of the 24 residents discharged to date.
One proposed outplacement site, J.B. Johnson Nursing Home is in crisis as profiled in the media this week. There are dangerously low numbers of staff, food supplies, and lack of payments to employees and vendors. In fact some staff from DCV were detailed there this past week. The proposed outplacement of the five residents identified for acceptance

at this facility has been put on hold. Four D.C. long term care ombuds persons were scheduled to visit the facility as of today, November 30. The ombuds attends the weekly outplacement meetings and will commence devoting one day a week to follow up on outplacement sites as needed by the Court Monitor. In addition, the ombuds will be visiting residents who have already been outplaced and they will be providing data to the Court Monitor.
On November 29, the Court Monitor along with the ombuds person visited a proposed outplacement site, Hadley Hospital Skilled Unit, with 20 beds available for DCV residents.
At the monthly outplacement meeting held Monday, November 27, providers attending mentioned that nursing homes have not received payment for over 60 days approaching 90 days. In addition, the providers said that most facilities in Maryland with D.C. medicaid provider contracts are not accepting residents from the District of Columbia because of this lack of payment.
2. RECOMMENDATIONS A) Expand Departments Involved in Outplacement The outplacement process
team be expanded beyond the social services department to also include nursing, dietary, therapeutic recreation departments, and when appropriate physical therapy and occupational therapy.
B) Interdisciplinary Team Care Plans All residents must have an interdisciplinary team care plan which reflects a counseling program for minimizing

transfer trauma and which gives direction to the receiving home regarding the individual's unique care needs. This will help ensure that there will be continuity of care. Not only is this humane, but it is also in accordance with federal and District law and regulations. The format for these care plans are available on the units and in fact are in each resident's chart. Some have already been developed through the good work of some of the unit clinical nurse coordinators and the Associate Directors of Nursing (ADONs). Those already developed can serve as a model for other staff. The format is part of the tracking system the Court Monitor's nursing home systems expert consultant brought to the facility in order to assess compliance with the Court Order. If this interdisciplinary discharge care plan is carried out successfully, it can serve as a model for the long term care community of the District of Columbia.
C) Social Service and Nursing Departments Social services department must work closely with the nursing department and in all instances inform the two (ADONs) of all residents scheduled for discharge. In this way, priority can be given to the development of the above described interdisciplinary care plans.
D) 24 hour Availability of Staff to Counsel Residents At all times including day, evening, and night shifts, residents must have an opportunity to talk about their feelings regarding moving to a new home. To do this, all staff who come in contact with residents, including housekeeping, must first be sensitized to their concerns and feelings, so they can in turn help residents. This task is too much to ask of and beyond the capability of one department. However, the social services department should certainly continue to take the lead as the initial contact for the outplacement facilities, coordinating the sending of appropriate plans, arranging transportation so that the residents may visit proposed transfer homes, and assisting with counseling.

E) Therapeutic Music Soothing music at a low volume be piped into the public address system in order to effect a calming atmosphere conducive to healing from a major life stress - the loss of one's home. This has been requested by the Residents Council and also suggested by a nursing homes system expert consultant to the Court Monitor. Mr. Silas Butler, Deputy Administrator, DCV, has said he will follow through with this request. A good resource in choosing music which is therapeutic for this population of residents is Ms. Celeste Brooks, the music therapist from the department of therapeutic recreation.
3. ACTION STEPS The following are action steps DCV has initiated and has indicated a commitment to continuing, I applaud these efforts. All these action steps will be closely monitored.
A) Model Plan to be Instituted on Each Unit for Counseling Residents to Minimize Transfer Trauma On November 13, 1995, Mr. Silas Butler and the Court Monitor met with the social services department. Mr. Butler requested that the social services department develop a model plan to be instituted on each unit for counseling residents to minimize transfer trauma. This plan is to be reviewed by Mr. Butler and the Court Monitor. The rationale for this approach, according to Mr. Butler, is the following:
- direct care staff do not know how to deal with upset residents regarding transfer trauma;
- staff need to be sensitized to clues in changes in behaviors of residents which may indicate relocation stress and anxiety;

- research studies indicate that if signs and symptoms are identified early enough transfer trauma is minimized;
- everyone on the unit who comes in contact with resents should be part of the resident support system, especially the nurse aides, but also including housekeeping;
- a model will give unit supervisors a framework with which to operate; - department heads will have a focus for expectations of performance to bring to their staff.
Mr. Butler indicated that this is a new mission for DCV and that closure presents an opportunity to improve the total system of care, which does not cost money, but does present a new way to add to the quality of life of the "people that we serve." The success of outplacement can only be measured in the way the residents are interacting in their new homes. Interdisciplinary care plans should reflect progress in this action step. The point should not be lost, that the bottom line for the receiving facilities is the reimbursable dollars they will receive for admitting the residents. Therefore, as Mr. Butler has said, "we must be advocates for the residents who cannot advocate for themselves."
In October the Court Monitor distributed to all department heads and administration current literature on transfer trauma which identifies model interdisciplinary care plans to minimize the stress of relocation and the trauma involved for the residents. These articles must be copied and be readily available to all staff directly involved in planning interdisciplinary discharge care.
10

On November 14, the Court Monitor met with Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia and Ms. Gladys Fountain, Interim Administrator for Long Term Care. I informed them of the following:
- there is a need for interdisciplinary team care plans reflective of the residents "highest practicable physical, mental, and psychosocial well being" including counseling regarding mrnimiTing transfer trauma;
- the interdisciplinary care plan could be utilized as the discharge plan in compliance with federal and District law and regulations, and the Court Orders;
- the interdisciplinary team care plan could be used as a model discharge care plan for the long term care community of the District of Columbia;
- the discharge care plan could enhance the image of DCV employees in the community, which Dr. Sloane mentioned was low.
The Court Monitor assured Dr. Sloane that the interdisciplinary team care plans were not a new 'paperwork' requirement, but in fact exist on the units and are in the process of being implemented as described in recommendation "b." above.
B) Inform Clinical Nurse Unit Coordinators On November 21, the Executive Director, the Deputy Executive Director, and the Court Monitor met with the two ADONs), the unit clinical nurse coordinators, and the new nursing staff development and quality assurance nurses responsible for education at the unit level. The Executive Director stressed she expects the nursing department to rise to the occasion and assume the leadership role vital for the successful development and implementation of the interdisciplinary care plans. Mr. Butler stressed that these plans would be the "basis the receiving nursing homes will have in order to put in place supports that will ensure quality of care (and that) the residents deserve the best that we have to offer." The
11

meeting was turned over to the ADONs with the charge, "it is your plan not ours because you know the residents the best."
The success of the outplacement process and whether or not it can be called humane depends on the commitment of all departments but most especially the nursing department. It is this department that has the responsibility for the 24 hour care of the residents and has the responsibility by federal law and regulations to coordinate the interdisciplinary care plans. The following is pertinent for the nursing department, the social services department, as well as all the interdisciplinary departments: unproductive group process dynamics must be set aside for the one goal of a humane discharge planning process. Resident's life or death literally depends upon it.
Ms. Disu, the new Associate Director of Nursing shared her model care plan developed for Mr. J.B. who was profiled in the October Status Report. This is a fine example of what nursing care can be at DCV. Ms. Disu developed the care plan at the bedside involving Mr. J.B. as much as possible, helped implement restorative programs, such as range of motion, brought in nutrition consult, physical therapy and occupational therapy, discovered that Mr. J.B. had a urinary tract infection, and began discussing with Mr. J.B. his eventual transfer to another facility. All of this is reflected in the interdisciplinary care plan and is a fine example for all staff to utilize. I especially recommend that social service as well as the rest of the staff at DCV use this care plan as a model. Ms. Disu has initiated implementation of care plans that give direction on how to counsel residents and prepare them for their move
C) Meeting with Residents. Relatives. Conservators and Responsible Party A 'Resident Outplacement Meeting with Residents, Relatives, Conservators and
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Responsible Party' took place on Tuesday evening, November 21, 1995. In attendance were about fifteen residents and about fifteen family members. Presenting and discussing with the attendees were Ms. Gladys Fountain, Interim Administrator for Long Term Care, District of Columbia; Ms. Alberta Brasfield, Executive Director, DCV; Mr. Paul Offher, Commissioner Health Care Finance for the District of Columbia; Ms. Helen Green, Medicaid, Medicare, Income Maintenance for the District of Columbia; Ms. Anne Hart, District of Columbia, Long Term Care Ombudsman; Revered Wesley Toepper, Chaplain, DCV; the Vice President of Providence Hospital and proposed outplacement site; the Nursing Home Administrator for Hadley Hospital Skilled Unit, a proposed outplacement site; the Vice President of Managed Care Services, Global Health Management, purchaser of Carrol Manor Nursing Home, a proposed outplacement site. Also present was Mr. Silas Butler, Deputy Administrator, DCV.
These meetings are scheduled to take place again in December and in January. A poignant aspect of this meeting was the presentation by Rev. Toeffer on the grieving process the residents are experiencing (as well as the staff) in suffering a major life loss the loss of one's home. Rev. Toeffer has been at DCV for thirty years, is a full-time Chaplain and a District of Columbia government employee.
D) Meet with All Department Heads to "lay groundwork to get everyone sensitive to issues of transfer trauma" (Mr. Butler) On Tuesday morning, November 28, Ms. Alberta Brasfield, Executive Director, and Mr. Silas Butler, Deputy Director, met with all department heads, the social service staff, and Rev. Toeffer. Rev. Toeffer repeated his presentation given Tuesday evening, November 21, to residents and families. Ms. Brasfield communicated her expectation for compassionate leadership behavior on the part of all. With Mr. Butler's leadership the outplacement process has a simple goal: at
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every possible intervention opportunity and on a daily basis, all staff should be prepared to listen to the residents concerns regarding transfer, even for example, during bathing, dining, activities, physical therapy, occupational therapy, and "to be genuinely kind and concerned about each other, to take care of residents, and to take care of each other."
E) Formalize Above Action Steps and Goals At the weekly outplacement meeting on November 29,1995, the model plan identified in "a)" above was reviewed. The two ADONs were asked to attend this meeting and will become part of the core weekly outplacement meeting team. Ms. Disu presented her model plans described above in Action Step "b)'\
It was agreed that the formalized plan for implementing the goal of a humane discharge planning process will be the following: (Ms. Disu is writing the notes from this meeting which will be reviewed by Mr. Butler and formally instituted. The formalized plan will be presented in the next Status Report.)
1. Start at the unit level to sensitize staff. The ADONs will contact the unit clinical nurse coordinators to schedule meetings with Rev. Toeffer and the pastoral team. At all meetings the president of the Residents Council is to be invited and to be considered a vital part of this team;
2. Unit coordinators to collect data on resident concerns to give to the ADONs social services, Chaplain and pastoral care team, and the Residents Council;
3. Initiate counseling for residents including the Residents Council, social services, pastoral care team.
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As of today, November 30, 1995, number one above has commenced. The formalized plan will be in full implementation by December 10. Any residents scheduled for discharge before that date will be immediately assessed and addressed.
4. PROFILE AND BRIEF CASE STUDY Unit 5B is a particularly touching, sad, and poignant example of systems breakdown, complacency in viewing residents potential, and passive neglect described in the October Status Report. Guiding the clinical coordinator, licensed nursing staf£ and the nurse aides will be a challenge for the newly assigned Associate Director of Nursing responsible for this unit, Ms. Batie Thomas, as well as the new quality assurance and staff development nurses responsible for educating nursing staff on this unit. However, care must improve for these residents in order for DCV to be in compliance with federal and District law and regulations and the Court order including humane outplacement discharge plans that reflect the residents full potential. According to the Nursing Home Reform Law, residents have a right to maintain and achieve the "highest practicable physical, mental, and psycho-social well-being." On Unit 5B, this is not the case.
Unit 5B is full of proud, elegant, old women, the majority of whom are for a good deal of the day and week flat on their back, neatly tucked in bed, and incontinent. For the most part these women are aware of their environment. On numerous occasions when visiting them and at various hours in the evening, they are as awake at 9pm as they are at 6:30pm. I ask them what they are thinking, and nearly all talk about their former lives, when they were active, productive, citizens engaged in life. I also ask all the residents: do you know DCV is closing, has anyone talked with you about it, do you know where you would like to go? The answers are almost always, no.
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I generally find residents at DCV, especially the vulnerable ones who are frail, to be starved for human contact, affection, and touch. Mr. Donald Bertman, a volunteer ombudsman and pastoral aide who has been coming to DCV for over twenty-five years has said that to him, "the biggest problem is not turning people, that is what sticks in my mind." Without turning residents, decubitus ulcers develop, incontinence sets in, contractures develop, the body and spirit wither away. Mr. Bertman's statement is eloquent in its simplicity and from the Court Monitor's data gathering on the units and at the bedside, one in which I sadly agree.
I am sharing the following brief case study as a small example which can be generalized to all the residents at DCV. It demonstrates how as resident can be known as an individual and the potential for this knowledge to be reflected in an individualized, interdisciplinary care plan, improvement in care, attainment of the "highest practicable physical, mental, and emotional health," and an outplacement discharge plan that gives direction to the new providers of care in the receiving facilities.
There is a picture on the bedside next to one resident, Ms. M.L. The picture is of her on stage in the Moulin Rouge in Paris in 1917. Ms. M.L. is now totally contracted. How profoundly sad for a dancer in her youth to be at the end of her life unable to move her legs. Contractures occur when no range of motion exercises have been performed and once set in, they are irreversible. Contractures in a resident are a systems failure and most especially a nursing care failure. At the outplacement meeting for residents and their families held Tuesday evening, November 21, 1995,1 met the guardian for Ms. M.L. She told me that Ms. L. Has a fine collection of old books, some dating back to the 1870's, and likes to be read to. I have never seen anyone reading to Ms. L. I doubt the staff knows this piece of data about this human being. I gleaned this information in one
16

minute of my conversation with the guardian. I am sharing this as an example of how really simple it is to get to know the resident, how information which is unique to the individual can be incorporated into an individualized interdisciplinary care plan and in turn is invaluable for a new facility to have and know about the human beings they will be receiving and providing a new home.
All data gathering, the resultant reflection and improvement in care, and the development of meaningful interdisciplinary care plans takes is the priceless commodity identified in the October Status Report to the Court - time, commitment, and caring.
Recommendations (A) All staff get to know the residents in a way that something meaningful about
them can be communicated in the interdisciplinary care plan and shared with the outplacement facility. This of course includes nursing staff, but it especially challenges the Therapeutic Recreation staff to become more meaningfully engaged in the lives of residents, especially those who do not appear to be meaningfully engaged in their environments, that is the frail, vulnerable bed bound residents. Depending on the needs of the residents, the core staff would be dietary, physical therapy, occupational therapy, therapeutic recreation, nursing.
(B) Actively engage the eighteen member therapeutic recreation staff to teach nurse aides at the bedside how to stimulate, engage, and provide activities that are unique to the individual, for example, reading to the resident as identified above, or listening to music.
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© A rhetorical question, the answer to which I hope to see in action: What ever happened to the good old therapeutic backrub?
A nursing home systems expert pro bono consultant to the Court Monitor, toured Unit 5B with me. This consultant has been in hundreds of nursing homes throughout the country. Her assessment was profound and one which I hope will give motivation to immediately develop and implement the humane discharge planning process. That is, the "condition residents are discharged in is the way they will die." The consultant also assessed that the proud, old, elegant women on Unit 5B are "warehoused."
I am writing this, of course, to inform the Court, but also to hopefully give motivation to the staff to see the world of the resident with a larger vision. I do believe, if residents do not get the full potential of care they require and deserve while still remaining at DCV, then the outplacement process cannot possibly be humane, which will be a violation of federal and District law and regulations, and the Court Orders. I know the staff is capable of rising to the occasion, and focusing on the unanimous goal of, in the words of Mr. Silas Butler, the Deputy Administrator at DCV, "maintaining the level of care in outplacement by upgrading care here (at DCV) before the residents leave." To be sure, this is also a difficult time for the staff, who are faced with loss of their jobs and the necessity of finding new employment. However, as staff, the primary goal is the best interest of the residents.
I am using unit 5B as an example, there are similar care situations on all units. However, I want the Court to know that there are also fine examples of improvement in care which the Court Monitor has observed since first entering DCV on August 28,1995. As Court Monitor, I must admit it is a bit frustrating, for I truly believe with the new leadership in
18

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nursing, with the commitment to professional behavior on the Executive Director and the administration's part, and with the on-going monitoring of the Court, DCV Nursing Home could be turned around into a model facility within two years. However, now with the outplacement process taking place, it is my sincere hope that these leadership energies will be put into developing and implementing a model outplacement plan which will benefit the residents of DCV Nursing Home and also serve as a model to the long term care community of the District of Columbia.
5. OUTPLACEMENT OF RESIDENTS WITH MENTAL ILLNESS This section addresses the special outplacement needs of residents with mental illness, including assessment and action steps to be implemented by Dr. Mary Alice Crockett, the Medical Director, who is charged by Mr. Silas Butler to oversee the outplacement of the residents with mental illness. The outplacement of the residents with mental retardation is addressed in this Report under the July 6, 1995 Stipulated Court Order Section D. Residents with Mental Retardation.
The assessment data for outplacement of residents with mental illness has been gathered from the following sources: the Court Monitor's attendance at the three outplacement meetings for residents with mental retardation; discussions with staff of the Commission of Mental Health and St. Elizabeth's Hospital; Ms. Corrie Kemp, Chief, Central Referral Bureau, District of Columbia; meeting with Dr. Sloane, Commissioner of Public Health, District of Columbia; meetings with social workers; staff on Unit b where many of the residents with mental illness live; conversations with the Bazelon Center for Mental Health Law; interviews with the members of the Dixon Committee and the Monitor for the Dixon committee; meeting with Dr. Donna Mauch, Special Master, Dixon
19

commission; review of the Dixon committee reports of the last several years; discussions with the D.C. Long Term Care Ombuds persons; discussions with mental health experts at the Mental Health Policy Resource Center; meetings with Dr. Mary Alice Crockett, Medical Director, DCV; discussions with Mr. Silas Butler, Deputy Administrator, DCV; observations of and interview with the residents.
Assessment Data All the assessment data described above regarding the discharge outplacement process applies here to the outplacement planning process for residents with mental illness. However, there are critical and unique concerns which apply to this special population which primarily relate to the November 7, 1995, Order Modifying Stipulated Order of July 6, 1995 in the areas of monitoring:
"all residents are transferred to appropriate residences which meet their individual needs and
D. review whether all necessary services and support have been arranged and are ready to be provided at the new residence."
- there is a lack of consensus on the best assessments to use for residents with mental illness to determine the most appropriate outplacement;
- No one knows exactly how many residents there are at DCV with mental illness either as a primary diagnosis or as a secondary condition, some estimate there are 80 residents. However, as a result of the weekly outplacement meeting of Wednesday, November 29, the ADONs will gather data from the units on the number and names of residents identified by staff with behavioral symptoms;
- some residents with mental illness are inappropriately exempted from further psychiatric assessments as mandated by law (PASAR). The reasons given are medical conditions which do not qualify for exemption;
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- there are not sufficient and appropriate residences, resources, services and supports in place for the outplacement of residents with mental illness;
- despite years of existence, the Dixon commission has been unable to develop appropriate community living situations;
- there are at least 100 residents of DCV who will be extremely difficult to place, many of whom have some form of behavioral symptoms.
- according to administration at DCV, DCV has funding through the end of 1996.
Action Steps Immediate remedies are needed. The Court Monitor will closely oversee the following action steps to be implemented by Dr. Crockett or whomever Mr. Butler identifies.
(A) Focus Group A Focus group will be formed for the following purposes: 1. Validate assessments and appropriateness of recommendations for type
of outplacement sites currently being conducted by a three person team from St. Elizabeth's and the Commission of Mental Health. The members of the focus group team will as much as possible be drawn from local experts within the Washington, DC area, including the National Institutes of Mental Health.
2. Identify potential appropriate outplacement sites.
(B) Consultant Team A consultant team will be identified to provide on-going specialty services to outplacement sites. It is generally agreed by most all those listed above from whom assessment data was gathered, that the only way nursing homes or other community based sites will accept residents exhibiting behavioral symptoms is to provide an on-going specialty consultant team. This team would be available to advise outplacement facility staff on the proper care, interventions, prevention strategies, environmental conditions suitable to the special needs of residents with mental illness or
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exhibiting behavioral symptoms, and would be available on an emergency basis. The composition of this team should consist of a psychiatrist, psychologist, geriatricpsychiatric nurse, and when appropriate, a recreation specialist and social worker. This would provide for the "necessary services and support" outlined in the November 7 Court Order.
© Home and Community Based Waiver Given the fact that the District of Columbia is the only jurisdiction in the country that does not have a home and community based waiver for care as an alternative to nursing homes and institutional care, and given the fact that DCV is funded until the end of 1996 (according to DCV administration), a home and community based waiver will be proposed. Dr. Donna Mauch, Special Master for the Dixon commission has agreed to assist the Court Monitor develop a proposal to be submitted in a future Status Report to the Court.
The need is immediate to find appropriate residences with appropriate support services and knowledgeable staff with access to a consultant team to care for this population of hard to place residents. In order for Dr. Mauch to be able to assist the Court Monitor, the Annual Costs Reports for DCV and the Budget for DCV is required to develop this proposal.
REQUEST TO THE COURT Given the fact that the Court Monitor has still not received the list of vendor phone numbers requested in the October Status Report as a Request to the Court to advise the Corporation Counsel on behalf of the District of Columbia, and therefore, the Court Monitor is unable to fully monitor vendor payments, I hereby respectfully request that the Court Order the Corporation Counsel on behalf of the District of Columbia to
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supply the Court Monitor immediately with the Annual Cost Reports and the Budget for D.C. Village Nursing Home.
n . UPDATE OF SYSTEMS
The October Status Report is recent and still current. Only those areas where there is a significant change in status will be profiled.
A. Medicine On October 26, 1995, Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia conducted a meeting at DCV to discuss the Department of Medicine and the October 20 Status Hearing in the Court.
Present were Dr. Sloane, Mr. Garland Pinkston and Ms. Barbara Mann, Corporation Counsel for the District of Columbia; Mr. Louis Norman and Ms. Frankie Wheeler, Office of Personnel, District of Columbia; Ms. Lori Taylor-Hayes, labor attorney, District of Columbia; Ms. Gladys Fountain, Interim Administrator for Long Term Care, District of Columbia; Ms. Alberta Brasfield, Executive Director, DCV; Dr. Mary Alice Crockett, Medical Director, DCV; Drs. Phan, Nyguen, and Allin, medical staff, DCV; Mr. Curmet Forte, President, Residents' Council, DCV; Dr. Adrian Wilson (dentist), president of the Doctors Council, and the Court Monitor.
The purpose of the meeting was to discuss the medical staff functioning and "cooperating within the structure at DCV" as Mr. Pinkston stated in an attempt to set a constructive
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tone for the meeting. However, after an hour and a half,it became clear to Dr. Sloane, that there was no willingness on the part of two of the medical staff and the Doctors Council President to follow the Request to the Court in the October Status Report and report directly to the Medical Director in all matters relating to resident care and to follow the Medical Director's suggestions for continuing education. Dr. Sloane ended the meeting indicating he would make his own decision on resolving the problem. As of the end of November, the psychiatrist and one medical staff have been detailed to other positions within the District of Columbia.
What saddened me most about this meeting was that the best interest of the residents was never the focus of the discussion from the Doctors Council, and that there was no indication of a willingness to entertain or heed the recommendations of the Court. The Doctors Council president exhibited an arcane view of health care delivery and certainly no knowledge of the Tninimnm standards of care for nursing home residents.
Coincidentally, the most recent edition ofWashington City Paper, November 24, 1995, has a front page cover story on the District of Columbia's public employee unions profiling the drain they are on the District. The first union profiled is the Doctors Council. The article describes the president of the Doctors Council as defending the indefensible.
A fee for service physician is covering the units previously covered by the departing medical staff. The Medical Director has supplied and made available necessary materials including the federal regulations for minimum standards of practice in nursing homes and current literature on treatment trends. Psychiatric services are to be arranged.
B. Nursing
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Two Associate Directors of Nursing (ADONs) have been assigned with one ADON responsible for Units 2A, 2B, 3A, 3B and the other ADON responsible for the care on Units 4A, 4B, 5A, 5B. In addition a contract is in place with National Nurses to provide 16 FTE licensed staff to be permanently assigned to DCV. Three nurses are assigned as clinical coordinators on the units to replace nurses who have left DCV employ. Also now there are two supervisors during the evening and night shifts. This should help accelerate the needed supervision at the unit level. The two ADONS have offices on their units. From this contingent of permanent assignments from National Nurses, there are now in place two teams consisting of a staff development nurse and a quality assurance nurse with responsibility for training at the unit levels, one team for the Units 2 and 3 and the other team for the Units 4 and 5. I see much more training of staff. I also see leadership behaviors on the unit level.
C. Infection Control Infection control is still very weak. The missing link is still no systematic and immediate follow-up when patterns emerge. I strongly recommend that one staff person be designated with responsibility for all aspects of infection control. Currently the staff person with jurisdiction for infection control does not have clear lines of authority for follow up inservice education. And, as quality assurance coordinator spends a good deal of her time compiling the '30 Day Compliance Report' as opposed to needed follow-up on the Units.
HL STIPULATED COURT ORDER. July 6,1995
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The October Status Report is recent and still current. Only those areas where there is a significant change in status will be elaborated on in this Status Report.
A. Medical and Nursing Care 1. Care of Decubitus Ulcers a. Defendants shall immediately cease the use of Elase and Intrasite gel
inappropriately for treatment of decubitus ulcers.
b. Defendants shall immediately ensure that all DCV residents receive appropriate and adequate preventive medical and nursing care and timely treatment for decubitus ulcers and/or other skin breakdown sufficient to maintain their good health. To this end, Defendants shall assess all residents for risk of skin breakdown within two days from the date of entry of this Stipulated Order, and shall develop and implement within twenty days thereafter, for each resident identified as at risk, a treatment plan fully adequate to prevent skin breakdown and/or to treat existing skin breakdown.
Status Re: Court Order Partial Compliance
Treatment nurses now cover weekend day shifts. However, I still do not see routine skin care checks on the units by the staff. I know the ADONs are working to this goal, but it has not yet reached the bedside on a consistent level. Coordinated interdisciplinary care for prevention and treatment of decubitus ulcers has begun, it is still not routine. Dietary must become more involved in advocating for improvement in nutritional status of those residents with and prone to decubitus ulcers. In recent weeks, decubitus ulcers on Units 4 and 5 have decreased markedly. Patterns will be studied for Units 2 and 3.
Care of Incontinent Residents
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Defendants shall immediately ensure that all incontinent DCV residents receive appropriate, adequate and timely nursing care in accordance with generally accepted nursing standards. For residents who have been identified as subject to becoming incontinent, nursing staff shall make rounds to check on their individual condition at least once every two hours. Nursing staff shall take all appropriate steps to care for and clean those residents who need nursing attention due to their incontinence. Nursing staff shall take special care to clean and treat ulcerated areas that may have become soiled due to incontinence.
Status Re: Court Order Partial Compliance
Restorative bowel and bladder programs have been instituted on each unit. Ms. Disu, ADON has been instrumental in establishing restorative programs. However, on numerous occasions I have seen toileting programs checked as having occurred every two hours when in fact residents have been up in wheelchairs all day.
I respectfully request that those compiling the '30 Day Compliance Report' cease including the position charts. They should be collected but kept with the unit coordinators. What would be a much more effective method of accountability is for the unit coordinators to document rounds they make to check for incontinence and positioning and to document interventions with staff when care is compromised with inaccurate charting. I still find numerous instances where residents are in the same position for hours, sometimes incontinent, most all contracted. In other facilities, staff who routinely indicate care given when it is not are terminated.
3. Adequate and Appropriate Nursing Staff a. Defendants shall ensure that continuity of nursing staff is maintained
to the maximum extent feasible during all shifts, seven days a week, on all DCV living units.
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b. By no later than January 1,1996, Defendants shall ensure that there is a sufficient permanent nursing staff at DCV to ensure that DCV does not routinely rely on contract nurses. Nothing herein prevents the use of contract nurses in emergency situations or to ensure that adequate nursing staff is available to Care for DCV residents.
Status Re: Court Order Partial Compliance
The rationale for staffing patterns seems to be a mystery. The numbers in the '30 Day Compliance Report' are meaningless unless the census for each unit is given. There should be an overall rationale for staffing patterns in the nursing office. Staffing appears to be done for the convenience of staff not resident care needs. A nursing home systems expert consultant to the Court Monitor will develop an analysis DCV staffing patterns for a future status report. To date, I have still not seen a shortage of actual staff, shortage in care given has been the problem. I do anticipate potential staffing shortages as the facility moves closer to closing.
There are six contract nurse staff vendors DCV relies on, all are owed vendor payments, with some threatening to terminate services by the end of the month.
4. Medication Errors a. Defendants shall ensure, within fifteen days from the date of entry of
this Stipulated Order, that all nursing staff on duty are trained in proper medication administration practices, and are adequately in serviced on and/or are sufficiently aware of the individual needs of the residents to whom they are administering medications.
b. Defendants shall ensure, within fifteen days from the date of entry of this Stipulated Order, that all medication errors are recorded, that adequate procedures are established to track all medication errors, that any causes for medication errors are identified and remedied, and that any other needed corrective
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action is taken in a timely manner to minimize medication error risk to the DCV residents.
A nursing home systems expert consultant to the Court Monitor will gather data on a regular basis commencing Sunday, December 3.
B. Measures Needed to Remedy Shortages 1. Food and Drink Defendants shall immediately ensure that sufficient supplies of
nutritious and appropriate food and drink are consistently maintained at DCV and that each resident daily receives adequate, well-balanced, nutritious and appropriate food and drink according to their individual nutritional needs.
Status Re: Court Order Dangerously close to Non-Compliance this week
On Monday, November 27, DCV had a one day supply of vegetables and bread. This is an intolerable scenario that should never have escalated to the final day of basic nutrient supplies for frail, fragile, medically compromised individuals, the residents of DCV.
The head of the dietary department appropriately requested purchase orders at the beginning of October. On Wednesday, November 22, the Court Monitor through an interview with the head of dietary was able, with difficulty, to get information from Ms. Costley that purchase orders were not received from the procurement office. And, that in fact if not received by the following Monday, dietary would be out of supplies of vegetables, bread, fish, and margarine.
It is amazing to me that the dietary department chief did not advocate for the residents and communicate her lack of receipt of the purchase orders in a timely manner to the executive director. It is also intolerable that the procurement office, Ms. Perkins, was not
29

forthcoming with the necessary purchase orders. To me this represents a callous disregard for the welfare of the residents of DCV. What is most stupefying of all, is that part of the evidence gathered through affidavits which lead to the legal action resulting in the Stipulated Court Order of July 6, 1995, is precisely the fact that basic nutrients were not available to residents.
The presence of the Court at DCV was able to prevent a repeat of the scenarios leading to the Court Order. Purchase orders were received and vendors contacted and supplies delivered. However, in order for the scenario described above not to repeat, that is, so that basic food and nutrients do not become dangerously close to depletion, the Chief of the Dietary department:
- will submit to the Executive Director with a copy for the Court Monitor biweekly listings of outstanding purchase orders, identifying items required and dates existing supplies will end;
- must exhibit leadership behavior by advocating for the needs of her department for the best interests of the residents. Passivity is not appropriate.
Coincidentally, on radio and television news, Monday evening and Tuesday morning, November 27 and 28, lack of food supplies such as vegetables at DCV was mentioned. Apparently, though, these broadcasts were an amazing coincidence. The Long Term Care Ombuds office has said that the source of this story was the president of the D.C. Health Care Association. That in a conversation with the television new reporter, he in general terms discussed the difficulty of vendor payments in the District and the impact on care giving, citing the affidavits referred to above.
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Howard University, Department of Nutritional Sciences has committed to the Court Momtor to perform the necessary assessments of supplies and nutrients, and adequacy of nutrition.
The following information on the diets submitted in the '30 Day Compliance Report' was supplied to the Court Monitor by the nutritionist for the Georgetown University Child Development Center, Dr. Golda Downer.
- The therapeutic value of the calorie diets, such as, 1200, 1500, and 1800 calories are impossible to judge without portions, which are not listed.
- The diet listed as high fiber in fact supplies an average amount of fiber intake, not high.
- The low sodium diet is too high in cholesterol.
The dietician from the Health Care Financing Surveyors (HCF) team in the exit conference on September 30, 1995, stated that DCV has more specialized diets, seven, than most nursing homes in the country. The fact of the matter is that residents have access to the canteens and vending machines and are free to add to any restrictions imposed by specialized diets.
2. Medications, Medical Supplies and Equipment a. Defendants shall ensure that adequate and appropriate supplies of
necessary medications, that meet the individual needs of the DCV residents, are consistently maintained at DCV no later than two days from the date of entry of this Stipulated Order.
A geriatric-pharmacologist expert consultant to the Court Monitor will supply data for this section.
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c Defendants shall maintain the plumbing and heating system at DCV to ensure that adequate amounts of hot water, at safe temperatures, are available for use by residents within two days from the date of entry of this Stipulated Order. Defendants shall also ensure that there is sufficient hot water to properly sanitize and clean eating utensils, plates and meal-related items.
Status Re: Court Order Compliance
3. Personal Care Items Status Re: Court Order Partial Compliance
I want the Court and the District of Columbia to know that Georgetown University School of Nursing is committed to community service in the District and has chosen to assist the Court Monitor at DCV. This is a tribute to the leadership of the Dean of the School of Nursing at Georgetown, Dr. Elaine Larson. It is also a tribute to the faculty member who is the Court Monitor's nursing homes system expert consultant, Dr. Sharon Mailey, a geriatric nurse practitioner and a former director of nursing in two nursing homes in the South. It is also a wonderful tribute to volunteers from the School of Nursing who have devoted their free time on weekends, under Dr. Mailey's and the Court Monitor's supervision, to collect the data for this section.
On Saturday, November 18, data on personal care items were gathered on Units 5A, 5B, 4A, 4B, and 3A, from 137 residents rooms. A check off list was developed by Georgetown for the following items: toothbrush, toothpaste, comb/brush, soap, lotion, deodorant, wash basin, water pitcher, cup, cup with water, water accessible to resident arm ban ID, denture cup, shaving equipment.
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The majority of items were present. Lotion was not present in over half of the residents rooms, which relates to the rhetorical question in section I. of this report, where are the backrubs? There are two items that were not present which is an alanning finding and directly relates to this Court Order in the areas decubitus ulcers, incontinence, and nutrition. That is in nearly all the rooms there were no cups with water and water was not accessible to the resident, cups were not present in over half of the rooms.
Hospitalizations for dehydration, sepsis, pneumonia, and the development of infections are no accident given this data. This data also supports the identified weakness in Infection Control profiled above under the Systems update and described in the October Status Report, and gives direction for immediate staff development.
On this same day, a nurse/attorney pro bono consultant to the Court Monitor reviewed the chart of a resident who recently died and was listed in the '30 Day Compliance Report', Mr. M.D. The primary finding was that there was no record of intake and output, that is no record of hydration.
C. Payment of Vendors I regret to inform the Court, that my request to the Court in the October Status Report has gone unheeded. It was my understanding that the Corporation Counsel had the power and authority of its office to counsel their clients to perform in the best interests of the residents. It is my hope that the Corporation Counsel assumes the power and authority of their office and wrestle the list of vendor phone numbers from which ever bureaucrat has it. Having these numbers directly relates to residents quality of life, for I am unable to determine how close services may be to termination for lack of payment.
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An example is the dietary services described above in B. 1. Food and Drink. Purchase orders are now in place for needed nutrients, but I was unable to monitor the logical next step, and that is to detennine if vendors were in fact going to deliver the needed supplies for the residents health and safety.
The following is data I do have. Status Re: Court Order As of November 30, 1995, Non-Compliance
Nurse Staffing Vendors Premier Nurse Staffing, Inc., formerly SAT, owed over $55,000 over 45 days outstanding. Will terminate services December 1, 1995.
CUP Health Care Services owed $106, 027. Will terminate services November 30.
National Nurses owed $79,193. Will terminate services December 1.
AMC owed $40,215.
Physical Therapist Therapeutic Management Services (TMS) owed $25,380. The physical therapist came on duty on September 5, 1995. TMS contract expires December 29, 1995. Will terminate services December 11.
D. Services for Individuals with Mental Retardation
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1. Defendants shall place all DCV residents with mental retardation in appropriate community-based residential and day programs which fully meet their individual needs as identified by appropriate interdisciplinary assessments, no later than October 31,1995. Defendants shall ensure that the placements are adequate to meet each individual's needs.
Status Re: Court Order Non-Compliance Since the submission of the October Status Report three residents with mental retardation have been discharged. Two residents Ms. P. A. and Ms. D.L were discharged to Wholistic Health Services. One resident, Mr. L.S. described in the Assessment Data of the outplacement process in section I. above was discharged from DCV to the Greater Southeast Hospital and then to Washington Nursing Facility, where he is waiting placement to D.C. Family Services. There are twelve residents with mental retardation currently at DCV.
CARECO an identified site for five residents is no longer a proposed outplacement site. Physical plant renovations required, such as, installing sprinkles were not acceptable option as well as the reimbursement rate proposed.
Symbral Foundation was identified as a possible replacement site and visited DCV. On November 8, the Court Monitor sat in on the meeting with the Symbral representatives and Mr. Richard Clevenger, program coordinator for GUCDC and Mr. Silas Butler. Mr. Clevenger reviewed the Individual Habilitation Plans and then Symbral toured Unit 5A, where the residents with mental retardation live. Symbral had no staff in their proposed facility. The Court Monitor asked how staff were acquired, and was told, through advertisement in the newspaper, local colleges and universities, and networking. As of November 27, Symbral Foundation is no longer a possible outplacement site. The District of Columbia ARC, the Court Monitor for the Pratt decree raised serious concerns
35

with Mr. Butler the Court Monitor and the Ombuds about Symbral's ability to be financially solvent and train and maintain staff to care for the residents.
Kennedy Institute a proposed outplacement site for four residents with mental retardation has gone on record protesting their rate assignment and the fact that they are owed $203,504 for Fiscal Years 1988-1993. Kennedy Institute has threatened to withdraw their proposal to provide services on December 8, 1995. The Court Monitor is scheduled to visit Kennedy Institute.
The remaining group homes, Metro, D.C. Family Services, and Wholistic are appealing their rate designation by the Commission on Health Care Finance.
Three residents originally designated for assignment to group homes, Ms. A.B., Ms. C.W., and Ms. C.L. are designated to be outplaced to nursing homes because of thenserious medical problems and nursing care needs. Although no homes are identified.
As of this writing, November 30, no residents are scheduled to be outplaced and in fact if Kennedy does withdraw, there will be no identified outplacement sites for any of the remaining 12 residents. If Kennedy Institute does not withdraw its proposal to provide services, then there will be no identified outplacement sites for eight, including the three residents needing nursing home care.
My concerns regarding the outplacement of residents with mental retardation are the same concerns listed in the October Status Report. I see similar issues in the outplacement of residents with mental retardation as raised in the Outplacement of Residents with Mental Illness in section I. of this Report. I remain particularly concerned
36

about the on-going demonstration of competency of the caregivers in the receiving facilities and homes. This major concern is based on the following assessment data:
- According to the Court Monitor for the Pratt decree, the staff at Wholistic Health Services refused to come to DCV to be trained by Georgetown University Child Development Center.
- Three residents with mental retardation outplaced to D.C. Family Services on June 30, 1995, although before the filing of this Court Order on July 6, were observed outside during the day: one resident was in pajamas on and no shoes; one resident disheveled and dirty; and the third resident's diaper was changed in public. One resident Mr. L.S. is scheduled to be outplaced to this facility.
- This same resident Mr. L.S. profiled earlier in this Report was transferred to the hospital and from there discharged to a nursing home in restraints. To me this is a systems failure, and that the appropriate people who know Mr. L.S. were not involved in informing caregivers of his needs.
-1 was very concerned to learn that a potential group home did not have caregivers in place and in fact did not know who they would get, described above under Symbral. This speaks to the 1970's and early 1980's which led to the Nursing Home Reform Law and the minimnm requirements for nurse aide training and on-going continuing education, as well as requirements for licensure and continuing education for administrators, and a stronger role for surveyors to help ensure quality.
- In a telephone conversation on November 17 with Dr. Richard Birkel, President of the Kennedy Institute, Dr. Birkel identified a need for a plan for continuity of care and oversight of caregivers. He sees this oversight in the DCV instance coming from the GUCDC as the primary caregivers to residents with mental retardation. Dr. Birkel believes that this will afford an opportunity to correct and shape staff behaviors in the receiving facilities. Dr. Birkel sees a need for oversight at least once a week for several
37

months and then gradually taper off. Dr. Birkel believes an outplacing facility cannot assume that residents will get care required unless these safeguards are in place. Dr. Birkel said he would feel better about receiving DCV residents if he knew he had access to on-going support for these residents care needs.
- Dr. Birkel and Ms. Darlene Nipper, Director, Division of Residential Services at the Kennedy Institute, feel that the remaining residents with mental retardation at DCV are among the most fragile-medically of residents in group homes in the District of Columbia. Ms. Nipper believes that if the above described consultation services are not available to group home providers, then the special care needs identified in the Individual Habitation Plans will not be met.
- In an interview with Dr. Golda Downer, the nutritionist for the GUCDC, Dr. Downer corroborated the statements of the Kennedy Institute experts. Dr. Downer believes that none of the caregivers in the group homes have experience with residents with dysphagia, which all the residents with mental retardation at DCV have. Dysphagia is an inability to chew and swallow on one's own, and it is neurologicalry based. Dr. Downer believes caregivers need training in food preparation and feeding and positioning before during and after meals. These residents are at great risk of aspiration pneumonia and death with each meal feeding. On-going consultation and supervision is vital until competency is demonstrated.
-1 have observed staff at DCV during evenings and weekends when GUCDC is not present, who are not properly positioning residents.
-1 believe GUCDC needs to be more active in the discharge planning process for residents with mental retardation and more proactive in assuring their needs are met in the community.
- Mr. Silas Butler of DCV as well as Ms, Corrie Kemp, Chief, Central Referral Bureau for the District of Columbia believe that a guarantee of an on-going consultation
38

specialty team would make outplacement more appropriate to residents needs and providers concerns, and that even nursing homes unwilling to take the three residents identified above may be more assured and inclined to do so.
- Mr. Butler believes that a small core team of specialty consultants, consisting of nutritionist psychologist speech pathologist and recreation specialist preferably from Georgetown, where there would be access to specialty clinics is a model necessary for the appropriate outplacement of the remaining 12 residents with mental retardation at DCV. Mr. Butler is in conversations about this team plan with Mr. Hubbard at Mental Retardation and Developmental Disabilities Administration (MRDDA), District of Columbia.
-1 believe the model for a consultation team to serve as a resource to outplacement sites at the residents new homes, identified in the Outplacement of Residents with Mental Illness section of this Report, would be appropriate for this population as well.
Recommendations 1) I therefore, recommend, the identification, development and implementation with all possible haste of a specialty consult team to serve as a resource to facilities and homes receiving DCV residents with mental retardation, to evaluate, train, serve, as resource to receiving facilities until staff is stabilized and competency is demonstrated. 2) GUCDC must become more proactive and actively involved in the discharge planning process for residents with mental retardation at DCV.
2. Defendants shall ensure uninterrupted clinical services, habilitation, and other services to all DCV residents with mental retardation. Such services shall remain in effect until all DCV residents with mental retardation are outplaced into appropriate community settings in accordance with the above provision.
Status Re: Court Order Partial Compliance
39
-i—wr

While GUCDC is present there is compliance. However, on numerous occasions on evenings and weekends, I have observed residents not engaged, in bed, and some positioned incorrectly as described above.
3. No individuals with mental retardation shall be admitted to DCV in the future except where this Court specifically approves the proposed admission.
Status Re: Court Order Full Compliance
40

 
 DEC-10-95 SUN 22:21 NCCNHR
HARRIET A. FIELDS, Ed.D., R.N.
172219th Street, NW Suite 604 Washington, DC 20009 PHONE: (202) 234-7142

FAX NO. 2023322949

P. 01

U.S. v. District of Columbia NH-DC-001-017

FAX TO:
COMPANY NAME: FAX NO: (Phone)
SENT BY: DATE:
# of Pages: (Inch this Cover Page):

r. Richard Farano, Mr. David Deutsch Civil Rights Division. U.S. Deot Of Justice 514-6273 307-3116 Dr. Harriet A. Fields December 10.1995
8 NOTES:

DEC-10-95 SUN 22:22 NCCNHR

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P. 02

HARRIET A. FIELDS, Ed.D.. R.N.
#604 1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
December 10,1995
The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001
Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Order Modifying Stipulated Order of July 6,1995
Dear Judge Hogan:
I am writing the Court now, before the next Status Hearing in January, because of four areas of concern which must be addressed immediately. I am also in this letter to the Court, recommending further data gathering and remedies to rectify what I have now identified as patterns detrimental to residents well-being.
The four areas I will address are the following: (1) update on Mr. L.R. profiled in my December 6, 1995, letter to the Court; (2) the process of procuring purchase orders for vendor services, whereby there is now no stock of normal saline used as a treatment modality for decubitus ulcers; (3) chronic non-compliance of payment of vendors, whereby there is now no duoderm in house for treatment of decubitus ulcers and no payment to National Nurses profiled in the Court Monitor's December 6, 1995, letter to the Court; (4) residents' being denied their own funds from their Personal Needs Allowance (PNA).
Each of these four areas are indicative to me of a common thread of similar patterns. These patterns are what I believe to be a misuse of government funds, passivity and lack of advocacy on the part of staff for residents' needs and the acceptance of the bureaucratic inertia described in the Court Monitor's October Status Report under C. Payment of Vendors (p. 22), and needless and unconscionable delays in issuing purchase orders from the Procurement Office of the Department of Human Services, District of Columbia.
A description of these patterns in action is profiled in the Court Monitor's November Status

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Report under EL Stipulated Court Order. July 6, 1995, B. Measures to Remedy Shortages. 1. Food and Drink (pp. 29-31.)
However, I want to assure the Court, there are some staff who are true advocates for residents rights. The two Associate Directors of Nursing (ADONs) are implementing proactive steps to improve the standard of practice and care and are also openly, constructively, and professionally implementing the Court Monitor's recommendations.
Each of the four areas listed above will be profiled. At the end of the profiles will be recommendations and remedies needed to rectify the patterns reflected in all the areas profiled.
(1) Update on Mr. L.R. profiled in December 6. 1995 letter to the Court.
On December 8,1995, Mr. L.R. was out of bed and up in his wheelchair and resumed his usual place at the entrance to DCV, where there is day light, activity, and other human contact Mr. L.R.S situation reveals a pattern of passivity on the part of the staff and also a non payment of vendor problem.
The internal problem revealed by this resident scenario is the following. To be sure, the nursing staff did contact physical therapy when Mr. LJL's wheelchair first broke. However, a systems failure set in whereby no one rectified the problem until the Court Monitor was notified by the ombuds person and the President of the Residents' Council, immediately stepped in and called the physical therapy department and the wheelchair repair vendor, and alerted the Court. Daily rounds by nursing and administration would have uncovered this negligence.
The external problem revealed by this scenario is that a previous repair to Mr. L.R.'s wheelchair has gone unpaid since April, 27th of this year and the vendor was unwilling to service DCV again as a result of this neglect in payment.
Not maintaining resident equipment is a violation of federal regulations and the Court Orders.
(2) Process of Procuring Purchase Orders CP.O.) for Vendor Services
Last week at the time of writing of the Court Monitor's November 30 Status Report to the Court, this problem was reflected in a shortage of food supplies to the residents. This week this problem is reflected in an inadequate supply on hand of treatment modalities for decubitus ulcers, specifically, normal saline to cleanse the site and duoderm to apply to the wound. (Duoderm will be discussed under vendor non-payment.)

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For about a week sterile water from treatment kits for other uses has been used to cleanse wounds. Sterile water is an appropriate substitute, however, normal saline is preferred. Normal saline is an item that should be routinely on hand in any nursing facility, and is also necessary for the sterile cleansing of other equipment, such as catheter and tracheostomy tubing.
While making rounds with the treatment nurse on Thursday evening, December 7,1995, the Court Monitor discovered there was no normal saline in-house. On unit 4A, at Mr. C.F.'s bedside while dressing Mr. C.F.'s stage in decubitus ulcer on his left hip, the treatment nurse told me mat they have been out of normal saline for about a week. This reminded me of a camping expedition, where ingenuity in substituting routine supplies saves the day. However, this is a human being with a gaping whole in his body. At times DCV is operating like an underdeveloped country, when in fact this is the nation's capital.
On October 10, 1995, DCV submitted a "request for purchase order" to the Procurement Office, Department of Human Services, District of Columbia. Among the items listed on the purchase order were normal saline and duodena. The request for purchase order was marked "Urgent per Court Order." Once purchase orders are sent from the Procurement Office and received by DCV, they are sent by DCV to the vendor for delivery of supplies. If the vendor has been paid, supplies will be delivered.
DCV received the requested purchase order on December 6,1995. Prior to receipt of the P.O., the staff person from DCV submitting the "request for purchase order" called Ms. Cheryl Perkins of the Procurement Office and stressed to her the urgent need for receipt of the P.O. for care of the residents and that priority should be given to DCV which is under a Court Order. Apparently, Ms. Perkins' response was that there are many District of Columbia agencies under Court Orders. I believe the analogy the DCV staff person used is a good one: "Ms. Perkins needs to know that DCV cannot be run like a stationery store, where you run out of pens or something: residents lives are at stake."
In a nursing facility it is not always possible to anticipate needed supplies months in advance. For example, the size of bandages needed will depend on whether a wound develops (which should not be happening), the site, and the anatomy of the resident.
According to staff and administration at DCV, receiving purchase orders in a timely fashion from the Procurement Office has been a chronic problem. (Recommendations to the Court are at the end of the profiles section.)
Lack of adequate supplies for resident treatment and care is a violation of federal regulations and the Court Orders.

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)f Payment of Vendors
As of Saturday, December 9, 1995, DCV is out of supply of one treatment modality for decubitus ulcers, duoderm. Treatment nurses are using a substitute which they believe is not quite as effective. One treatment nurse does have a limited supply of duoderm only because, through her wisdom and experience, she secreted supplies anticipating this scenario. There is no duoderm, although I am informed emergency supplies are on the way, because District Healthcare, the vendor, has not been paid. District Healthcare is owed approximately $42,000.
Update on National Nurses. Inc.. profiled in December 6, 1995, letter to the Court: On Thursday evening, December 7,1995, Mr. Ronald Messenheimer, President of National Nurses, Inc., left a message for the Court Monitor, that he had received "confirmation from the Chief Financial Officer's office (for the District of Columbia) that National will be payed in the next check run on Friday or Monday. I will continue services pending receipt of check on Friday or Monday."
On Friday afternoon, December 8, 1995, Ms. Barbara Mann of the Corporation Counsel's office for the District of Columbia, left a message for the Court Monitor concerning National Nurses Inc., that "we are not aware of any termination prior to the weekend or immediately thereafter, it is our understanding a check will be delivered to them not later than Thursday of next week. We are covered for the weekend at DCV." This information is in conflict with the information Mr. Messenheimer was told the day before from the Chief Financial Officer's office.
The Court Monitor will inform the Court on a regular basis. Within the past week, the Court Monitor has begun to notice shortages of staff, primarily of nurse aides. Contract nurse staffing vendors are supplying nurses. However, none of them have been paid. Most recently in a letter dated December 6,1995, to Mr. Vemon Hawkins, Director, Department of Human Services for the District of Columbia, CUP HealthCare Services has indicated they will terminate services on Thursday, December 14, 1995. CUP HealthCare Services is owed 593,102.86, ($11,935.77 of which is from December 1994.)
Nurse aides are District of Columbia government employees, are unionized, and are opting to take annual leave before DCV closes and they loose their benefits. Further monitoring is needed to determine why there are not nurse aide replacements and where there may be a potential source. Apparently, through the Personnel Department of the District of Columbia, there is difficulty securing staff for a limited term employ.
DCV receives one of the highest Medicaid reimbursement rates in the continental United States, approximately $240 per resident per day. This amounts to approximately $87,600

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FAX NO. 2023322949

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per resident per year. When the Court Monitor first arrived at DCV on August 28,1995, there were 270 residents. That is a total reimbursement rate of approximately $24,000,000 per year. Approximately half of mis total is federal funds and approximately half is District funds. According to DCV administration, as mentioned in the Court Monitor's November Status Report to the Court, DCV is funded through fiscal Year 1996. Where are these funds?
The same vendor non-payment problems profiled in the affidavits of June 1995, which led to the Stipulated Court Order of July 6, 1995, are the same problems today. (Remedies needed to rectify this situation are at the end of the profiles section.)
(4) Residents Denied Personal Needs Allowance (PNA)
Residents are to receive their Personal Needs Allowance (PNA) on the first of each month. As of today, the residents have not received their December funds, nor can anyone tell them when they will receive their money. The residents have a Holiday shopping trip planned for Friday, December 15, 1995.
The Personal Needs Allowance is residents' money and in the District of Columbia amounts to $70 per month. The source of the PNA is two-fold. One is for the "categorically needy.*' These are residents with no other source of income and who receive Supplemental Security Income (SSI). This amounts to a federal minimum share of $35 per month and in the District
of Columbia amatching share to equal the $70 per month. (I believe the ratio in the District
is federal contribution of $40 and the District of Columbia contribution of $30.) The second source of PNA is the "medically needy." That is residents with social security, disability, and or public or private pensions. From these sources of income, $70 per month is withdrawn and to be put into the residents PNA The remainder of these sources of income contribute to the residents Medicaid reimbursement rate.
In an interview with the teller at DCV on Friday, December 8, 1995, the teller told me that he has not received money in two and a half months, what he has been using to give to residents as their PNA is money remaining in the fiscal budget (I believe last year's.), and that he normally receives funds every week to two weeks. The teller also told the Court Monitor that the PNA is from the District of Columbia Treasury.
It is a violation of federal law and regulations to co-mingle resident funds with anv other account. Resident funds in excess of $50 are required by federal regulations to be in an "interest bearing account (or accounts) that is separate from any of the facility's operating accounts, and that credits all interest eamed on resident's funds to that account." [42 CFR Part 483.10 © (1) through (7)].
Judge Hogan, I cannot tell you how sad and pitiful it is to see the residents hovering around
5

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the window of the teller, across the hallway from the administration offices. There is a steady stream of residents throughout the day. The residents have not reached the justifiable anger stage yet, although some are close to it In their eyes you can see that they are stunned, bewildered, and hurt On Thursday, December 7 the staff was paid. The residents are acutely aware of this and the fact, that there is no money to pay them their own funds.
The residents have so little in life, it is their dignity that is being robbed from them as well as their money. Being deprived of their PNA adds to the stress of the impending loss of their homes, and the stress of institutionalization at the Holiday season.
Recommendations and Immediate Remedies Needed
I believe all the above situations will continue unless the recommendations and remedies mat follow are immediately put in place. As DCV continues to approach closing, I can foresee operations unraveling, as it has already begun to do so in the areas profiled above: nurse staffing, dressings for the treatment of decubitus ulcers, wheelchair repairs, and the residents' Personal Needs Allowance. I foresee the non-payment of vendors becoming out of control.
I believe the primary issue is the misuse of and lack of accountability for government funds earmarked for the operations of D.C. Village Nursing Home and for the direct care of the residents of D.C. Village Nursing Home - the most vulnerable and frail of the District of Columbia population. Non-payment of vendors is symptomatic of this larger issue and is manifested in the culture of tolerance for and acceptance of bureaucratic inertia. The behaviors surrounding this culture are manifested internally at DCV by the acceptance of and tolerance for lack of supplies for basic humane care, and externally among DCV government officials, by the tolerance and acceptance of needless delays in the procurement process.
Therefore, in order to prevent the further dissolution of residents' rights the following immediate remedies are needed: (These remedies are not to supplant my recommendations in my Status Reports to the Court, the remedies identified here specifically relate to the concerns identified in this letter.)
(1) An independent audit under the Court's auspices, of the government funds earmarked for DCV. (For over a month now the Court Monitor has requested the Budget and Annual Costs Reports of DCV, most recently in the November Status Report.):
(2) Since there are dedicated federal and District matching funds earmarked solely for the operations and direct care of the residents at DCV, there is no need for requests for purchase orders to enter the bureaucratic maze of the D. C. Government process. And since DCV has a scheduled closing date of the end of March, 1995, all requests for necessary purchase orders will be filled within a two week turn around:

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(3) An accounting of Resident Personal Funds:
(4) Establishment immediately of a separate account for residents* personal funds including the residents' Personal Needs Allowance.
Judge Hogan, I look forward to serving the Court in monitoring the implementation of these recommendations and immediate remedies needed for the best interests of the residents of D.C. Village Nursing Home.
Sincerely,
Harriet A. Fields, Ed.D., R.N. Court Monitor
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann, Mr. Garland Pinkston Office of the Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

 
 HARRIET A. FIELDS, Ed.D., R.N. #604
1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

U.S. v. District of Columbia
llllllI NH-DC-001-018

Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Order Modifying Stipulated Order of July 6, 1995; Order, December 22, 1995

Dear Judge Hogan:
The enclosed is the January Status Report to the Court.
It primarily addresses the December 22, 1995, Court Order.
Judge Hogan, it is a privilege to serve the Court for the best interests of the residents of D.C. Village Nursing Home.

Sincerely,

Harriet A. Fields, Ed.D., R.N. encl.

i ri!

cc: Mi. Richard J. Farano "Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann, Mr. Garland Pinkston Office of the Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

STATUS REPORT United States of America v. The District of Columbia, e t Al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home;
November 7, Order Modifying Stipulated Order of July 6,1995;
Order, December 22,1995
Submitted by: Harriet A. Fields, Ed.D., R.N.
Court Monitor January 17, 1996

STATUS REPORT United States of America v. The District of Columbia, e t al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home;
November 7, Order Modifying Stipulated Order of July 6,1995;
Order, December 22,1995
Submitted by: Harriet A. Fields, Ed.D., R.N.
Court Monitor
Date: January 17, 1996

INTRODUCTION

1

I. DECEMBER 6 AND DECEMBER 10, 1995, LETTERS TO THE COURT . . . 2

H. CONCLUSION OF WHAT IS IMMEDIATELY NEEDED FOR THE BEST

INTERESTS AND PROTECTION OF THE RESIDENTS, TO SAFEGUARD

THEIR WELFARE, AND PREVENT FURTHER VIOLATION OF THEIR

RIGHTS

3

HI. ASSESSMENT DATA SUPPORTING NEED FOR NEW MANAGEMENT . . 3

A. Outplacement of Residents with Mental Retardation

4

B. Issues with Respect to the Discharge and Outplacement of Residents with

Mental Illness

8

C. General Discharge and Outplacement Issues

11

D. Measures to Remedy Shortages

13

E. Food and Drink (Stipulated Court Order, July 6, 1995)

15

F. Provision of Health and Nursing Care

19

IV. IMMEDIATE ACTION STEPS

23

A. Mental Retardation

23

B. Mental Illness

24

C. Outplacement

24

D. Nursing Care

24

V. POTENTIAL MODELS FOR NEW MANAGEMENT

24

APPENDIX A: December 6 and December 10, 1995 Letters to the Court

APPENDIX B:

Report of the Evaluation of Food and Nutrition Services of the D.C. Village Nursing Home

APPENDIX C: ' Payment of Vendors

STATUS REPORT United States of America v. The District of Columbia, et al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home; November 7, Order Modifying Stipulated Order of July 6,1995;
Order, December 22,1995 Submitted by:
Harriet A. Fields, Ed.D., R.N. Court Monitor Date:
January 17, 1996
INTRODUCTION This is the third monthly Status Report submitted by the Court Monitor to the Court. The first Status Report was submitted to the Court in October 1995, prior to the October 20 Status Hearing. The second Status Report was submitted November 30, 1995, prior to the December 4, 1995, Status Hearing.
Pursuant to the Stipulated Order of July 6, 1995, the Court Monitor was appointed August 1, 1995, the initial estimated budget was approved September 6, 1995, and monitoring activities commenced August 28, 1995. A Preliminary Status Report was submitted on September 5, 1995. On November 7, 1995, the Order Modifying Stipulated Order of July 6 was filed expanding the Court Monitors's duties to oversee the outplacement process of the residents of DCV. (The District of Columbia announced closing of DCV in early August, after the July 6 Stipulated Order was filed and after the appointment of the Court Monitor.)
On December 20, 1995, the Court found the District in contempt of the July 6 Stipulated

Order and the amended November Order. On December 22, 1995, the Court issued a remedial Order.
This January Status Report will concentrate on this remedial Order of December 22, 1995, and the Court Monitor's assessments of the ability of the District of Columbia to comply with this Order.
This Status Report is divided into five main areas: (1) brief review of the monitor's December 6 and December 10 letters to the Court subsequent to the November Status Report; (2) the monitor's conclusion as to what is immediately needed for the best interests and protection of the residents, to safeguard their welfare, and to prevent further violation of their rights; (3) assessment data supporting the need for new management; (4) action steps that must be implemented now by DCV in the interim; (5) potential models for new management;.
I. DECEMBER 6 AND DECEMBER 10,1995, LETTERS TO THE COURT After the November 30 Status Report and the December 4 Status Hearing it became necessary on two occasions to write the Court prior to the next scheduled Status Hearing of December 20, 1995.
The December 6, 1995, letter to the Court profiled the negative impact on the life of one resident in particular, who is wheelchair dependent, and the potential negative impact on the life of the residents in general, through termination of nursing services, due to lack of payment of vendors.
The December 10, 1995, letter to the Court profiled (1) non-maintenance of resident equipment-wheelchair; (2) unconscionable delays in the process of procuring purchase

orders for vendor services, so much so that essential supplies for resident care and treatment are lacking; (3) chronic non-compliance of payment of vendors so much so that essential services for resident care and treatment were lacking; (4) residents were denied their Personal Needs Allowance which was in the District of Columbia Treasury. Recommendations in the December 10 letter called for an (1) immediate audit of government funds earmarked for DCV; (2) requests for purchase orders be filled within two weeks; (3) an accounting of residents' personal funds; (4) establishment immediately of a separate account for residents' personal funds, including the residents' Personal Needs Allowance.
The December 6 and December 10, 1995, letters to the Court appear in Appendix A of this January Status Report.
H. CONCLUSION OF WHAT IS IMMEDIATELY NEEDED FOR THE BEST INTERESTS AND PROTECTION OF THE RESIDENTS, TO SAFEGUARD THEIR WELFARE, AND PREVENT FURTHER VIOLATION OF THEIR RIGHTS
It is with much thought; painful deliberations; data gathering; consultation with experts; input from staff and contract employees; interviews and observations of all the residents at DCV; meetings with District of Columbia government officials; and the employ of a nursing home systems expert consultant on January 3, 4, and 5, 1996, (who was also a consultant to the Court Monitor at DCV in September at the time of the Health Care Financing Administration (HCFA) survey and is a former HCFA Regional Survey Team Coordinator and currently serving as a consultant to a HCFA contractee and is conducting HCFA surveys throughout the country); that the Court Monitor comes to the following conclusion:

In order to protect the residents' health, ensure continuity of care, safeguard the residents* rights according to federal and District law and regulations, and protect the residents from the trauma of relocation, a new management team is needed immediately. For the bests interests of the residents of DCV, I base my conclusion on current and ongoing conditons and practices which pose serious and widespread danger to the health and welfare of the residents.
ASSESSMENT DATA SUPPORTING NEED FOR NEW MANAGEMENT The following assessment data relates to the Court Order of December 22, 1995, and when needed for clarification, the previous Court Orders of July 6 and November 7 are cited. The assessment data and recommendations profiled in the Court Monitor's October and November Status Reports are still current and valid unless otherwise indicated here and the recommendations still stand. This section of assessment data supporting the need for new management is in addition to the data already presented to the Court.
A. Outplacement of Residents with Mental Retardation There is no constructive movement in this area. Currently there is an
impasse between the group home providers and the Commission on Health Care Finance over a mutually agreed upon rate. There are not enough identified group homes to care for the particular, individual needs of the residents with mental retardation at DCV.
Group homes have not been paid for approximately one half year. As a result one resident with mental retardation, Mr. L.S., who was profiled in the November Status Report, has been waiting to be discharged to D.C. Family Services, a group home. D.C. Family Services is now in a budget crisis of its own and cannot accept this resident until

it is reimbursed for three residents it received from DCV in June. Within the last week, it came to the Court Monitor's attention that Mr. L.S. is still in Washington Nursing Facility, the nursing home to which he was discharged after he had an acute care procedure performed at Greater Southeast Hospital Center, where he was transferred from DCV in the autumn. The Washington Nursing Facility is not where he should be today.
Not only is this an example of the financial problems which constitute barriers to placement, but it is also an example of a systems breakdown at DCV. All those involved with Mr. L.S., including social service at DCV and the GUCDC assumed that Mr. L.S. was in his designated group home. However, it has not been determined if Mr. L.S.'s individualized habilitation plan has been sent anywhere. It is not known if the Washington Nursing Facility is capable of caring for the individualized needs of Mr. L.S. The Court Monitor, along with a staff person from the GUCDC group, will visit Mr. L.S. in his current setting, to determine appropriateness of care and level of staff knowledge. (A visit was scheduled last week, but was rendered impossible by the blizzard.)
There has been no movement in identifying and developing the specialty consultation team described in the November 30 Status Report to the Court and reiterated in the December 22, 1995, Court Order. At a meeting at DCV on Thursday, December 28, 1995, with Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia; Dr. Guido Zanni, Commissioner of Mental Health for the District of Columbia; Ms. Orlene Grant from the Commission of Mental Health Office; Ms. Gladys Fountain, Interim Administrator for Long Term Care from the Commission of Public Health; and the Executive Director of DCV, the Court Monitor reiterated this fact. The response from the Executive Director of DCV was that the residents with mental retardation have case managers at the Mental Retardation and Developmental Disabilities Administration (MRDDA) and they are handling this. The Court Monitor's October 16,

1995, Status Report to the Court on page 26-27 identifies the inadequacy of this situation. To this date, nothing has changed.
On the morning of December 29, 1995,1 met in the hallway at DCV, the psychologist from the Georgetown University Child Development Center (GUCDC), who was dismayed and annoyed at the continued treatment GUCDC receives. He informed me that when the GUCDC staff left for work that morning, they had no idea if this would be their last day because the GUCDC contract expired that day and had not been renewed. In fact one GUCDC staff person began packing his books. It was only later that morning that GUCDC staff at DCV received a letter by courier stating that their contract was being renewed until January 12. The Court Monitor immediately went to the Executive Director of DCV with this staff person from GUCDC and reported this to her. The Executive Director's response was, "you do not understand bureaucracy." The Court Monitor reminded the Executive Director, "my role is to report the life of the residents to the Court, and this is detrimental to the life of the residents." I also reminded the Executive Director that the District is now in contempt of the Court Orders, and that she has to let the Court Monitor help her help the residents, stop defending a system that is not defensible, and defend the residents by being vocal and advocating for what is needed to protect and safeguard the residents health and welfare.
The Executive Director in the presence of the Court Monitor and the GUCDC staff person called MRDDA and was informed that the GUCDC contract had in fact expired and that GUCDC would be renewed after January 12, 1996, at 14 day increments.
I continue to remain greatly concerned about the adequacy of the group homes to appropriately provide for the individual needs of the remaining residents with mental retardation at DCV. On December 15,1995,1 visited one proposed group home

site with the president of the group home, Kennedy Institute. The plans were to rely on aides to provide the bulk of care and to be supervised by a Licensed Practical Nurse (LPN). The turnover rate for aides in group homes is generally acknowledged to be every three months. I asked what contingency plans do they have when aides do not show up for work, and was told that they have about a 95% success rate with a back-up list.
Factored into the staffing plans were the provisions that the residents would be away from the home for six hours a day at day programs. But in fact the group home provider admitted that there are not really adequate or appropriate day programs for the DCV population of residents with mental retardation. However, he did express that the group homes that do accept this population could be creative and perhaps share the resources of the specialty consult team to provide that appropriate day programs, much as GUCDC is now doing at DCV.
This group home provider said that given the severe health needs of the residents with mental retardation at DCV, group homes cannot accept these residents without access to a specialty consult team. He also said that Catholic Charities of D.C., which runs the Kennedy Institute, is approximately $1,000,000 in debt from lack of payment by the District for the seven group homes it runs.
Except for one resident currently on Unit 2B with a one to one nurse aide assignment, the remaining eleven residents with mental retardation are on Unit 5A. The total current census on Unit 5A is sixteen residents. The current usual staffing pattern for day, evening, and night shifts on Unit 5A is to have one licensed nurse staff and two nurse aides. Usually, in a nursing home with a resident population of 16, this would be adequate. However, given the individualized attention the residents with mental retardation need in accordance with their individual habilitation plans, I now believe this

staffing pattern is inadequate on the evening, night, and weekend shifts when the GUCDC staff are not present. Group home staffing patterns are planned at one aide to four residents.
The Court Monitor met with the program coordinator for the GUCDC, Mr. Richard Clevenger, on January 5, 1995, at DCV. We discussed the above situations. Mr. Clevenger suggested that GUCDC explore hiring their own aides to complement staffing on Unit 5A. It would be much more cost effective than the amount DCV is presently paying for nurse aides. In addition, GUCDC would have greater access to educating and supervising the aides in the care of the residents with mental retardation. Also, these residents would have assured continuity of care, which is so important and is not consistently the case now. According to Mr. Clevenger, GUCDC has considerable experience in hiring, training, and supervising "habitation aides" for a similar population in other settings.
In a meeting that same afternoon with Mr. Silas Butler, the Deputy Administrator of DCV and Mr. Clevenger, the Court Monitor informed and discussed all the above with Mr. Butler. Mr. Clevenger recommended that the GUCDC offices be moved from the second floor of an attached building, for the most part inaccessible to the residents with mental retardation, to Unit 5A. Mr. Butler said he would immediately put those plans into effect.
Historically at DCV, the GUCDC staff has not been included as an integral part of the life of the residents with mental retardation, including full participation in care planning and the planning of the residents outplacement. It is my understanding from interviews and reading past memos and letters, including those from the Pratt Monitoring Program and Georgetown University to the administration at DCV, that the administration, nursing, and social services departments have been resistant to expertise beyond theirs.
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The Court Monitor told Mr. Butler, who is charged with coordinating the outplacement process for all residents, that GUCDC should be attending the weekly, Wednesday morning outplacement meetings, and that I have invited Mr. Clevenger to do so. Mr. Butler has agreed to this.
The medical assessments for the three identified residents in the December 22, 1995, Court Order is a current example of lack of consultation with and integration of the program expertise in mental retardation supplied by the GUCDC at DCV. On January 5, 1996,1 asked the Medical Director (MD) about these medical assessments. She informed me that the assessments had been conducted earlier in the week. The MD did not consult with nor ask GUCDC for references and names of medical doctors who know the residents, who have expertise in mental retardation, and who have knowledge of care that can be provided in group homes. Instead, without collaborating with the GUCDC experts, the MD sought out two medical doctors who do not know the residents. Not collaborating with and coordinating expertise is a detriment to the residents.
This is not an isolated example. There is virtually no interdisciplinary coordination and cooperation at DCV. Secrecy and defensiveness is rampant among department heads and trickles down to staff in most all departments. A notable exception was the fine team work of the physical therapists, and ironically, their contract has expired and to date has not been renewed. The outplacement of residents with mental illness provides another example.
B. Issues with Respect to the Discharge and Outplacement of Residents with Mental Illness
DCV has employed the services of Geriatric Psychological Systems (GPS) to conduct the psychosocial assessments of residents. GPS is a consulting firm with presence in several

nursing homes in the District.
GPS will review the Minimum Data Set which is the federally mandated individual assessment tool to be used as a basis for developing the individualized care plans, which are also mandated by federal law and regulations.
The GPS team consists of a nurse, social worker, psychologist, psychiatrist, and a finance person to determine Medicare Part B reimbursement eligibility. The psychologist is scheduled to conduct evaluations of residents with psychiatric diagnoses based on the findings from the Minimum Data Set assessments. Then the psychiatrist is scheduled to review psychotropic medications, based on the psychologist recommendations.
The ombudsperson has had concerns in the past with the psychiatrist chosen by GPS and and in July 1995, filed a complaint with the local licensing authority. These complaints concerned non-visits to residents and questioned appropriateness of medications ordered. The complaints were investigated by the local licensing authority and HCFA and were substantiated. These concerns were shared with the GPS administrator who said that he had heard concerns raised before about the psychiatrist. The GPS administrator went on to say that the psychiatrist has essentially a good Medicare reimbursement record.
On December 27, 1995, the GPS consulting team met with staff at DCV. After the meeting, the Court Monitor met with GPS staff and shared the Court Orders and the Status Reports to the Court. The regional president of GPS told the Court Monitor, "Your November 30 report outlines our work completely."
It is unclear to date how needed psychiatric therapies will be conducted on an ongoing basis as long as the residents remain at DCV. Further monitoring is required.
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My concerns with the outplacement of residents with mental illness, in addition to those already presented to the Court in previous reports, are two-fold. (1) The manner in which the consulting firm was chosen is symptomatic of the pervasive attitude of noncollaboration among departments, defensiveness to constructive input, secrecy and lack of sharing of information; (2) I see no way under the current structure for outplacement of residents that the recommendations of GPS will be systematically incorporated into the interdisciplinary discharge plans and communicated to the outplacing facilities.
(1) On the afternoon of December 19, 1995, an outplacement meeting took place at DCV specifically to discuss the outplacement of residents with mental illness. Attending and chairing the meeting was the Deputy Administrator for DCV, the Chief of the Central Referral Bureau for the District of Columbia (who is a member of the outplacement and attends all the weekly meetings), the Ombudsperson, the Medical Director, and the Court Monitor.
The Deputy Administrator at DCV has been charged with overall oversight of the outplacement process. He in turn designated the Medical Director to oversee the outplacement of residents with mental illness primarily because, at the Deputy Administrator's own admission, he does not know much about mental illness. However, at her own admission, the Medical Director said she does not know much about mental illness either.
The Medical Director was asked to present an update on the outplacement of residents with mental illness. This presentation indicated little understanding of the seriousness of the deficiencies in the care at DCV and the deficiencies of the available resources within the District to adequately care for this population. This, despite the fact that the Court Monitor met with the Medical Director a month beforehand and outlined for her a path to
11

follow to appropriately outplace residents with mental illness. This information is outlined in the November Status Report in the section on 'Outplacement of Residents with Mental Illness'.
On my way out the door of the facility that evening, the Medical Director informed me that GPS was expected at DCV the next day for an interview. I do not understand the unwillingness to share this information in the appropriate meeting and to receive input for the best interests of the residents with mental illness. It was at the Court Monitor's insistence to the Deputy Administrator that the Ombudsperson and the Chief of the Central Referral Bureau attend this meeting. These two have years of knowledge of the difficulties in outplacing this population and are members of the outplacement team.
At a meeting at DCV on the evening of December 28 with Dr. Harvey Sloane, Commissioner of Public Health, District of Columbia; Dr. Guido Zanni, Commissioner of Mental Health, District of Columbia; the Executive Director of DCV; and the Interim Administrator for Long Term Care for the District, the Medical Director objected to the provisions in the December 22, 1995, Court Order specifically relating to providing consultation services to receiving facilities to ensure safe and effective transition to new residences. This objection demonstrates a lack of awareness of the seriousness of a contempt citation and a professional entrenchment which clouds objectivity.
I do believe that charging the Medical Director to oversee outplacement of the residents with mental illness is not a positive use of her considerable strengths in the areas of home care and hospice care. I, therefore, recommend that oversight of the outplacement of residents with mental illness be given to Ms. Corrie Kemp, Chief of the Central Referral Bureau for the District of Columbia. In this capacity, Ms. Kemp has current knowledge of all the caregiving sites in the District, their strengths and weaknesses, their abilities to
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care for the residents with mental illness, and what licensure and regulatory requirements may be needed to facilitate the ability of certain sites to prepare to receive this special population.
(2) Current management structure at DCV does not provide for the incorporation of the data and recommendations expected from GPS into the interdisciplinary discharge plans and the follow up communication to the outplacing facilities.
The outplacement of residents is currently coordinated by the social services department. The head of the social services department has been observed telling clinical nurses on the units that psychosocial assessments have already been done. There have been virtually no current psychosocial assessments conducted for the residents, despite the protestations from the social services department. This leads me to the following additional concerns.
C. General Discharge and Outplacement Issues The Action Steps described in the November 30 Status Report, which DCV initiated and, at that time, indicated a commitment to continue, have not been continued.
There have been no further meetings since the November meeting with residents, relatives, and responsible parties, although, DCV committed to scheduling these meetings for December and January.
Counseling residents and staff began and ended in December. There has been no involvement of other disciplines, such as, dietary and therapeutic recreation in the outplacement process.
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The only leadership to date in the outplacement process has come from the Associate Director of Nursing, Ms. Disu. However, since she has been out on emergency medical leave, all the action steps identified in the November 30 Status Report have stopped. The social service department has taken no leadership in counseling residents and staff and in coordinating with other departments the individual interdisciplinary discharge care plans. Residents discharged from the hospital to a skilled unit within the same hospital have not had their discharge care plans sent from DCV. Ms. H.W. and Mr. H.J. are two recent examples. In these two instances, the ombudsperson was not notified of the residents outplacement.
On January 4, 1996,1 received a telephone call from the nephew of resident Ms. H.D. The nephew, Mr. D.D., had received a call the week before from the administrator of the Skilled Nursing Facility a few blocks from DCV, pressuring the nephew to authorize outplacement of his aunt that day. Mr. D. wants his aunt outplaced to Carroll Manor which is near his home in Maryland. Mr. D. was told by the administrator that Mr. D's aunt could go the administrator's facility and when a bed opens at Carroll Manor, she could be transferred. Mr. D. wanted to know, if it was necessary to immediately outplace his aunt against his wishes, which would cause needless trauma to Ms. H.D. This is undue pressure on residents and family members and is a violation of their rights.
The nursing homes identified for outplacement have a primary motivation to receive reimbursement, therefore, the residents rights have to be protected.
D. Measures to Remedy Shortages
Under the current management structure, shortages continue to occur which pose serious harm to the health and welfare of the residents. A few examples follow.
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Physical Therapy On December 14,1 asked the Executive Director if she knew if the physical therapy contract had been renewed. She said that she did not. I asked if she knew that the physical therapist had not been paid. She said that she did not. The Executive Director said she would follow up on the matter and get back to me.
On Thursday late afternoon, December 28, 1995, the physical therapist, while leaving DCV, told the Court Monitor that she was on her way downtown to sign an extension until January 9, of her contract which expired that next day, December 29. The physical therapist told me that the contracts for physical therapy services would be up for open bidding; that she had no idea if she would be servicing DCV after January 9, 1996; and that TMS Management Services, the physical therapy vendor, had not been paid.
At the December 28 evening meeting described earlier with the Commissioner of Public Health" for the District; the Interim Administrator for Long Term Care for the District; the Commissioner of Mental Health for the District; and the Executive Director of DCV, the Court Monitor raised the serious issue concerning physical therapy services. The Executive Director said she was "completely on top of it" and that the physical therapist was going to have her contract renewed today. I asked if the she knew for how long, and the Executive Director said until January 9. And then I asked what would happen after January 9. The Executive Director said, "I don't know." The Interim Administrator for Long Term Care said it is "contract procedure" to have open bidding and that the physical therapist may not be the same one, but that there would be physical therapy services.
The Court Monitor told the meeting attendees, that this means one of three scenarios. One, that there will be no physical therapy services at DCV after January 9, two, that there will be an interruption of services, and/or, three, that there will be a lack of continuity in services by supplying a new contract vendor. Any of the above is
15

unacceptable and intolerable for the health and welfare of the residents. Dr. Sloane, the Commissioner of Public Health for the District of Columbia shook his head and said to the Interim Administrator for Long Term Care, Ms. Gladys Fountain, "this isn't right, see what you can do.M
As of this writing, there is no physical therapist at DCV.
Occupational Therapy Since October 24, 1995, there has been an outstanding request for a purchase order for needed supplies for hand splints to prevent further contractures in residents. The causes of contractures and the serious jeopardy contractures of both hands and legs pose to residents health have been profiled in previous Status Reports to the Court. Development of contractures stems from passive neglect which over time is chronic abuse. According to occupational therapy staff, the Medical Director'and the Executive Director were given these requests for purchase orders in October. To date, there are no supplies at DCV to make hand splints to prevent further contractures of residents hands. Among many other normal daily human activities, contractures of hands have serious health consequences relating to preventing residents from feedings themselves, attending to personal hygiene, such as, grooming, toileting, brushing teeth, and drinking water for hydration.
Procurement In a meeting at DCV on December 22, 1995, with Mr.Vernon Hawkins, Director of the Department of Human Services for the District of Columbia; the Commissioner of Public Health for the District; the Interim Administrator for Long Term Care for the District; the Executive Director and the Deputy Administrator of DCV; and the Court Monitor, Mr. Hawkins said that he would be detailing Ms. Cheryl Perkins from the Procurement Office in the Department of Human Services of the District of Columbia to DCV two half days a week, Monday and Wednesday.
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At a meeting in Mr. Hawkins office on the campus of St. Elizabeth's on December 26, 1995, attended by vendors, the dietary department head at DCV; the Executive Director and Deputy Administrator of DCV; the Commissioner of Public Health and the Interim Administrator of Public Health; the Chief of Staff for Mr. Hawkins; and the Court Monitor, Mr. Hawkins again reiterated that commencing the following Wednesday, January 3, 1996, a representative from the procurement office would be detailed to DCV to write purchase orders.
On Wednesday, January 3, 1996, the Procurement Office representative, Ms. Cheryl Perkins, did not come to DCV. When the Court Monitor inquired, I was told that Ms. Perkins took a leave day. On January 4,1 left a message for Mr. Hawkins stating my disappointment that he did not send a representative from the Procurement Office as he had said that he would.
To date there has been no representative from the Procurement Office at DCV.
E. Food and Drink (Stipulated Court Order, July 6.1995) Defendants shall immediately ensure that sufficient supplies of nutritious and
appropriate food and drink are consistently maintained at DCV and that each resident daily receives adequate, well-balanced, nutritious and appropriate food and drink according to their individual nutritional needs.
Status Re: Court Order Non-Compliance
Two experts in dietary services and nutrition from the Department of Nutritional Sciences, Howard University, in the District of Columbia, served as consultants to the Court Monitor. The expert consultants were at DCV on December 27, 28, 29, 1995, and January 2,3,4, and 5,1996. I urge the reader of this Status Report to go to Appendix B for the complete report of the nutrition experts.
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The major findings of the food and nutrition experts are the following. Inservice There is No Inservice on resident care, diet and nutrition. The last documented
inservice in this area was in 1993. This is a violation of federal regulations and professional standards of practice.
Policies and Procedures There are No Policies and Procedures. The Policy and Procedures Manual was incomplete and outdated. Policies and Procedures were lacking in the following critical areas of resident care and food service management: 1. Decubitus ulcer protocol; 2. Documentation of food consumption; 3". Hydration schedule; 4. Unplanned weight loss; 5. Menu analysis; 6. Menu Substitutions; 7. Staffing pattern; 8. Job descriptions; 9. Employee scheduling; 10. Employee orientation; 11. Purchasing procedures; 12. Emergency food and beverage supplies; 13. Re-assessment of post-hospitalized residents. There is a lack of uniformity in resident care management.
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Food Service Systems In order to ensure that sufficient supplies of nutritious and appropriate food and drink are consistently maintained an effective procurement system and an effective inventory control system are required. The food and nutrition experts found that DCV did not have inventory records which would: provide accurate information of food and supplies in stock; determine purchasing needs; provide data for food cost control; and prevent theft and pilferage. Findings also included no storeroom requisition files, no purchasing manual, and no policies and procedures concerning purchasing, including receiving, storage, and inventory control.
Menus The food and nutrition experts found that in the area of the preparation of menu items in the needed quantity and with the desired quality, there are major violations of standards of professional practice. Three of the critical areas are the following:
(1) Food service personnel are not using recipes to determine portion sizes; (2) Smaller portion serving utensils are being used for food items on resident trays, when larger portion sizes are necessary for adequate nutrition; (3) Consistent with findings in the November 30 Status Report, portion sizes are not on menus, production sheets, nor recipes. Therefore, according to the food and nutrition experts the nutritional status of the residents is at risk.
Consistent with the findings of the HCFA surveyors in September 1995, there are more diets prescribed than probably any nursing home in the country. The experts found 20 different diets, many very restrictive. This is contrary to current dietary and nutrition practices in nursing homes today. Physician diet prescribing practices do not reflect current knowledge of nutritional health for nursing home residents. Restrictive diets lead to diminished food intake and increased use of supplements, and can lead to increased
19

use of gastric tubes prescribed for feeding. Whereas, resident satisfaction and improved food intake are associated with more liberal diet policies. I have yet to hear a resident express satisfaction with the meals at DCV.
There is a heavy prescribing of and reliance on gastric tubes at DCV. Gastric tubes are placed directly into the stomach for feeding. There is a body of literature on iatrogenic malnutrition, which is malnutrition induced by physicians.
Clinical Nutrition Care Management
Chart reviews for clinical nutrition care management provided the following findings. (1) In all charts reviewed, there were no records of food consumption and fluid
consumption, typically called intake and output records. The experts say that a record of food and fluid intake is a standard practice for nutrition care management. "With only an occasional notation, it is virtually impossible to assess the nutritional adequacy of a resident's food and fluid intake." Monitoring fluid intake is vital to adequate hydration of nursing home residents.
(2) There is an excessive reliance on dietary supplements which are associated with decreased appetite and food ingestion.
(3) Nearly half of the residents identified to receive increased fluid intake had no interventions listed on the care plan in their charts, and had no increased fluids on their meal trays.
(4) Significant weight loss or gain is not adequately addressed by dietary with no interdisciplinary collaboration and follow-up.
(5) A number of care plans were inaccurate or inadequate. (6) One third of the annual nutrition assessments did not contain significant data about the residents.
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Meal Observation and Tray Accuracy A consistent pattern of tray inaccuracies was found. For example, Mr. C.F. is to receive a high fiber diet and cranberry juice, and yet he consistently receives white bread instead of wheat bread and rarely receives cranberry juice. He is often told by the dietary department that cranberry juice is "too expensive." The experts say that cranberry juice is not expensive.
Recommendations Some of the recommendations from the experts based on critical deficiencies posing serious harm to residents health and welfare are the following .
(1) Needed ongoing continuing education by the professional community. (2) "Establish and implement an effective and consistent program of hydration including a Hydration Policy to ensure uniform approaches in the prevention and treatment of dehydration. Both Nursing and Dietary Departments will need to collaborate to devise policy and procedures." (3) Implement food and fluid intake assessment procedures. (4) Comply with Residents' Rights by posting menus on each unit. (5) Implement a "more uniform and aggressive approach to addressing significant unplanned weight changes." (6) Adopt a "uniform and systematic interdisciplinary care program to reflect a more integrated approach" to resident care. (7) Establish a Quality Assurance program reflective of professional standards of practice and federal and District law and regulations.
The food and nutrition experts and the Court Monitor found an alarming and troublesome attitude among staff which was also voiced by the Interim Administrator for Long Term Care for the District, when I introduced the nutrition experts to her. That is, that since
21
'i if

DCV is closing at the end of March, what is the point of looking at operations.
Another dismaying attitude is that instead of viewing the food and nutrition experts to the Court Monitor as possible sources of professional growth and as colleagues to learn from, especially the experts from Howard University here in the District of Columbia, the head of the dietary department called the Corporation Counsel complaining about the data they were being asked to review.
Summary In summary, the food and nutrition expert consultants to the Court Monitor believe that nutrition can make a difference between life and death and that the lives of the residents of D.C. Village Nursing Home are at risk.
F. Provision of Health and Nursing Care There is, once again, virtually no leadership in the nursing department. The Director of Nursing (DON) hired three months ago has left employ at DCV. A nurse from the Commission of Public Health has been detailed to serve as acting DON.
Although the District's goal for outplacement of over 220 residents is March 31, 1996, this is not realistic. I foresee the facility open through at least a good part of 1996. The Commissioner of Public Health concedes that there are approximately 70 residents who will be virtually impossible to outplace. It is not acceptable to have an acting DON. The residents need immediately competent, consistent, and stable nursing leadership and nursing staff for as long as they remain in their homes at DCV.
The one leader in nursing administration has been on emergency sick leave since before Christmas. Since her emergency surgery, the announcement over the public address
22

system every two hours to turn residents has stopped. The interdisciplinary counseling sessions regarding transfer trauma for staff and residents has stopped. The therapeutic music played over the public address system has stopped. A nursing facility cannot run on the strength of one committed, caring, knowledgeable leader alone.
There are few permanent licensed nurse staff left. The licensed nurse staff on the units are, for the most part, from contract agencies. I have found in discussions with the management of the contract nurse staffing agencies, that most of them are not aware of the Nursing Home Reform Law and the minimum standards for long term care as exemplified in the federal regulations.
The clinical contract nurses are not pennanently assigned to units, and, therefore, are not involved in the life of the residents. They do not know the residents, nor do the residents know them. Two residents of DCV for many years, Mr. M.W. and Mr. C. F., the President of the Residents' Council, were asked who their clinical nurse coordinators are on their respective units. Neither one knew the answer. This is unacceptable for a long term care facility. To be sure, there are a few contract staff who are usually assigned to the same units and who are also providing good care.
The nurse aides on the units are essentially without supervision. The contract nurse staff do not supervise the nurse aides, and, when they try to, for the most part are ignored by the nurse aides. This is an intolerable practice and a danger for the health and welfare of the residents. All nursing staff, including nurse aides, must have job descriptions, performance evaluations, and expectations of performance for retention of position. In the December 22,1995, meeting with Mr. Vernon Hawkins, Director of the Department of Human Services for the District of Columbia, Mr. Hawkins said that he realized there is a tension between contract staff and nurse aides.
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Without leadership from nursing administration, the clinical coordinators do not receive the supervision they need. The rehabilitation potential of the residents is not realized. Examples of evidence of this is the presence of contractures, incontinence and the level of bowel and bladder rehab programs, as well as the lack of physical therapy professional services to provide leadership to the ten physical therapy aides in areas such as performing range of motion exercises. This is unacceptable for a long term care facility. This is all described in previous Status Reports to the Court.
It is time to enforce the Appropriate Nursing Staff provisions of the Stipulated Court Order of July 6,1995.
Decubitus Ulcers Before the emergency medical leave of the Associate Director of Nursing (ADON), weekly decubitus ulcer care rounds were initiated on Wednesday mornings. These'rounds consisted of the two ADON's, the clinical nurses on the units, the treatment nurses, the Medical Director, and the resident. It is my understanding that these rounds have now been scheduled to take place once a month because "they take too long." There are very few more important activities in a nursing home than the interdisciplinary care team rounds conducted at the bedside as frequently as possible.
Infection Control The infection control staff person should have her office on a resident care unit and should be constantly making rounds on the units and in residents' rooms.
Eighty percent of suction equipment placed at the bedside was observed to be dirty. Policies and Procedures for Tube feeding and Hydration must immediately be developed.
There are still monthly reports of hospital admissions due to dehydration, infections,
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pneumonia, sepsis all of which are related to inadequate infection control procedures and follow-up continuous education. Hospitalizations for these causes also related to lack of hydration, lack of adequate hand washing, poor nursing care, and improper incontinent care. Hospitalizations for dehydration are considered "immediate jeopardy to resident health" according to federal regulations and can be grounds for the imposition of temporary management.
Residents are in need of better grooming. For example, residents were observed with dirty hair and dirty nails. On the units dirty wheelchairs and dirty geri-chairs were noted.
Personal care items must not be placed on the floor as observed.
Environmental rounds were conducted in the Nutrition department on December 13 and a form for corrective actions to be taken by December 20. The form was returned to Quality Assurance/Infection Control with no identified corrective action taken.
Pharmacy There are five phannacists at DCV. Not one could provide information on what residents are on psychotropic medications and what the medications are and the dosages, despite the fact this information is required knowledge according to federal regulations.
The medication drug pass observations conducted by the pharmacists are frequently based on insufficient numbers of observations in which to make a conclusion on drug error percentages. The federal regulations state that observations are to be made on 20 to 25 doses of medications. For example, if five residents are on five medications, this would fulfill the requirement. In several instances, observations and conclusions are based on zero, two, or five doses of medications.
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One resident, Ms. S.B, has been without a prescribed medication for her hands since September.
All the Court Monitor's nursing home systems expert consultants have assessed that throughout the country nursing homes the size of DCV have one pharmacist. Medications are obtained through a Medicaid contract vendor and are received within twenty-four hours. It is not necessary to have a cumbersome attachment to the pharmacy at St. Elizabeth's as is currently the case.
Quality assurance programs and policies and procedures reflective of a collaborative relationship with medicine, nursing and other departments are lacking. (This is true for all departments in other areas as well.)
All the Court Monitor's nursing home systems expert consultants have found DCV departments divided, isolated, and with no collaborative approach.
Social services These comments are in addition to comments about social services in the Outplacement sections of this report. One resident, a young man who is wheelchair bound, is in obvious need of dental attention. He has been a resident of DCV since 1982. The nursing homes systems expert consultant to the Court Monitor earlier this month asked him if he would like his teeth fixed. He said that if his teeth were fixed he would not have to repeat himself so much and tears came to his eyes. There is also a full-time Dentist at DCV. It is a violation of the medical social services requirements in the federal regulations not to have coordinated dental services for this young man.
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IV. IMMEDIATE ACTION STEPS A. Mental Retardation GUCDC move their offices immediately to Unit 5A, where the residents
with mental retardation live. B. Mental Illness The Chief of the Central Referral Bureau assume leadership for
coordinating the outplacement of residents with mental illness. C. Outplacement The head of the Social Services Department be removed from involvement
in the outplacement process and leadership for outplacement from the social services be transferred to Ms. Betty Blythe.
D. Nursing Care Contract nurse staffing vendors and their contract staff receive immediate
inservice from the professional community on the Nursing Home Reform Law and the federal regulations which outline the minimum requirements for standards of practice for nursing home care. The vendors will assure that no contract staff is sent to DCV without this continuing education. While at DCV, the contract staff must be supervised.
V. POTENTIAL MODELS FOR NEW MANAGEMENT I am drawing upon the expertise of professionals in long term
care and nursing home operations to propose models to the Court used in other parts of the country. Many of the consultants to the Court Monitor live in the District, know DCV, have local, national, and international reputations, and are vitally concerned about the health and welfare of the residents.
A new management team should have the ability to hire and fire personnel. Front
27

line caregiving staff should be given the opportunity to be retained if they meet and agree to specific performance criteria.
There are professional association lists of qualified management teams, as well as federal government teams, and the potential for a creative use of local talent. These will be researched and presented to the Court immediately.
On Saturday, January 13, 1996,1 met with Dr. Harvey Sloane, Commissioner of Public Health for the District and shared with him my assessments and conclusion for the need of new management at DCV.
On Monday, January 15, 1996, at Dr. Sloane's initiative, Dr. Sloane and the Court Monitor met with Dr. Philip Lee, the Assistant Secretary of Health and Human Services in the U.S. Department of Health and Human Services. The purpose of the meeting was to share with Dr. Lee the situation at DCV. The D.C. Initiative, the intent of which is to explore how federal agencies may be of service to the District, is under Dr. Lee's Office. The Court Monitor gave copies of the Court Orders and the Status Reports to Dr. Lee, who said he would explore the use of Commissioned Corps personnel to serve at DCV.
On Tuesday, January 16, 1996, a conference call was held with Mr. Vernon Hawkins, Director of the Department of Human Services for the District, Dr. Sloane, the Commissioner of Public Health, and the Court Monitor. Mr. Hawkins shared with the Court Monitor his conceptual thinking regarding a management team for DCV. According to Mr. Hawkins, his thoughts include bringing in a management team to lead the nursing and dietary departments, and outside consultation for medical care. Mr. Hawkins' plans include detailing Ms. Sue Brown, currently with the Commission on Health Financing in the District, to supervise "day to day policy formulation and
28

direction,", to have authority to procure items and "sign off on personnel action," and to coordinate activities of a management team in nursing and dietary.
Mr. Hawkins also said he met with the Chief Financial Officer for the District, Mr.
Anthony Williams, regarding payment issues at DCV. Mr. Hawkins was to hear from Mr. Williams at 5pm, Tuesday, January 16 regarding authorization of payment of vendors. The Court Monitor asked Mr. Hawkins to please call once he heard from Mr. Williams that day. As of this date, I have not heard from Mr. Hawkins.
The Court Monitor shared with Mr. Hawkins concerns about his plans. The first concern is that on December 19, 1995, the Court Monitor called Ms. Sue Brown to inquire about financial audits, which would be necessary in order to apply for home and community based waivers for the outplacement planning of residents with mental illness. Ms. Brown would not speak with the Court Monitor until a representative from the Corporation Counsel's office was also a participant in the phone conversation. I gave Ms. Brown the number of Ms. Barbara Mann, with whom I happened to have just spoken. At the end of the conversation, I told Ms. Brown that I look forward to meeting her. Ms. Brown told me that she does not want to meet any court monitor nor have anything to do with a court.
I also shared with Mr. Hawkins that more than two departments would need new management, and that I do not believe a management team will accept supervision from the District under a Contempt citation.
Conclusion I believe the announced closure of DCV by the Mayor and the City Council after the Stipulated Order of July 6 was filed and the appointment of the Court Monitor, has
29

undermined the efforts of the Court to improve life for the residents in their homes at DCV.
My previous assessments of a motivated and caring staff were based on a model and assumption of staff independent and separate from the binds of the District government. However, it is now clear to me that DCV is micro-managed from outside its walls and campus; micro-managed from aframeworkthat does not factor in the welfare of the residents. That the framework from which it is micro-managed is fueled by protection of itself and insulation of its member to the detriment of the object of its services - the residents of DCV. That it produces a closed system, not open to input and growth for the betterment of and improvement in resident care.
I now have serious concerns for the health and welfare of the residents. I believe new management at DCV under Court monitoring will protect the residents health and welfare and prevent further violation of their rights.
I do not believe that at present the District of Columbia is capable of directly caring for the residents of DCV nor following the Court Orders. My duty is to present to the Court the life of the residents and the status of compliance of the District with the Court Orders. The Court Orders merely profile decent care practices, which any of us would want for our loved ones, and which should be expected of a compassionate society and especially of a nursing home in our nation's capital.
30

 
 APPENDIX A

U.S. v. District of Columbia NH-DC-001-019

DECEMBER 6 AND DECEMBER 10,1995 LETTERS TOTHE COURT

HARRIET A. FIELDS, Ed., R.N. #604
1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
December 6, 1995
The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001
Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Order Modifying Stipulated Order of July 6, 1995.
Dear Judge Hogan:
I am writing to inform you of a situation relating to vendor payment at DCV which is having a direct impact on the operations of administration and the nursing department in terms of the amount of time spent trying to put corrective systems in place. If this situation continues, there will be a direct negative impact on resident care by Sunday.
The situation is the following. National Nurses, Inc. is among the many vendors who have not been paid within "forty-five days from the date of a legitimate invoice is received." Stipulated Order. July 6, 1995.
As a consequence, as of 11pm last night and again tonight, National Nurses has threatened to withdraw their services. Thus, the District of Columbia would be out of compliance with "needed goods and/or services procured for the benefit of the DCV residents shall not be terminated due to...non-payment or delinquent payment of...vendors." Stipulated Order. July 6, 1995.
National is a particularly important vendor. DCV has two contracts with National, one is for as needed staffing, which will only increase as more DCV employees leave relating to closing. The second contract, implemented in the beginning of October with another phase in on November 6, is for management level nurses.

This second contract provides for the 16 FTE permanently assigned nurses to serve as replacement unit clinical coordinators on three of the units where DCV employees have left. In addition, this second contract provides for the permanently assigned quality assurance and staff development education personnel to work at the unit level in conjunction with the two Associate Directors of Nursing (ADONs) . It is this activity that is so critically needed for continuity of care, improvement in care, development of the interdisciplinary discharge care plans described in the Monitor's November Status Report, and required under federal and District law and regulations and the Court Orders.

Under the first contract, National supplies within a twenty-four hour period, five to six nurses for the evening and night shifts combined. Coverage for these positions has been arranged through other contract nurse staffing vendors through Saturday. However, as of Sunday, December 10, 1995, the nursing department projects much difficulty filling these slots with other vendors, who have also not been paid. It is non-payment of this first contract that is out of compliance.

The Court Monitor, late this afternoon, was able to convince Mr.

Ronald Messenheimer, President of National Nurses, not to

withdraw .the services of the management nurses, since

technically the payment of their invoices is not yet out of

compliance.

Of course, it is certainly within Mr.

Messenheimer's business prerogative to do so.

It is my understanding from Ms. Gladys Fountain, InterimAdministrator for Long Term Care, Commission of Public Health, District of Columbia, from information she received from Janette Michaels, Consent Decree Coordinator for the District of Columbia, that as of late this afternoon, Mr. Garland Pinkston of the Office of the Corporation Counsel will hand deliver a voucher for payment to Mr. Williams, the Chief Financial Officer for the District of Columbia.
As of 7:30pm this evening, the vice-president for National Nurses, Inc., Mr. Grant, has told me that they will continue to provide services tonight, but the payment situation must be resolved tomorrow morning or the threat to withdraw all staff will occur.
The scenario described above must not be allowed to occur month after month, the residents are coming painfully close to suffering.
I want to briefly share another lack of payment example and how pitifully it has affected one resident, Mr. L.R. It also provides another example of how critical the vendor payment list with phone numbers is to the Court Monitor in order to help prevent needless violation of residents rights and needless pain

and suffering of the frailest of District of Columbia residents.
Mr. L.R., a young man, is a total quadriplegic. That is he has no use of his arms or legs. . He also has complete use of his mind. Mr. L.R. has been in bed for a month because the right foot rest of his wheelchair is broken. The physical therapy department has not been able to get a response from the vendor which repairs wheelchairs, Rehabilitation Equipment Professionals (REP). The Court Monitor spoke with the vendor today and was informed by REP that they have an outstanding bill for payment for repair to Mr. L.R.'s wheelchair of $587.50 from April 27, 1995. It is my hope that by reading this, the ablebodied decision makers of District will be shamed into improving the life of the able-minded artist, who is imprisoned in his bed because of this negligence.
The payment to these two vendors, especially National Nurses, will be closely monitored, and the Court Monitor will inform the Court on a daily basis of progress.
Once again, Judge Hogan, it is a privilege to serve the Court and to work with all concerned parties for the best interests of the long term care residents of the District of Columbia.
Sincerely',
Harriet A. Fields, Ed.D., R.N. Court Monitor
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann Asst Corporation Counsel for the District of
Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001
T-irr

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
December 10, 1995
The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001
Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Order Modifying Stipulated Order of July 6, 1995
Dear Judge Hogan:
I am writing the Court now, before the next Status Hearing in January, because of four areas of concern which must be addressed immediately. I am also in this letter to the Court, recommending further data gathering and remedies to rectify what I have now identified as patterns detrimental to residents well-being.
The four areas I will address are the following: (1) update on Mr. L.R. profiled in my December 6, 1995, letter to the Court; (2) the process of procuring purchase orders for vendor services, whereby there is now no stock of normal saline used as a treatment modality for decubitus ulcers; (3) chronic non-compliance of payment of vendors, whereby there is now no duoderm in house for treatment of decubitus ulcers and no payment to National Nurses profiled in the Court Monitor's December 6,1995, letter to the Court; (4) residents' being denied their own funds from their Personal Needs Allowance (PNA).
Each of these four areas are indicative to me of a common thread of similar patterns. These patterns are what I believe to be a misuse of government funds, passivity and lack of advocacy on the part of staff for residents' needs and the acceptance of the bureaucratic inertia described in the Court Monitor's October Status Report under C. Payment of Vendors (p. 22), and needless and unconscionable delays in issuing purchase orders from the Procurement Office of the Department of Human Services, District of Columbia.
A description of these patterns in action is profiled in the Court Monitor's November Status

Report under IE. Stipulated Court Order. July 6,1995, B. Measures to Remedy Shortages. 1. Food and Drink (pp. 29-31.)
However, I want to assure the Court, there are some staff who are true advocates for residents rights. The two Associate Directors of Nursing (ADONs) are implementing proactive steps to improve the standard of practice and care and are also openly, constructively, and professionally implementing the Court Monitor's recommendations.
Each of the four areas listed above will be profiled. At the end of the profiles will be recommendations and remedies needed to rectify the patterns reflected in all the areas profiled.
(1) Update on Mr. L.R. profiled in December 6. 1995 letter to the Court
On December 8, 1995, Mr. L.R. was out of bed and up in his wheelchair and resumed his usual place at the entrance to DCV, where there is day light, activity, and other human contact Mr. L.R.S situation reveals a pattern of passivity on the part of the staff and also a non payment of vendor problem.
The internal problem revealed by this resident scenario is the following. To be sure, the nursing staff did contact physical therapy when Mr. L.R.'s wheelchair first broke. However, a systems failure set in whereby no one rectified the problem until the Court Monitor was notified by the ombuds person and the President of the Residents' Council, immediately stepped in and called the physical therapy department and the wheelchair repair vendor, and alerted the Court. Daily rounds by nursing and administration would have uncovered this negligence.
The external problem revealed by this scenario is that a previous repair to Mr. L.R.'s wheelchair has gone unpaid since April, 27th of this year and the vendor was unwilling to service DCV again as a result of this neglect in payment.
Not maintaining resident equipment is a violation of federal regulations and the Court Orders.
(2) Process of Procuring Purchase Orders (P.O.) for Vendor Services
Last week at the time of writing of the Court Monitor's November 30 Status Report to the Court, mis problem was reflected in a shortage of food supplies to the residents. This week mis problem is reflected in an inadequate supply on hand of treatment modalities for
decubitus ulcers, specifically, normal saline tocleanse the site and duodenn to apply to the
wound. (Duodenn will be discussed under vendor non-payment.)

For about a week sterile water from treatment kits for other uses has been used to cleanse wounds. Sterile water is an appropriate substitute, however, normal saline is preferred. Normal saline is an item mat should be routinely on hand in any nursing facility, and is also necessary for the sterile cleansing of other equipment, such as catheter and tracheostomy tubing.
While making rounds with the treatment nurse on Thursday evening, December 7,1995, the Court Monitor discovered there was no normal saline in-house. On unit 4A, at Mr. CF.'s bedside while dressing Mr. CF.'s stage HI decubitus ulcer on his left hip, the treatment nurse told me mat they have been out of normal saline for about a week. This reminded me of a camping expedition, where ingenuity in substituting routine supplies saves the day. However, mis is a human being with a gaping whole in his body. At times DCV is operating like an underdeveloped country, when in fact this is the nation's capital.
On October 10, 1995, DCV submitted a "request for purchase order" to the Procurement Office, Department of Human Services, District of Columbia. Among the items listed on the purchase order were normal saline and duodena. The request for purchase order was marked "Urgent per Court Order." Once purchase orders are sent from the Procurement Office and received by DCV, they are sent by DCV to the vendor for delivery of supplies. If the vendor has been paid, supplies will be delivered.
DCV received the requested purchase order on December 6, 1995. Prior to receipt of the P.O., the staff person from DCV submitting the "request for purchase order" called Ms. Cheryl Perkins of the Procurement Office and stressed to her the urgent need for receipt of the P.O. for care of the residents and that priority should be given to DCV which is under a Court Order. Apparently, Ms. Perkins' response was that there are many District of Columbia agencies under Court Orders. I believe the analogy the DCV staff person used is a good one: "Ms. Perkins needs to know that DCV cannot be run like a stationery store, where you run out of pens or something: residents lives are at stake."
In a nursing facility it is not always possible to anticipate needed supplies months in advance. For example, the size of bandages needed will depend on whether a wound develops (which should not be happening), the site, and the anatomy of the resident.
According to staff and administration at DCV, receiving purchase orders in a timely fashion from the Procurement Office has been a chronic problem. (Recommendations to the Court are at the end of the profiles section.)
Lack of adequate supplies for resident treatment and care is a violation of federal regulations and the Court Orders.

(3) Chronic Non-Compliance of Payment of Vendors
As of Saturday, December 9,1995, DCV is out of supply of one treatment modality for decubitus ulcers, duoderm. Treatment nurses are using a substitute which they believe is not quite as effective. One treatment nurse does have a limited supply of duoderm only because, through her wisdom and experience, she secreted supplies anticipating this scenario. There is no duoderm, although I am informed emergency supplies are on the way, because District Healthcare, the vendor, has not been paid. District Healthcare is owed approximately $42,000.
Update on National Nurses. Inc.. profiled in December 6,1995, letter to the Court: On Thursday evening, December 7,1995, Mr. Ronald Messenheimer, President of National Nurses, Inc., left a message for the Court Monitor, that he had received "confirmation from the Chief Financial Officer's office (for the District of Columbia) mat National will be payed in the next check run on Friday or Monday. I will continue services pending receipt of check on Friday or Monday."
On Friday afternoon, December 8, 1995, Ms. Barbara Mann of the Corporation Counsel's office for the District of Columbia, left a message for the Court Monitor concerning National Nurses Inc., that "we are not aware of any termination prior to the weekend or immediately thereafter, it is our understanding a check will be delivered to them not later than Thursday of next week. We are covered for the weekend at DCV." This information is in conflict with the information Mr. Messenheimer was told the day before from the Chief Financial Officer's office.
The Court Monitor will inform the Court on a regular basis. Within the past week, the Court Monitor has begun to notice shortages of staff; primarily of nurse aides. Contract nurse staffing vendors are supplying nurses. However, none of them have been paid. Most recently in a letter dated December 6,1995, to Mr. Vernon Hawkins, Director, Department of Human Services for the District of Columbia, CUP HealthCare Services has indicated they will terminate services on Thursday, December 14, 1995. CUP HealthCare Services is owed $93,102.86, ( $11,935.77 of which is from December 1994.)
Nurse aides are District of Columbia government employees, are unionized, and are opting to take annual leave before DCV closes and they loose their benefits. Further monitoring is needed to determine why there are not nurse aide replacements and where there may be a potential source. Apparently, through the Personnel Department of the District of Columbia, there is difficulty securing staff for a limited term employ.
DCV receives one of the highest Medicaid reimbursement rates in the continental United States, approximately $240 per resident per day. This amounts to approximately $87,600

per resident per year. When the Court Monitor first arrived at DCV on August 28, 1995, there were 270 residents. That is a total reimbursement rate of approximately $24,000,000 per year. Approximately half of mis total is federal funds and approximately half is District funds. According to DCV administration, as mentioned in the Court Monitor's November Status Report to the Court, DCV is funded through fiscal Year 1996. Where are these funds?
The same vendor non-payment problems profiled in the affidavits of June 1995, which led to the Stipulated Court Order of July 6, 1995, are the same problems today. (Remedies needed to rectify this situation are at the end of the profiles section.)
(4) Residents Denied Personal Needs Allowance (PNA5)
Residents are to receive their Personal Needs Allowance (PNA) on the first of each month. As of today, the residents have not received their December funds, nor can anyone tell them when they will receive their money. The residents have a Holiday shopping trip planned for Friday, December 15, 1995.
The Personal Needs Allowance is residents' money and in the District of Columbia amounts to $70 per month. The source of the PNA is two-fold. One is for the "categorically needy." These are residents with no other source of income and who receive Supplemental Security Income (SSIj. This amounts to a federal minimum share of $35 per month and in the District of Columbia a matching share to equal the $70 per month. Q. believe the ratio in the District is federal contribution of $40 and the District of Columbia contribution of $30.) The second source of PNA is the "medically needy." That is residents with social security, disability, and or public or private pensions. From these sources of income, $70 per month is withdrawn and to be put into the residents PNA. The remainder of these sources of income contribute to the residents Medicaid reimbursement rate.
In an interview with the teller at DCV on Friday, December 8, 1995, the teller told me that he has not received money in two and a half months, what he has been using to give to residents as their PNA is money remaining in the fiscal budget (I believe last year's.), and that he normally receives funds every week to two weeks. The teller also told the Court Monitor that the PNA is from the District of Columbia Treasury.
It is a violation of federal law and regulations to co-mingle resident funds with anv other account Resident funds in excess of $50 are required by federal regulations to be in an "interest bearing account (or accounts) mat is separate from any of the facility's operating accounts, and that credits all interest earned on resident's funds to that account" [42 CFR Part 483.10 O (1) through (7)].
Judge Hogan, I cannot tell you how sad and pitiful it is to see the residents hovering around
5

the window of the teller, across the hallway from the administration offices. There is a steady stream of residents throughout the day. The residents have not reached the justifiable anger stage yet, although some are close to it la their eyes you can see that they are stunned, bewildered, and hurt On Thursday, December 7 the staff was paid. The residents are acutely aware of this and the fact, that there is no money to pay them their own funds.
The residents have so little in life, it is their dignity that is being robbed from them as well as their money. Being deprived of their PNA adds to the stress of the impending loss of their homes, and the stress of institutionalization at the Holiday season.
Recommendations and Immediate Remedies Needed
I believe all the above situations will continue unless the recommendations and remedies that follow are immediately put in place. As DCV continues to approach closing, I can foresee operations unraveling, as it has already begun to do so in the areas profiled above: nurse staffing, dressings for the treatment of decubitus ulcers, wheelchair repairs, and the residents' Personal Needs Allowance. I foresee the non-payment of vendors becoming out of control.
I believe the primary issue is the misuse of and lack of accountability for government funds earmarked for the operations of D.C. Village Nursing Home and for the direct care of the residents of t).C. Village Nursing Home - the most vulnerable and frail of the District of Columbia population. Non-payment of vendors is symptomatic of this larger issue and is manifested in the culture of tolerance for and acceptance of bureaucratic inertia. The behaviors surrounding this culture are manifested internally at DCV by the acceptance of and tolerance for lack of supplies for basic humane care, and externally among DCV government officials, by the tolerance and acceptance of needless delays in the procurement process.
Therefore, in order to prevent the further dissolution of residents' rights the following immediate remedies are needed: (These remedies are not to supplant my recommendations in my Status Reports to the Court, the remedies identified here specifically relate to the concerns identified in this letter.)
(1) An independent audit under the Court's auspices, of the government funds earmarked for DCV. (For over a month now the Court Monitor has requested the Budget and Annual Costs Reports of DCV, most recently in the November Status Report.'):
(2) Since there are dedicated federal and District matching funds earmarked solely for the operations and direct care of the residents at DCV, there is no need for requests for purchase orders to enter the bureaucratic maze of the D. C. Government process. And since DCV has a scheduled closing date of the end of March, 1995, all requests for necessary purchase orders will be filled within a two week turn around:

(3) An accounting of Resident Personal Funds:
(4) Establishment immediately of a separate account for residents* personal funds including the residents' Personal Needs Allowance.
Judge Hogan, I look forward to serving the Court in monitoring the implementation of these recommendations and immediate remedies needed for the best interests of the residents of D.C. Village Nursing Home.
Sincerely,
Harriet A. Fields, EAD., R.N. Court Monitor
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann, Mr. Garland Pinkston Office of the Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

"1 •••'' — '

•

•

rim-

APPENDIX B
REPORT OF THE EVALUATION OF FOOD AND NUTRITION SERVICES OF THE D. C. VILLAGE NURSING HOME

REPORT OF THE EVALUATION OF FOOD AND NUTRITION SERVICES OF THE D.C. VILLAGE NURSING HOME Submitted by Mamie W. Byrd, R.D., L.D. Jewel L. Lewis, M.Ed, R.D., L.D. Allan A. Johnson, Ph.D., L.N.
Department of Nutritional Sciences Howard University
January 17, 1996

REPORT OF THE EVALUATION OF THE FOOD AND NUTRITION SERVICES AT THE DISTRICT OF COLUMBIA VILLAGE NURSING HOME
The food and nutrition services components of the D.C. Village Nursing Home were evaluated at the request of Dr. Harriet Fields, Registered Nurse, the Court Monitor, during the period of December 20, 1995 through January 5, 1996, by two (2) Howard University faculty members: Mrs. Mamie Byrd, Registered/Licensed Dietitian, Instructor, and Project Director of the Howard University Health Promotion Institute, and Mrs. Jewel Lewis, M.Ed., Registered/Licensed Dietitian, Assistant Professor, Department of Nutritional Sciences.
Mrs. Byrd has an extensive background in nutritional care management and Long-Term Care services, as well as teaching Clinical Nutrition at Howard University. Mrs. Byrd conducted the evaluation of clinical nutrition services.
Mrs. Jewel Lewis teaches Food Service Systems Management and Quantity Food Production Management at Howard; served as the state agency nutritionist for the D.C. Office on Aging for five (5) years; former Food Service Director of the Washington Center for Aging Services, and has practiced dietetics for 26 years. Together this teams' experience exceeds 40 years of clinical nutrition care and foodservice administration and management. Mrs. Lewis performed the evaluation of foodservice administration, management, production, and service.

This report addresses the findings from the evaluation according to the following:

Court Order:

To ensure that sufficient supplies of nutritious and appropriate food and drink are consistently maintained at DCV and that each resident daily receives adequate, wellbalanced, nutritious and appropriate food and drink according to their nutritional needs.

FOOD SERVICE DEPARTMENT ADMINISTRATION

Three problems were identified in the policies and procedures area:

1. The policies and procedures manual was incomplete and outdated.

2. There were no apparent policies to cover the following critical areas of patient care and foodservice management:

a. Decubitus ulcer protocol b. Documentation of food consumption ci Hydration schedule d. Addressing unplanned weight loss e. Menu Analysis f. Menu Substitutions g. Staffing pattern h. Job descriptions i. Employee Scheduling j. Employee Orientation k. Purchasing procedures 1. Emergency food/beverage supplies m. Re-assessment of post-hospitalized residents

3. Lack of uniformity in patient care management

RECOMMENDATIONS

1. Prepare policies and procedures for each of the critical areas of patient care and foodservice management, including the above listing. Procedures should be adequately detailed to ensure the desired treatment out outcome for the policy written.

2. Conduct in-service training to acquaint staff with the policies and procedures developed.

FINANCIAL ANALYSIS/BUDGET ISSUES
Documentations were not provided for this area. The Food Service Director had promised to meet with me at 8:30 a.m. on January 4, 1996 to provide data to support the above, as well as other materials requested. However, I was kept waiting in her office for l hour and she never showed up though I was told that she was in the building. I left the building at 9:35. She had informed me earlier that she would not be in the office the following day. I was told that she had complained to the Corporation Council regarding the request for documents and was later asked by the Court Monitor not to collect any more data.
RECOMMENDATIONS
An audit of financial activities at D.C. Village be conducted by an independent auditor.
FOOD SERVICE SYSTEMS
In order to ensure compliance with the above court order, the following foodservice systems must be in existence and rigorously adhered to:
First, .there should be an effective procurement system which includes a purchasing manual that incorporates statements of objectives, scope, authority, and relationships. A good manual can provide continuity and consistency, which are difficult to maintain otherwise.
Receiving, storage, and inventory control are some of the critical elements of procurement.
Receiving
Receiving can be defined as an activity for ensuring that products delivered by suppliers are those that were ordered in the purchasing activity.
The receiving process involves more than just acceptance of and signing for delivered products. It also includes verifying that quality, size, and quantity meet specifications.
When procedures are not systematized, a number of problems may arise, such as losses due to carelessness, failure to assure quality and quantity of goods delivered, and pilferage. Competent personnel with specified responsibilities, well written specifications, procedures for critical control, adequate supervision, scheduled receiving hours and procedures to ensure security are desired elements of the receiving activity.
• i

Storage Storage is the holding of goods under proper conditions to ensure quality until time of use. Only those personnel authorized to store goods, issue goods, check inventory levels, or clean the areas should have access to storage facilities since prevention of theft and pilferage is a major concern. Both have impacts on the availability of adequate food supplies. Inventory Records Inventory is a record of food, supplies, and materials owned by the facility. Inventory records have four basic objectives. 1. Provision of accurate information on food and supplies in
stock 2. Determination of purchasing needs 3. Provision of data for food cost control 4. .Prevention of theft and pilferage Inventory control is the technique of maintaining food, food supplies, and materials at desired quantity levels. The major objectives of this control are to maintain quality of goods and supplies, to minimize inventory costs, and to ensure that adequate quantities of food are on hand for production and service needs. A periodic physical count of food and supplies in storage is an important requisite of any inventory control system. D.C. Village failed to provide documentation of:
1) Inventory 2) Storeroom requisition files 3) Existence of a purchasing manual 4) Policies and procedures regarding purchasing, including
receiving, storage, and inventory control
ir

RECOMMENDATIONS
1. Develop an effective procurement system, including a purchasing manual, statements of objectives, scope, authority, and relationships, including a section for each of the elements of the procurement system.
3. A periodic physical count of food and supplies in storage be conducted and records be retained according to the required legal period.
4. Appropriate staff receive in-service training in numbers 1,2, and 3 above.
The second critical area in the foodservice system is production or the preparation of menu items in the needed quantity and with the desired quality, at a cost appropriate to the foodservice operation. While quantity deals with numbers, quality should include not only the aesthetic aspects of a food product but also the nutritional value and the microbiological safety of the product.
The basic tool for the production system is the production sheet which translates the menu into a plan of operation and is the single most- important, available production control. This form should contain as a minimum the following information:
• *census
• menu item
• *recipe
• *portion size
• total portions
• *amount to prepare
• distribution of portions
• *overproduction and underproduction
• special instruction and comments
• preparation
• *menu substitutions

Six (6) of the above eleven (11) elements of minimum information were omitted on the production sheet used at D.C. Village (identified by asterisks). This discussion is limited to three (3) of those six (6) items since they impact directly on the court order. Recipe Standardized recipes must be used in order to verify yield, or number of servings, compute food costs, and ensure consistent quality. Recipe numbers and titles need to be indicated in order to avoid any confusion by the production staff, including cooking utensil(s) and service equipment.
Portion Size
This is needed for use in calculating quantities to prepare and for communicating to food service personnel the standards on which production is based. Quantity of Food to Prepare Should be indicated in pounds, etc. for meat and dry ingredients; the size and number of cans, etc. for canned items ; and the number (#) of pounds for frozen foods, etc. While some of the information was available it was not always being used appropriately. Production sheets listed the number of servings to produce, but the quantities of food required to be produced to achieve these numbers were omitted. Other irregularities included:
1. Recipes were not being used by foodservice personnel to determine portion sizes.
2. Improper serving utensils were being used for four (4) food items during a luncheon meal: three (3) ounce serving utensils were being used where 4 ounce portions were required.
3. Portion sizes were omitted on menus, production sheets, and recipes. Therefore the nutritional status of residents is at risk.
i n

RECOMMENDATIONS
1. Develop a system for food production and service including policies and procedures for effective production controls.
2. Modify, update or adopt a recipe system to include (a) portion sizes, (b) specifications of cooking equipment to be used to prepare the food item, (c) type(s) of serving utensil(s) to ensure the desired portion size is achieved.
3. Modify and update production sheets to include portion sizes and quantities to be prepared.
4. Include portion sizes on all menus, including nourishment sheets.
5. Conduct in-service training for appropriate management and staff to familiarize them with items 1, 2, 3, and 4 above.
6. Adopt a comprehensive and systematic program for trayline quality assurance and monitoring, including the designation of appropriate staff to check each station on the trayline for proper serving utensils prior to the beginning of each meal.
7. Documentation of menu substitutions on the menu as served and on the production sheets. Residents should be notified of necessary changes through an approved and effective mechanism.
8. Purchase an appropriate nutrient analysis computer software package to analyze all menus.
The entire menu system should be reviewed. The diet manual indicates that the facility provides eight (8) different routine diets, excluding test diets, but records indicate that 20 different types of diets have been prescribed for the residents, varying in complexity and compositions and similar to those found in a an acute care hospital diet manual.
Many of the diet prescriptions are very restrictive. Generally this type of situation lends itself to noncompliance with the diet order on the part of the resident such that food intake is diminished, plate waste is prevalent, and residents become extremely dissatisfied with the meal service. Geriatricians, especially geriatric dietitians and nutritionists, advocate and recommend a more liberal dietary pattern for nursing home residents.

Greater satisfaction and improved food intake have been demonstrated through the use of a more liberal diet. The use of nutritional supplements are usually decreased as a consequence and often results in tremendous costs savings to the facility.
Residents at D.C. Village were very vocal about expressing their dissatisfaction with the food served at the facility, including complaints about "receiving the wrong food item(s); "unattractive meals"; "tasteless food"; "small servings", " the same foods served for Christmas as any other day".
RECOMMENDATIONS
1. Adopt a more liberal dietary pattern consistent with the dietary practices of most nursing homes to improve the dietary intake of residents.
2. Advise physicians of the need to use the facility's diet manual as a guideline for ordering diets for their patients in order to achieve the goals of the facility.
CLINICAL NUTRITION CARE MANAGEMENT
The Court Monitor, Dr. Harriet Fields, Registered Nurse, requested that this portion of the evaluation be focused on the nutritional care management for three (3) categories of residents: (1) those with decubitus ulcers(pressure sores), (2) those who had experienced significant unplanned weight changes, and (3) and those who had experienced frequent hospitalizations. A sample of twelve (12) residents was randomly selected from a list of twenty-four (24) residents provided to the evaluator by the Court Monitor.
The twelve (12) charts were reviewed to assess the quality of residents' care and to determine the degree of compliance with federal and local regulations. Findings were as follows:
1. One hundred percent (100%) of the records lacked documentation of food consumption, that is, no record was available which documented the amount or percentage of food, beverages and dietary supplements consumed by the resident. The use of food consumption records is a standard nutrition care management practice. With only an occasional notation, it is virtually impossible to assess the nutritional adequacy of a resident's food and fluid intake.

2. Sixty-seven percent (67%) of the records contained prescribed dietary supplements. Frequency of use and volume prescribed is of concern due to the fact that excessive use of dietary supplements has been demonstrated to suppress appetite and decrease the amount of food ingested during the service of regular meals.
3. Forty-two percent (42%)of the records indicated that residents were to receive increased fluids based on assessed needs by the Registered Dietitian. However no distinct identifiable interventions were observed on the charts or resident's meal trays in comparison with those residents who did not have recommended or prescribed interventions.
4. Twenty-five percent (25%) had experienced significant, unplanned weight loss or gains which were not aggressively and sufficiently addressed by dietary interventions. In three (3) cases no follow-up strategies were suggested or implemented, eg., re-weighing of residents to verify changes in weight and to rule out scale errors; calorie counts; meal observations; visitation of residents during meal hours to validate food consumption; review and update food preferences or perhaps consultations with the attending physicians, nursing aides or family members, etc..
Case Study:
A. Mr. B.T., a resident of unit 2B, is a quadriplegic with multiple decubiti who has recently experienced significant weight changes as well as a relatively recent hospitalization. The resident's weight history is as follows :(8/95) 149 lbs., (9/95)164.5 lbs., (10/95) 132 lbs. During the months of (11/95) and (12/95) resident refused to be weighed. The dietitian documented her awareness of his weight problem in her progress note of 10/24/95. However there was no documented effort to explain the loss; changes in appetite; adequacy of intake; acceptance and tolerance of diet; and no plan of care or intervention strategies were proposed. A later consultation with the Nursing Coordinator for this unit revealed that Mr. B.T. had experienced a hospitalization for urinary retention which was probably the reason for his unusual pattern of weight changes. However, the 10/95 weight still represented a significant weight loss from this resident's usual weight. Further, the nursing records revealed his refusal of the prescribed supplements, yet this was not addressed in the dietitian's progress notes or the care plan. The supplements were not discontinued and no other dietary interventions were proposed.

Other nutrition related problems noted regarding this resident include a moderately depressed serum albumin level of 3.3 mg/dl per 6/95 lab results and no follow up was done or recommended. In view of the problem with severe weight loss, decubiti and poor oral intake this indicator can serve as a predictor of malnutrition. An albumin level of less than 3.5 mg/dl frequently reflects protein-calorie malnutrition.
Nursing was also the verbal source of other very pertinent information such as the resident's non-compliant behaviors refusal to be turned, refusal to do ADL's and refusal to eat anything if he did not get what he had specifically requested from the dietary department. While this resident has a long history of being a very "picky eater", none of these facts was noted in the dietary or nursing progress notes nor in the resident's interdisciplinary care plans.
Finally, an interview, with a Registered Nurse who stated that she has had a twelve (12) year history of caring for this resident, revealed that he had recently exhibited signs of "giving up" and depression. She explained that she believed this may have something to with the recent changes in his behaviors, as well as his mental and emotional outlook on life. Yet none of these observations or suspicions had been documented. The writer inquired about a psychiatric consult or if there was anyone who was emotionally close to resident who could possibly coax or encourage him. The response was that she had hoped that he was scheduled to be seen by an outside group of consultant psychiatrists who were currently making rounds. The chart review was performed on 1/5/96 and none of this was reflected in the resident's chart at that time. The Head RN stated her intention to adjust the IDT patient care plans to reflect more detailed and relevant aspects and issues surrounding the management of his care.
5. Seventeen percent (17%) of resident's care plans did not reflect the current resident status and care or simply did not adequately address the care needed.
6. Thirty-three percent (33%) of annual nutrition assessments omitted significant data regarding the resident's progress as it related to residents' nutritional status and the nutritional care plan goals. Current issues of resident care were also omitted.
10

Meal Observation and Tray Accuracy
During this review several meal rounds and tray line observations were conducted, including meal trays of those residents who were included in the patient sample of for charts reviewed. However observations were not limited to those alone.
During and throughout the visitation a pattern of tray inaccuracies became evident.
1. On 12/28/95 Mr. CF of Unit 3A who has a diet prescription for a High Fiber diet received white bread which was even marked on his tray card. Apple juice was on his tray, also. Reviewing the dietary department's carded file revealed that he should have received wheat bread and cranberry juice, according to physician's order.
2. On 1/3/95 JB's chart on Unit 3A indicated that he was to receive a 2 gram Sodium Pureed diet, but he was served a dental soft diet. Fortunately, this resident was able to tolerate the diet very well. However, the question arises regarding the need for re-evaluation by the dietitian to recommend an upgraded diet for this resident. A pureed diet probably would not have been acceptable to this resident. .However, the diet sent to the resident did not correlate with the diet order or tray ticket.
Other examples of tray inaccuracies were noted, and are available upon request.
RECOMMENDATIONS
1. The development and implementation of a comprehensive system for nutritional care management of the residents at D.C. Village nursing home.
2. The development and implementation of a uniform system for documenting the nutritional care management of residents at D.C. Village nursing home.
3. Establish policies, procedures, goals, and objectives for training management and staff in tray accuracy and tray line monitoring, including outside conferences, courses, seminars, work shops, and/or professional consultants.
4. Routine updating and documentation of residents1 food preferences, dislikes, and allergies.
11

5. Establishment and implementation of an effective and consistent program of hydration, including a Hydration Policy to ensure uniform approaches in the prevention and treatment of dehydration. Both Nursing and Dietary Departments will need to collaborate to devise a policy and procedures.
6. Institute a mechanism or method for assessing and documenting food intake.
7. Comply with residents' rights by developing a policy to post menus on each unit and follow through with the same.
8. Comply with the facility's policy for the re-admission of residents after hospitalization.
9. Implementation of a more uniform and aggressive approach to addressing significant unplanned weight changes.
10. Adoption of a uniform and systematic interdisciplinary care program to reflect a more integrated approach to patient care and describe the plans in writing.
11. Evaluate use of commercial nutritional supplements. 12. Establish a program of quality assurance monitoring which
includes the following areas: a) tray accuracy b) analysis of all menus for nutrient content c) timeliness, accuracy, uniformity and quality of
nutritional care documentation. d) interdisciplinary care plans, treatment protocols, and
client surveys and/or questionnaires.
12
-mrr

APPENDIX C PAYMENT OF VENDORS

Vendor Name Allied Medical Consults
District Healthcare SRT Premier Nursing Serv

Person Contacted Donna Thompson
Sonique Foster L. Duvall

D C V I L > G E NURSING HO VIEVENDC RREPORT

What Suppled?

Outetar Dales & Service* Payment Continue to Ship/

Invoice Rendered

Status

Provide Service?

RN's, LPN"s Yes 10/3/95 12135.41 DCV claim Yes, If they can find nurses to go. Many will not go because they has

10/3/95 4365.55 check in mi il not been paid by the agency. Soon to be none who will go.

10/6/95 954 56

12/29 for $1 7,000 .

11/2/95 460.24

11/2/95 8993.48

11/3/95 260.56

12/7/95 7014.12

•

Yes Still awaiting info

Awaiting info from vendor, but vendor indicated future as supplier is uncertain

RN's.LPWs Yes approx $20,000 ove Per Jeanett Possibly not, if check not rec'd very soon

90 days

Michael, ch )ck

cut as of 1/ 0/96

still not rec' I

Hill-Rom

Richard Hughe: Specialty Mad No
beds

Yes, only because after extensive collection efforts for prior past due balance, DCV overpaid by $4,000 which vendor considers deposit.

J.P. Food Service

A/R Dept.

Food

No

COD ONLY

John Sexton Continental Foods Mr. Leonard Various food Yes items

Nov., Dec, Jan., 16.319.50

now due Yes

SYSCO

Terry in credit Various food No

Account not open now, would have to be reevaluated if order placed. May 1995 last order.

Southern Int'l Corp Calico Industries

Jose Abraham Food

Yes

Finance dept. Kitchen and No
janitorial supp.

:1,140.60

Current, Ja Yes shipment
Account suspended, might still ship

EECO

Srenda

Kitchen exhaus No
serv.& supp.

P.O. has expired. If new P.O. Issued

Galliher & Huguely

Cindy, A/R

Lumber

Yes "$182.34 finance ch Sept inv. fx.Account on hold Dec. financ i
chg now du )

Pameco Corp.

John Wood Refrigeration No

Yes

supplies

>ro-Ed

3am, A/R

Educational No
material

Yes, nothing ordered since 1992

A & A Hearing Center

Sharon ?oehland

-tearing aids Mo

Yes, but probably COD or with deposit. Bad time collecting Fall 1995

Technical Sales & Services

Dean, A/R

Computer repai Yes August inv. $25 bal

Yes, vendor seems to think just a misunderstanding

Vendor Name CUP

Person Contacted
Dianne Johnson

What SuDDlled?
Nurses

Outstar Dates & Services Invoice Rendered
Yes 12/5/94 $11935.11 8/8/95 $1874.81 9/1/95 $7042.58 9/5/95 $1915.26 9/19/95 $2139.87
10/3/95 $15059.46

Payment Continue to Ship/

Status

Provide Service?

-

DCV claims Still sending nurses now. but Mr. Harris, owner, is planning to send a

still tryingjo letter Indicating termination of nurses if old invoices not paid

process.

Vendor has

been paid

for more

recent Inv.

 
 FEB-01-96 THU 17:47 NCCNHR

FAX NO. 2023322949

P.02

HARRIET A. FIELDS, Ed.D., R.N.
#604 172219th Street. N.W. Washington. DC 20009 Message: (202) 234-7142

February 1,1996

IIIII I IfI III (Mlf ifl °| i f l l T f I

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

NH-DC-OoT-020

Re: Court Order The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV);
November 7, Oder Modifying Stipulated Order of July 6,1995 Court Order, December 22, 1996

Dear Judge Hogan:
It is a privilege to serve the Court on behalf of the residents of D.C. Village Nursing Home. My cause as Court Monitor, which I have devoted myself completely, is to report the truth as I see it as it effects the lives of the residents of DCV and the ability of the defendants to comply with the Court Orders.
I stand by all my statements in all of my submissions to the Court including the Court Monitor's most recent January 17, 1996, Status Report and Appendices. I will be happy to attest to my submissions to the Court under oath. I am saddened and pained that the defendants chose to devote their energies (behind closed doors with the considerable personnel resources from the District) into falsely refuting the messenger's January 17 Status Report, as opposed to taking the message to the bedside as a vehicle to improve care for the residents.
It is a tribute to the courage of the Court in its relentless concern for the health and welfare and rights of the residents through the issuance of the Court Orders and the findings of contempt, that the reactive steps defendants have taken to improve care for the residents at DCV have come about.
The intent of this letter to the Court is not to elaborate all the inaccuracies, and misrepresentations of the defendants January Responses and submissions to the Court, but rather U> focus on two

FEB-01-96 THU 17:47 NCCNHR

FAX NO. 2023322949

P.03

which have profound and immediate impact onthe health and welfare of the residents. These
areas relate to my continued concern with the outplacement process, which I have elaborated on in my previous submissions to the Court. These concerns acutely and specifically relate to the outplacement of the residents with mental retardation and the outplacement of the residents with mental illness.
Outplacement of Residents with Mental Rft?rd3tion
Yesterday, Wednesday, January 31,1996,1 had a telephone conversation with Ms. Sheila Gaither, Chief Operating Officer (COO) of D.C. Family Services. Ms. Gaither did in fact have a meeting on January 24 at DCV and did review the records of nine residents with mental retardation. However, the remaining statements by the defendants on the page before numbered page 5 of the Defendants January., submission to the Court are false. According to Ms. Gaither the truth is the following:
(1) D.C. Family Services has the capacity to accept seven residents, not nine - six residents at their O Street, SE site, and one resident at their 58Street, NE site. However, there has been no agreement with DCV as to exactly who these residents would be.
(2) The O St. site is currently under "reconstruction" to fit D.C. regulatory codes and and the particular physical care needs of the six residents. It is expected that this work will be completed in about two weeks.
(3) There are no direct care staff in place as yet, an ad was placed in last Sunday's paper. /
(4) There was no mention of a January 29 date for commencing of training mentioned at the January 24 meeting. No date has been scheduled tor training. No training has taken place.
Ms. Gaither indicated that direct care staff including certified nurse aides, as well as nurses and licenced practical nurses, will need training on the particular and individual care needs of this population of residents. Ms. Gaither recognizes, as well as have other group home providers said to me, that the remaining residents with mental retardation at DCV are among the most medically fragile of all residents with mental retardation in the District of Columbia.
Ms. Gaither would like to see training of D.C. Family Services nurses and licensed practical nurses at DCV by the Georgetown University Child Development Center (GUCDC) staff and then to have the GUCDC staff on site at D.C. Family Services facilities to work with and observe the licensed staff and train the direct care giver certified nurse aide staff. Ms. Gaither believes this training must take place in order for DC Family Services to responsibly and adequately care for seven of the residents with mental retardation from DCV. Because of the fragile condition of the residents, Ms. Gaither has plans tor a 4 staff to 6 residents ratio for care giving in addition to a licensed practical nurse.

FEB-01-96 THU 17:48 NCCNHR

FAX NO. 2023322949

P.04

(5) D.C. Family Services has not been paid since July, and that isthey have not been paid
for three residents with mental retardation from DCV discharged to DC Family Services on June 30, 1995.
(6) D.C. Family Services has no agreement with the District of Columbia on an interim per diem rate for the O Street facility.
Because of all the above factors, especially items (4), (5), and (6) above, D.C. Family Services will not accept residents from DCV until the items above are resolved.
I also snared with Ms. Gaither what I have previously profiled in my November 30,1995. Status Report to the Court and what I had heard again last Saturday, January 27, 1996, at DCV from a therapeutic recreation staff person who observed it. That is that three residents discharged at the end of June to D.C. Family Services Division Street site were found outside during the day, one to be dirty and disheveled, another in pajamas, and the third whose diaper was changed in public. Ms. Gaither said she did not know about this, there is no excuse for this, and said she would look into it. Ms. Gaither also assured that there is a new house manager hired in September for this site, for whom she has high praise for her competency, and that there has been increased inscrvice and follow-up inservice at this site.
Today, Thursday, February 1, 1996, I faxed to Ms. Gaither the above section under 'Outplacement of Residents with Mental Retardation.' Ms. Gaither affirmed to me ihat it is an accurate representation of our telephone conversation of yesterday.
An additional concern regarding the outplacement of residents with mental retardation is the following. On Monday, January 29, 1996, a memo was issued by DCV listing residents scheduled for outplacement this week. On the list are the three medically fragile residents with mental retardation listed in the December 22, 1995, remedial order of the Court. Yet, the identified receiving skilled nursing facility staff have received no orientation and training in the individualized care needs of these residents. There is no contract in place for specialty consultation team to supply these services. This is a violation of the Court Orders.
Outplacement of Residents with Mental Illness
I continue to remain very concerned about the outplacement of residents with mental illness. A significant number of residents with mental illness at DCV were inappropriately outplaced to DCV from St. Elizabeth's Hospital several years ago. My concerns are that the residents with mental illness will be once again inappropriately outplaced from DCV to a site
which is not appropriate for their individualized needs pursuant tothe Court Orders. The Dixon
Committee is also focused on the most appropriate settings for individuals with mental illness. A letter to the Court Monitor expressing their concerns is submitted with this letter to the Court.
To date there is no indication of assessments completed on residents, although, I am told the
3

FEB-01-96 THU 17:48

NCCNHR

FAX NO. 2023322949

P. 05

"assessments are in transcript." On Saturday, January 27, 1996, the Court Monitor along with a consultant to the Court Monitor, who is also conducting surveys on a consultant basis for the Health Care Financing Administration, reviewed several charts. We asked the nurse on Unit 3B, where most of the residents with mental illness who were discharged from St. Elizabeth's Hospital live, if there are assessments in the chart. The nurse assured us there are, yet we could find none. We asked the nurse to show us where they are, she could find only an order for assessments. There is also no counseling for residents nor adequate psychiatric services as identified in the Court Order of December 22, 1995.
At this time it is not possible to determine whether there will be a specialty consult team in place nor are sites identified to ensure a safe and effective transition to their (the residents) new residences, to train the new residence staff in how best to care for the individual, and to help meet the individuals' ongoing individualized needs...until the receiving facility staff is stabilized and their competency demonstrated as specified in the Court Orders. This is particularly problematic, since the defendants are continuing on the path of a March 31, 1996, outplacement date for all residents at DCV.
Additional Overall Concerns with Outplacement
The outplacement process continues to violate residents' rights and federal regulations and the Court Orders. The interdisciplinary discharge plans are not adequate. At present they do not reflect input from the interdisciplinary team as identified in the Court Order of December 22, 1996. Of 23 resident charts reviewed by the ombuds person, no record had a psychosocial summary from social service, no record had data from therapeutic recreation, no record had data from physical therapy nor occupational therapy, and three records had data from the dietary department.
For the residents who will not need nursing home care, there has been no discharge planning for ihe support services they will need to live in the community, such as, homemaker services and personal care aides, which would include meal preparation.
In summary, Judge Hogan, I respectfully request that the Court suspend the outplacement process until the above situations are rectified. If the defendant chooses to comply with the Court Orders and not remain in contempt, the suspension of the outplacement process should be very short-lived. I believe all that is necessary are the following:
(1) The contract for the specialty consult team for residents with mental retardation be finalized.
(2) The search for and the contract with the specialty consult team for residents with mental illness be identified and finalized with input from the Court Monitor as specified in the Court Orders.

FEB-01-96 THU 17:49 NCCNHR

FAX NO. 2023322949

P. 06

(3) The appropriate rates for services be agreed upon and finalized.
(4) The interdisciplinary team from DCV meet and develop for each resident the individualized discharge summary and plan.
I continue to remain committed to worlcing with the District of Columbia and all concerned parties for the best interests of the residents of DCV and to protect the residents rights, health, and welfare.
Once again, Judge Hogan, it is a privilege to serve the Court.
Sincerely,
Harriet A. Fields, Ed.D., R.N. Court Monitor
Attachment (1) Dixon Committe letter to Court Monitor, February 1, 1996
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholcr 901 15th Street NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann, Mr. Garland Pinkston Office of the Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

FEB-01-96 THU 17:47 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.D., R.N. 1722 19th Street, NW Suite 604
Washington, DC 20009 PHONE: (202) 234-7142

FAX TO:
COMPANY NAME: FAX NO: (Phone)
SENT BY: DATE:
# of Pages: (Inch this Cover Page):

Mr. Richard J. Farano. Mr. David Deutsch U. S. Department of Justice. Civil Rights Division 514-6273 307-3116 Dr. Harriet A. Fields
February 1.1996
6 NOTES:

 
 FEB"01-96 THU 18:11 NCCNHR
02/01/96 THU 16:59 FAX 2022230409

FAX NO. 2023322949
BAZELON CTR

P. 02
12 002

BAZCLON

U.S. v. District of Columbia

MfcNTAX HEALTH
LAW
C-a Ri*« Mil HummD W o
DlXON
IMPLEMENTATION MONITORING COMMITTEE
JOXCW BEUiLAOQUA. f H D . ProfurOT. Codecs g.'5iMii! W v k Uninnily •* So«* CPICUM BOB COUINS Cwwimer Advocitc.
ELIZABETH JONRS Bmeuefvb Direecrc M « i l u n l DniMflcy Low Center C M A A U I P- MOROAKI, ESQ. DCDiuumn, ' '. ' '
MARLFJJE Ross, M J V NBCVOUci Adult Scrvfe*
:
DOROTHY SMARTS UrtmnAfcim, . . •'. WWDC
. STEIN, MD
nfPiyehtocryi
ROASKT M O O N , MSW
Cootdlnstor

February 1, 1996

NH-DC-001-021

Harriet Fields, Ed.D., R.N. #604 1722 19th Street, H.W.
Washington, D.C. 20009

Re: D.C.Village

D«*r Or. Fields:
Thank you for the opportunity to participate in the meeting at D.C. Village last Monday to discuss outplacement of individuals with special needs. Asyou know, we are deeply concerned about efforts to assess and outplace those D.C. village residents who have mental illness, many of whom were transferred from St. Elizabeths Hospital and are Dixon class members.

We were very impressed by the presentation made by Herb Hoelter and Rick valway of the National center on Institutions and Alternatives (NCIA). This agency's track record working with so-called "hard to place" clients is impressive, and their approach and practice embraces the "best practices" model that we know works with this population. We were very pleased that Hs. A. Sue Brown accepted NClA's offer to develop assessments and outplacement plans for six residents and would like to see this or similar effort undertaken for all D.C. Village residents with special needs.

Under the pjxon court orders, individuals with mental illness who have been hospitalized at St. Elizabths or who are at risk of (re)hospitalization are entitled to treatment in the least restrictive setting conducive to their care needs. Unfortunately, many Dixon class members were transinstitutionalized into nursing homes, including D.C. village, not because it was the most optimal or least restrictive, but because it was the only setting available for elderly mental health consumers with challenging medical and/or behavioral needs. Yet, in reality, many class members did not and do not have 24-hour specialized medical care needs and to move them again into a nursing facility setting simply continues a practice of Inappropriate placement.

Also, as Hs. Brown reiterated during the meeting, many private nursing homes are unwilling to admit D.C. village residents who have mental health histories and/or current behavioral issues. The placement of

1101 Fifteenth SawtHW, Suito 1212, Wiuhlnicon DC 20005-5002. (202) *«7-S73O:TDD (202) 467-«32: MX (202) 2ZJ-W09

FEB-01-96 THU 18:11 NCCNHR
02/01/96 THU 17:00 FAi 2022230409

FAX NO. 2023322949
BAZELON CTR

P. 03
1^)003

Page 2
these so-called "hard-to-place" residents presents special challenges and requires specialized knowledge and expertise.
However* this alone is not enough. Successful outplacement also will require the development of some new service capacity. Existing capacity ia simply not adequate to meet the care needs of these residents, (indeed, if that capacity existed, it is likely that D.C. village's census would be far lower today.) Previously, we were informed by Mr. Vernon Hawkins that the Commission on Mental Health Services had agreed to work with D.c. Village to develop placements for those residents requiring placement in a 24-hour staffed residence. (See attached letter.) In addition, at least several local providers have offered to conduct assessments and develop individualized treatment plans for DC Village residents. Now, NCIA is also offering its expertise (see attached letter). Yet, without effective coordination between DC village, the commission on Mental Health services, other District agencies, and providers and without a willingness to allocate resources to develop alternative settings and supports, the outplacement efforts will continue to falter and class members will not receive the care and supports they need.
We understand that the Court's orders require the District government to identify and create a specialty consultant team to ensure the safe and effective transition of residents with mental illness to their new residences. Given the needs of this population and the need to develop alternative services, we think NCIA or an agency with a similar track record of assessing and providing care to "hard-to-place" residents is best suited to undertake this task. In addition, representatives of key District agencies (such as the Commission on Mental Health Services) ought ta be assigned to work with the team to assure coordination of effort and access to needed resources.
We also would like to remain involved in this effort and to assist in any way we can.

Baaelon Center

ittee

FE&-01-96 THU 18:10 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.D.,R.N.
1722 19th Street, NW Suite 604 Washington, DC 20009 PHONE: (202) 234-7142

FAX TO:
COMPANY NAME: FAX NO: (Phone)
SENT BY: DATE:
# of Pages: (Tncl. this Cover Page):

Mr. Richard I. Farano. Mr. David Deutsch IT. S. Denartment of Justice. Civil Rights Division 514-6273 307-3116 Dr. Harriet A. Fields February 1.1996
NOTES:

 
 APR-P3-96 WED 21=37 NCCNHR

FAX NO. 2023322949

P. 02

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

ApnH.,900

U.S. v. District of Columbia

•

II IIHIII HI II I II II H I III III III

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

NH-DC-001-023

Re: The United States of America v. The District of Columbia, et aL, Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6, 1995; November 7, Order Modifying Stipulated Order of July 6,1995; Court Order, December 22, 1996; Court Order, February 23, 1996
Dear Judge Hogan:
I want to assure you that due to the presence of the Court and through the issuance of the Court Orders, there are systems in place at DCV which are effecting an appropriate, humane, and dignified outplacement of the residents of DCV to their new homes. The outplacement process is and will be closely and continually monitored.
This letter to the Court primarily focuses on the outplacement process of the residents of DCV to their new homes. However, it also addresses the defendant's chronic non-compliance of payment of vendors. In addition, this letter to the Court raises my concern regarding the residents' Personal Needs Allowance (PNA) which was first brought to the Court's attention in December.
Overview of the Outplacement of Residents
Since September 6,1995, through today, April 2,1996,107 residents have been outplaced. Of this number 46 residents have been outplaced since the issuance of the February 23, 1996, Court Order. There are 145 residents yet to be outplaced, of this number it is estimated that there are 40 residents, including 16 with mental illness, for whom there are no outplacement sites identified to date, and for whom further planning is needed.
Ms. Sarodel Childs, the District of Columbia Long Term Care Ombudsperson at D.C. Village Nursing Home has been instrumental in.reviewing residents' discharge packets, working closely with Ms.

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Corrie Kemp (the new head of the social services department and the DCV staff person coordinating the discharge process), and helping to ensure that necessary and current information is included, so that the receiving facilities will have appropriate and adequate information to meet the residents1 individualized needs. Ms. Corrie Kemp continues to do an exemplary job.
The discharge packets reflect input from the disciplines pursuant to the Court Orders. Judge Hogan, I want you to know, it is refreshing and touching to me that I now hear discussions and plans for the discharge of the residents that profile the residents' lives and reflect input from the staff who know and knew the residents best - therapeutic recreation, nurse aides, staff nurses, and in particular instances, social services. This interdisciplinary cooperation now being practiced, which should have been routine part of care for the residents for years, is directly related to the presence of the Court at DCV and the issuance of the Coun Orders. It is helping effect an individualized and appropriate outplacement of the residents. lx is vital to continue to monitor the outplacement process in order to ensure the residents rights are protected.
The Court Monitor has visited some of the outplacement sites to date and has witnessed care being given with knowledge of the individual residents' needs, likes and dislikes which contributes to the residents' quality of care and quality and life. The Court Monitor will continue to visit outplacement sites especially for residents outplaced before the issuance of the February 23 Court Order. The ombudspersons role is to conduct follow-up visits to residents outplaced, which they do. In addition, the therapeutic recreation staff at DCV have been visiting residents outplaced and reporting at the weekly Wednesday outplacement meetings the status of the residents outplaced and identifying areas requiring further follow-up. For example, a recent finding by the therapeutic recreation staff is that some residents outplaced do not have their Personal Needs Allowance (PNA).
There have been ten deaths of DCV residents at their outplacement sites, in addition to Mr. Larry Stanford profiled in the Court Monitor's March 19,1996, letter to the Court. Nearly all the deaths have occurred among the sickest, frailest, and oldest residents, many of whom had healing decubitus ulcers. For the most part these residents required skilled nursing care which is why Hadley Hospital Skilled Nursing Unit became their new home. I do believe that part of these residents' infirmity was related to years of neglectful care at DCV profiled in previous reports to the Court, with the presence of the Court they received the attention their care needs warranted and the residents have a right to and deserve. Nevertheless, with the District of Columbia's announced closing of DCV, the trauma of transfer of so physically compromised individuals can unavoidably hasten their death. The literature supports the phenomenon of transfer trauma, which was originally brought to the Court's attention in my September Preliminary Status Report to the Court. The Court Monitor has visited Hadley Hospital Skilled Nursing Unit on two occasions to date and has found staff knowledgeable of the individualized care needs of the residents from DCV, the discharge packets helpful to the receiving facility staff, and the residents, dean, satisfied, and appearing to be well cared for.
Approximately 95 residents are scheduled to be outplaced to Carroll Manor, to date, 31 have been. This past Friday, March 29,1 visited Carroll Manor with one of the Court Monitor's nursing home systems expert consultants, Dr. Sharon Mailey from Georgetown University. Dr. Mailey has geriatric nurse practitioner graduate students at Carroll Manor working with the geriatrician and

APR-03-96 WED 21:38

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geriatric fellows at Carroll Manor. This team is conducting the initial medical assessments and followups of DCV residents.
Carroll Manor- is undergoing new management and new ownership. On Friday, I met with the new administrator and the new director of nursing, explained to them why I was there, told them about the Court Orders, and we openly agreed to meet further to discuss the individualized care needs of the residents. I found them to be very receptive.
I also visited the DCV residents at Carroll Manor in their rooms and on the units, some of whom had been outplaced as recently as the day before. The residents faces did light up at the site of a familiar face. These residents appeared to be happy, clean, well groomed, hair styled, properly positioned in wheelchairs, with a brightness and sparkle in their eyes and carriage. Many were attending a weekly scheduled Friday afternoon happy hour. One recently outplaced DCV resident from Unit 5B, Ms. N.S., whom I usually saw in bed and weeping, was up, dressed, downstairs and participating in the happy hour. Ms. N.S. was bright, alert, smiling, talkative, and without tears.
I sat in on the ongoing medical rounds and the case conference of another DCV resident outplaced the day before. Participants were the geriatrician at Carroll Manor, Dr. Charles Cefalu, geriatric nurse practitioner graduate students from Georgetown, the geriatric fellows, and Dr. Mailey. The conclusion by this group of experts in long term care was that the dietary, medical, and medication management of this recently outplaced DCV resident was inadequate and deficient. These findings certainly independently corroborate thefindingsin previous Status Reports to the Court and definitely support the findings of the nutrition expert consultants to the Court Monitor from Howard University, Department ofNutritional Sciences profiled in the January 17, 1996, Status Report. For example, this resident on admission to Carroll Manor on March 28 registered an IS pound weight loss from the last recorded weight taken at DCV at the beginning of March, yet no dietary nor medical follow-up at DCV had been indicated.
Expert medical management is part of the routine medical care and follow-up at Carroll Manor. I do believe that the residents from DCV outplaced here will be in medically competent hands, that they will receive medical workups when needed and routine and knowledgeable medical attention, something consistently lacking at DCV and profiled since the Court Monitor's October Status Report to the Court.
Beginning next week, Providence Hospital Skilled Nursing Unit is scheduled to take between 15 and 52 DCV residents.
I want to make it clear to the' Court, that the systems in place pursuant to the Court Order of February 23, provide the best safeguards reasonably and humanly possible to prevent unnecessary and tragic circumstances to occur now and in the future.
Residents with Mental Retardation
As of March 8,1996, the Specialty Consultation Team contract for residents with mental retardation
3

TBT

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has beenfinalizedwith Georgetown University Child Development Center (GUCDC). This contract provides for GUCDC to offer consultation services off-site to staff at the new homes for residents with mental retardation. This contract was too late to be of benefit to Mr. Stanford.
Due to the presence of the Court and the issuance of the Court Orders, systems are now in place and have been and are being implemented to ensure that staff in receiving settings are knowledgeable in the individual care needs of this very special population. The Specialty Consultation Team is an admirable care model for any jurisdiction to meet the care needs of its most vulnerable population. It is imperative that the Court ordered framework remain in place. For example, the three very medicallyfragileresidents with mental retardation have been outplaced to Health Care Institute (HCI) on March 18. GUCDC has been there for training of staff, and will set up a schedule with HCI for ongoing consultation. Furthermore, GUCDC is planning to offer a 20 hour training program for nurse aides at HCI in the special and delicate care needs of this population of residents, and will issue a certificate of completion at the end of the training.
In addition, at the approval of GUCDC, direct care staff at DCV, who have cared for the physical care needs of these residents for years, accompanied the three medically fragile residents to HCI. For the first week the DCV staff remained at HCI during the day and evening shift and helped the HCI staff become accustomed to the individualized physical care procedures and routines necessary for these residents, for example, how to bath, dress, and properly position severely contracted residents with mental retardation.
Ms. Sarodel Childs, the District of Columbia Ombudsperson at DCV, has visited these residents at HCI and reports that they appear, engaged in their environment, dean, and well cared for.
Plans are in place for two residents to be outplaced to Wholistic group home for residents with mental retardation on April 15. According to Mr. Silas Butler, Deputy Administrator at DCV, several overnight and dinner visits are to be scheduled prior to this date so that the residents may be acquainted with the surrounding and help provide a more secure transition before actually moving. Direct care staff at DCV who know the residents will accompany them on these overnight visits and stay with them for several days and nights after outplacement in order that the residents do not awaken in the night and become frightened in unfamiliar surroundings, and in order that they see people they have been familiar with for years. Mr. Brady, the psychologist from GUCDC who has worked with these particular residents for years, will especially spend time with these residents, Ms. AJL and Mr. K.F. In addition, Mr. K.F. who is also autistic, has a colostomy needing changing in the early moming. The receiving facility staff will be able to observe the techniques necessary to be provided for bis particular and individualized care needs .
There is still no agreement on an interim rate between D.C. Family Services (D.C.F.S.) and the District of Columbia. D.C. Family Services is scheduled to receive six residents with mental retardation from DCV. However, according to Ms. Sheila Gaither, COO. of D.C.F.S., until an interim rate is settled, they cannot accept the residents. Ms. Gaither did indicate that they have nursing staff identified. D.C.F.S,is owed $38,720.24 for January for their Division Street site, where there are three former DCV residents outplaced in June 1995. D.C.F.S. is owed $9,340.80 for the

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September care of one of these residents, Mr. CM.
There remains one resident with mental retardation at DCV, Mr. P.L., for whom no outplacement site has been identified to date.
Residents with Mental Illness
There have been 71 transition care planning meetings for residents who are listed with mental illness (the source of the list is still undetermined). Geriatric Psychological Systems (GPS) participated in these meetings and shared their assessments. These meetings have been coordinated and chaired by Ms. Catherine Carroll who has been detailedfromthe Commission of Public Health for this task. Ms. Carroll is an outstanding example of professional behavior and has done an exemplary job. Ms. Carroll exhibits care and compassion for the individual residents and demonstrates fine leadership skills. The participants in these interdisciplinary care team meetings were the direct care staff most knowledgeable of the residents' lives through the years and described above in paragraph five. In many instances physical therapy and the dietary department also contributed. In addition, the ombudsperson, Ms. Sarodel Childs, participated in nearly all of these care planning meetings.
From these meetings, counseling was identified as needed for 27 residents. This counseling has begun by GPS.
Last Thursday, March 28, the Court Monitor and the Court Monitor's expert consultant in geriatric psychiatric nursing home systems. Dr. Frieda Butler, reviewed all 71 of the transition care plans and shared our input with Ms. Catherine Carroll. The advice given for the best interests of the residents and for compliance with the Court Orders was the following:
(1) Transition plans reflect a dominance of a medical model not particularly appropriate for nursing home care.
(2) In cases where behavioral care management is indicated as follow-up, in no instance is it recommended that a geriatric psychiatric nurse be part of the follow-up care team. This is in violation of the Court Order and is not realistic with curren: long term care prartices throughout the country where geriatric psychiatric nurses are utilized and employed for assessing, monitoring, and implementing behavioral interventions. It is also cost effective.
(3) Many of the residents with labels of mental illness have been carrying around this "stigma" for decades with no follow-up assessment and update. In fact, for the most part, the last noted psychiatric review and assessment of any kind for the residents took place in 1991. This is in violation of federal regulations which require annual reviews, despite the fact that there was a full time psychiatrist on staff at DCV from 1991 to the end of 1995.
(4) Many elderly residents with a history of mental illness "mellow" when they are old and their physical care needs become the dominate requirement for long term care attention.

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Ms. Carroll agreed with the above input and assured the monitor that the transition plans will reflect this advice.
The use of GPS as the Specialty Consultation Team for the residents with mental illness has not been finalized, although DCV is moving in this direction. GPS does have a presence in many nursing homes throughout the metropolitan area which is advantageous. They are also willing to serve in this role. The Court Monitor will meet with GPS sooa In addition, according to Ms. Carroll, Carroll Manor has their own psychiatricteam for their residents.
Residents Identified for Independent Living
There are six residents whose level of care qualify for independent living. Transition care planning meetings to ensure these residents care needs will be met in the community are taking place this week at DCV. Ms. Catherine Carroll is also taking the lead in coordinating these meetings with the interdisciplinary direct care staff who have known these residents for years. Vocational rehab evaluations are to be scheduled this week for these residents. No sites have been identified as yet for five of the residents. Mr. C.W. will be outplaced to Green Valley next week. The Court Monitor will keep the Court informed of the progress in identifying new homes for these residents and that appropriate services are in place before outplacement.
Chronic Non-Compliance of Payment of Vendors
Attached to this letter to the Court'is information in chart form on the status of vendor payment. Most problematic, and for which there is a direct impact on care of the residents, is the noncompliance of the July 6 Court Order, Section C Payment of Vendors, for the contract nurse staffing vendors.
In my December 6 letter, I brought to the Court's attention the serious non-payment of the contract nurse staffing vendor, National Nurses. This vendor provides the bulk of nurses to DCV. It is distressing to me that there has been no payment to this vendor since December and once again National Nurses is forced to discontinue service if payment is not received by next week, as indicated in the attached letter of April 2 to Mr. Vemon Hawkins, Director, Department of Human Services for the District of Columbia by Mr. Ronald Messenheimer, President of National Nurses. This vendor is owed over $200,000..
Total Healthcare Resources, Inc. (THR) another nurse staffing vendor has suspended services as of March 28. THR is owed approximately $115,000, for services rendered in November, December, and January. The nurses provided by THR at DCV are excellent direct care givers and the residents need their expertise.
SRT another contract nurse staffing vendor is owed over $88,000. These vendors are being given assurances that they will be paid and in good faith continue vital direct care services for the residents, only to find out time and time again the assurances are hollow. Of most serious concern is that with

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the dosing of DCV, the only reliable source of care for the residents will be contract vendors, since many of the DCV employees are being offered early retirements or early "outs" and have left employ.
CUP, a nurse staffing vendor, was forced to terminate services on April 1, services were reinstated April 2 on reassurances to CUP by Ms. Janette Michaels, the consent decree coordinator for the Department of Human Services for the District of Columbia, that CUP would be paid this Friday. This reassurance is very problematic to me.
In a meeting on Friday, March 22,1996, with the Court Monitor, Mr. Vemon Hawkins and Ms. Sue Brown, and with Ms. Michaels in attendance, Mr. Hawkins asked Ms. Michaels about the status of vendor payments. Ms. Michaels assured Mr. Hawkins and myself that there were no problems, that payments were up to date. The above and the attached information indicate that this was a misrepresentation.
On the last page of the attached "DC Village Nursing Home Vendor Report" a vendor formerly called Associated Healthcare is listed. This was a contract staff nurse vendor and last provided services at DCV in October. Because of chronic late payment this business went bankrupt. They are still owed S6324.34 for services rendered at DCV during part of September and the first week of October 1995.
Personal Needs Allowance (PNA)
At a recent weekly Wednesday morning outplacement meeting, the therapeutic recreation staff person, who had visited five residents outplaced to Health Care Institute since September and most recently December 27, reported that these residents did not have access to their PNA. Ms. Sue Brown indicated at this meeting that the residents' PNA was being "drawn down from the D.C. Treasury " and that "some monies are not totally transferred." I was shocked. My December 10 letter to the Court profiled this problem and in Court on December 20, the defendant represented that this matter had been settled.
On March 7,1 wrote the Executive Director of DCV, Ms.'Alberta Brasfield, requesting clarification and specific information on all the residents PNA accounts. Ms. Brasfield promptly responded, for which I am grateful. However, the responses raise more questions for me than answers. I will, therefore, seek further clarification on this matter in order that I may accurately report to the Court soon. Federal regulations require that residents'PNA be in separate, interest-bearing accounts. I need to assure myself that this has been, and is, the case for the residents and that they have been receiving all of their money.
In the material received from Ms. Brasfield, there is evidence that once residents are outplaced to their new homes their social security checks have been returned to the Social Security Administration instead of being forwarded to the residents. In the interest of humanity, I ask DCV to stop this and to forward the residents' money directly to them.

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Judge Hogan, it is a privilege to serve the Court and to work with all concerned parties for the best interests of the long term care residents of the District of Columbia.
Sincerely,
%
Harriet A. Fields, Ed.D., R.N. Court Monitor
Attachments (2)
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann, Mr. Garland Pinkston Office of the Corporation Counsel for the District of Columbia 441 4th Street, NW, Suite 680 Washington, DC 20001

APR-03-96 WED 2 1 : 4 2 NCCNHR

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P. 10

NATIONAL NURSES SERVICE, INC.

April 2, 1996
Vemoo E. Hawkins Interim Director Department of Human Services Building 801 Bast, Second Floor 2700 Martin L. King Avenue, S.E. Washington, D C . 20032
Dear Mr. Hawkins:
Payment to National Nurses Service in the amount of $239,563.30 (see attached list) for services provided at D.C. Village is past due. We are particularly concerned due not only to the large outstanding balance, but also because we understand that none of these past due invoices have even been entered into the FMS system for processing as of 2:00 p.m. today, April 2, 1996. Therefore, in the event we do not receive payment on or before Priday, April 12,1996, we will have no alternative but to discontinue service.
Thank you for your attention to this matter.
Sincerely,
Ronald L. Mesaenheimcr Presldent
RLM.ejf cc: Dr. Harriet Fields

1110 BONIFANT STREET, SUITE 310, SILVER SPRING. MARYLAND 20910 • (301} 565-7890 • (301) 587-1073 PAX

DC VILLAGE NURSING HOME VENDOR REPORT

CD

CO

INVOICES OPEN > 45 DAYS

CO CD

VrNTlfW

CONTACT

suppi.rFs

DATES

PAYMENT

CONTINUE SERVICE!

ro

DISTRICT

TORINE

MEDICAL,

3/19/93

$7518.75

AFPROX. $27000

YES,

HEALTHCARE MITCHELL

JAN1TORAL,

3/19/93

$8347.50

REC'D, BUT VENDOR

IF PAID

ro

INDUSnUAL. 1/21/93

$64)7.00

DOES NOT KNOW

& SAFETY

1/21/93

$179.25

FOR WHICH INVOICES

SUPPLIES

2/28/94

$9913.15

6/27/94

$2499.30

7/11/94

$556.00

7/25/94

$1837 50

TO

9/9/94

$4050.07

9/9/94

$1045.80

9/9/94

$1645.24

9/9/94

S2499.3O

9/12/94

$2766.75

5/5/95

S1S0J&

$50155.61

NATIONAL PATIENT JUDY

SPECIALTY BEDS 3/31/95

$K 110.00

DC VILLAGE SAYS THEY ARE

YES

CARE SYSTEMS OGABY

9/30/95

$1276.00

CUTTING A S27O0O CHECK

10*31/95

$8925.00

11/30/95

$8925.00

lZ'31/95

$7950.00

1/30/96

$6925 00

$42111.00

ro

ALLIED MEDICAL MRS. CRYC1ONE CONSLXTS

2/20/96 2/22/96

$1095.35 $7445.31 $8540.66

YES

CroD
CO

rCrooO

CO

^»

CO

CUP

KAREN

NURSING

1/21/96

$17447.4)

DC VILLAGE SAYS THEY

SVC

\TEIRA

2/4/96

S4568.67

WILL PAY BY FRIDAY

TERR

2/18/96

$20265.25

4/1/96

$42281.33

• of

NATIONAL

MARK

CONTRACT

12/7/95

$9295.63

YES

NURSES SVCS CONHEADY

NURSING

12/7/95

SI 6703.72

DC VILLAGE NURSING HOME VENDOR REPORT

CD CO

CO CD

VENDOR

CONTACT

SUPPLIES

INVOICES OPEN > 45 DAYS

DAIE&

SERVICES

PAYMENT

TONTINE srawre?

m

rv>

CONTINUED... NATIONAL NURSES SVCS

12/14/95 12/14/95 12/21/95 12/21/95

SI 1034.59 $11880.25 $9137.95 $13032.58

ro

12/28/95

$6964.29

12/28/95

$13406.58

1/4/96

$10560.66

1/4/96

$10217.26 S ~

»

1/11/96

$5668.80

1/11/96

$11141.75 1 / '

1/18/96

S12855.19

1/18/96

$9886 011/ v

2/6/96

$11039.06

2/6/96

$8798.72

2/7/96

$17138.88

2/7/96

$26398.17

2/15/96

S9768.63

2/15/96

«1U77,91

$£36*06.63 tf

3

SRT-PREMEIR

KJELLY JOHNSON

NURSING

9/7/95 9/7/95 11/23/95

S2334.7O $4433.50 $7349.43

MRS. RICHARDSON SAYS PAYMENT IN PROGRESS

YES

ro

11/23/95

$5303.33

ro

1/4/96 1/4/96

$2191.45 $3277.55

CO
CrrooO

1/18/96

$6629.16

CO *>.

1/18/96

$12806.71

CO

1/25/96

$2075.93

1/25/96

$5808.85

2.'l/96

$6071.73

2/1/96

$9186.49

2/8/96

$7507.49

2/8/96

$4013.70

2/15/96

S34I2.T7

ro

TO

DC VILLAGE NURSING HOME VENDOR REPORT

CD

to

I

INVOICES OPEN > 45 DAYS

CO

9

VEtqpOR

CONTACT

SJJPPLIES

DATES

SERVICES

PAYMENT

CONTINUE SERVICE?

en

ro

CONTINUED...

2/15/96

SS26LQ1

d

SRT-PREMER

$88663.40

CO

J

T.H.R.

EMMA

NURSES

NOV.

$15673.20

DC VILLAGE

SVC. SUSPEKDED

3

(TOTAL

RESUMADERO

DEC.

S5O98.25

PROMISED TO 3/28-WILL COMMENCE

d

HEALTHCARE

$9087.50

PAY $115000

ONCE PAID $115000

CO

RESOURCES,

$7954.90

FORNOV-

o

J

INC.)

$3635.35

JAN

pa

$3480.45

11|J1

$8559.00

$4500.00

$10483.08

JAN.

$9437.07

$3289.00

1I

$3097.50 $5541.93 $275270

$8762.03

$2806.30

$10719.68
3
$114877.94

•

3 J

T.H.R.

1/2 FEB BILLED 3/1

$11964.10 $2366.70 $5981.88

ro rCoD
CO

$ 1758.40 $22071.08

rCrooO

CO

DIVISION

MILDRED

DISPOSABLES 4/7/95

$(5.00

YES

CO

MEDICAL

4/13/95

$2498.75

CONTINENTAL SKIP BAKING
JACOBS GARDNER JOHN

FOOD

1/22/96 2/7/96

OFFICE SUPPLIES 7/M

$62.05 CR. $411.74
SI 11.00

YES, HOWEVER 45 DAY CUTOFF
YES

DC VILLAGE NURSING HOME VENDO CO

CO

INVOICES OPEN > 4S DAYS

O3

VENDOR

CONTACT

S11PM.IF.S

DATE

SFRVTCRS

CONTINUE SERVICE!

m<=>

ro

OCE
BUSINESS SYSTEMS

AMY STRONG

COPIER LEASING

*
•
COPIER SERVICE CONTRACT

1/1/94 8/1/94 10/1/94 11/1/94 12/LW 12/28/94 2/12/95 5/8/95 10/4/95 11/4/95 12/5/95 1/4/96 2/8/96 7/20/94 10/31/94 11/17/94 12/18/94 1/19/05 2/17/95 3/20/95 5/18/95 6/16/95 7/20/95 8/18/95 9/29/95
10/18/95 11/17/95 12/29/95 1/18/96

$488.00 $488.00 $488.00 S48S.O0 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.25 $488.25 $488.25 $488.25 $488.25 $488.25 $488.25 S488.25 $438.25 S512.66 $512.66 $512.66 $512.66 $512.66 $512.66 $516.66

NO SERVICE UNTIL PAY

MENT; WORKING W/

CO

SALES REP.

ro ro
CO
rCrOoo
CO
CO

2/15/96

$14839.53

DC VILLAGE NURSING HOME VENDOR REPORT

INVOICES OPEN > 45DAYS

ANSWERS INCORP. (FORMERLY ASSOC. HEALTHCARE) RECEIVED A CHECK OF APPROXIMATELY S34000 THE WEEK OF MARCH 11 AFTER TRYING TO COLLECT FOR FIVE MOKTKS FOR AUG./SEPT. SERVICES. PER CYNTHIA IT WAS A PRIMARY REASON THAT ASSOC HEALTHCARE WENT BANKRUPT. THEY WILL NOT PROVIDE SERVICE TO DC VILLAGE NURSING.

THE FOLLOWING VENDORS WERE CONTACTED ON .VI8/% AND HAD NO RECORD OF INVOICES OUTSTANDING > 45 DAYS:

ACTION SUPPLY

BERNARD FOOD INDUSTRIES

BRIGGS ICE CREAM €HEMTRON

EAST TECH, INC

*

•

HEALTHCARE LAUNDRY

HILL ROM

J. P. FOOD SERVICE

KELLOGG

MAZOLERCH

MEAD JOHNSON

SANDOZ

SKANE MEATS

REPORT DATE: 4/1/96

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CO
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en

 
 HARRIET A. FIELDS, Ed.D., R.N. #604
1722 19th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Avenue, NW, 4th Floor Washington, DC 20001

U.S. v. District of Columbia
il
NH-DC-001-025

Re: The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6, 1995; November 7, Order Modifying Stipulated Order of July 6, 1995; Court Order, December 22, 1996; Court Order, February 23, 1996

Dear Judge Hogan:
This letter to the Court is an update since my April 3 letter to the Court on the outplacement of DCV residents to their new homes.
As of today, there are 88 residents at DCV remaining to be outplaced. Of this number, 42 residents have no identified placement site to date.
Ms. Come Kemp is the leader in the outplacement process at DCV. She is a dedicated professional and is active in her advocacy on behalf of the residents and in ensuring, to the best of her ability, that the residents individualized needs will be met.
All of the defendants both within and outside DCV, from those designated by Mr. Vernon Hawkins, Director, Department of Human Services, and Dr. Harvey Sloane, Commissioner of Public Health for the District of Columbia, must continue to give Ms. Kemp their undivided support so she may be able to guide the remaining outplacements in the professional manner in which she has been operating, and for which she has tremendous capabilities. In addition, Ms. Catherine Carroll must also be given continued and undivided support to carry on her fine work.

TUT

Residents Identified for Independent Living
Currently there are three residents to be outplaced into the community. There are two major concerns, one of which is most immediate and critical.
(1) Immediate Need for CASH The residents will not have access to their Supplemental Security Income (SSI) checks
until after they are discharged and living independently. The rent for the residents will be $132 and they will receive food stamps. It is not clear how long it will take until they directly receive their checks; however it is estimated by some this will take two weeks to a month, although the business office at DCV estimates longer. Therefore, these three residents, Mr. C.W., Ms. M.M., and Mr. M.W., upon discharge will need a sufficient supply of money for down payment, rent, telephone, food, and other basic supplies for living.
Ms. Peggy Graves, detailed by Mr. Vernon Hawkins from the Department of Human Services of the District of Columbia, is preparing a financial needs statement for each resident. Mr. C.W. is scheduled to be discharged to his new home this week. Ms. M.M. is scheduled to be discharged to her new home May 1. A home for Mr. M.W. has not yet been identified. The residents cannot be discharged without this subsistence level of cash, without which Mr. C.W. and Ms. M.M. face loosing their apartments. This problem is of great concern to all those involved in planning.
Mr. Vernon Hawkins was made aware of this problem in a meeting April 12 with the Court Monitor, Dr. Harvey Sloane, Ms. Corrie Kemp, Ms. Catherine Carroll, Ms. Peggy Graves, and Ms. Gladys Fountain. But as of this date the District of Columbia has not identified a source for the needed money.
Yesterday at DCV, I reiterated this immediate and serious concern to Dr. Harvey Sloane. Dr. Sloane was on his way to a meeting with Mr. Hawkins. Discharging residents without this needed subsistence level of cash is essentially assigning residents who have lived within an institution for years to a condition of homelessness.
(2) Vocational rehabilitation services Institutionalized residents who will be living in the community need to be meaningfully
engaged in their environments with purpose to their lives in order to thrive and meet their individualized needs. For this to occur, they need the opportunity to develop skills through vocational rehabilitation. Responsible management would have initiated vocational rehabilitation months and months ago. For the residents decertified for nursing home care years ago, vocational rehabilitation should have been initiated years ago. Lack of initiative and proactive planning for the residents contributed to the rationale for new management of DCV in the Court Monitor's January 17, 1996, Status Report. It is distressing to me that the process of planning for vocational rehabilitation was just initiated last week, with the contact of the Rehabilitation Services Administration in the Department of Human Services of the District of Columbia. Follow through is vital.

It is inconceivable to me that Mr. Vernon Hawkins and Ms. Sue Brown will do anything other than intercede with the appropriate District of Columbia agencies as needed, so that the major concerns identified above will be resolved. Thus, allowing Ms. Kemp and Ms. Carroll to continue their leadership and follow through. This situation will be closely monitored.
My April 3 letter to the Court identified six residents who the transition team identified as qualified for independent living. However, since that time, the Occupational Therapists and Physical Therapists have completed their excellent assessments of the six residents and determined that three of the six residents are not sufficiently capable of independence in the activities of daily living, for example, ability to prepare food. In addition, two of the three residents as determined by the health care team and the residents have medical supervision issues and precarious personal coping capabilities which prevent them from successfully functioning independently. Therefore, these two residents will be appropriately outplaced to community residence facilities. The sites have not been selected, although these two residents are in the process of making visits.
One resident, Mr. C.F., currently states that he wants to live in the community independently. There are several activities of daily living for which Mr. C.F. would need assistance, for example, dressing with buttons, cooking, shopping (removing items from shelves and carrying them home), bathing, determining water temperature, laundry, and descending stairs. The community would be the "least restrictive" environment according to federal law for him, however, it would not be safe nor would he be able to function independently unless Mr. C.F. had available to him a personal care aide seven days a week to perform the above tasks, among various others. Currently, there is a lack of sufficient personal care aides in the District of Columbia to perform such tasks seven days a week for Mr. C.F. I will keep the Court informed of the progress in planning for the most appropriate outplacement for Mr. C.F. in accordance with the Court Orders and federal law, the Americans with Disabilities Act.
Residents with Mental Illness
Thirty-four residents who were on the list of still indeterminate origin of residents with mental illness have been outplaced. All of these residents have a primary medical diagnosis requiring long term nursing home care, as recently assessed by the transition team that included Geriatric Psychological Systems, Inc. (GPS). One resident was discharged to his family after extensive review and evaluation and a one week trial visit. A return assessment after the one week visit was conducted with his family and the transition team including GPS, which is currently serving as the Speciality Consultation Team for residents with mental illness.
There are 35 residents remaining at DCV. Sixteen are being considered by three nursing homes in the area. All these remaining residents have a primary medical diagnosis requiring long term nursing home care.
One resident, Mr. E.J., whose primary diagnosis is mental illness, as recently evaluated by GPS, will be outplaced to a community residence facility for persons with mental illness. Mr. E.J. has visited

two sites to date and will visit at least two more sites before outplacement to a community residence. The site has not been finalized to date.
Residents with Mental Retardation
This past week, two residents, Ms. A.R. and Mr. K.F., were outplaced to Wholistic a group home for residents with mental retardation. Georgetown University Child Development Center (GUCDC) has been serving as on-site consultants to Wholistic, and GUCDC staff accompanied the residents to their new homes. In addition, staff from DCV spent last weekend (the residents first weekend in their new homes) with these individuals for the day and evening shifts.
Although an interim rate still has not been mutually agreed upon, D.C. Family Services as of yesterday "has every intention" of accepting the six residents identified for outplacement. There is still no date for staff training and no admission date for the residents. At this point, there seems to be no good faith effort to resolve the interim rate dispute.
There still remains one resident, Mr. P.L., for whom no outplacement site has been secured.
The District is well beyond the agreed upon and Court Ordered February 29,1996, outplacement date for residents with mental retardation.
Visits to Outplacement Sites
The Court Monitor, with a nursing home systems expert consultant, is visiting residents outplaced to their new homes in order to determine continued appropriateness of setting and to ensure that the residents' individualized needs are met in accordance with the Court Orders.
I have visited J.B. Johnson Nursing Center and the 15 residents outplaced there to date; met with the new management company, the administrator, admissions coordinator, therapeutic recreation director, toured all the units with the director of nursing; and met with all the residents. The new management company is open to any suggestions for improving care for the residents. I found the residents happy and alert, something I did not consistently see at DCV.
I have visited a proposed outplacement site operated by Allegis Health Care Centers in Grosvenor, Maryland.
My major concern to date is the staff-to- resident ratio at Carroll Manor Nursing Home in Hyattsville, Maryland. Over 50 DCV residents have been outplaced there to date. The current ratio is one certified nurse assistant to 12 residents during the day. As mentioned in my April 3 letter to the Court, this facility is undergoing new management, however, the arrangements made to outplace residents there were made with Providence Hospital and Sr. Carol and Mr. Ed Cook, Vice President. I will be meeting with them soon to review the Court Orders in order that I may be able to assure the Court that the Court Orders will be met for the best interests of the residents. The Geriatrician at

Carroll Manor is giving extra attention to ensure that the residents medical needs will be met, since this facility is in the process of hiring new staff. The staffing issue was originally pointed out to the Court Monitor and the nursing home systems expert consultant by the sister of a recently outplaced DCV resident.
Personal Needs Allowance (PNA)
I am enclosing my March 7, 1996, letter to Ms. Alberta Brasfield requesting information on the residents' PNA Ms. Brasfield responded on March 13 and March 21, and I am grateful for her attention to the matter. In Ms. Brasfield's responses, admissions are made that the residents' "PNA balances [are being] held by the District of Columbia" (March 13) and that there were "moneys previously held by District of Columbia on behalf of DCV residents" (March 21). This is in violation of federal law and regulations. However, I am happy for the residents sake that, as of March 19, 1996, all residents' PNA accounts remaining in the D.C. Treasury were transferred to separate interest-bearing PNA accounts on each resident's behalf at Independence Federal Savings Bank.
According to personnel in the business office at DCV, on December 14, 1995, separate accounts were established for the residents at Independence Federal Savings Bank (USB), one for the PNA and one for Cost of Care. Many residents already had personal savings accounts established at JJFSB.
For the most part when the residents' PNA was in the D.C. Treasury it was transferred quarterly to IFSB. Therefore, the District did retain what could have been interest for the residents in violation of federal law. However, in order to research this further, it would take away energies and resources now more directly needed for the residents in monitoring their outplacement to their new homes. In addition, the computer records for the residents is in somewhat of a chaotic state of affairs. As of October 1995, the business office computers at DCV were removed by the Office of Long Term Care Administrator and since then are no longer hooked into the main frame computers within the Office of Long Term Care Administration in the Department of Human Services for the District of Columbia. Therefore, the Office of Long Term Care Administration does not have current information on residents accounts since October. And, the DCV business office does not have access to computer records since mid-October. Therefore, all accounts from mid-October to date are hand entered in booklets. This system within the Long Term Care Administration and DCV is primitive and, as indicated by the business office personnel at DCV, would probably be a "nightmare for auditors."
While visiting residents outplaced to J.B. Johnson Nursing Center last week, I inquired about the residents' PNA. The residents all have their PNA accounts, information for which was easily retrieved by the facilities state-of-the-art computers. I was told by the business office at J.B. Johnson that, until new management took over the facility in December, the facility had the same primitive accounting set-up with the Office of Long Term Care Administration. (J.B. Johnson Nursing Center is owned by the District but now privately managed by the same group which manages Washington Center for Aging Services, also owned by the District.)

Now when DCV residents are outplaced, checks from their EFSB personal savings accounts, PNA accounts, and if they have one, their burial accounts, either accompany the residents to the new facilities, or are mailed within a few days. These reactive steps taken by the defendants are all in the residents' best interests. If it were not for the presence of the Court at DCV, residents' rights would still be violated.
Mr. Alex Teneza, accounting technician in the business office at DCV, has demonstrated a kindly sensitivity to the plight of the residents' living situation. Mr. Esmeraldo Cruz, accountant in the business office at DCV, has been helpful in supplying information.

Chronic Non-Compliance of Payment of Vendors

Attached to this letter to the Court is an updated 'DC Village Nursing Home Vendor Report'. Direct care providers are still without payment in violation of the Court Orders and one contract nursing staff vendor has still not been able to resume needed direct care services.

Some examples of overdue payments to direct care providers (nursing and physical therapy) in violation of the Court Orders are the following:

•

National Nurses Inc., although payments have been made, is still owed $24,663.11.

•

SRT-Premeir is owed $52,594.59.

•

Total Healthcare Resources, Inc. (THR) is owed $52,953.50 and is unable to reinstate their

valuable direct caregivers until paid.

•

CUP is owed $20,882.13 and indicates they will have to discontinue services this weekend

if not paid.

•

Therapeutic Management Services (TMS) provides essential and needed physical therapy

services, which are now vital in the health team assessment of the residents for transition

planning to their new homes. Their services are vital in order to identify the most appropriate

setting to meet the residents' individualized needs. The physical therapists have always

responded professionally to any requests to assess the residents in addition to their own

proactive professional behavior on behalf of the residents. TMS has still not been paid for

January services on an invoice submitted February 13. This non payment was brought to the

attention of Mr. Vemon Hawkins in the April 12 meeting referred to previously in this letter

under Residents Identified for Independent Living.

At this meeting Ms. Gladys Fountain told Mr. Hawkins that TMS has not been paid for January services because their invoice was submitted with their February invoice and the District cannot pay two invoices at once. Ms. Fountain received this information from a phone call made during this meeting to Mr. Terry Thomas, former administrator at DCV, working on behalf of Ms. Queen in the

TFT

Department of Human Services. The information given by Ms. Fountain to Mr. Hawkins was false. The February invoice was submitted March 10. I pointed out the facts and the inaccuracies in Ms. Fountain's statement to the April 12 meeting attendees, and suggested that they call the president of TMS into the meeting and verify it, since I had just seen the physical therapist in the hallway on her way to assess a resident at the bedside. The physical therapist was not asked to validate the correct information nor has TMS been paid for January services in the amount of $5145.00. In previous reports to the Court, I have chronicled the non-payment of services to this critical direct care vendor.
The physical therapists function without payment out of care, concern, and compassion for the residents. This is a small business and is pained by lack of payment. My concern is that the physical therapists will be taken advantage of, and that if DCV does close as projected within several weeks, they will not be paid at all, which would be unconscionable. To me this scenario alone warrants an escrow account to assure payment and/or a Court Order to guarantee payment.
Yesterday, I received a copy of the defendants' pleading Opposition of the District of Columbia to the Motions of Plaintiff and Plaintiff-Intervenor for Further Relief to Remedy Continuing Contempt and for Contempt Sanctions.
I have a few concerns regarding this, they are the following:
(1) On page 3, the defendants state that as of April 18, 1996, the "contracts for National Nurses and American Therapeutics were pending approval at the control board." I called the D.C. Financial Control Board this morning to verify this statement because it was not known to me that there were any outstanding contracts for these two vendors. According to Mr. Doneg McDonough of the Control Board this statement in the defendants pleading is false and "does not match our records here."
The Control Board records indicate that for National Nurses, Inc., a 120 day contract for 24 hour coverage for the period March 1 through June 28, 1996, was approved February 28, 1996. This February date is the last activity for a contract for National Nurses with the Control Board.
The Control Board records for American Therapeutics indicate that a 120 day contract for services from February 18 through June 18, 1996, was reviewed and approved February 21, 1996. This February date is the last activity for a contract for American Therapeutics with the Control Board.
Given the front page article in the Metro section of today's, Thursday, April 25, 1996, Washington Post and similar coverage on WTOP radio news this morning, these false assertions are particularly problematic to me. The article and radio news broadcast profile false assertions about contracts made by the Department of Human Services and Mr. Veraon Hawkins.
(2) Page 4 of the pleading states that the "defendants took immediate and appropriate action to resolve matters adversely affecting their ability to timely pay the D.C. Village vendors." These same vendors who supply vital direct nursing care services are still not payed in violation of the Court Orders. The fact is that the treatment nurse supplied by THR switched contract nurse staff vendors

in order to receive a pay check. However, the contract nurse staffing vendor to which the treatment nurse switched subsequently threatened termination of services because of lack of payment.
(3) On page 10 of the pleading the defendants refer to the "imminent closure of the facility" and "less than 100 residents whose numbers are being reduced almost daily". If there is one but one long term care resident at DCV, it is the duty of the District of Columbia to provide services.

Once again Judge Hogan, it is a privilege to serve the Court and to work with all concerned parties for the best interests of the long term care residents of the District of Columbia.

Sincerely,

Harriet A. Fields, Ed.D., R.N. Court Monitor

Attachments (1) DC Village Nursing Home Vendor Report (2) Court Monitor Letter to Ms. Alberta Brasfield

cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20001

Ms. Barbara Mann Office of the Corporation Counsel 441 4th Street, NW, Suite 680
Washington, DC 20005

TTT

VENDOR

CONTArr

DC VILLAGE NURSING HOME VENDOR REPORT

SUPPLIES

INVOICES OPEN > 45 DAYS

DATES.

SERVICES

PAYMENT

CONTINUE SERVICE?

DISTRICT

TORINE

HEALTHCARE MITCHELL

MEDICAL, JANTTORAL. INDUSTRIAL, & SAFETY SUPPLIES

3/19/93 3/19/93 1/21/93 1/21/93 2/28/94 6/27/94 7/11/94 7/25/94 9/9/94 9/9/94 9/9/94 9/9/94 9/12/94 5/5/95

$7518.75 8347.50 6417.00 179.25 9913.15 2499.30 556.00 1837.50 4050.07 1045.80 1645.24 2499.30 2766.75
880.00

APPROX. $27000 REC'D. BUT VENDOR DOES NOT KNOW FOR WHICH INVOICES; WORKING WITH A/P @ DC VILLAGE

YES, IF PAID

NATIONAL PATIENT JUDY

SPECIALTY BEDS 3/31/95

8110.00

DC VILLAGE IS

YES

CARE SYSTEMS OGLESBY

9/30/95

1276.00

NOT RETURNING

10/31/95

8925.00

CALLS.

11/30/95

8925.00

12/31/95

7950.00

1/30/96

6925.00

2/29/96

50.00

2/29/96

5600 00

47761.00

ALLIED MEDICAL MRS. CRYC1ONE CONSULTS

CUP

JAMES

NURSING

HAYNES

3/12/96 3/12/96
3/5/96

5973.93 13912.06 19885.99
20882. J3

VENDOR NEEDS $ FOR PAYROLL

YES
YES. THRU 4/27/96

VENDOR

CONTACT

DC VILLAGE NURSING HOME VENDOR REPORT

INVOICES OPEN > 45 DAYS

SUPPLIES

DAffiS.

SERVICES

PAYMENT

CONTINUE SERVICE?

T.H.R. (TOTAL HEALTHCARE RESOURCES. INC.)

EMMA lUiSUMADliRO AND JUNE BROWN

NURSES

NOV. DEC.

JAN.

FEB.

$15673.20

DC VILLAGE

5698.25

PAID $23463.60

9087.50

SINCE 4/1/96

7994.55

REPORT

3635.33

3480.45

8599.00

4500.00

10483.08

2752.70

6663.93 BAL DUE

2806.30

10719.68

11964.10

2366.70

5981.88

2758.40

5727.55

2014.60

3534.30

912.0D_

SVC SUSPENDED 3/2S-WILL COMMENCE ONCE PAID $115000

JACOBS GARDNER JOHN

OFFJCE SUPPLIES 7/94

111.00

YES

KEBLER

MEAD JOHNSON JOANELLE

DIETARY

3/6/96

469.80

YES

PATTON

SUPPLEMENT

VENDOR

CONTACT

DC VILLAGE NURSING HOME VENDOR REPORT

SUPPLIES

INVOICES OPEN > 45 DAYS

QAIE&

SERVICES

PAYMENT

CQNTTNUE SERVICE?

NATIONAL NURSES SVCS

STEW NELSON CONTRACT NURSING

SRT-PREMEIR

TONY SILER

NURSING

12/21/95 12/28/95 12/28/95 1/4/96 1/11/96 1/31/96 2/7/96 2/15/96 2/21/96
9/7/95 9/7/95 11/23/95 11/23/95 1/4/96 1/4/96 2/1/96 2/8/96 2/15/96 2/22/96 2/22/96 2/29/96 2/29/96

$2544.82 254.16 311.13 144.79 71.55 324.28 29.55 974.78
20008.05 24663.11

THESE ARE BALANCES DUE EXCEPT FOR 2/21/96

2334.70 4433.50 7349.43 5303.33 2191.45 3277.55
244.32 BAL DUE 15.58 BAL.DUE
3412.37 3809.77 7362.52 3954.07 8906.00

YES YES

ABBOTT

JOSIE

DIAGNOSTICS

12/12/95 12/12/95 2/7/96
2/22/96

102.84 99.24 7219.50 8158.55
15580.13

VENDOR

CONTACT

DC VILLAGE NURSING HOME VENDOR REPORT

SUPPLIES

INVOICES OPEN > 45 DAYS

DAIE

SERVICES

PAYMENT

CONTINUE SERVICE''

OCE

AMY STRONG COPIER

BUSINESS

LEASING

1/1/94

$488.00

SYSTEMS

8/1/94

488.00

10/1/94

488.00

11/1/94

488.00

12/1/94

488.00

12/28/94

488.00

2/12/95

488.00

5/8/95

488.00

10/4/95

488.00

11/4/95

488.00

12/5/95

488.00

1/4/96

488.00

2/8/96

488.00

2/24/96

488.00

COPIER

7/20/94

488.25

SERVICE

10/31/94

488.25

CONTRACT

11/17/94

488.25

12/18/94

488.25

1/19/95

488.25

1)
o
UJ

2/17/95 3/20/95

488.25 488.25

x
UJ

5/18/95

488.25

6/16/95

488.25

a

7/20/95 8/18/95

512.66 512.66

IN

9/29/95

512.66

10/18/95

512.66

11/17/95

512.66

Q

12/29/95

512.66

UJ

1/18/96

516.66

2/15/96

512.66

(h

3/14/96

.512.66

I

15840.19

Ti-

ro

I

a .

n

NO SERVICE UNTIL PAY MENT; WORKING "W/ SALES REPANDMARCH RUNNER

DC VILLAGE NURSING HOME VENDOR REPORT

VENDOR

CONTACT

SUPPLIES

INVOICES OPEN > 45 DAYS

DATES

SERVICES

PAYMENT

CDNTINUESERYJCEl

HEALTHCARE LAUNDRY

TED SCHIMPFF

LAUNDRY SERV

3/1/96 3/1/96 3/8/96 3/8/96

$1620.75 5659.68 1032.75 5449.86 13763.04

COULTER CORP JAY BRIAS

PT. TESTS

3/95-2/96

17755.32

INVOICED 4/11/96

to

PENDING FUNDING

HDI DIAGNOSTIC FREIDA BACKER

CONTROL SOL.

10/13/95

87.50

IBM

NANCY

PRINTER

11/1/95

HOWARD

MAINT.

12/1/95

10

1/1/96

UJ

2/1/96

L)
t-i

3/1/96

u.

u.

o

46.00 46.00 46.00 46.00 46.00 230.00

SHANE MEATS DEBBIE

FOOD

3/7/96

1313.98

SHANE

3/11/96

6J25J£

1939.37

u

Ul X

HOOD'S INST. JESSIE

FOOD

3/8/96

UJ

FOOD

REEVES

z a

CONTINENTAL ROB

FOOD

3/12/96

131.45 498.09

YES
YES YES YES
YES, IF PAID

p ui
I •t N I 0:
a.

DC VILLAGE NURSING HOME VENDOR REPORT INVOICES OPEN > 45 DAYS

THE FOLLOWING VENDORS WERE CONTACTED ON 4/19/96 AND4/22/96 AND HAD NO RECORD OF INVOICES OUTSTANDING > 45 DAYS:

r>

ACTION SUPPLY

a!

AMERICAN COMBUSTION

AMES

th

CALICO

*

CALVA, INC.

«>

CHEMTRON

?.

COLUMBIA DIAGNOSTIC

COMMERICAL KITCHEN

DIETARY SPECIALTIES

DIVISION MEDICAL SUPPLIES

EAST'HiCH, INC

lilECO

w

HILL ROM

m

HOBART

«

J. P. FOOD SERVICE

MAZOLERCH

MARTEC

PAMECO CORP.

POTOMAC BOOK HOUSE

R E . MICHEL

ROCHE BIOMEDICAL LABORATORIES (COMPLETE VERIFICATION DEPENDENT ON SUPPLING ACCT. #)

ROSS LABORATORIES

SANDOZ

SOUTHERN INT'L

TECHNICAL SALES AND SERVICES, INC.

TRIBLES. INC.

W. W. GRAINGER

*a-

REPORT DATE: 4/23/96

i

a: a.

 
 ttAY-09-96 THU 17:23 NCCNHR

FAX NO. 2023322949

P, 02

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
U.S. v. District of Columbia
llll III IIIII III NH-DC-001-026
The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Ave, NW, 4th Floor Washington, DC 20001
Re: The United States of America v. The District of Columbia, et ai, Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6, 1995; November 7, Order Modifying Stipulated Order of July 6,1995; Court Order, December 22, 1996; Court Order, February 23, 1996
Dear Judge Hogan:
This is an update since my recent letter to the Court of April 25 on the outplacement of the residents of DCV to their new homes.
To date there are 62 residents remaining at DCV. Of this number 35 residents still have no identified outplacement site. Eight residents are tentatively scheduled to be outplaced during the remainder of this week.
Residents with Mental Retardation
Six residents with mental retardation were outplaced this week to D.C. Family Services' group home site on O Street, S.E. Mr. R.W., Mr. T.S., and Mr. F.McE. were outplaced Tuesday and Ms. S.A., Ms. S.P., and Mr. T.M. were outplaced Wednesday. DCV staff accompanied the residents and will remain at the site for the day and evening shifts for the remainder of this week. Georgetown University Child Development Center (GUCDC) staif will be conducting orientation and training for the new direct care staff in the residents' new homes. D.C. Family Services reports that the presence of the DCV staff on-site is very helpful to their new staff.
There has been community concern and some opposition to the presence of this group home. Seemingly some of the opposition is related to the comparatively large number of group homes in

ttAY-09-96 THU 17:24

NCCNHR

FAX NO. 2023322949

P. 03

Ward 7 and also apparently to the manner in which the block and community was introduced to presence of the group home. I cannot believe for a moment the opposition is related to the residents who will be living now at this site, for to me they are truly angels who did not asked to be born with their challenges, but bravely live with them which is an inspiration to us all. The ombudsperson, Ms. Sarodel Childs and I visited the group home on Tuesday morning, May 7, before the residents were outplaced. We met with some of the new staff and the construction person for D C . Family Services, who with his partner has lovingly restored the home to meet the special needs of the residents. We also introduced ourselves and talked for a time with one of the neighbors who was walking by about his and his neighbors concerns. We invited him and his family to visit with the residents at anytime and to continue to apprise us of his and his neighbors concerns.
Ms. Sarodel Childs continues her fine advocacy and review of residents outplacement packets. As a result, she was able to prevent the continuation of an apparent District of Columbia Mental Retardation and Developmental Disabilities Administration Policy of not transferring residents' funds. The residents outplaced this week have the same protections now as the general population of DCV residents outplaced, and that is, their accounts from Independence Federal Savings Bank are transferred to the new payee at the new receiving facility. Based on what has transpired in Court and representations made by the defendants about the residents personal needs allowance (PNA), it was disconcerting to me that it took proactive intervention by the ombudsperson for the reactive steps taken by the District of Columbia to comply with federal law and regulations regarding residents' funds-
D.C. Family Services and Wholistic Habilitative Services have received interim rates for the O Street and Bunker Hill Road group home sites, respectively.
On May 2,1 visited Wholistic Habilitative Services group home on Bunker Hill Road, N.E. with Dr. Frieda Butler, the nursing home systems expert consultant to the Court Monitor. This site is the new home for Ms. A.R. and Mr. K.F. The home appeared bright, cheerful, and clean. We visited at dinner time. The food appeared nourishing and well balanced. The residents were receiving attention from the staff on a one to one basis. The neighborhood is certainly conducive to outdoor activities, and the residents had just returned from a walk around the block with the staff.
A concern which will be monitored is that in the home there were limited resources for stimulation and physical activity. In addition, the Habilitation and Transition plans for Ms. A.R. and Mr. K.F. call for enrollment in off-site Day Programs so that they may be meaningfully stimulated beyond maintenance to meet their full potential and individualized needs. Mr. K.F. has been accepted by one, but there is no date for commencing participation. An application for Ms. A.R. is pending. The progress of application and enrollment in off-site Day Programs will be monitored and reported to the Court. Until Ms. A.R. and Mr. K.F. are attending and meaningfully engaged in outside day programs, the defendants are not in compliance with the Court Orders.

TT

MAY-09-96 THU 17:24

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FAX NO, 2023322949

P. 04

GUCDC has commenced providing inservice and training to staff at both group home sites, Wholistic and D.C. Family Services. This is an admirable model for community placement and it is a tribute to the Court that it exists.
There is one remaining resident with mental retardation at DCV, Mr. P.L. There is no site identified for him. Mr. P.L. is wheelchair bound and because of his physical needs his chair is wider, 27 inches, and longer, 67 inches, than most group homes are structurally able to accommodate. Until the dimensions of his wheelchair were actually known, Mr. P L . was scheduled for outplacement to D.C. Family Services 0 Street she. According to Mr. Butler today, there is no vacancy "within the system" for Mr. PL. This is of very serious concern to me, for Mr. P.L. is truly where he should not be to meet his individualized needs in continual violation of the Court Orders. Immediate and proactive planning is needed by the District to find the most appropriate site for Mr. PL. to meet his individualized needs pursuant to the Court Orders. The planning for this will be closely monitored and reported to the Court on a regular basis.
Residents Moving to Independent Living
Mr. C.W. was discharged to his new home this week. Ms. Peggy Graves has been instrumental in coordinating the planning for the outplacement of the three residents who will be moving to independent living, including Mr. C.W. Within the best of her abilities, Ms. Graves is being as thorough as possible to meet the residents individualized needs. A complete list of services and programs established for the residents will be profiled in a future letter to the Court. Mr. C. W.'s food stamps are scheduled to be ready on May 17. In the interim, he has supplies of food goods from DCV and a local Church. Mr.C. W. should receive his first SSI check on May 22. He was discharged with $70. My concern about the need for cash as profiled in my April 25th letter to the Court is still valid.
Ms. M.M. is scheduled to be discharged next week. There is still no site identified for the third resident, Mr. M.W.
I have an overall concern with the lack of consistent proactive planning. Since my last submission to the Court, another example became apparent, and once raised by the Court Monitor, reactive steps have been taken by DCV for the best interests of the residents.
For weeks at the weekly outplacement meetings, Mr. Silas Butler reported that two of the three residents scheduled to be outplaced to independent living would be enrolled in rehabilitation medicine programs because these two residents, Mr. C.W. and Mr. M.W., have amputations of both their legs. At a planning meeting for Mr. C.W. last Wednesday afternoon, May 1, no mention was made of follow-up medical care. I inquired about this and the medical director at DCV responded that Mr. C.W. could walk into any facility of his choice, go to the admitting area and enroll himself.
I do not believe that residents who have been institutionalized for years should be left to their own

Tin 1 • TTTTT

HAY-09-96 THU 17:25

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FAX NO. 2023322949

P. 05

devices to negotiate the maze of a medical center to establish their own medical follow-up. This is a daunting task even for the able-bodied among us and often too intimidating to even begin to initiate, let alone to know how to follow-through.
I am very distressed, that in retrospect the representations made for weeks at the weekly outplacement meetings were not being carried out by the medical director. Nevertheless, I am happy for Mr. C.W.'s sake, that as a result of the concern raised at the May 1 meeting, Mr. C.W. is enrolled (by the medical director) at the rehabilitation medicine program of Washington Hospital Center, the facility of his choice, and his first appointment is May 17.
I believe expecting these residents to find and otherwise walk into and enroll themselves for medical care represents an insensitivity to the demands of the new independent lifestyle of the DCV residents institutionalized for years. I was stunned by this expectation and very concerned about the potential negative consequences on the new lifestyle for these DCV residents. I am communicating my concern to the Court, so that this iapse in careful attention and planning for the residents does not happen again, and so that the outplacement of the remaining DCV residents continues with dignity and respect for their individualized needs.
Continued Concerns Regardine Lack of Proactive Initiatives
The concern raised in my April 25th letter to the Court regarding vocational rehabilitation to meet the residents individualized needs is still valid. It applies not only to the three residents scheduled for independent living, but also to the younger than average-age nursing home residents, who are are indeed able-minded although not able-bodied. In order to meet their individualized needs upon outplacement in accordance with the Court Orders, vocational rehabilitation services must be made available to them. I am concerned about the planning for these services and will closely monitor the situation and report to the Court.
Yesterday, another instance of a lack of proactive initiative became known to me, and greatly concerns me, regarding a resident in the general population awaiting outplacement. At Wednesday's weekly outplacement meeting, Mr. R.W. was profiled as scheduled for outplacement, yet within the last few weeks he has refused to leave, refused to eat, stopped breathing on a number of occasions, has been admitted a number of times to local hospitals, and has refused treatment. I have seen situations like this before when human beings will themselves to die. Mr. R.W. has told staff he will not leave DCV. The trauma of transfer can render an individual with a feeling that there is no recourse left but to take control of one's life in manner similar to this.
To the nursing department's great credit, a nurse aide has been detailed to Mr. R.W.'s room around the clock to monitor his breathing. However, the specialty consult team which provides counseling was not contacted by the medical department, and not contacted until the presence of the Court requested that Ms. Sue Brown to do so immediately. Ms. Brown followed up and informed me yesterday afternoon that Geriatric Psychological Systems (GPS.) is now scheduled

TT

HAY-09-96 THU 17:26 NCCNHR

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to see M r R.W. today.
I do have a concern that there will be a few hard to place residents who will have no identified sites by the latest projected closing date of DCV in three weeks. For the best interests of the residents in order to be placed in the most appropriate sites to meet their individual needs pursuant to the Court Orders, residents should not be moved until the most appropriate (not interim) sites are found and provisions for their individualized needs are established with respect and dignity.
In the most recent "30 Day Compliance Report' received by me, which is the March report, there are a number of hospitalizations listed for dehydration related reasons which had been such a great source of concern several months.
Once again it has come to my attention that the defendants were advised not to meet with nor speak to the Court Monitor. Friday, May 3, at the District's initiative, a weekly scheduled meeting with Mr. Vernon Hawkins, Dr. Harvey Sloane, Ms. Gladys Fountain, and the Court Monitor was to take place at 4pm in Mr. Hawkins' office. At 3:25pm on Friday, May 3,1 received a phone call canceling this meeting with no rescheduling date. I subsequently learned, that Mr. Goode in the general counsel's office of the Department of Human Services for the District of Columbia, advised the defendants to take this action. I believe this advice was not constructive and a disservice to the defendants. It is the role of the Court Monitor to advise the defendants on how to comply with the Court Orders for the best interests of the residents. Therefore, the only parties to suffer by this counsel are the defendants and ultimately the residents.
Outplacement visits
On May 2,1 met with Sr. Carol Keehan, President of Providence Hospital, along with Dr. Frieda Butler. I shared with Sr. Carol the Court Orders, highlighting those that relate to the outplacement of the residents to the most appropriate settings to meet their individualized needs. Providence Hospital is currently managing two nursing homes, the new one built on its premises and the facility in Hyattsville, MD, Carroll Manor. The Hyattsville facility is scheduled to be sold and to be operated under new management. However, Sr. Carol assured me that soon a meeting will be set-up with the new management, the Court Monitor and Sr. Carol to review the Court Orders with the new management. I will follow-up on this and report in a future letter to the
Court.
Vendors
As of this writing, National Patient Care Systems has not received the Court ordered (at the defendants request) payment past due of $47,761.00, despite the defendants unseemly request of the Court to issue an order to pay this vendor. The Court graciously issued the Order for the best interests of the residents. This vendor supplies specialty beds for residents with decubitus ulcers.

MAY-09-96 THU 17:26 NCCNHR

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Attached to this letter to the Court is a fax sent to me by National Patient Care Systems identifying invoice numbers and amount due.
In a telephone conversation on Wednesday, May 8, with Ms. Janette Michael, consent decree coordinator for the Department of Human Services of the District of Columbia, Ms. Michael indicated that the "check has been cut today... and mailed." Ms. Michael indicated that "as soon as she received the Court Order" which she said shejust received, she was able to "cut the check". Now she is awaiting a Court Order so she may "cut" another check to National Patient Care Systems for $6300. The defendants request was dated April 4, the Court Order for payment to this vendor was issued April 16. I received my copy April 18.
My concern is that the defendants are venturing onto a path of disrespect and abuse of the federal judicial system; that requests for Court Orders for payments of vendors will become a pattern until DCV is closed; and that the Court Orders, as in this instance, will be cavalierly handled and still not honored in a timely fashion.
My concern is only heightened by the fact that the Corporation Counsel has asked the Court to issue an order for payment to Assur Qual which was never a vendor at DCV providing services to the residents. Rather Assur Qual was the defendants expert in its attempt to refute the need for the Court Order to improve care and services for the residents at DCV.
The vendor providing needed and expert direct care to residents, TMS (Therapeutic Management Systems), the physical therapists, received partial payment of the January invoice in the amount of $2849. The physical therapists are owed $2296 remaining on the January invoice and $6885 for the February invoice submitted March 11,for a total to date past due of $9181.
Attached to this letter to the Court is a copy of an "Account Statement" from National Nurses listing invoices for which partial payments were made and for which remaining payments are still due according to the vendor.
Given the recent article in The Washington Post regarding the removal of contracting authority from the Department of Human Services, it would be helpful to know to whom questions concerning contracts and vendor payments for services for the residents should be directed.
Once again, Judge Hogan, it is a privilege to serve your Court and to work with all concerned parties for the best interests of the long term care residents of the District of Columbia.
Sincerely,
Harriet A. Fields, Ed.D., R.N. Court Monitor

HAY-09-96 THU 17:27

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Attachment (1) National Patient Care Systems vendor list (2) National Nurses, Inc. vendor list
cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20001
Ms. Barbara Mann Office of the Corporation Counsel 441 4th Street, NW, Suite 680 Washington, DC 20005

HAY-09-96 THU 17:27 NCCNHR
May-O7-96 O3:49P NPCS INC

FAX NO, 2023322949
2O1 641 854.1

K

23 EMPIRE BOULEVARD SOUTH HACKENSACK, NJ 07606-1805
(201) 641-7400/(800)955-4555 FAX: (201) 641-8541

DATE: TO:

FAX TRANSMISSION CO VER PA GE
f

LOCATION:

FROM:

EXTENSION: -

TOTAL NUMBER OF PAGES (INCLUDING COVER) INSTRUCTIONS:

P. 09
v. UJ.

-<r /7

MAY-09-96 THU 17:27 NCCNHR
May-O7-96 O3:49P NPCS INC

FAX NO. 2023322949
2O1 641 8541

P. 10
p.02

DC VILLAGE HOSPITAL 2 DC VILLAGE LANE S.W.
WASHINGTON. DC

2003 2

93475 106155 108473 110682 112937 115251 116559
"f 19864

03/31/95 09/30/95 10/31/95 11/30/95 12/31/95 01/31/96 02/29/96 02/29/!
03/31/96

I I I I I I I
I B

. GEORGE
BRYD BRYD BRYD BKYD BRYD , HELEN 3RYD
MARY

'-•C t 27'•- • •-"
^:-- 0 '(<-. 1 -::c

05/07/96 DCVIL

9025.00 8850-00 8925.00 8925.00 7 9 50.00 6925.00
50. 00 .00.. 6 300 00

SI 10.0* 127(9.00 S925.00 3925.00 7950.00 6925.00
50. 00 5 600.0.JL6300.00

CURRENT 0.00

• 1 TO 30 6300. 00

31 TO 60 5650 .00

61 TO 90 6925 .00

54061 .00 OVER 90 35186 .00

MAYr09-96 THU 1 7 : 2 8 NCCNHR

FAX NO. 2023322949

P. 11

NATIONAL NURSES SERVICE 18O7 LIBBIE AVBNUE SUZTB #206 RICHMOND, VA 23226
(800) 846-6755

ACCOUNT:

ACCOUNT STATEMENT

D.C. VILLAGE

OATS OP STATEMENT:

ATTN: DELORES RICHARDSON

D.C.VILLAGE INVOKES* & DATE:
I

MAY 8, 1996 D.C. VILLAGE 2

AMOUNT DUE:

INVOICE! & DATE: AMOUNT DUE:

#238

12/21/95 2,544.82

#284

12/28/95

311.13

#363

01/04/96

144.79

#440

01/11/96

71.55

#637 #707 #712 #2348J 1

02/07/96 02/15/96 02/21/96 03/01/96

#234903 03/08/96 #235li3 03/20/96

29.55 974.78
7.94 97.41
452.70 7.94

#638

02/07/96

02/21/96
#234832 03/01/96 #235054 03/15/96 #234904 03/08/96 #235124 03/20/96

7.35
1,188.89 2,590.07 1,173.11 7,799.00
66.19

SUBTOTAL

1,570.32

SUBTOTAL

$ 15,896.90

TOTAL AMOUNT NOW PAST DUE

$ 17,467.22

HAV-09-96 THU 17:23 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.O., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142
TO:

FROM: Dr. Harriet A. Fields DATE: NO. OF PAGES (INCLUDING COVER): U_
MESSAGE:

 
 HAY-22-96 WED 03:57

NCCNHR

FAX NO. 2023322949

P. 02

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street. N.W. Washington, DC 20009 Message: (202) 234-7142

M.X22.19K

U.S. v. District of Columbia
IIIII i l l III || || III IHUM

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Ave> NW, 4th Floor Washington, DC 20001

• ••

• • • • mm m m

NH-DC-001-028

Re: The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6,1995; November 7, Order Modifying Stipulated Order of July 6, 1995; Court Order, December 22, 1996; Court Order, February 23, 1996

Dear Judge Hogan:
This is an update on the outplacement of the residents of DCV to their new homes since my May 9 letter to the Court.
There are 49 residents remaining ax DCV. Of this number 30 residents have no identified outplacement site. This is of very serious concern, especially in light of the District of Columbia's arbitrary and artificial projected closing date of May 31,1996 - next week. Pursuant to the Court Orders, residents must be outplaced to the most appropriate sites to meet their individual needs.
The Mayor of the District was briefly at DCV on Monday afternoon, May 20. According to the Interim-Administrator for Long Term Care, the purpose of the visit was to see the staS, the residents, and to inspect the facility, auditorium, etc., for the Summer Youth Services Initiative and Leadership Program which is scheduled to commence at DCV on June 24. Representatives from this program toured with the Mayor.
I met with the Mayor briefly and told the Mayor that the facility cannot close until all the residents are appropriately outplaced to sites which can meet their individual needs; that there are a number of residents who have no site identified to date; that between now and next week it is highly unlikely appropriate sites will be found; and that the residents now left at DCV are the District's most vulnerable citizens. I told the Mayor that Dr. Harvey Sloane the Commissioner of Public

HAY-22-96 WED 03:58

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Health and I were meeting with the D.C. Health Care Association (DCHCA) on Tuesday to make them aware of the need for outplacement sites within the District, and to plead with them to accept the residents. DCHGA consists of the administrators of the 20 nursing homes within the District of Columbia. I also told the Mayor that I am prepared to meet with each facility to review the residents needs and to facilitate a smooth transition from DCV to their new homes. I also told the Mayor that I am willing to take any proactive steps to help the residents of DCV find the most appropriate new homes. The Mayor stated that in "government if you don't give deadlines you never get anything done" and that of course the facility would not be closed until the residents have a home.
I am confidant that the Mayor understands that the residents cannot be outplaced until the most appropriate sites are identified to meet the residents individual needs pursuant to the Court Orders.
On Monday evening at DCV a meeting was held for the residents with no identified outplacement site, their family members, and guardians. If a family member had a preference for a particular nursing home for their relatives, they were encouraged to contact that facility directly, because family intervention is often persuasive to long term care facility operators. In addition family members were encouraged to contact Ms. Corrie Kemp in the Social Services Department and the Ombudsperson, Ms. Sarodei Childs. There was genuine love and concern among family members and guardians present.
Dr. Sloane, myself, and Ms. Gladys Fountain did meet yesterday, Tuesday, with DCHCA at their luncheon meeting held this month at Hadley Hospital (site of Hadley Skilled Nursing Facility which has accepted 39 DCV residents) and each of us spoke briefly. I introduced myself as representing the residents and the Court, and identified the nursing homes in the District that have and have not accepted and admitted DCV residents. I also offered to work with the facilities as often as necessary, to meet with their administrators, directors of nursing, direct care staff, social workers, and admissions coordinators to effect a smooth transition. I believe Dr. Sloane, Ms. Fountain, and I presented a concerned, dedicated, and cohesive effort to help the community help the residents. We invited the attendees to "come down the hill" (which is where DCV is geographically from Hadley Hospital) and meet the residents.
The residents remaining at DCV with no identified outplacement site are no different from any other nursing home population, except for the fact they do not have a home. Also, a number are younger than the average age nursing home population and, therefore, could benefit by being meaningfully engaged in their environments through vocational programs as identified in my May 9 letter to the Court on page four.
A tribute to a municipality is the ability to care for its citizens who have no one else to care for them and no place else to go. DCV played this role for many years, this chapter must end with dignity. The feelings and atmosphere of sadness, bewilderment, and rejection among the remaining residents at DCV is perhaps best captured by Mr. M.W., 40 years old, who profoundly

HAVr22-96 WED 03:58

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asks these simple questions: "Don't other facilities realize that the DCV residents are homeless?" "Are the [outplacement team] just giving up?" "What happens to the ones that have been refused [by other nursing homes]?" uIs May 31, really DCV closing date?"
A weakness in the District's long term care system is highlighted by the outplacement process at DCV. There is a lag between the needs of the current long term care resident eligible population in the District and the services facilities are willing to provide. The fact that there are so many residents remaining with no identified outplacement site partly relates to the fact that there are few options to placement other than institutionalized long term care. The District of Columbia lags behind most all jurisdictions in this country in applying for medicaid waivers to redirect federal funding from institutional to community based long term care. Redirecting funding affords more appropriate and greater variety of care settings options for individuals requiring long term care.
The need for a medicaid waiver for institutionalized long term care was first identified in my November 30, 199S, Status Report to the Court on page 22. Required for that were the Annual Cost Reports and the Budget for DCV which were never forthcoming from the defendants. With a medicaid waiver, creative and appropriate sites can be identified and developed to meet the changing profile and needs of the long term care population. Medicaid waivers usually afford care to be given in settings more cost effective than institutional long term care. For the best interests of the long term care resident population of the District of Columbia and for the nation's capital city to become responsive to current trends and needs in long term care, the District must avail itself of this care option and put behind its inexplicable failure to do so to date.
Residents with Mental Retardation
There is still no identified outplacement site for Mr. PL. Tomorrow morning, Wednesday, May 22, there is a meeting at DCV with Georgetown University Child Development Center (GUCDC) to discuss Mr. P.L. Mr. PX.'s last medical evaluation was conducted one year ago. According to some GUCDC staflC given his fragile medical condition, a re-«valuation of his medical status by experts in mental retardation identified by GUCDC would be in order. Some have speculated that perhaps an appropriate site would be Health Care Institute. This is the where the three medically fragile residents, Ms. A.B., Ms. C.L., and Ms. C.W. were outplaced in March. GUCDC provides on-site training of staff and interaction with the residents several times a week pursuant to the Court Orders and for the best care interests of the residents. According to GUCDC the Health Care Institute staff find GUCDC's input very valuable for their care-giving to these residents.
Enrollment and attendance at off-site day programs have not begun for the two residents, Ms. AJL and Mr. K.F., outplaced to Wholisric Habilitative Programs. The Individual Habilitation Plans for three of the six residents at D.C. Family Services identifies attendance at off-site day

ttAYr22-96WED 03:59 NCCNHR

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programs. To date sites have not been identified. The District must follow-through with identifying and enrolling the residents with all due attention and haste pursuant to the Court Orders commencing with the July 6 Court Order. The defendants' case managers at the Mental Retardation and Developmental Disabilities Administration must ensure that the day program provisions of the July 6, 1995, Court Order are enforced and that the residents with mental retardation constitutional rights are protected.
National Patient Care Systems received payment of $47,861,000 on Monday, May 20.
Ms. Alberta Brasfield, Executive Director of DCV and the licensed nursing home administrator, is to become administrator at Stoddard Baptist Nursing Home on June 3.
The identification of outplacement sites for the remaining residents at DCV will be carefully monitored to ensure that the residents are outplaced to the most appropriate settings to meet their individualized needs pursuant to the Court Orders. Following that, residents will be monitored in their outplacement sites until I can assure the Court that the residents remain in apppropriate settings and that the staff is knowledgeable in providing care to meet their individualized needs.
Judge Hogan, it is a privilege to serve your Court for the best interests of the long term care residents of the District of Columbia.
Sincerely,
0
Harriet A. Fields, Ed.D., R.N. Court Monitor

cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005

Ms. Barbara Mann Office of the Corporation Counsel 441 4th Street, NW, Suite 680 Washington, DC 20001

MAY-22-96 WED 03:57 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

TO: Mr. Richard J. Farano and Mr. David Peutsch

COMPANY: Civil Rights Division FAX: 514-6273

PHONE: 307-3116

FROM: Dr. Harriet A. Fields DATE. Mav 22. 1996 NO. OF PAGES (INCLUDING COVER): S

MESSAGE:

 
 JUN-07-96 FRI 03:21 NCCNHR

FAX NO. 2023322949

P. 02

HARRIET A. FIELDS. BID.. RN. #604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

June 6,1996

U.S. v. District of Columbia

Ms. A. Sue Brown D C . Village Nursing Home Washington, DC

NH-DC-001-029

Re: Off-site day programs ecommended for residents with mental retardation (Court Order, July 6,1995, Sectioh D. I.) and the reported denial of acceptance of residents with tracheostomy and gastric tubes

Dear Ms. Brown:
I am writing to you in my capacity as Court Monitor to advise the defendants on how to comply with the Court Orders and federal aw and regulations.
It was communicated yesterday du ing the course ofthe weekly outplacement meeting that the
specialty consultation team for iresidents with mental retardation recommended a "comnmnitybased day treatment program (for l^s5.. S.A). Referrals to several community programs were made. Ms. A. was not accepted : to her tracheostomy." Further it was reported that the team recommended a "community-bases day treatment program (for Ms. S.P.).... Day programs will not accept residents that are fed en terally."
There are off-site day programs operating in the District of Columbia that accept individuals with tracheostomy tubes and gastric tubjs (for enteral feeding).
In a telephone conversation today vith Dr. Ali, vice president for clinical services at PSI, a day program for residents with mental ttardation, Dr. Ali informed me of the following:
PSI accepts individuals witi) tracheostomy and gastric tubes. Medicaid certified day prog rams are not permitted to deny admittance because of tracheostomy and/or gastri< tubes. PSI has in its program "several' medically fragile individuals with tracheostomy and/or gastric tubes. PSI would welcome the individual habilitation plans (IHP) of the two residents with tubes

JUNTO7-96 FRI 03:21 NCCNHR

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P. 03

at D.C. Family Services gn >up home on O Street, S.E., whose IHP indicates off-site day programs. These individua Is are Ms. S.A. and Ms. S.P. Information should be sent to:
Ms. Sandra Boudu lion Intake Coordinator PSI Services, Inc. 770 M Street, S.E. Washington, DC 2( 003 [Telephone: (202) 47-3870]
In another telephone conversation today with Ms. Juanita Cook, program director of Better Treatment Center, an off-site day irogram for residents with mental retardation, Ms. Cook informed me of the following:
Better Treatment Center is aware of the requirement for medicaid certified facilities not to discriminate against indivic uals with tracheostomy and gastric tubes, Better Treatment Center hiis a unit already set aside to handle the needs of such individuals, but needs to gt t the emergency equipment, Ms. Cook has known for y jars the two individuals mentioned above in addition to the third resident at D.C. Famijy Services for whom an off-site day program is recommended, Mr. T.M. Better Treatment Center wjould welcome the IHP's of these three individuals. Information should be sent to:
Ms. Juanita Cook Program Director Better Treatment denter 5511 14th Street, N. W. Washington, DC 2(1001 [Telephone: (202) 29-2227]
According to federal disabilities lajv, it is improper and illegal to discriminate against individuals based upon their disability. This d scrimination directly impacts the civil rights of the two individuals mentioned above, Ms. .A. and Ms. S.P. Failure to provide community-based day treatment programs and allowing scrimination in medicaid certified programs to continue in other off-site day programs for inc ividuals with mental retardation, directly denies the residents identified above their rights and re tders the District of Columbia in further violation of the Court Orders.
The purpose of the Court Orders tora specialty consultation team is to provide training,
supervision, and consultation to cdregivers who are unfamiliar with the unique and individual needs of the residents with mental •etardation. It is the defendants responsibility with the assistance of the valuable gift the ( 'out has provided to the mental retardation community through the issuance of the Court Orders, to work with those off-site day programs to demystify the tubes which result in policies Liat discriminate against those with disabilities in violation of

JUN-07-96 FRI 03:22 NCCNHR

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federal law.
The time of passivity and inertia in protecting the rights of the District of Columbia's most vulnerable is long gone. Let us he p the defendants comply with the Court Orders for the best interests of the long term care residents of the District of Columbia.
The next Status Hearing in Court its June 18. Please let me know the progress of the defendants, including the Mental Retardation a nd Developmental Disabilities Administration (MRDDA), compliance with the Court Orders
Sincerely,

Harriet A. Fields, Ed.D., R.N. Court Monitor

cc.

The Honorable Thomas F Hogan

U.S. District Court for the District of Columbia

Mr. Richard J. Farano Mr. David Deutsch U.S. Department of Justice Civil Rights Division

Mr. William Isaacson Kaye, Scholer

Ms. Barbara Mann Office of the Corporation ounsel for the District of Columbia

Mr. Wayne Casey, Acting Director Department of Human Sendees District of Columbia

Ms. Frances Bowie, Admhjustrator Mental Retardation and Devielopmental Disabilities Administration District of Columbia

JUN-07-96 FRI 03:20 NCCNHR

FAX NO. 2023322949

P.Ol

HARRIET A. FIELDS, Ed.D., R.N.
#604 172219th Street, N.W. Washington, DC 20009 Massage: (202) 204-7142

FAX TRANSMITTAL

TO: Mr. Richard Farano and Mr. David Deuts^h

COMPANY: Civil Rights Division

FAX: S14-6273

PHONE: 307-3116

FROM- nr. Harriet A. Flrids

DATE: June 6. 1996

.NO. OF PAGES(INCLUDING COVER):

MESSAGE:

 
 JUN-16-96 SUN 15:56 NCCNHR

FAX NO. 2023322949

P. 02

HARRIET A. FIELDS, Ed.D., R.N. #604
172219th Street, N.W. I Washington, DC 20009 M«ssag»: (202) 234-7142

June 16,1996
The Honorable Thomas F. Hogan
U.S. District Court for the District o 'Columbia 333 Constitution Ave, NW, 4th Floor Washington, DC 20001

U.S. v. District of Columbia NH-DC-001-030

Re: The United States of America v. The District of Columbia, et aL, Civ. No. 95-948, TFH, DC. Village Nursing Home (DCV), Court Order, July 6,1995; November 7, Order Modifying Stipulated Order of July 6,1995; Court Order, December 22, 1996; Coirt Order, February 23, 1996

Dear Judge Hogan:

As of this writing there are five residents remaining at DCV. All have identified outplacement sites.
Mr. M.W. is due to be outplAced into independent living in his own apartment in the District, as soon as his new home is equipped by DCV with necessary supplies and furniture and proper paper work is completed, foil example, identification cards, housing pass, income verification, food stamps, metro pass
Mr. J.B. and Mr. HJB. are scheduled Monday to be outplaced to Pleasant Living Convalescent Center in Edgewater, Maryland.
Mr. EJ t is scheduled to be Autplaced to J.B. Johnson Nursing Center. Mr. C.F. has an independent living site identified for him in the District, but at this writing no vacant room and no scheduled date to move. The systems identified above for Mr. M.W. also apply to Mr. C.F. and, in addition, Mr. C.F. will need a personal care aide daily.

Since the presentation by Dr.

Sloane and the Court Monitor to the nursing home provider

community in the District of Coli fia on Tuesday, May 21. Mr. Bryant Hall, administrator of

Capitol Hill Nursing Center, has litted 14 more residents from DCV. These beds were made

available by converting space throuj an exemption from the certificate of need expressly for

DCV residents. This is a tribute to *.Hall for since this meeting he has nearly singularly among

bis peers, demonstrated a coi

commitment and concern for the District of Columbia's

"wnr

JUN-16-96 SUN 15:56 NCCNHR

FAX NO. 2023322949

P. 03

most vulnerable and poor, the last n maining residents of DCV who had no home in which to go. In addition, Ms. Alberta Brasfield, nner administrator at DCV and now the new administrator at Stoddard Baptist Nursing Home,aadinitted another DCV resident who had no other home identified. (Incidently, this resident, Ms. S.B., outplaced yesterday reports today that "everyone is nice...the food is much better.") Th ough these actions most all DCV residents will remain in the District or just across the line in Car 'oil Manor Nursing Home in Hyattsville, Maryland. Only a handful of DCV residents have been outplaced beyond a fifty mile radius of the District and some at family members request. Therefo 'e, nearly all DCV residents will be within the jurisdiction of the long term care orabuds program in the District.

Residents with Mental Retardation

As of June 13 all the residents with jnental retardation have been outplaced. Judge Hogan, your

Court Orders especially the Court rder of February 23 has been vital in ensuring that the most

appropriate and current informatk

to their new homes in order

that the receiving facility staff are ki lowiedgeable of the residents individual care needs. This is

true for the outplacement of all the esidents but especially so for the outplacement of the

residents with mental retardation, every instance the outplacement of this population required

constant and vigilant oversight until literally the residents were out the door and in the

transportation vehicle to take them o their new homes.

Mr. P.L.

On June 13, . PX. was outplaced to Catonsville Community

Convalescent Center in Catonsville, Maryland. All necessary and appropriate plans and action

steps were and are in place. TheS ecialty Consultation Team, Georgetown University Child

Development Center (GUCDC), vinted the she on June 3 to assess the appropriateness of the site

and the ability of staff to care for M . PX.'s particular needs. GUCDC reports the following:

activities which would be equivalen to day programming for Mr. P.L. take place daily at the

facility; there are a few other reside ts with "pervasive developmental disabilities'* similar to Mr.

P.L.; a "sensory stimulation kit"has been acquired for the residents with mental retardation; there

are occupational therapy, physical t lerapy and speech language services provided and daily

physician visits; several residents ha ve "feeding tubes" and the "facility is capable of handling Mr.

L.*s needs."; the facility can accomi aodate Mr. P.L.'s wheelchair; the "administration were

pleased that the GUCDC team will available for consultation and training."

Mr. PL. was outplaced ace mpanied by a registered nurse from DCV who has known Mr. P.L. for years. Two certified nirse aides (CNA's) from DCV who have known Mr. PX. for years were with him for the day anc evening shifts this past Thursday and Friday and one will be with him on the day shift through tt weekend. In addition, a registered nurse (R.N.) from DCV who has known Mr. PX. for quite me time was at Catonsville Convalescent Center when Mr. PX. arrived and stayed with him fo the day shift on Thursday and again on Friday. The R.N.
reports there is a R.N. at Catonsvill e who will be caring for Mr. PX. who knew him when he was a resident at Forest Haven years ag before he was admitted to DCV. According to the DCV

JUN-16-96 SUN 15:57 NCCNHR

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P. 04

R.N., Mr. P.L. demonstrated recog lition of this former Forest Haven now Catonsville staff person through his open, enthusiastj;:, and endearing smile upon seeing her. Next week GUCDC staff including the psychologist, occipational therapist, recreation therapist, speech language pathologist, and nutritionist are to commence training and consultation to the Catonsville Community Convalescent Center st^ff in the unique and individual care needs of this special resident.
Judge Hogan, I want you to know Uat the most valuable gift the residents with mental retardation
can have is your Court Order forth< Specialty Consultation Team to train, educate, and serve as consultants to the staff in the:residei its new homes. I believe this has already markedly improved the lives of the residents with menta retardation. It is certainly a model to be emulated from this time forward in the District and in the mental retardation community nationally. Just this past Wednesday, the coordinator of the KJCDC program marvelled at the improvement in the lives of the residents recently outplaced to t 0 Street, S.E. site of D.C. Family Services. Through GUCDC's presence as consultants ind educational resources and their ability to work with the staff and the residents in their newI ome, GUCDC has seen residents up every day, dressed, with shoes on, sitting in chairs, at the dining table for meals, and out of doors. The program coordinator reports in all his years DCV, he saw one resident, Mr. R.W., up out of bed "maybe three times." Now Mr. R.W. is up ind dressed everyday.
The program coordinator also gave an example of the detrimental impact on the quality of life the lack of a specialty consultation tean, such as provided for in the December 22 Court Order in this case, can have. While recently at P I day program to provide specialty consultation services for Mr. K.F., a DCV resident outplace< to Wholistic Habilitative Services on April 18 and who commenced the day program on Jui ie 5, the program coordinator saw an individual he knew from Forest Haven where GUCDC hada presence several years ago.
While at Forest Haven, GUCDC WiiS able to work with the staff and this individual (whom GUCDC had not seen in years) wb had a habit of hitting himself in the head and causing injury to himself, so much so that the star!oi itfitted him with a metal helmet to protect himself. While at Forest Haven GUCDC was able to work with this individual and the staff to the point that he 'graduated' to wearing a baseball ciipp and then to the point that he no longer exhibited this selfdestructive behavior, The project coordinator was touched and saddened to see last week this former Forest Haven resident exhib ting the same self-destructive behavior that GUCDC was able to eliminate years ago. The project coordinator opined that if a specialty consultation team had been in place for this resident when he went to his group home from Forest Haven (as well as many others in their experience) as It is in this case (Civ. No. 95-948) this individual would certainly today have a higher qualit of life than he is obviously having now, and that his resorting to previous self-destructive behavic rs is a direct result of the lack of knowledge by present caregivers of previous care interventions that at the time improved the individual's life. Your Court Order, Judge Hogan, provid continuity of care and, in turn, quality of life and protection of residents' rights.

JUN-16-96 SUN 15:58 NCCNHR

FAX NO. 2023322949

P. 05

Payment of Vendors

ge Hogan, I am relating all of this to you now because a

situation has just come to my attend >n this past Thursday which shocked and distressed me and

directly relates to the specialty consi Itation team in this case and the payment of vendors. In

April, I originally requested from GIICDC information <on payment for their services for the

residents with mental retardation at X)V. At that time I had heard that the University had not

been paid although GUCDC staffal DCV were receiving their pay checks. Georgetown was only

able to get back to me June 13wbi<i c i are the three pages in attachment one in this letter to the

Court. According to GUCDC the sfendants owe them $668,685.94. I confirmed with the

accounts analyst at GUCDC that tbi sum all relates to services provided to residents of DCV.

Upon receiving this information on "hursday, I immediately shared it with Ms. Sue Brown who

called Ms. Frances Bowie, Administ •»itor of the Mental Retardation and Developmental

Disabilities Administration (MRDDJ i) in the Department of Human Services. I faxed the attached
vendor listing to Ms. Bowie and to is. Jeanette Michael, the consent decree coordinator at the
Department of Human Services. In addition, I also spoke with Ms. Michael on Friday, June 14 about this matter. Ms. Michael told me that the Department of Human Services "knew that GUCDC is owed money but h come s under another Court Order, Joy v. Evans, through MRDDA." To me this is an inexpli able position to take, for the fact of the matter is that at times about half of the residents with menial retardation at DCV were not Evans class members and the

GUCDC contract was extended and amended;at DCV specifically designating GUCDC as the

specialty consultation team pursuani to the Court Order of December 22,1995, for all residents

with mental retardation at DCV.

The accounts analyst has told me thjit GUCDC does not intend to terminate services because they are committed to their staff and to tieiresidents, but that this chronic failure to pay is presenting a hardship to them. At this point:in tine GUCDC is the only vendor in this case that still has an ongoing, vital, and direct impact on th protection of the residents rights. At the very least this vendor should be paid immediately or the services rendered since the time of the Court Order for the Specialty Consultation Team. Ii is distressing to me that the defendants have not honored the vital contribution this vendor proviicesito improve the quality of life of the District's most vulnerable by not reimbursing for se rvices:rendered. It is also of concern to me that although there is acknowledgement by the Department of HiLuman Services that this vendor is due payment,
the defendants position is that this vjendor payment hem pertains to another Court Order, even though MRDDA is part of the Dep, rtment of Human Services and is listed in the United States Complaint filed on May 19, 1995, pertaining to this case, and the attached listing of outstanding invoices all relate to services provid id to residents of DCV.

In my fax to Ms. Bowie, I asked he to get back to me as soon as possible, that we are in Court on Monday, and I need to know fron her. As of this writing I have not heard from Ms. Bowie, As administrator of MRDDA, Ms. lowie is listed as a defendant in this case in the Complaint filed with the Court on May 19, 19S I have other concerns about MRDDA that relate to DCV residents with mental retardation w o are now in their new homes. This concern was profiled in my June 6 letter to Ms. Sue Brown |and for which the Court, the Plaintiff the Plaintiff-Intervenor, and the Defendants were copied an is attachment two to this letter to the Court.

JUN-16-96 SUN 15:58 NCCNHR

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P. 06

Dav Programs There ai i two residents, Ms. S.A. and Ms. Si5, for whom off-site day programs are indicated in their indi dual habilitation plans and who have tubes. Ms. S.A. has a
tracheostomy and Ms. S.P. hasa gastric tube. There isapparently apervasive policy in
community based day programs in District not to accept residents with tubes, for example, tracheostomy and gastric tubes, MI BDA's failure to provide day programs for residents whose individual habilitation plan calls for iff-site community based day programs and allowing the policy by programs receiving medi id funding to discriminate against individuals with tubes, violates the Court Order of July 6, 995, and the residents rights under federal disabilities law. There are many states throughout tt e country where all day programs accept residents with all sorts of tubes. Maryland, for exam; le, is one. The status of the provision of day programs will continue to be monitored.
Ms. AJL outplaced to Wholistic Ha silhative Services on April IS is to begin her day program at Better Treatment Center on June 17
Soecialtv Consultation Team for R iidents with Mentaininess
Judge Hogan, another gift to the loi g term care community in the District of Columbia is your Court Order for the Specialty Const ltation Team for residents with the label of mental illness. Geriatric Psychological Systems: hi and still does provide counselling for the residents regarding transfer trauma; conducted assessm nts of the residents necessary for staff in the receiving facilities to provide care which meei the residents individual needs, these assessments are part of the residents outplacement discharg packets that go with the residents to their new homes; reviews psychotropic medications vhen indicated; has and continues to serve as consultants for care issues to meet the residents individual needs; has begun to and is scheduled to provide follow-up counselling services to re dents in their new homes as well consultation services to the new caregivers of the residents.
Just this past week, I contacted a G S counsellor on several occasions regarding the outplacement of a resident the counsellor was following. GPS, in turn, visited the resident on several occasions at DCV this past veek before her outplacement and is scheduled to see her in her new home next week. The coo: dinator of the outplacement of the residents with mental illness at DCV, Ms. Catherine Carri >U,has said of the specialty consultation team that, "it has been very helpful, it really has."
Qutnlacement Visits to Residents ir heir new homes
Once ail the residents are outplaced I will turn my attention to visiting the resident in their new
homes ax least two or three times ui til I can assure the Court that the residents remain in appropriate settings and that their ii dividual needs are being met by their new caregivers. At which time I will submit a Final Rej ort to the Court. Two Therapeutic Recreation staff at DCV, who have worked with and known e residents for years and who have consistently

JUN-16-96 SUN 15:59 NCCNHR

FAX NO. 2023322949

P. 07

demonstrated a keen sensitivity to the restidents, have asked to accompany me on these visits. I

believt this would be of great benefi to the residents by enabling them to see a

, friendly,

and caring presence, and to the Coiuft Monitor by providing a historical context to the residents

current status.

Once again, Judge Hogan, it is a prn ilege to serve your Court for the best interests of the long term care residents of the District of Columbia.

Sincerely,

A

Harriet A. Fields, Ed.D., R.N. Court Monitor

Attachment One - GUCDC vendor list of outstanding invoices Attachment Two - June 6 letter to Ms. Sue Brown

cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 100 Washington, DC 20005
Ms. Barbara Mann Office of the Corporation C >unsel 441 4th Street, NW, Suite 6(50 Washington, DC 20001

JUN-16-96 SUN 15:59 NCCNHR

FAX NO. 2023322949

P. 08

SENT BY-

6-13-36

ChiU
TRAMSM1TTAL eOVBI SHEET

TO:

We

FAX*

Ail 5tqi/_

BILLING FOR RX:4285-87O CJ>

Q-I

INVjT

DATE

PERIOD

TOTAL INVOICED AMOUNT FOR PERIOD

GROUPING SUBTOTAL

VOUCHER NUMBER

PERIOD COVERED

DATE

TOTAL PAID OUTSTANDING FOR PERIOD AMOUNT

05/15/92

DEC 30 91 - FEB 29 92

5.523.11

5,523.11

0.00

15,523.11)

08/24/92

MAR I 91 -IUN 3092

3O3,3«O.«2

3/1-9/30

11/30/92

163.498.90

09/30*92

IULI92AUO3I92

153,950.17

VOCE)AM309IOn)OI

•

11/30/92

142,421.49

CT3 •«r

07/27/95

SEP 92

50.9W.2O

VOCEJAM309IO/OW

•

11/30/92

197,386.40

(5,004.20)

CT> CVJ

03/17/93

OCT92

41,293.40

VOCEIAM309IO/003

SEP/OCT

08/27/93

46.297.40

5,004.20

CVJ CO

549,594.39 VOCEfAN25809/00t

ro

03/17/93

NOV92

79.33O.IV

79,330.19 VOCEJAN26012/0001

NOV

09/02/93

71.568.H6

(7.761.33)

OJ C3

cvi

06/30/93 09/28'93

DEC 92 DEC 30 92 - APR 30 93

7», 135.56 234.779.15

VOCEMN32272/000! 312,914.71 VOCEIAN32272/0001

10/27/93

3I2.914.7J

10/27/93

0.00

c5

09/28/93

M A V I 9 3 - A U O 3 I 93

252,215.52

VOCEMN.U806/00I

SEP

11/02/93

14,374.00

252.285.52 VOCEIAN33806/001

11/02/93

152,519.13

(85,391.69)

10

09/28/93

II

03/30/94

12

07/14/94

13

09/29/94

SEP 93
OCT93- DEC 93 IAN 93 - MAY 94 JUN 94 • AUC94

59,700.60
202,472.21 2S5.483.09 l(t7,7O7.72

59.700.60
VOCJAP31843/VOCIAP31844 OCT-JUM VOCJAP3l843/VOCfAP3l844 OCT- DEC 675,663.02 VOC1AP31843/VOCIAP31844 OCT-DEC

J/V 11/28/94
p
m

0.00
747,660.47 • •

(59.700.60) 71,997.45

14

09/29/96

SEP 94

51,718.09

51,718.09

0.00

(51,718.09)

w

02/03/95

OCT94-NOV94

110,976.81

110,976.88 VOCEMR04577/OOOI VMSEIAX06O09/O001

OCTANOV ovum
AD OCT-NOV 05/30/95

50.498.1)0 40,199.52

(20,279.36)

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16

07/27/9$

17

07/27/95

DEC 94 IAN 95

18

07/27/95

FEB 9$

40,501.04 60,213.82 83,003.19

VOCEIARI56VS/OOOI VOCEIAR13695/0001 183,718.05 VOCEIARI5695/OOOI

DEC - FEB •

12/04/95

140,128.00
•
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(43,590.a5)

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07/27/95

MAR9S

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20

07/27/95

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07/27/95

MAY 95

CO

CO

22

07/27/95

IUN93

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23

10/02/95

IUL95

38,164.35 40.931.89 35,468.02 J7.44O.76 4l,0t6.43

38.M4.35 40,931.89 35.468.02 37,440.76 41,086.43

0.00

(38,864 JS)

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(40,931.89)

0.00

(35,468.02)

0.00

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0.00

(41,036.43)

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10/02/9.1

AUO95

aZ

25

12/07/95

SEP 95

2A

I2/O7/W

OCT95

11

01/26/96

NOV9S

28

01/26/96

DEC 95

29

03/29/96

JAN 96

30

03/29/96

FEB96

CO

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31

05/03/96

MAR 96

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59.6S7.I2
79.472.17 55,307.81 44,932.57 43,753.62
54.561.30
37,514.40
42,30t.97 2,»92,823.97

59,6*7.12
79.472.17 VOCEIAB039I4/000I 55.307.81 VOCEJAB03044/000I 44.9J2.57 VOCEIABO3949/000I 43,753.62 VOCEIABO3949/Q00I
54,5(1.30
37.584.40
42,308.97 2,I92,«23.97

SEPT/95
ocrns
NOVA DEC
NOV A DEC

02/1J/V6 01/29/96 02/15/96 02/15/96

0.00
686.25 55,307.81 8S.686.19 *
0.00
0.00
0.00 2,224.131.03

(59/W7.12) (78,785.92)
0.00
0.00
(54,561.30)
(37,584.40)
(42,308.97) (66S.6S5.94)

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JUN-16-96 SUN 16:00 NCCNHR

FAX NO. 2023322949

P. 11

HARRIET A. FIELDS, Ed.0.. R.N. #604
172219th Strwt,N.W.
Washington, DC 20009 Jessaga; (202) 234-7142

June 6,1996

Ms. A. Sue Brown D.C. Village Nursing Home Washington,DC
Re: Off-site day programs rec ommended for residents with mental retardation (Court
Order, July 6,1995, Section I). 1.) and the reported denial of acceptance of residents with tracheostomy and gastric tubes

Dear Ms. Brown:

I am writing toyou inmy capacity as Court Monitor to advise the defendants on how to comply
with the Court Orders and federal la\ r and regulations.

It was communicated yesterday durir g the course of the weekly outplacement meeting that the specialty consultation team for reside its with mental retardation recommended a "community-
based day treatment program (for Ms . S.A). Referrals to several community programs were
made. Ms. A. was not accepted due to her tracheostomy." Further it was reported that the team recommended a "community-based day treatment program (for Ms. S.P.).... Day programs will not accept residents that are fed rate ally."

There are off-site day programs oper iting in the District of Columbia that accept individuals with tracheostomy tubes and gastric tubes (for enteral feeding).

In a telephone conversation today wi h Dr. Ali, vice president for clinical services at PSI, a day program for residents with mental retardation, Dr. Ali informed me of the following:

• PSI accepts individuals with

stomy and gastric tubes.

• Medicaid certified day p:

are not permitted to deny admittance because of

tracheostomy and/or gastric tbbes.

PSI has in its program "sever iT medically fragile individuals with tracheostomy and/or

gastric tubes.

PSI would welcome the indrv[dual habilitation plans (IHP) of the two residents -with tubes

JUN-16-96 SUN 16:01 NCCNHR

FAX NO. 2023322949

P. 12

at D.C. Family Services group home on OStreet, S.E., whose IHP indicates off-site day programs. These individualsa Ms. S.A. and Ms. S.P. Information should be sent to:
Ms. Sandra Bouchelioi Intake Coordinator PSI Services, Inc. 770 MStreet, S.E. Washington, DC 2000$ [Telephone: (202) 547^3870]

In another telephone conversation toe ay with Ms. Juanita Cook, program director of Better Treatment Center, anoff-site day pro jram for residents with mental retardation, Ms. Cook informed me of the following:

Better Treatment Centeris

of the requirement for medicaid certified facilities notto

discriminate against indivi with tracheostomy and gastric tubes,

Better Treatment Center has unit already set aside to handle the needs ofsuch

individuals, but needs to get emergency equipment

Ms. Cook has known for the two individuals mentioned above in addition tothe

third resident at D.C. Family ervices for whom an off-site day program isrecommended,

Mr.T.M

Better Treatment Center woi 1welcome the IHP's of these three individuals.

Information should be sentto

Ms. Juanita Cook

Program Director

Better Treatment Cen er 5511 14th Street, N.P

Washington, DC 2000 1

[Telephone: (202) 82SI-2227]

According to federal disabilities law, t isimproper and illegal todiscriminate against individuals based upon their disability. Thisdiisci imination directly impacts the civil rights of the two individuate mentioned above, Ms. S J . and Ms. SJP. Failure toprovide community-based day treatment pro'igrams and allowing discriminationin medicaid certified programs to continuein other off-site day programs for indivi iuals with mental retardation, directly denies the residents identified above their rights and rend< rs the District ofColumbia in further violation of the Court Orders.

The purpose of the Court Orders for i specialty consultation team isto provide training,

supervision, and consultation to carej jvers who are "nfan^i)t*r with the unique and individual

needs of the residents with mental ret irdatioa Itisthe defendants responsibility with the

of the valuable gift the Coi rt has provided tothe mental retardation community

through the issuance of the Court Or< iers, to work with those off-site day programs to demystify

the tubes which result in policies that discriminate

those with disabilities in violationof

JUN-16-96 SUN 16:01 NCCNHR

FAX NO. 2023322949

P. 13

federal law.
The time of passivity and inertia in pr< itectingthe rights of the District of Columbia's most vulnerable is long gone. Let us help the defendants comply with the Court Orders for the best interests of the long term care residents of the District of Columbia.
The next Status Hearing in Court is Ji ne 18. Please let me know the progress of the defendants, including the Mental Retardation and Developmental Disabilities Administration (MRDDA), compliance with the Court Orders.
Sincerely,
Harriet A. Fields, Ed.D., ILN. Court Monitor
cc. The Honorable Thomas F. Ho jan U.S. District Court for the District of Columbia
Mr. Richard J. Farano Mr. David Deutsch U.S. Department of Justice Civil Rights Division
Mr. William Isaacson Kaye, Scholer
Ms. Barbara Mann Office of the Corporation Couhsd for the District of Columbia
Mr. Wayne Casey, Acting Din ctor Department of Human Service \ District of Columbia
Ms. Frances Bowie, Administr ttor Mental Retardation and Devd< •pmental Disabilities Administration District of Columbia

JUN-16-96 SUN 15:55 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.0., RN. #604
172219th StrMt,N.W. Washington, DC 20009 M*SMQ«: (202) 234-7142

FAXTRANSMTTTAL

TO: Mr. Richard Farano and > [r. David Deutsch

COMPANY: Civil Rights Divisio •

FAX: 514-6273

PHONE: 307-3116

FROM: Dr. Harriet A. Fields

DATE: June 16. 1996

JSO. OF PAGESONCLUDING COVER):_H

MESSAGE:

 
 HARRIET A. FIELDS, Ed.D., R.N. #604
1722 19th Street, N.W. Washington, DC 20009 Message:(202) 234-7142

June 28. 1996

U.S. v. District of Columbia
II III I IIIII III II II III I II INI I

The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Ave, NW, 4th Floor Washington, DC 20001

BVH

••

••

«• •

•

NH-DC-001-031

Re: The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6, 1995; November 7, Order Modifying Stipulated Order of July 6, 1995; Court Order, December 22, 1996; Court Order, February 23, 1996

Dear Judge Hogan:
I have obtained a copy of the defendants June 25 submission to the Court and I am compelled to comment.
Now, after the last resident has been outplaced, I am very disappointed in the District of Columbia's position regarding payment to Georgetown University Child Development Center (GUCDC). As I pointed out in my June 16 letter to the Court, GUCDC is the only vendor with still "ongoing, vital, and direct" contact with the residents as the Specialty Consultation Team for residents with mental retardation pursuant to the December 22, 1995, Court Order, through the extension of their contract to September 30, 1996. Therefore, to say that payment to this vendor is "moot" because there are no more residents is false, misleading, and makes a mockery of the Court and its Orders.
There seems to be little appreciation by the defendants of the seriousness of the Court finding them in of contempt of the Court Orders. The defendants would have failed to care for its most vulnerable, infirmed, and poor were it not for the presence and intervention of the Court. Now the defendants are quibbling over which U.S. District Court's Orders they are continuing to violate. The one page attachment to this letter to the Court is a list I received from GUCDC of the residents with mental retardation living at DCV at the time I commenced my monitoring

an

1 iurr

duties. Of the fourteen remaining living residents, nearly half are not and never have been Evans (Pratt) class members - Ms. A.B. at Health Care Institute; Ms. S.P., Mr. T.M., and Mr. T.S. at D.C. Family Services; and Ms. A.R. and Ms. D.L. at Wholistic Habilitative Services. Yet all the living residents on this list benefit by the ongoing intervention and expertise of GUCDC. In April the defendants presented an unseemly request to this Court to issue Court Orders to pay other vendors for which they alleged there were no contracts and thus were prohibited under District law to pay. For the best interests of the residents, the Court graciously complied. And yet, in this instance, the defendants admit that GUCDC is a DCV vendor providing ongoing services to residents; they acknowledge there are serious amounts in overdue payments pursuant to the July 6 Court Order under 'Payment of Vendor'; and yet they are continuing the contempt of the Court Order of July 6.
In my January 17 Status Report I profiled how GUCDC staff did not know from day to day, week to week if they would still be employed because the GUCDC contract was immently due to expire and it had not been renewed. According to the accounts analyst at GUCDC, this vendor was without a contact from the defendants from January to May of 1995. While the defendants request the Court to issue Court Orders so other vendors may be paid, the defendants were and are ignoring, violating, and continuing the contempt of the existing Court Order which applies to payment of this vendor. In the Bi-weekly Report to the Court pursuant to the December 22, 1995, Court Order, no mention is ever made of the "financial...problems" of non-payment of this vendor.
The logic of the defendants position escapes me. The defendants must not realize it, but looking objectively, their position is disrespectful of the Court. The defendants seem to be playing one U.S. District Court Chamber against another. GUCDC contract for Specialty Consultation Team services continues through September 30, 1996. Their position, that since GUCDC has not threatened termination of its services non-payment to this vendor does no harm, is callous and irresponsible. It is this type of thinking that led me to the conclusion that DCV needed new management in my January 17, 1996, Status Report to the Court. It seems to this day that the defendants do not hold dear their civic responsibility to care for the District of Columbia's most vulnerable, frail, infirmed, and poor - those who cannot defend themselves. I only report facts, data that is corroborated, and the truth as I see it. Therefore, only when I received from the GUCDC accounts analyst report on June 13 (although I requested it in April) did I submit to the Court the status of payment to this vendor.
MRDDA is part of the defendant class in this case. The defendants are admitting that MRDDA is disregarding Court Orders. I am also concerned that MRDDA be held accountable pursuant to the July 6 Court Order, to appropriately plan with GUCDC and the group home provider to offer the off-site Day Programs to Ms. S.A. and Ms. S.P., when the experts agree it is the appropriate time for them to benefit from such programming. Last Friday, June 21, 1996,1 met with Ms. Sue Brown and the program coordinator for GUCDC to develop a plan in which MRDDA, GUCDC, and the group home provider for these two residents, D.C. Family Services, could all work together to proactively identify an appropriate day program for Ms. S.A. and Ms. S.P. We also

discussed training of the day program staff by GUCDC in the care of these residents so that when the expert consultation team deems Ms. S.A. and Ms. S.P are ready for off-site Day Programs, systems will be in place to receive these residents, including care of their gastric and tracheostomy tubes respectively. (These concerns were profiled in my June 16 and June 6, 1996, submissions to the Court.) I urge the defendants to take advantage of GUCDC expertise now, before the GUCDC contract is due to expire. This morning I had a telephone conversation with Ms. Frances Bowie, Administrator of MRDDA relating the above to her. Ms. Bowie informed me that next Tuesday a meeting is scheduled with MRDDA and GUCDC to discuss among other things, the above concern regarding off-site day programs and the possible extension of the GUCDC contract so that the mental retardation community in the District will have further benefit of their expertise. During the next several weeks while I focus my monitoring activities on visiting the residents in their new homes, I will also monitor the progress of planning for the off-site day programs for the two residents mentioned above.
Preliminary data on two residents, Mr. C.F. and Ms. S.B., outplaced recently, one of whom was the last resident to leave DCV, indicate that they are thriving and happy. Mr. C.F. is in an independent/supported living arrangement in the community with a personal care aide four hours a day, five days a week, who among other duties provides needed assistance with the preparation of his meals. Mr. C.F. reports he will be planning with the building manager to develop programs for the tenants regarding, among other topics, residents' rights. I have never heard Mr. C.F. happier, nor have I heard Ms. S.B., outplaced recently to Stoddard Baptist Nursing Home, happier with a lightness and gaiety to her voice, something which was completely undetectable while she was residing at DCV. Ms. S.B. has told me that she is "not used to such kind treatment," and just yesterday she added, "we have fun over here." This resident also soberingly reminded me that "we had to pay for the District's poor management, some paid with their lives."
Judge Hogan, it is a privilege to serve your Court for the best interests of the long term care residents of the District of Columbia.
Sincerely,
a
Harriet A. Fields, Ed.D., R.N. Court Monitor
Attachment One GUCDC Resident Listing'

cc: Mr. Richard J. Farano Mr. David Deutsch Civil Rights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 15th Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann Office of the Corporation Counsel 441 4th Street, NW, Suite 680 Washington, DC 20001
Mr. Michael Schuster Office of General Counsel, AARP

GEORGETOWN UNIVERSITY INTERDISCIPLINARY HABILITATION TEAM RESIDENT LISTING - D.C. VILLAGE

P = Pratt Class

(Revised 08/23/95)

 
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FAX NO. 2023322949

P. 02

HARRIET A. FIELDS, Ed.D., R.N.
#604 172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

U.S. v. District of Co urnb a

'

Illliillli

till 111 1 »" 1 'flH-DC-001-033 The Honorable Thomas F. Hogan U.S. District Court for the District of Columbia 333 Constitution Ave, NW, 4th Floor Washington, DC 20001

Re: The United States of America v. The District of Columbia, et al., Civ. No. 95-948, TFH, D.C. Village Nursing Home (DCV), Court Order, July 6,1995; November 7, Order Modifying Stipulated Order of July 6, 1995; Court Order, December 22,1996; Court Order, February 23,1996
Dear Judge Hogan:

I have obtained a copy of the defendants' pleading submitted to the Court on August 9,1996, subsequent to the statement in Court on August 7. I am writing you, Judge Hogan, to inform you that the defendants' position of terminating monitoring duties September 1 is unreasonable. It is unreasonable because discharge of the residents of DCV is not "satisfactorily and successfully completed" (Court Order, November 7,1995), and will not be so until I can assure the Court that all placement(s) are "appropriate and adequate to meet each person's individualized needs" (Court Order, February 23, 1996).

I cannot assure the Court that this is true until I have visited the well over two hundred thirty residents from DCV. Simply because the residents are no longer at DCV does not assume that the District of Columbia has discharged its legal obligations, for which they have so often been in contempt of in this case, to ensure individualized needs are met in a setting adequate and appropriate for the resident.

The defendants* position is unreasonable for the following reasons: (1) the Court Orders of November 7, December 22, and February 23, specify continuing
monitoring until the residents individualized needs are met and that placement is appropriate and adequate to meet each resident's individualized needs;
(2) summer scheduling difficulties relating to vacations and leaves of key facility staff in the residents' new homes and who have requested meeting with the monitor;
(3) time required to complete my Final Report to the Court.

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The July 6,1995, Court Order appointed the Court Monitor to advise and oversee the defendants' compliance with the Order. I was appointed August 1, shortly thereafter, the District of Columbia announced closure of D.C. Village Nursing Home (DCV).
Appropriately and humanely for the best interests of the residents of DCV in order to protect the residents' rights, the Court expanded the duties of the monitor to oversee the outplacement process which resulted in the November 7 Court Order. (It is of note that at that time the defendants objected to the expansion of the monitor's duties.) Monitoring duties were further expanded with the December 22,1995, and February 23,1996, Court Orders.
I have serious concerns about the adjustment and, therefore, the adequacy of placement of all of the residents and cannot determine if adequate and appropriate services are being provided as outlined in discharge packets, and as might be expected from the trauma of transfer, until I see each and every resident. This is a unique opportunity to ensure that the Court Orders are fully met by monitoring the adaptation, adjustment and determining whether DCV residents individual needs as reflected in care plans, assessments, and that needed specialized services are taking place. The February 23, 1996, Court Order states that "nothing in this order shall be construed to limit the authority and responsibilities of the Monitor...as set forth in the...Court's orders."
It is important to remember that the trauma of transfer is greater for DCV residents than for the general population of nursing home residents in this country. This is so because the residents had no control nor choice in the decision to close the place where they resided, the overwhelming majority of whom had lived at DCV for many, many years, some for decades. In fact, several of the most medically fragile did not survive the trauma of transfer, the literature documents this phenomenon.
My concerns relate to the residents with mental retardation, residents with mental illness, residents discharged into the community after years of institutionalized living, and residents now residing in other nursing homes. Judge Hogan, I want you to know I do expect to find the residents healthier and happier, but I cannot assure the Court that the defendants have successfully discharged their duties until I visit the residents, the new staff as caregivers of the residents, and the new settings in which the residents of DCV live. The following are some examples relating to my concerns for the DCV residents.
Although required to be outplaced in October, 1995, according to the July 6, 1995, Court Order, the residents with mental retardation were outplaced late after many findings of contempt. One resident Mr. P.L. was one of the last to be discharged before closure of DCV. Mr. P.L. has been profiled in many of my other letters to the Court. He is residing in a facility which is geographically the farthest away from the District, he also has no family. He has specialized caregiving needs, such as, feeding, suctioning, and positioning which have to be adhered to constantly to prevent choking and death. Mr. P.L., a young man, is also in need of day programming. At this moment it is unclear what provisions there are for day programming to

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FAX NO. 2023322949

P. 04

provide him with the stimulation required. The speciality consult team for residents with mental retardation visits and works with staff, however, their contract is due to expire September 30, 1996. It is imperative that according to the Court Order of December 22 the "receiving facility staff is stabilized and their competency is demonstrated." This is not known yet and cannot be until I can assure the Court.
The monitoring of the continued adequacy of placement of Ms. A.R. and Mr. K.F. is required. They reside in a group home that had not previously had residents which exhibited their unique characteristics, maple syrup disease and pica behavior (a tendency to grab and injest any objects in site), and autistic behavior, respectively. In addition, the adequacy of their off-site day treatment program needs to be monitored.
The adjustment and adequacy of the group home for the remaining residents with mental retardation and the District of Columbia's status in planning for and providing day programming services, especially for Ms. S. A. and Ms. S.P. as profiled in previous submissions to the Court, needs to be monitored, as well as the adequacy of case management services. In addition, as identified for Mr. P.L. above, speciality consultation team services need to be maintained until "facility staff is stabilized and their competency demonstrated" (Court Order, December 22).
Mr. M J . has taken to wandering out of his new nursing home and has been seen several blocks away on a corner drinking with a group of men. While at DCV, Mr. M.J. was retiring and rarely left the unit. The facility administrator and the director of social services is anxious for me to visit them to discuss Mr. M.J.s identifiable adjustment difficulties. Mr.MJ. walks slowly with a limp and with the assistance of a cane and is a potential target for criminal preying behavior. Mr. M.J. has asked that his burial fund be withdrawn, he is in his early forties. Mr. MJ.'s discharge packet recommended vocational rehabilitation services and to be followed by the specialty consultation team for residents with mental illness. The administrator has told me that he is having difficulty getting the specialty consult team to see Mr. M.J. and asked for my help. This DCV resident's outplacement is not "satisfactorily and successfully completed" (Court Order, November 7) until I can determine that his placement is "appropriate and adequate to meet (his) individualized needs" (Court Order, December 22). Because of vacation schedules a death in the family of key staff, this facility is unable to meet with me until the end of August.
The last residents to leave DCV were the most difficult to outplace. No facility in the District would accept Mr. J.B. and Mr. H.B. They were outplaced to a nursing home beyond a 50 mile radius of DCV. Mr. J.B. consistently demonstrated acting out and psychotic behavior at DCV. His outplacement discharge plan identified interventions to care for him. The new facility has a psychiatric team which is not the specialty consult team identified in the Court Order of December 22. With these residents outplaced last, time is needed to determine the adjustment of the residents, whether their individualized needs are met and whether this nursing home is appropriate and adequate (Court Orders, December 22,1995, and February 23, 1996) especially for Mr. J.B.'s unique needs. Only then can it be said that their outplacement has been "successfully and satisfactorily completed" (Court Order, November 7,1995).

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Mr. E J . was discharged from St. Elizabeth's Hospital to DCV and is now residing in a group home for residents with mental illness. It is unclear at this time, whether the defendants are providing adequate and appropriate services required for Mr. E. J. as identified at time of discharge, for example, counselling, day programs, case management, nutritional services, vocational rehabilitation, safety provisions in the community to prevent wandering and destructive behavior exhibited at DCV.
Mr. C.F. is without the primary medical doctor identified for him by the defendant at the time of discharge from DCV. When Mr. C.F. first visited the medical doctor in the community identified for him, he was informed by the medical doctor that he would not see him because the medical director at DCV had not forwarded information to the community medical doctor as the medical director at DCV indicated she would. Upon his second visit to the community medical doctor, Mr. C.F. was told by the community medical doctor that he would not accept Mr. C.F. as a client and that he had informed the medical director at DCV of this weeks before. Another resident also discharged into the community was assigned the same medical doctor by the defendants at time of discharge from DCV. This resident, Mr. M.W., is primarily wheelchair bound. Both these residents have complex medical conditions. Discharge is not "satisfactorily and successfully completed" (Court Order, November 7) until the discharge is "appropriate and adequate to meet (their) individualized needs" (Court Orders December 22 and February 23, 1996). In a previous letter to the Court, I profiled how another resident discharged into the community, Mr. C.W., if not for the intervention of the Court, would have been discharged by the defendants without provisions for medical follow-up. All these residents have complex health problems, and as institutionalized for years, humanely should not be expected to fend for themselves in a maze of health care providers that even the able-bodied find daunting.
To date, the receiving nursing home for Ms. S.B. has been unable to coordinate her various medical appointments in the District and obtain follow-up information from them. Until this is done, outplacement is not "satisfactorily and successfully completed" (Court Order, November 7) and "appropriate and adequate to meet (her) individualized needs" (Court Orders, December 22 and February 23,1996.) Ms. S.B., a quadriplegic, has numerous and complex medical needs which necessitate coordination and continuity of care which has not yet occurred.
Judge Hogan, these are just a few examples of some situations that have already come to light and which indicate that the defendants have not successfully complied with all of the Court Orders. Of the approximately 230 residents I anticipate there will be more. I also anticipate that it will take me limited time to assure the Court that defendants are in compliance with all of the Court Orders by ensuring that all the residents "individualized needs" are being met, that the outplacement is "appropriate and adequate" (Court Orders, December 22,1995, and February 23, 1996), and then by informing the Court that the outplacement of the residents of DCV "has been satisfactorily and successfully completed" (Court Order, November 7, 1995).
To take the position of terminating monitoring duties before ensuring that all the residents "indivualized needs" are being met and that the outplacement is "appropriate and adequate"

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(Court Orders, December 22, 1995, and February 23,1996) is callous and insensitive to the needs of the residents of DCV. It is important to be mindful, that it is the defendants who violated the civil rights of the residents of DCV, the District of Columbia's most vulnerable, infirmed, and poor. The Court Monitor was appointed as a result of this (Court Order, July 6,199S). It is also the defendants who required a Court Order to ensure that the residents have water and cups for water and that the residents and staff have soap (Court Order, December 22). It is the defendants who required a Court Order to provide saline to treat Mr. C.F.'s decubitus ulcer and duoderm for Mr. J.B. decubitus ulcer, and required a Court Order to turn the residents so they would not remain incontinent and sitting in urine on their bedsores with a hole in their bodies to the bone with tissue oozing out as Mr. C.F. and Mr. J.B. had, and who are now deceased (Court Order, December 22). It is the defendants who allowed Mr. L.R., a young abled- minded man who is a quadriplegic, to be imprisoned in his bed for a month because they did not fix his wheelchair. And it is the defendants, whom the Court found on numerous occasions in contempt of all the Court Orders in this case.
Due to vacation schedules of many of the staff who are directly caring for the DCV residents and for management staff who have asked to meet with me in the residents new homes, many of the facilities are unable to meet with me until the end of August and one facility, not until mid September. This particular nursing home, has nearly 40 of the sickest DCV residents, this facility is preparing for its first Joint Commission accreditation visit at the end of September and originally asked me to visit in early October. At my urging the soonest appointment I could obtain was mid September. The majority of residents, approximately 90, are at a nursing home in Hyattsville, Maryland, just across the District line. Since the closure of DCV this facility is under new management. It has taken several weeks for their staff and management to get settled.
After my visits, I anticipate it will take a substantial amount of time to prepare my Final Report to the Court. I will submit my Final Report by the time of the last Status Hearing in this case.
My duty as Court Monitor is to assure the Court that transfer is complete. I am respectful of the Court's desire to put closure to this case in a timely fashion as is the desire of all the concerned parties. However, my duty and concern is to assure the Court that the residents of DCV individual needs are being met, that the placements are appropriate and adequate, and write and submit my Final Report to you. I know there are monitoring situations in the District which in my opinion are unconscionably prolonged with very little evidence of benefit to the clients. I assure you, Judge Hogan, I intend to be involved in this case not one day more than what is required to complete my duties to the Court for the best interests of the residents of DCV. It is a privilege to serve your Court.
Sincerely,
Harriet A. Fields, Ed.D., R.N. Court Monitor

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cc: Mr. Richard J. Farano Mr. David Deutsch Civil Sights Division U.S. Department of Justice P.O. Box 66400 Washington, DC 20035
Mr. William Isaacson Kaye, Scholer 901 ISth Street, NW, Suite 1100 Washington, DC 20005
Ms. Barbara Mann Office of the Corporation Counsel 441 4th Street, NW, Suite 680 Washington, DC 20001

AUG-1-2-96 HON 06:00 NCCNHR

FAX NO. 2023322949

P. 01

HARRIET A. FIELDS, Ed.O., R.N.
#604
172219th Street, N.W. Washington, DC 20009 Message: (202) 234-7142

FAXTRANSMITTAL

TO: Mr. Richard Farano and Mr. David Deutsch

COMPANY: Civil Rights Division

FAX: 514-6273

PHONE: 307.3116

FROM: Dr. Harriet A. Fields DATE: August 12. 1996

_NO. OF PAGES(INCLUDING COVER):__L

MESSAGE:

 
 U.S. v. District of Columbia
1DI1IIIIIII NH-DC-001-036
FTNAt/ttF/PORT to the
Honorable Thomas F. Hogan
United States of America v. The District of Columbia, fit. al. Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by: Court Monitor Harriet A. Fields, Ed.D., R.N.
Date: January 21,1997

FIN AT, REPORT United States of America v. The District of Columbia, ei. ai.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
CONTENTS

INTRODUCTION

1

Case Summary: Mr. C.F

3

OVERVIEW

4

Internal Systems Breakdown

6

Case Summary: Mr. J.B

7

External Systems Breakdown

8

Case Summary: Mr. L.R

10

OUTPLACEMENT

12

Case Summary: Ms. M.L

14

Case Summary: Ms. L.E

15

Case Summary: Mr. W.S

16

Case Summary: Mr. B.A

16

Residents with Mental Illness

17

Case Summary: Mr. C M

18

Case Summary: Ms. L.S

19

Case Summary: Mr. E.J

20

Case Summary: Ms. G.M

21

Case Summary: Ms. S.B

22

Residents with Mental Retardation

23

Case Summaries: Ms. A.R. and Mr. K.F

26

0 Street S.E., Group Home Site

28

Case Summaries: Ms. C.W., Ms. C.L., and Ms. A.B

29

Case Summary: Mr. P.L

30

Outplacement of Residents into the Community

30

Case Summary: Mr. C.W

30

Case Summary: Mr. M.W

31

Case Summary: Ms. M.M

32

Monitoring at the Outplacement Sites

33

LESSONS TO BE LEARNED

34

Professional collaboration

34

Monitoring Role

36

Continuity of Monitoring

38

Community Involvement

38

Advocates

39

Federal and Local Surveyors

39

CONCLUSION

41

Case Summary: Mr. H.B

41

APPENDIX A: CHRONOLOGY OF MAJOR EVENTS APPENDIX B: COURT ORDF.RS APPENDIX C: COURT MONITOR'S SUBMISSIONS TO THE COURT

FTNAT.RFPOKT to the
Honorable Thomas F. Hogan
United States of America v. The District of Columbia, ei. al. Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home
Submitted by: Court Monitor Harriet A. Fields, Ed.D., R.N.
January 21,1997
"It's heaven! I'm free!" — Mr. C. W. aformer resident of the District of Columbia Village Nursing Home upon his outplacement after 10 years.
This is the Final Report in the matter, United States v. District of Columbia, ei al., Civ. No. 95-948 (TFH), Re: D.C. Village Nursing Home (D.C. Village). It chronicles the violation of the civil rights of the residents of D.C. Village, the nursing home owned and operated by the government of the District of Columbia, and the role the Court played in reversing this injustice. This Final Report profiles how wrongs were righted, how professional behavior - humane behavior in practice - overcame ignorance, indifference, incompetence, and callous disregard for the most vulnerable, .infirmed, and poor among us.
Although this case deals with dying and death, it also draws a portrait of hope, courage, and uncommon compassion. Lives were improved in this case and smiles came to faces long frozen in despair. The former residents of D.C. Village are now "free", their civil rights are no longer violated, they are now tended to with time, commitment and caring, the elements missing at D.C. Village. You can see it in the residents' eyes, happiness has replaced emptiness.

This Final Report shows how the Court in one year successfully accomplished what the Defendants would not or could not do for decades, and in the end, how the Court's active intervention was required to effect the humane outplacement of the residents. The shame of it is that the federal Court had to compel an entire civic government to perform its most basic duties, to honor the public trust, and to fulfill its responsibility as public servants to its citizens by caring for its most in need.
What should have been a simple cooperative endeavor to improve the lives of the residents of D.C. Village, the Defendants turned into an adversarial contest fraught with recalcitrance, denials and defiance of Court Orders, which brought on formal contempt citations and findings of continuing contempt. The District repeatedly proffered unconscionable excuses to defend their indefensible, self-serving operations that should have been an embarrassment and disgrace to any government. For let it not be forgotten, it was the Defendants who required a Court Order to "ensure immediately that water, and cups for water, are present...in each residents' room... ensure that individuals with decubitus ulcers are not left to sit or lie in their own soiled linens...ensure that adequate supplies of soap are available for the residents" (Court Order, December 22,1995).
How profoundly appalling it is that the Defendants required Court Orders to provide the most basic of human needs, yet, how profoundly vital all the Court Orders were in protecting the residents civil rights, health, safety, and welfare. This Report is a tribute to the professionalism and humanity of one United States District Court Judge, The Honorable Thomas F. Hogan.
At this time the Monitor can finally assure the Court that the outplacement of the residents of D.C. Village "has been satisfactorily and successfully completed" complying with the Court Order of November 7, 1995, and that their "individualized needs" are being met and that the outplacement sites are "appropriate and adequate" complying with the Court Orders of December 22,1995, and February 23,1996.

The beauty of this case is that it was so profoundly helpful to so many individuals in such a short period of time. The best way to grasp the depth and impact of the Court's service to the District of Columbia's most vulnerable, in firmed, and poor, is to review the sampling of individual case summaries placed throughout this Report, starting here with Mr. C.F.
Case. Summary: Mr. C.F. For years Mr. C.F. lived at D. C. Village with an underlying longing to be on the
outside. Mr. C.F. is in his fifties, yet.living at D.C. Village beyond his needfor it, he learned institutional dependency and no one took the initiative to get him out. As President of the Residents' Council, Mr. C.F. unselfishly advocated for others (those institutionalized at D.C. Village and in other long term carefacilities) but notfor himself.
Mr. C.F. now lives in the community in an independent/supported living apartment in the District on the first floor, which is handicapped accessible.
"Ifeel wonderful living on my own...I feel great, " says Mr. C.F. with his eyes sparkling and a constant smile on his face. Mr. C.F. has his own room and shares a large, comfortable kitchen and handicapped accessible bathroom with three other neighbors. A resident case manager and building manager are on-sitefull time including weekends. Mr. C.F. is provided with a home aide four hours a day five days a week who helps him prepare meals (which is difficult for Mr. C.F. because he has limited use of his hands) and assists him when needed with personal hygiene. On Fridays the aide prepares mealsfor Mr. C.F. to put into the microwave for his weekend dining. Once he has adapted to living independently in this supported environment, Mr. C.F. plans to move to a larger apartment. Mr. C.F. has a computer in his room which he uses in his active participation in nursing home reform advocacy organizations in the community. In fact, he serves on the board of directors of some of these organizations, and hasfor years, and volunteers at one of them afew days a week. He travels on public transportation and assumes appropriate responsibility for his medical attention. Mr. C.F. is also considering plans toform a residents' council in his building. Mr. C.F. hasfamily in the area and numerous friends in the District.
Mr. C.F. no longer wears the sad, pained, burdened, and weighted expression of

one who is trying to heal the pain of others while carrying around his own. Mr. C.F. exudes a vitality and joy of life and a sense of hope for his own possibilities for the first time since I have met him.
OVERVIEW
The struggle to protect the constitutional and legal rights of the residents of D.C. Village began on May 19,1995, when Mr. Richard J. Farano of the United States Department of Justice, Civil Rights Division entered the United States Court House on Constitution Avenue in Washington, D.C. and filed the United States' Complaint pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA) against the District of Columbia, alleging that the civil rights of the residents of D.C. Village had been and continued to be violated. The Honorable Thomas F. Hogan, United States District Court Judge for the District of Columbia was assigned to the case. A month later on June 19,1995, the United States filed a Motion for a Preliminary Injunction to Enjoin Dangerous and Life-Threatening Practices and to Ensure Basic Care, Services and Treatment at the nursing home. These pleadings profiled appalling abuses of the D.C. Village residents. After the United States filed its motion for a preliminary injunction, the Long Term Care Ombudsman intervened in this case. This office had for many years identified neglect, abuse, and poor care at D.C. Village.
In addition to naming the District of Columbia as a Defendant, the other named Defendants in this case are the Mayor of the District, Marion Barry; the then Director of the Department of Human Services, Vernon Hawkins; the Administrator of the Mental Retardation/Developmental Disabilities Administration, Frances Bowie; and the then Executive Director of D.C. Village.
On July 5, 1995, moments before the hearing was to take place on the United States' motion for the preliminary injunction, the Defendants agreed to consent decree language that mirrored the proposed remedial order in the United States' pleading. On July 6, 1995, Judge

Hogan signed and filed the parties' Stipulated Order which enumerated specific remedial measures to redress the alleged deficiencies in the nursing home. By signing this document, the Defendants agreed to comply fully with the Court Order. This July 6,1995, Court Order also provided for the appointment of a Monitor to oversee the District of Columbia's compliance with the Court Order, and according to District of Columbia Code, Section 32-1420, advise the Defendants on how to comply with federal and District law and regulations.
On August 1,1995, Dr. Harriet A. Fields, this writer, was appointed Court Monitor by Judge Hogan. Two week later, and before the Monitor could begin on-site inspection, the Mayor and City Council of the District of Columbia unexpectedly and callously announced the closure of D.C. Village. Instead of choosing to improve care for the residents in need, the Defendants' seemingly reactive remedy was to close the facility under the guise of fiscal responsibility. This unilateral decision was made with no consultation with the Court or the parties to this case, and most especially with no consultation with the residents of D.C. Village. The Defendants' decision was made without the most rudimentary understanding of, or regard to, the consequences of their actions, namely the debilitation and often premature death associated with the trauma of transfer of elderly and frail individuals. Soon after entering the facility, the Monitor reluctantly discovered and subsequently reported to the Court, that the Defendants had no competent governmental oversight nor management ability within D.C. Village to carry out the abrupt decision to close D.C. Village and to appropriately and humanely outplace the residents. As a result the Plaintiffs successfully moved the Court to augment the responsibilities of the Monitor to oversee the transfer and outplacement process (Court Order of November 7, 1995, Modifying the Stipulated Order of July 6, 1995).
As Court Monitor, I first entered D.C. Village in August of 1995 and found that every allegation filed against the Defendants in the United States' Complaint and the United States' Motion for Preliminary Injunction, including the Residents' Declarations of June 1995, and every violation of the residents' rights that the July 6th Stipulated Order required be remedied, still boldly existed.

There was a top to bottom systems breakdown of the Defendants operation of D.C. Village. There was no institutional focus on resident care. There was institutional neglect and, as identified in the Monitor's October 16,1995, Status fteporr to the Court, neglect over a period of time is abuse. Furthermore, there was no identifiable competence in the governmental oversight, administrative and support structure. What existed was a bumbling, self-serving bureaucracy in violation of the first Court Order of July 6, 1995, and in the months that followed, in violation of the Court Orders of November 7,1995, December 22,1995, and February 23, 1996. Group-think predominated and suppressed individual initiative in well-intentioned individuals time and time again — a bureaucracy so ethically blinded it led potentially competent staff into inertia and dysfunction.
Internal Systems Breakdown
The initial assessments of the Monitor and the nursing home systems expert consultants, originally profiled in the October 16,1995, Status Report, identified among other deplorable conditions: residents with no affect or emotion; residents who had lost their spirit; residents passively accepting their own neglect, not knowing after so many years that poor level of care was not the norm; residents who rarely or ever smiled; residents with bewildered and even pained expressions; human beings dying from decubitus ulcers with holes in their bodies so deep that bone was exposed and tissue oozing out of the wound; an over-utilization of easy-to-use gastric tubes for feeding residents through the stomach, replacing the human contact of staff, which would require time and effort to help and encourage the residents to be nourished by mouth; no soap for simple hygiene in many of the units and residents' rooms highlighting an inadequate infection control program; pervasive use of physical restraints (residents literally tied down); failure to ensure that vendors be timely paid often resulting in interruption or termination of critical services, supplies, and medications; overmedication with psychotropic drugs (chemical restraints); vital nutritious food and drink not always available; food that was so unappetizing it robbed the residents of their desire to eat; residents who no longer needed nursing
6

home care and should have been discharged to the community years ago still languishing at D.C. Village; residents in bed all day when they should not have been; residents who could not move, were not turned in their beds; residents lying in their own urine and feces; dirty halls, rooms, equipment, and furniture, all reeking with the odor of urine; under-functioning, disorganized departments with no interdisciplinary cooperation; no supervision of direct care staff; no nursing leadership; policies and procedures that were twenty years old, if they exited at all; care plans that were years out of date, if they existed at all; an astonishing lack of knowledge by the medical staff of minimum standards of nursing home practice; desperate need for education and training of all caregivers in the minimum standards of care as reflected in federal law and regulations and the Court Orders.
To protect the residents health, safety, welfare, and rights, the Monitor was compelled to immediately advise the Defendants on the need to initiate institutional systems reform, which included: a care planning system in order to track compliance with Court Orders and federal law and regulations; training staff on how to use this care planning system; strongly encouraging an interdisciplinary approach to care; encouraging the assignments of contract nurse staff to the same units for continuity of care; training clinical nurse coordinators in appropriate supervisory techniques; educating staff on how to care for residents without restraints in accordance with federal law and regulations; introducing weight log books on each unit and training the staff in how to track life-threatening weight gain or loss in compliance with federal law and regulations; educating staff on how to develop an essential bowel and bladder training program for incontinent residents; incorporating rehabilitation concepts into direct care and daily bedside practice, such as range of motion exercises, and a regimen for turning the residents which included reminders broadcast every two hours over the public address system; and more. It was very humbling and gratifying when on one of the last tours of the units the Monitor made in June 1996, a staff nurse hugged me and said, "we are now giving the type of care the residents deserve."
Summary: Mr. J.B. On a Sunday evening in late September 1995, the Monitor and the nursing home

systems expert consultant found Mr. J.B. in his bed, lying in urine, unturned, totally contracted, with a gapping hole in his body to the bone, and with a distinct odor of dead skin. This was a blatant violation of the Court Order of July 6, 1995 — afull two and a half months after its issuance — which stipulated among other very basic care practices, that "Nursing staff shall take all appropriate steps to carefor and clean those residents who need nursing attention due to their incontinence. Nursing staff shall take special care to clean and treat ulcerated areas that may have become soiled due to incontinence. " Unbelievably, D.C. Village staff seemed unaware that Mr. J.B. 's condition and treatment were not normal for a nursing home resident. We immediately brought Mr. J.B. 's condition to the attention of the D. C. Village direct care-givers so that appropriate steps could be taken.
Constant and vigilant monitoring reversed Mr. J.B. 's suffering. Mr. J.B. 's interdisciplinary care plan was developed at his bedside with his involvement and he was provided with counseling and consultations regarding his eventual transfer to another facility. For the remaining four months of his life, never again was Mr. J.B. not turned; never again did he lie in "soiled" bed clothing and linens; never again did the odor of death emanatefrom his bed; and Mr. J.B. 's condition, as witnessed on the evening of September 24, 1995, never again returned.
Mr. J.B. 's condition was so preventable, and his suffering so quickly reversed, it made conditions at D. C. Village even more senseless. That D. C. Village allowed Mr. J. B. 's condition to exist, not only violated the Court Order and federal law and regulations, but it was also a gross violation of Mr. J.B. 's civil rights. Mr. J.B. 's case is descriptive of how the Defendants' violation of all the Court Orders harmed one individual's life and how the Court's presence and intervention helped improve not only Mr. J.B. 's life, but the lives of all the residents while they still lived at D.C. Village. (Mr. J.B was profiled in the October 16, and November 30, 1995, Status Reports to the Court.)
External Systems Breakdown
Two major examples of the entire systems failure are the District's procurement process and vendor payment system, which for decades has had a life-threatening, and in many instances

life-ending, impact on the District's most defenseless.
The first individual Defendant listed in this case, the Mayor of the District of Columbia, just recently identified the procurement process as the District's biggest problem. This announcement came nearly one year after the Monitor first identified the problem in this case. The day before Thanksgiving in 1995, D.C. Village was about to run out of vegetables, bread, fish, and butter (see November 30,1995, Status Report, pages 29-30). The lack of basic food stuff available for the residents was directly related to the failure of the District's Department of Human Services Procurement Office to process the request for purchase orders, a completely preventable problem. Immediately, the Monitor advised the Defendants on what to do to ensure that purchase orders were received, vendors contacted, and supplies delivered. The presence of the Court was able to rectify this intolerable situation expeditiously so that the residents would not suffer. Egregious procurement problems continued in other areas at D.C. Village. However, after reporting these problems to the Court and after appropriate legal motions were filed, these were also rectified. The Court Order of December 22, 1995, directed the Defendants to "ensure immediately that the District of Columbia procurement office responds immediately to urgent requests for health care and other supplies to ensure that the health care needs of the D.C. Village residents are appropriately met." It took the Defendant, the Mayor, decades to admit to what the Court in this case recognized, reported, and rectified in a matter of weeks.
The second example of the District's systems failure was its chronic inability to timely pay critical vendors and to execute necessary contracts with these vendors. This was especially important at D.C. Village where the District purposely relied heavily upon contract nurses and other important vendors to provide critical services, supplies, and food to the residents. The Monitor's continuing submissions to the Court profiled the failure of the District to timely pay its vendors which resulted in the constant threat of interruption and sometimes actual termination of vital services and supplies. Instead of taking responsibility and immediately correcting this situation for the welfare of the residents, the Defendants through their Corporation Counsel, fostered delay and actually misrepresented to the Court reasons why they failed to pay vendors, for example, scapegoating the District of Columbia Financial Responsibility and Management

Assistance Authority (D.C. Financial Control Board) by claiming they had not yet approved contracts, when in fact contracts had been approved months earlier. These misrepresentations occurred on such a continuous basis, that the Court felt compelled to refer the Corporation Counsel to the grievance committee of the Court on May 17,1996, and found it necessary to threaten the top Administrators of the Department of Human Services with contempt and jail if they did not begin to tell the truth. Meanwhile, the second named individual Defendant in this case, the then Administrator of the Department of Human Services, Vernon Hawkins, was ousted from his position by the Mayor on orders of the D.C. Financial Control Board for gross incompetence, particularly in the areas of procurement, vendor contracts, and vendor payments. It appears that at least in part, this Defendant's removal was precisely for the deficiencies profiled throughout this case (see Monitor's April 25,1996, letter to the Court in Appendix C). Indeed, as early as December 1995, the then Acting Corporation Counsel said that the Monitor had uncovered the major weaknesses of the District government, namely the procurement process and the vendor payment system.

Case Summary: Mr. L.R.

While sitting at a bus stop on his way to work several years ago, a bullet in the back rendered Mr. L.R.. totally dependent on others for his care. Not only a victim of crime while able-bodied, he was also a victim of numerous indignities suffered at D. C. Village which were violations of his rights. Mr. L.R.,an able-minded man in his thirties was profiled in the December 1995 letters to the Court as the resident who was "imprisoned in his bed" because his wheelchair was broken and the District had failed to pay his wheelchair vendor.

Due to his medical condition, Mr. L.R. required a catheter, but the ones supplied to him by D.C. Village were chronically the incorrect size causing an overflow of urine. This was in violation of the Court Order of July 6, 1995, that their be "an adequate and appropriate quantity of medical supplies and equipment...that meet the individual needs of the D.C. Village

residents."

On a Friday afternoon, months after the July 6th Court Order, Mr. L.R. was

appropriately concerned about his care over the weekend. In an attempt to advocate for himself, Mr. L.R. approached the then Director of Nursing who sat down with Mr. L.R. and calmly

10

explained to him why it would take several weeks for him to receive the proper size catheter. While she calmly defended the inhumane and unconscionably prolonged purchase order procedures of the Department of Human Services for the District, before her sat Mr. L.R. in his wheelchair, with urine seeping down his leg and stained to his pants. The Monitor observed this interaction and strongly advised the Defendants that they immediately obtain the correct supplies for Mr. L.R. From that day on, never again did Mr. L.R. not receive the supplies required for his health, welfare, and the protection of his rights, and through the Court's intervention (see Court Order of December 22, 1995, at V.,C.) the procurement system improved for all the residents benefit.
Today, Mr. L.R. is President of the Residents' Council in his new home. He has not encountered medical supply shortages in his new home. He has become more active and writes poetry which the staff are trying to help him publish. He has afriend at the nursing facility, a young man in a wheelchair. The activities director is exploring vocational rehabilitation for him and ways for Mr. L.R. to work and still maintain his health coverage. Mr. L.R. has plans to complete his general education degree (G.E.D.) and then to become an inspirational speaker for youth. It is Mr. L.R. who is truly inspirational.
Another example of the failure of the external government oversight was the illegal depositing of the residents' meager monies, known as the Personal Needs Allowance (PNA), into the D.C. Treasury. These are relatively small sums of money which must be deposited monthly into the residents' individual bank accounts. Instead of doing this — which is required by federal law and regulations — the District illegally retained the funds. This act amounted to theft of the residents' funds for the District's own benefit, thus, robbing the residents, the poorest people in the District of Columbia, of their money and the interest due to them (see December 6 and 10, 1995, letters to the Court, Appendix C). Finally, over a year after this was first reported to the Court and after much prompting, the Defendants have agreed to obtain an independent auditor's accounting of the residents' funds and interest due. This report should be released shortly.
Added to the above examples of systems failure was the sudden and ill-conceived
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announcement of the closing of D.C. Village by the Mayor and City Council.
OUTPLACEMENT
From the time the Monitor first entered D.C. Village it was obvious that the Defendants, including the D.C. Village administrators and staff, did not possess the requisite knowledge, background, or experience and were incapable themselves to responsibly, legally, and ethically discharge the residents, especially those with special needs. Indeed, the head of the D.C. Village Department of Social Services who was designated to "coordinate" the outplacement did not even professionally or personally know the residents, even though she had been employed at D.C. Village for approximately 25 years. In addition, there was a danger that the already compromised health of the residents would further suffer while the facility's resources were being diverted away from basic care, required, deserved and demanded by the Court and federal law and regulations, towards the premature and frenetic discharge activities (some of which had already begun). This was of grave concern given the years of neglect the residents had already suffered as profiled above and in my submissions to the Court (see Appendix c).
Indeed, a D.C. Village staff member in the Social Services Department confided in me that the outplacement of the residents was already "chaotic." For example, individual discharge folders were sparse at best and did not present a clear picture of the residents; there were no interdisciplinary care plans for the residents; outplacement was disorganized and beyond the ability of the Social Services Department; residents were not being informed of their impending transfer, most did know where they were going, nor were they given choices as to their new home contrary to federal law and regulations; staff were not talking to the residents; residents were confused, bewildered, and lost; no resident received any type of counseling to decrease the anxiety and trauma of relocation.
My first submission of September 5,1995, alerted the Court to the inevitable detrimental impact of uprooting frail and institutionalized individuals — even from abusive situations — when this decision is made without their control. The Court Order of November 7, 1995,
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Modifying the Stipulated Order of July 6, augmented the responsibilities of the Monitor to oversee the transfer and outplacement of the residents "including the residents' rights to an opportunity for participation in their discharge process."
The Monitor was compelled to take a proactive stand to immediately advise the Defendants to develop and implement humane outplacement procedures to decrease the needless suffering and, in some instances, premature death of the individuals entrusted to the care of the Defendants. These procedures (originally identified as assessments, recommendations, and action steps in the November 30, 1995, Status Report to the Court many of which were translated into the Court Order of December 22, 1995) included the following: expanding the D.C. Village outplacement team beyond the social services department to include the nursing, dietary, and therapeutic recreation departments, and when appropriate, the physical therapy and occupational therapy departments; developing an interdisciplinary team care plan which included a counseling program for minimizing transfer trauma; developing an educational program for all employees to sensitize them to the trauma the residents confronted so that everyone from department heads to the housekeeping crew would know how to caringly converse with the residents 24 hours a day seven days a week; collecting data on residents' concerns by the unit clinical nurse coordinators which were used as the basis for weekly counseling sessions with residents which took place on each unit under the guidance of nursing and social services, with staff, residents, and the President of the Residents' Council present; developing a detailed outplacement discharge packet for each and every resident profiling individual residents' unique needs; ensuring that the staff got to know the residents in a meaningful way so that important information about them was communicated in the Interdisciplinary Team Care Plan, included in the outplacement discharge packets, and shared with the staff in the residents' new homes so that the new staff would really know the residents and be able to provide them with individualized care; expanding the weekly outplacement meetings to include representatives from all the departments; introducing soothing music broadcast throughout the facility as requested by the Residents' Council.
Finally, the residents and/or their guardians had an opportunity to visit at least two
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TIT

outplacement sites, had a right to refuse proposed sites, and ultimately chose their own their own outplacement site.
The outplacement of the residents, a few of whom are profiled below, bears witness to the journey of the residents of D.C. Village from dying to hope.
f Summary: Ms. M.L. Ms. M.L., profiled in the November 30, 1995, Status Report, was among the
proud, elegant, old women "warehoused" at D.C. Village who spent most every day all day in bed, not turned, incontinent, unable to walk due to contractures, and whose body and spirit were withering away. Ms. M.L. was a dancer in her youth. At her bedside was a photograph of her on stage at the Moulin Rouge in Paris in 1917. How profoundly sad for a dancer in her youth to be at the end of her life unable to move her legs, and it was so preventable.
At an outplacement meeting, the Monitor learned from Ms. M.L. 's guardian that Ms. M.L. had a rare book collection and "loved to be read to. " This was exactly the type of essential, individualized information, uniquefor each resident that helpsprevent the trauma of transfer when moving to a new environment. (Infact, through the Monitor's insistence and through the Court Orders, such individualized, helpful information was included in each and every resident's outplacement discharge packet.) Before her death at 96 years of age, Ms. M.L. was out of bed, dressed, sitting up, being read to, and listening to music. Thus, with no extra expense save for a slight bit of compassion, this former dancer was finally given quality of life, quality of care, and a dignified death.
Due to her advanced age, 96 years, and frail condition, Ms. M.L. was outplaced to Hadley Hospital Skilled Nursing Facility where over thirty other frail D.C. Village residents have been outplaced. (Hadley recently received three years accreditation from the Joint Commission on Accreditation of Healthcare Organizations. The accreditors told the facility that they have seen only one nursing home with "sicker" residents. Since it is a skilled nursing facility, Hadley received the sickest individuals from D.C. Village, some of whom have since died, but they did so with dignity. My April 3, 1996, letter to the Court on page two profiles the residents outplaced to this facility.)
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In the January 17, 1996, Status Report, the Monitor was forced to recommend new management, when it became unequivocally clear that the present D.C. Village administrators and staff were incapable in every way of carrying out the Court Orders and of properly outplacing the residents. For months and months, Defendants fought needed change, fought with the Court, fought with the Monitor, and were counseled on more than one occasion not to meet with, or even speak to, the Monitor. This posture did nothing but delay needed reforms and in effect harmed the residents of D.C. Village. Indeed, the February 1,1996, letter to the Court requested a halt to outplacement until the Specialty Consult Teams for residents with mental retardation and for residents with mental illness was put in place, and the interdisciplinary team met and developed an outplacement summary and plan for each resident that addressed the residents' individualized needs. (See more'detailed description of Specialty Consult Teams below.) In addition, there was no planning for the residents who no longer needed nursing home care and who had been institutionalized years longer than necessary. After appropriate legal intervention, the Court Order of February 23, 1996, suspended outplacement until the Monitor and Ombudsperson, Ms. Sarodel Childs, were satisfied that each and every resident had an "adequate and appropriate interdisciplinary assessment and individual discharge plan," and that each and every outplacement met the requirements of the Court Orders and federal law and regulations. The Ombudsperson and the Monitor participated in all outplacement meetings, including the weekly outplacement meetings.
After much prompting, the Defendants removed the head of the Department of Social Services, and from outside D.C. Village but from within the District of Columbia government, the Defendants eventually assigned four competent women to become the new outplacement management team who would implement Court Orders and the Court Monitor's outplacement recommendations. The professionalism of these women has been profiled in the Monitor's letters to the Court of February 21, April 3, April 25, May 9, June 6, and June 16, 1996. Finally, a competent team approach to outplacement began to take place.
Case. Summary: Ms. L.E. Ms. L.E., who is 92 years old had not walked at D. C. Village for years, had little
15

appetite, was poorly nourished, and had been placed on numerous psychotropic medications. Today, in her new home, Ms. L.E. has learned to not only transfer herself from
her wheelchair to a walker (an assistive device), but and has learned to walk with the walker. She has regained her appetite and has gained 10 pounds, and her psychotropic medications have been reduced. When asked what do you think made the difference in Ms.L.E. 's improvement, the charge nurse responded, "knowing what s right for the resident, giving them individualized attention, knowing they could do it. " Ms. L.E. never received this kind of individualized attention atD.C. Village.
Ms. L.E. lives at the Stoddard Baptist Nursing Home where eight D.C.Village residents live.
Summary: Mr. W.S. While at D.C. Village, Mr. W.S., an elderly man,for years had a gastric tube
placed in his stomach for feeding and was isolated and rarely spoke. Today, in his new home, Mr. W.S. no longer has a gastric tube and enjoys his
appetizing three meals a day by mouth. He is provided with individualized attention and he is involved in activities and talks with attentive staff and other residents.
Mr. W.S. lives at the Washington Center for Aging Services, where five D.C. Village residents live.
Case. Summary: Mr. B.A. When Mr. B.A. left D. C. Village nearly everyone cried. For he was more than
frail, he was a skeleton and one of the few remaining residents with large decubitus ulcers eating away at him. I truly thought he would expire within afew weeks. Mr. B.A. was always in bed, contracted, gaunt, with no appetite.
Today, Mr. B.A. has gained twenty pounds, has afull appetite, and his decubitus ulcers have healed. I have seen him out of bed, sitting in a chair, dressed in street clothes. Mr. B.A. looks decades younger, he looks alive for the first time since I met him.
Mr. B.A. lives at the St. Thomas More Nursing Centerjust across the District line in Hyattsville, Maryland, where over seventy-five D. C. Village residents live.
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TUT 1 H " IT M

1 • M l II

Only a handful of residents required outplacement beyond the area, in further reaches of Maryland, all are thriving.
Residents with Mf P t a l Tilness
In addition to the above outplacement procedures, there were special procedures required for the residents with a label of mental illness. The majority of residents with mental illness had been inappropriately transferred from St. Elizabeth's Hospital to D.C. Village in 1991. A psychiatrist was transferred with these residents and there was in place a monitoring program for the mental illness community in the District. Despite these "safeguards," when the Court commenced monitoring in August of 1995, the majority of the residents were not receiving any type of psychiatric care nor counseling except for an inappropriate and an overabundant use of psychotropic drugs. Also, the psychiatrist lacked sufficient knowledge of the federal law and regulations pertaining to the appropriate use of psychotropic medications. Clearly, the monitoring program for the' mental illness community in the District failed these residents with mental illness at D.C. Village for years, as evidenced by the lack of needed attention given them.
For these residents, the Ombudsperson participated in the majority of their interdisciplinary outplacement planning meetings. Furthermore, the Monitor and the mental health expert consultant reviewed all the outplacement discharge packets developed from these interdisciplinary care planning meetings. The Monitor then ensured that the expert advice of the mental health consultant was incorporated into these outplacement discharge packets.
To humanely outplace this population of residents, the Monitor recommended a Specialty Consult Team, which would consist of a psychiatrist, psychologist, geriatric psychiatric nurse, social worker, and when appropriate, a recreation specialist. After the United States and the Plaintiff-Intervenor filed appropriate legal papers, the Court by its Order of December 22, 1995, ordered that the Specialty Consult Team be created. While the residents were still at D.C. Village, the Specialty Consult Team provided counseling for the residents to minimize transfer trauma and not just for those with a label of mental illness, but for any resident needing it;
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conducted assessments of the residents which were included in the outplacement discharge packets, and utilized by staff in the receiving facilities to provide care in order to meet the residents' individual needs; reviewed psychotropic medications and made recommendations for needed adjustments to the medical doctors (which sadly were often ignored while the residents were still at D.C. Village); and served as consultants on care issues to meet the residents needs.
Today, the Specialty Consult Team continues to provide individual follow-up counseling to residents in their new homes as needed, and serves as consultants to the staff on care issues.
Case Summary: Mr. CM. Mr. CM. is a large man in hisforties and a Vietnam Veteran. While at D. C
Village he most always sat in the day room on his unit in a wheelchair in the same corner against the wall, slumped over, staring, disheveled, clothes not clean, food often spilled on him, with no affect or expression on his face. He would periodically erupt in loud outbursts which were frightening to others. I never saw staff interact with him, I never heard Mr. CM. speak, nor did I ever see him out of his wheelchair, no matter what time of day.
Mr. CM. was admitted to his new home frightened and still over-medicated on psychotropic drugs, contributing to his restless and verbally disruptive and abusive behavioral symptoms, which in turn were frightening to the new staff and residents. Upon admission, his medications were immediately evaluated and greatly reduced.
Today Mr. CM. is a new person. I have visited him a number of times now since his outplacement. On all visits Mr. CM. is smiling and happy. When I first visited him, I told Mr. CM. that I never saw him smile at D.C. Village, his response to me was that, "Ismile all the time now, once they took me off the drugs...I am finally happy; I haven 't been myfun self for years...I am having fun. "
Mr. CM. takes daily walks with the staff and is always neatly dressed. In fact, the staff have given Mr. CM. a neck tie, white shirt, and sweater, which he wears regularly and with obvious pride. On one visit with the attorneys for the United States (the Plaintiffs) and the Corporation Counselfor the Defendants, Mr. CM. had a basket of fresh fruit infront of him which he offered to us. Mr. CM. never had been given fresh fruit at D.C. Village.
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"BT

Mr. CM. no longer lives with a deadened spirit, he now has ajoy of life. Mr. CM. lives at Capitol Hill Nursing Center where over twenty D. C. Village residents live. (Capitol Hill Nursing Center was profiled in the Monitor's June 16, 1996, letter to the Courtfor its community commitment and concern for the last remaining residents ofD. C. Village, see Appendix C.)
Generally the staff at the residents' new homes have said that once the over-medication of psychotropic drugs was decreased and the residents were weaned from them, they found as one staff member said, "a whole new individual."
Case Summary: Ms. L.S. Ms. L.S., a beautiful woman, wheelchair bound, who spent most all day everyday
at D. C. Village roaming the halls shouting profanity loudly and profusely. She was disheveled, gaunt, unkempt, hair not combed sticking out wildly, and there was little attention to personal grooming (as was the case with most all the residents). While at D. C. Village, I never heard Ms. L.S. speak in sentences nor say intelligible words except for profanity. Occasionally during weekdays, Ms. L.S. would seek refuge in the offices of the staff who caredfor the residents with mental retardation, who had befriended her. (These were not D.C. Villagestaff,but outside contractors.) It was touchingly obvious that Ms. L.S. was starved for adult contact and attention. Ms. L.S. was a music and dance teacher in a local university before her stroke.
Today Ms. L.S. is groomed, her hair neatly combed, her nails polished, she smiles frequently and her natural beauty shines through. Ms. L.S. no longer roams the halls shouting and now often speaks in intelligible sentences. Ms. L.S. receives individualized attention from staff,and inparticular from a social worker. Further, she is involved in individualized music activities therapy, which is directly related to her past life when she was able-bodied.
Ms. L.S. lives in Carroll Manor Nursing Home in the District, where over twenty D. C. Village residents now live. A new facility, this nursing home looks just like that — a home. It isfully carpeted, the common room or day room isfurnished like a living room, with inviting sofas and chairs, plants and a huge television screen. The dining area looks like a nice restaurant with flowers on the table, place mats, and tableware, and coffee and tea available all
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day. Residents rooms have warm-colored -woodfurniture and are made to seem as personable and individualized as possible. There is a swimming pool in the building with a wheelchair lift, and the nearby physical therapy area is outfitted with the most up-to-date therapeutic equipment.
I believe this warm, soothing environment helps contribute to the calming effect this home has had on Ms. L.S. and the other residents.
C^ Summary: Mr. E.J. Although needing therapeutic structure to his day, Mr. E.J. was not provided this
at D. C. Village. For example, most days Mr. E.J. would sit in the canteen area or be "penalized" for not returning to his unit. As a result the D. C. Village staff often left him in his room by himself. Unlike the other residents with mental illness at D. C. Village who had overriding medical conditions requiring nursing home outplacement, Mr. E.J. was fully functioning and had no medical need to be in a nursing home.
Today Mr. E.J. lives in the community in a group homefor residents with a label of mental illness. "It's lovely here, I couldn 't askfor anything better," he says. Mr. E.J's. home is in a wonderful large old house on a well cared for and manicured block in the District. His landlady maintains an inviting, warm, clean, comfortable home and prepares fresh food and produce daily, something neither Mr. E.J. nor any of the other residents had at D.C.Village. There is a peaceful, cozy backyard with a relaxing sitting area. (When visiting Mr. E.J, he took great pride in showing his visitors his living space, which was neat, clean, and decorated with some of his own mementoes.) It is obvious that Mr. E.J. caresfor and responsibly tends to his living space in his home in the community. Mr. E.J. has an attentivefamily nearby and his son comes to visit him often.
Every day during the week Mr. E.J. attends a day program in the community for residents with mental illness. Attendance at his day program provides Mr. E.J. with the daily structure, supervision and activities appropriate for him. This type of structure and activities were never provided for Mr. E.J. at D. C. Village. When asked how he likes his day program he says, "I like the concern they have for us, you can tell by how we are treated they really care and respect us."
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Cnxp. Summary: Ms. G.M. Ms. G.M., a woman in her forties, young for a nursing home resident, and
ambulatory, received dialysis treatment two days a week While at D.C. Village, Ms. G.M. was child-like and would wander the halls aimlessly. She had no responsibility to assume, and no program to assist her to develop skills to become responsible and independent.
Today, Ms. G.M. is a new person. She is an adult. Ms. G.M. still attends dialysis treatment but now with another resident, a young woman who has a double amputation of her legs. Ms. G.M. has taken on the responsibility of "looking after" this resident. Ms. G.M. is given individualized attention by the social services and activities staff and is assuming appropriate responsibility for herself. Ms. G.M. is enrolled in ajob training program, and returns to her nursing home at the end of each day. Ms. G.M. is currently awaiting placement to a day program which would therapeutically ease her into community living. The Director of Resident Services in her new nursing home is planning, with Ms. GM.for her to eventually live in a group home in the community — a much more appropriate settingfor her. This transition is possible for her now that Ms. G.M. is receiving the type of attention, programming, responsibilities, and adult respect that was lacking at D.C. Village.
Ms. G.M. is currently living at IB. Johnson Nursing Center in the District, where over 20 D. C. Village residents now live.
Casp. Summary: Ms. S.B. Ms. S.B., a young woman in her forties, wheelchair bound, and since her early
2O's without the use of her arms and legs, is completely dependent on others for her care. Ms. S.B. merely existed at D. C. Village for over 15 years. Even though Ms. S.B. has a keen sense of humor, I rarely saw her smile and her affect was most always pained. She was given a label of "trouble-maker" by D.C. Village staff and administration, as well as by administrators in other nursing homes in the District, simply because she could and would articulate deficiencies, neglect, and abuses in her care and in the care of others. What was particularly touching about Ms. S.B. was that she seemed to possess a selfless, altruistic concern, and rare sensitivity for the rights and plight of other defenseless individuals.
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While at D.C. Village, the staff subjected her to verbal taunts and threats, lack of basic care and numerous other indignities. For example, staff and administrators failed to give Ms. S.B. any type of care to encourage her growth and development. Not until her last few months at D.C. Village did Ms. S.B. move into a private room, which she had requested for years. Ms. S.B. had lived in a room with three other very elderly and sick residents. Whenever a resident room became available, Ms. S.B. was told over and over again that the room would be usedfor a staff office, despite thefact that there were already offices and a nurses' station on every unit. Ms. S.B.found herself in a situation ofpowerlessness. Ms. S.B. had owned a telephone, her only lifeline to the outside world, yet for years at D.C. Village, it remained in storage, because no one took the initiative to install itfor her.
During her very first week in her new home, Ms. S.B. s telephone was installed, such a simple task, such a simple act of human kindness.
Staff and administration at Ms. S.B. 's new home have stated that they were "appalled at the medications she came with. " There have been several interdisciplinary team care planning meetings with representatives from all departments (one of which the Monitor and consultant attended) to coordinate her care and establish the most appropriate medications for her.
Today, Ms. S.B. reports that she is "not used to being so happy...not used to smiling so much...not used to people being so nice. " She adds, "I don't have to worry about violation of rights and stealing and crude snide comments, " as Ms. S.B. so often received from nurse aides at D. C. Village. Ms. S.B. 's assessment of the difference in her care is that, "nurse aides are supervised and doing what they are supposed to do. "
Ms. S.B. has been given a new label from the staff, "refreshing. " One staff member commented, "I always lookforward to caring for her. " Another nurse aide has told Ms. S.B., "you always make my day, it's not often I have a resident with a sense of humor. "
Ms. S.B. has plans to obtain her general education degree (G.E.D.). The Director of the Social Services Department is planning with Ms. S.B. for her tojoin a networking club for other young wheelchair bound individuals in the District. Further, the social worker has started a younger adults club at Ms. S.B. 's new home. Ms. S.B. adds, "they do things here for you they never did at D.C. Village."
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Ms. S.B. lives at Stoddard Baptist Nursing Home. The new Administrator is Ms. Alberta Brasfield, who admitted Ms. S.B. when there was no other site identified in the District for her. This Administrator was also the new Executive Director of D.C. Village when this case was filed, and thus, became the fourth listed Defendant in this case. In a new, positive environment with a Board of Directors' philosophy of resident-centered care, both are thriving.
Residents with Mental Retardation
As was the case for residents with mental illness, special additional steps were required for the residents with mental retardation prior to their outplacement and after to ensure continuity of care.
Many of the residents with mental retardation were inappropriately transferred to D.C. Village in 1991, when Forest Haven, the last District-run institution for those with mental retardation, was closed under the Evans v. Barry, ei_al. case. These residents were literally dumped into D.C. Village, which was not capable of handling their unique needs. Therefore, Georgetown University Child Development Center (GUCDC) received a subcontract to provide their expertise in habilitation and care for these individuals. GUCDC provided services to the D.C. Village residents with mental retardation Monday through Friday for the most part during the day and occasionally on a Saturday. However, during the evenings and nights and on most weekends these residents did not receive the appropriate habilitation care and attention necessary for them. The administrator of the District's Mental Retardation and Developmental Disabilities Administration is the third named Defendant in this case.
In the July 6, 1995, Stipulated Order, the United States insisted, and the Defendants agreed to discharge all of the individuals with mental retardation, and to place them into appropriate community settings that met their individualized needs, by October 31, 1995.
When monitoring first commenced, however, it quickly became clear that the Defendants were incapable of complying with the Court Order of July 6, 1995, to appropriately outplace this
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population by October 31,1995, and to ensure that these residents individualized needs would be met. In fact, the Defendants missed this deadline and subsequent express deadlines and continued to violate the Court Orders until the last resident with mental retardation was finally outplaced on June 13,1996.
This Monitor's assessments, which were originally profiled in the October and November 1995 Status Reports, identified the following initial problems with the process that had been put in place: the case manager from MRDDA — who knew the residents the least — was responsible for identifying the outplacement site; outplacement sites identified were resistant to accepting the residents because of the District's failure to pay for past services and continuing disputes with the District over interim rates; outplacement sites identified by the Defendant were often not appropriate for the residents physical needs (for example, a number of wheelchair bound residents were identified for outplacement to the second and third floors of a building that had no elevator and or sprinkler system); three of the residents had medical conditions beyond the capabilities of the staff at group homes to care for them; there was no plan for staff training on how to care for these unique individuals in the residents' new homes; and once residents with mental retardation were to be discharged, there was going to be no assessment of the adequacy of the care they were receiving to meet their ongoing needs. GUCDC reported that some residents with mental retardation were outplaced prematurely and without their knowledge, even though GUCDC knew the residents better than anyone else, including (MRDDA), who had been entrusted with the responsibility of overseeing the outplacements. This was another example of the Defendants failure to collaborate with appropriate and knowledgeable professionals for the best interests of the residents. This was simply unacceptable. Obviously, MRDDA had failed its responsibilities. Indeed, the November 30, 1995, Status Report, and my subsequent submissions to the Court indicated how every outplacement site identified by the Defendant had proven to be inappropriate and had "fallen through."
To humanely and appropriately outplace this special population, the Monitor recommended that an additional Specialty Consult Team be created which would consist of professionals with particular expertise in developmental disabilities and mental retardation,
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including a nutritionist, psychologist, speech pathologist, and recreation specialist. In conjunction with this recommendation in the November 30,1995, Status Report, the United States and the Plaintiff-Intervenor filed appropriate motions, and after a hearing, the Court issued the Order of December 22, 1995. Through the constant insistence of the Ombudsperson and the Monitor, MRDDA finally expanded and extended the contract for GUCDC to include off-site duties, and they became the Specialty Consult Team. This Specialty Consult Team provided onsite training of staff in the residents' new homes; demonstrated specific and unique care-giving techniques, for example how to feed, turn, and position medically compromised individuals with mental retardation; directly facilitated the residents adjustment in their new homes so that their individual needs were met; accompanied the residents on the day of their outplacement and, in some instances, stayed with them for several days; conducted inservice education programs for all staff, from activities to housekeeping, at the Health Care Institute where three medically fragile residents were outplaced; served as consultants to the staff in the community-based Day Programs where two residents attend; and more. The Specialty Consult Team remained in place until competency was demonstrated by the new caregivers.
It is for the non-payment of this Specialty Consult Team vendor, GUCDC, which rendered the Defendants their last continuing contempt citation on July 15, 1996. In fact, GUCDC had not been paid in full for their services at D.C. Village since 1991. Once this became known and reported to the Court in June 1996 (see Monitor's June 16 and June 28,1996, letters to the Court in Appendix C), and after the United States and the Plaintiff-Intervenor filed legal papers, payment to this vendor was completed by the end of July 1996. In addition, the group home providers in this case, who had not been paid in full for years, have currently been paid to date.
The Court Order for a Specialty Consult Team has provided continuity of care, quality of life and protection of the residents' rights.
The Monitor and consultant expert in mental retardation have visited all the residents with mental retardation from D.C. Village in their new homes. All of the residents are receiving
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continuity of care and are in the most appropriate setting to meet their individual and unique needs. These residents have been profiled in nearly every submission to the Court (see Appendix C).
Case. Summaries: Ms. A.R. and Mr. K.F. Ms. A.R. and Mr. K.F. live on Bunker Hill Road, N.E., in a group home for
individuals with mental retardation operated by Wholistic Habilitative Services. Five individuals with mental retardation live in this home. (In fact two other residents are also former D. C. Village residents, Ms. D.L. and Ms. P.A. They had moved to this home prior to my involvement in the outplacement.) The house is in a quiet neighborhood, on a block with nicely manicured lawns. Their house is very much a home, comfortable and warm, beautifully decorated with green leather sofas and green leaf patterned drapes. The residents bedrooms are personalized and decorated with matching bedspreads and drapes and the residents have their own space. The home is bright, cheerful, and clean and has a happyfeeling to it. The curtains and blinds are open to let in light and the world outside. And the residents are very much part of the world outside, for not only do they take frequent walks in their nice neighborhood, but in the well maintained backyard, there is a lovely, inviting, comfortable, and nicely constructed wooden deck, which is wheelchair accessible and a sitting area among large old trees. All the residents enjoy this area and use itfor recreation under the supervision of attentive staff On the Monitor's visits with the mental retardation expert consultant, the food served to the residents was always nourishing and well-balanced. The staff provide the residents with attention on a one-to-one basis. Each resident is given an empowering role with real responsibilities, for example, clearing the table after meals. Ms. A.R. and Mr. K.F. have been integrated into the life of the home.
The house manager said the Specialty Consult Team has been "very, very helpful, we could not have done it without them. " The Specialty Consult Team has provided instruction, demonstration, and consultation to the Wholistic staff on how toproperly carefor, how to interact with, and how tofeed the residents. The Team has also instructed the new care-givers in the most appropriate activities for the residents to maximize their habilitation potential.
Since they moved from D.C. Village to the community, both Ms. A.R. and Mr. K.F.
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look brighter, happier, and they are well groomed. Ms. A.R. is much more engaged in her environment and interactive with others.
She responds readily to instructions, and is much more social than she was during her days at D. C. Village. With oversight from an aide, Ms. A.R. takes her own plate from the dinner table to the kitchen. Ms. A.R. readily follows instructions, and now drinks from a cup. Her gait has improved and Ms. A.R. has learned to walk up and down stairs in her new home.
Mr. K.F. has not exhibited aggressive behavior he so often erupted into at D.C. Village. Mr. K.F. interacts with his peers and staff in the home. He has one-on-one attention, especially at meal times, and is learning to eat at the table with others. Mr. K.F. has a sparkle to his eyes which I did not see in him at D. C. Village.
Both Ms. A.R. and Mr. K.F. attend off-site day programs Monday through Friday for at least five hours a day.
Ms. A.R. attends Better Treatment Center in the District. The staff at Better Treatment say that the Specialty Consult Team has been "very helpful"especially with Ms. A.R.. 's unique dietary needs. The collaboration among the Specialty Consult Team, Ms. A.R. 's group home providers, and the day treatment program staff have effected a smooth transition ensuring continuity of care in Ms. A.R. 's new life in the community. Ms. A.R. has developed interpersonal relationships with peers and staff and has established a close constructive relationship with one particular staff person. She is much more responsive and engaged when seeing other people. The day program staff provides Ms. A.R. with respect and utilize proactive strategies to help her develop herfull potential. I have seen Ms. A.R.. grow since her outplacement.
Mr. K.F. attends a day program at PSI Services in the District. The staff report that when Mr. K.F. first arrived, he would run and snatch items from others, especially food. Mr. K.F. now sits still, eats at a table with a group, and does not grab others food. Mr. K.F. is on a bowel and bladder training program (as he is at his group home) and he is brought to the toilet every two hours. Mr. K.F. is now able to indicate to the staff when he needs to use the bathroom by patting his stomach and he has learned to wash his hands. Mr. K.F. is involved in structured activities with other day program attendees and has taken a likening to caring for
27

plants. A staff member at the day program said, "we are very proud seeing (Mr. K.F.) improve...he is like a different person, "and describe him as "lovable. " He socializes and has adjusted to his surroundings. It is obvious when visiting Mr. K.F. that staff have great affection for him, as was evident with the staff at Ms. A.R. 's day program. Care has been coordinated among the Specialty Consult Team, the group home providers, and the day program staff to ensure that Mr. K.F. 's individualized needs will continue to be met.
Grnup Six former D.C. Village residents with mental retardation live at this group home operated by D.C. Family Services. This home is in a beautiful neighborhood and the house has been lovingly remodeled to be handicapped accessible. In the rear of the house is a nicely constructed wooden ramp which leads into a spacious backyard with an areafor barbecues. The residents enjoy their comfortable outdoor space. The residents at this group home are severely physically impaired., nevertheless, they are up and out of bed everyday and neatly dressed in street clothes. While at D.C.Village some of these residents were rarely out of bed, especially Mr. R. W. and Mr. T.S. who essentially had not been out of bedfor years. With trained staff members, the residents are engaged in one-on-one therapeutic activities appropriate for their individual development. All the residents have progressed considerably toward attaining their individual potential. The Specialty Consult Team has been particularly helpful in establishing nutrition protocols. Incidentally, the nutritionist formerly with the Specialty Consult Team is now the nutritionist for D.C. Family Services, and the fulltime Licensed Practical Nurse at the home worked at D. C. Village and knew the residents when they lived there. At D.C. Village, Mr. T.M. wasfed by an invasive gastric tube through his stomach, which he would continually pull out. At his new home in the community, he is slowly learning tofeed himself Mr. T.M. is up and out of bed now, dressed, engaged in his environment, and he is much more sociable. Whereas upon his outplacement to this group home he would not allow human contact, he now allows others to touch him. The 0 Street staff are actively working with Mr. T.M. to help him progress to the point he can attend an off-site day
28

program. At his new home in the community, Mr. F.M. is up all day and dressed and he
wears shoes now which he never did at D. C. Village. While at D. C. Village, except when she was sleeping in bed, Ms. S.A. remained on
a mat on the floor. Now Ms. S.A. sits up straight in a wheelchair and eats at the dining table. She is on a bowel and bladder training program. With the input of the Specialty Consult Team, this group home provider along with a day program in the District are now planning to transition Ms. S.A. to off-site day programming.
Since she has left D. C. Village, Ms. S.P. is on a program to wean herfrom the gastric tube in her stomach, is learning to eat by mouth, and her weight has improved. She can now wipe her mouth when requested to by staff. Ms. S.P. has learned to clap her hands and seems much happier now than she was during her days at D. C. Village. As with Ms. S.A. there are current plans to transition Ms. S.P. to an off-site day program.
Cnso Summaries: Ms. C.W., Ms. C.L., and Ms. A.B. These three medically fragile residents with mental retardation now live at Health
Care Institute (HCI), a skilled nursing facility in the District. The Specialty Consult Team has been essential in easing these residents transition to their new homes. This Specialty Consult Team has conducted regular inservice education programs for all HCI staff from administration to housekeeping. The Activities Department has worked closely with the Specialty Consult Team to ensure that these three residents receive habilitation care to meet their individual and unique needs, and in addition, they receive music therapy and one-on-one sensory stimulation. Along with the other female residents of HCI, Ms. C.W., Ms. C.L., and Ms. A.B. receive "glamour therapy, " such as regular manicures and hair styling which improve their quality of life.
It is evident when visiting Ms. C. W., Ms. C.L., and Ms. A.B., that they are cared for with affection and respect by knowledgeable staff. Ms. A.B., who was rarely out of bed at D. C. Village, is up out of bed and dressed much more so now than she ever was before. Her medications have been readjusted and she breathes more easily. Ms. C. W. who was always confined to her bed and wheelchair at D. C. Village, is now being taught to crawl, with the watchful expertise of the HCI physical therapists and nursing staff In addition, Ms. C. W. makes
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much more frequent eye contact with those about her than she did at D.C. Village.
Case Summary: Mr. P.L. Mr. P.L. also medically fragile lives at Catonsville Convalescent Center. The
Specialty Consult Team has been instrumental in ensuring Mr. P.L. 's unique needs are continuing to be met by his new caregivers. The Team has consulted with the Catonsville Activities Department and placed Mr. P.L. into programs appropriatefor his habilitation potential. Mr. P.L. has an endearing smile, and when visiting him it is clear that Mr. P.L. is also caredfor with affection and respect by knowledgeable staff.
Outplacement nf Residents into the Community
When on-site monitoring commenced in late August 1995, there were some residents who should not have been institutionalized, they should have been outplaced into the community years earlier. Furthermore, residents were not appropriately stimulated to reach their "highest practicable physical, mental, and psycho-social well-being" (1987 federal Nursing Home Reform Law). This lack of stimulation and long term neglect created a pall of powerlessness and inertia, where sadness reigned, and the residents rarely smiled. For example, Mr. C.F. remained in an environment where he did not need to be; Mr. M.W. wanted to get out, but did not know how; Ms. M.M. felt trapped.
Case Summary: Mr. C. W. Frustrated knowing that he remained inappropriately institutionalized and left
with nothing to do, Mr. C. W. would often help staff distribute and collect meal trays. Mr. C. W. has a double amputation of his lower legs, however, he walks well with prostheses, and because of his highfunctioning was frequently mistaken for staff. Meanwhile, no one at D.C. Village was assuming responsibility for his discharge planning, leaving Mr. C.W. wandering with no purpose and left to languish in an institution where he did not belong.
"It's heaven, I'm free, " was Mr. C.W. 's response when asked how itfeels living outside of D.C. Village.
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Mr. C.W., 55 years old, lives independently in the community, in a church owned apartment building which is handicapped accessible. He does his own shopping, and loves to cook his ownfood. He participates in recreational activities sponsored by the management of his apartment building and has already been to Atlantic City and Solomon's Island. He is also linked to a vocational rehabilitation counselor in his neighborhood. When visiting Mr. C. W. it is clearly obvious that he is well liked by the full time management staff of his building and his neighbors.
He travels by public transportation and daily takes long walks in his nice neighborhood in the District. Mr. C. W. no longer takes the many medications that were prescribed for him at D.C. Village, and he states that living independently "makes you feel better. " Mr. C.W. has become baptized in the church next to his apartment building. Mr. C. W. has a sparkle, lightness, and happiness to him which was never present at D. C. Village. During the visit with Mr. C.W. in his new home he did not stop smiling and laughing which became contagious. One cannot help but be extremely happy for him and all the residents in their new homes.
Mr. C.W. was profiled in the Monitor's May 9, 1996, letter to the Court, describing the Defendants intention to outplace Mr. C.W. with no arrangementfor medical follow-up. The presence of the Court was able to rectify this insensitivity when it surfaced at an outplacement meeting. Today, Mr. C. W. receives consistent and regular medical follow-up at a medical center in his neighborhood.
tP Summary: Mr. M. W "I am very much better....I was so glad to get out." Mr. M. W., an innocent gunshot victim, used to sit for hours at a time in the day
room at D. C. Village working on puzzles and waiting "to get out, " now he likes being out of D.C. Village a "whole lot better. "
Mr. M. W. has an amputation of his leg andfor the majority of time is in a wheelchair. Mr. M. W. lives in a public housing building in the Districtfor senior citizens in a handicap accessible apartment. The bathroom is wheelchair accessible with appropriate safety features. His apartment isfurnished comfortably. Mr. M. W. likes to cook and eat what he likes.
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Nonetheless, he knows what is good for him andfollows a diet recommendedfor his circulatory condition. He hasfamily and friends in the District who are his support system and shop for
him.
>:Ms. M.M. Ms. M.M., a woman in her forties, became institutionalized several years ago when she was unable to walk. After learning to walk again, however, Ms. M.M. remained unnecessarily institutionalized for years. While at D.C. Village, Ms. M.M. usedtowalk restlessly through the halls looking for activities to engage in and stimulate her and always talked longingly about "getting out on her own, " and yet little to no planning was done on her behalf. Mr. M.M. is hard of hearing and had wanted to learn sign language for a number of years. On a visit to Ms. M.M. in her new home with attorneys for the United States and for the Defendants, Ms. M.M. reported to us that while living at D.C. Village whenever she had expressed a desire to learn sign language, she was mocked and ridiculed bystaff. Today, Ms. M.M. lives in an apartment on her own in the community and is taking responsibility for her new independence. Ms. M.M. is actively engaged in vocational rehabilitation training and is looking forward to working again. She regularly takes herself to her medical appointments for her rehabilitation therapy. Ms. M.M. has joined a church and has become an active participant in its activities and has begun to learn sign language. Ms. M.M. S apartment is customized for a hard of hearing person with a voice volume device on her telephone and a light in various areas of her apartment which activates when someone rings her doorbell. Ms. M.M. likes her apartment and where she lives.
Ms. M.M. walks around the corner to the nearby supermarket with a shopping cart and loves to do her own cooking. Ms. M.M. comfortably and easily travels on public transportation to her appointments and community activities, and visitsformer D.C.Village residents outplaced to other homes. It is really quite thrilling to see people who were, in effect, imprisoned become free.
All the residents outplaced into the community have food stamps to help meet their nutritional needs, a vocational rehabilitation counselor and training, appropriate medical
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attention, Medicaid coverage, subsidized rent, metro access cards for easier transportation, and supplemental security income. The former D.C. Village residents who live in apartment buildings have caring and attentive staff and their apartments are furnished comfortably with items supplied by D.C. Village. For those requiring it, the apartments are tailored to the disability and handicap needs of the individual residents. Touchingly, many of the residents maintain regular contact and "check up" on each other by telephone. It is obvious upon visiting the residents, how much they appreciate the great gift of their new found independence and freedom.
The last resident of D.C. Village was humanely outplaced on June 24, 1996.
Monitoring gf tho Outplacement Sites
"Our Warmest Welcome...We're Happy You're Here With Us and We Know You'll find many new Friends Here..." This is a sign that greets the residents in one new home, it sums up the reception all of the D.C. Village residents have received in all of their new homes.
Monitoring at the outplacement sites has consisted of meeting with the administration, department heads, and direct care staff, reviewing residents' charts and plans of care, touring the entire facility, and visiting at traditional and non-traditional times, such as, evening and weekends. Furthermore, I shared and left copies of the Court Orders with the administration in every nursing home visited, and reviewed the residents history at D.C. Village with staff and administration. Many of the outplacement visits to the residents were made with the Monitor's expert consultants in nursing home systems, mental health, and mental retardation. Any care issues or questions that arose were able to be resolved with the staff, residents, and administration on-site during these visits, or in follow-up, and without requiring the assistance of the Court. There has been open and ongoing communication with all outplacement sites.
The Court Monitor's duty is to evaluate and determine that the residents individualized needs are being met and that the outplacement sites continue to be appropriate and adequate, and
33
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then to report to the Court that the residents "discharge has been satisfactorily and successfully completed" (Court Order of November 7,1995).
The Court Monitor has visited each and every resident outplaced from D.C. Village in their new homes and can assure the Court that the outplacement sites are currently appropriate and adequate. I fully expect that the outplacement sites will continue in their admirable efforts to meet the individualized needs of the residents.
LESSONS TO BE LEARNED
It is instructive to learn how the Court and justice turned an appalling situation around and gave the residents quality of care and quality of life.
I believe this case was so helpful to the victims whose civil rights had been violated because the professional behavior tenet of a client/society focus was the guiding framework: and was never lost. There was no vested interest except the swift, tireless, and relentless pursuit of the protection of the residents' civil rights, their quality of care and their quality of life. The successful outcome of this case was due to the particular vigilance of the Court in calling frequent Status Hearings often on a weekly basis; holding the Defendants accountable to the Court Orders, and holding the Defendants and their Counsel responsible for violating them and their solemn oath to comply; the compassionate oversight of the United States Department of Justice; and the constant presence of the Court in the facility. A professional collaboration emerged. The Court Monitor's submissions to the Court consisted not only of necessary assessments of compliance, but in all instances included recommendations and identified action steps to advise the Defendants on how to comply with the Court Orders and federal law and regulations. These recommendations and action steps in turn were often incorporated into the frequent pleadings of the Plaintiffs, and the resultant issuance of the Court Orders addressed these concerns when the Defendants refused to act. This type of proactive professional collaboration is particularly efficient and effective in cases of recalcitrant Defendants and quickly delivers help to the individuals who need the intervention of the Court in the first place — those
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-•r--

• gww—i

nr

whose civil rights have been violated.
A second example of effective collaboration also highlights the bitter sadness of this case and the senselessness of the Defendants reactions. Well over a year after the Complaint was filed by the U.S. Department of Justice, and well over a year of denials, of fighting the Monitor, of motions to deny the Monitor's expansion of duties, of advice from counsel not to speak with the Monitor, and of a motion to terminate the Monitor before the Court's work was completed (see August 11,1996, letter to the Court in Appendix C), a constructive professional collaboration was finally put into action: On September 25, 26, and 27, 1996, both the Plaintiff (represented by Mr. Richard J. Farano and Mr. David Deutsch of the U.S. Department of Justice), and the Defendant (represented by Ms. Barbara Mann of the Corporation Counsel for the District of Columbia) accompanied the Court Monitor on visits to all the residents outplaced to the community, all the residents with mental retardation outplaced in the District, and the majority of residents outplaced to nursing homes in the area. Whenever residents and/or staff identified unresolved transition issues, for example lack of payment of contract services or lack of payment to group home providers, all three visitors either resolved them on site or follow-up was promised in a spirit of cooperation. Ms. Mann is to be credited for her responsiveness to the needs and problems identified by residents and staff in these visits, and in a follow-up letter to the Court Monitor of October 28, 1996, Ms. Mann listed her interventions in resolving the remaining issues, including payment of services, and offered to be of further assistance. Not to discredit the import of this process at this time, but it is a shame that it took one year and one month after the presence of the Court at D.C. Village to effect this intelligent, non-combative, non-litigious team approach.
This belated advocacy and teamwork on the part of the Corporation Counsel for the best interests of the residents is what should have existed on day one of this case, instead of the constant denials and misrepresentations in Court. Indeed, the Plaintiffs representative lamented that the teamwork among all concerned parties is what he expected to happen the day the Defendants signed the consent decree agreeing to comply with the stipulations of the first Court Order of July 6, 1995.
35
i •' •

This process of ieamJKQik by all concerned parties, Plaintiff, Defendants and the Court is a mn^tn"-*™""***1 f o r resolving Court cases. This kind of professional collaboration should be enforced system wide-to ensure the competence, responsibility and accountability of government to right wrongs, and to ensure that government intelligently and swiftly care for its most precious charge and prevent the suffering of its most defenseless.
Another valuable lesson to be learned is that defensiveness is harmful to the defenseless, and useless and embarrassing for the Defendants and their representatives who signed consent decrees on their behalf. Counsel is better served by knowing first hand the needs of the individual's whose civil rights have been violated, and then to advise their clients, the Defendants, to provide the individualized interventions required to protect the civil rights of human beings and to comply with Court Orders.
The failure of the Defendants to provide the very basic services to its most needy points to the system-wide breakdown, lack of political will to do what is right by its citizens, and a misfocused bureaucracy as profiled in this Report and in the Monitor's previous submissions to the Court. When individuals within a government bureaucracy are blinded to their mission as public servants and function solely for their own benefit and aggrandizement, then the neglect, abuse, and trampling of the civil rights of the systems most defenseless is the sad consequence. When individuals within a government bureaucracy have a single client/society focus and function as public servants to benefit their constituents as human beings with rights, then a bureaucracy can be used as a tremendous force for good, as evidenced by the swift success of this case. This type of client/society focus must be imposed on individuals within a disfunctioning bureaucracy, as it
this case by Court Orders, contempt citations, and threats of imprisonment. wasm
Role
Monitoring in this case always held dear the charge to advise the Defendants on how to comply with the Court Orders and federal law and regulations, no matter what the price, no matter what the resistance.
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Monitors, Special Masters, and Receivers must not be lulled into functioning as if their positions should remain in place for years. They should be proactive for the good of those whose rights are being violated, in this case the residents of D.C. Village. When the Monitor sees egregious abuses, then immediate interventions are required by bringing the wrong to the attention of the direct caregivers and overseeing its immediate resolution, then notifying administration, and finally identifying the systems failure. (For example, when this Court Monitor first arrived at D.C. Village, initial assessments identified an overabundance of physical restraints and no knowledge of current federal law and regulations pertaining to their use. Within a few weeks there were virtually no physical restraints in the facility. This process came about by literally overseeing staff untie residents and educating staff about the federal law and regulations.)
I believe that oftentimes facilities and staff simply do not know how to improve care, and therefore, it is the professional duty of the Monitor to take immediate proactive steps, and when necessary bring in expert consultants, to protect the rights health, safety, and welfare of the defenseless. This should be followed by recommendations and action steps for system-wide improvement to ensure abuses do not recur. In the case of obstinate Defendants, it is imperative to notify the Court of the need for the Defendants to implement the Court Monitor's recommendations and action steps, and it is vital to frequently communicate with the Court on the Defendants status of compliance with the Court Orders.
As the eyes and ears of the Court, with a mandate to be objective and neutral, the Court Monitor in no instance should rely solely on the word of the Defendants to monitor compliance with Court Orders or to correct their crimes by their own will. If this were the case these types of judicial appointments would not be needed. This is not to say that Monitors should not work with the Defendants, they should always attempt to, but with open eyes. To highlight this point, on one of my last nights of touring the units at D.C. Village, a nurse came up to me and told me, "When you first came here when you were making rounds on all the units, the administration would call the next unit before you got there and warn them and then they would go there and try
37

to clean things up and try to snow you, but you kept on coming back and now they hate you."
This addresses another vital lesson to be learned. Monitoring must occur at traditional and non-traditional hours, for example, evenings, nights, and weeksnHs and should be frequently unannounced in order to truly obtain an objective assessment of the lives and care of the residents.
Continuity of Monitoring Another lesson to be learned is that it is imperative for the welfare of the residents that monitoring not cease at the point of the last resident's outplacement, but must continue until the Monitor determines that the outplacement sites are "appropriate and adequate to meet each persons individualized needs." Visiting the residents in their new homes and meeting with staff has not only helped ensure that the residents individualized needs are being met, but I believe, these visits have spread an enormous amount of goodwill in the community for the cause of justice and the protection of the rights of the most vulnerable, infirmed, and poor among us. In addition, I believe the Monitor's position should not be prolonged indefinitely, but continue only until the Monitor can assure and report to the Court that each and every resident is "satisfactorily and successfully outplaced."
Community Involvement Cultivating expert consultants from the local community of professionals is a valuable lesson for other Monitors. It is an opportunity for professionals to be.involved in community service, spreads goodwill and, I believe, can be a lesson to the Defendants that there is competence among their midst ready to serve. This Court Monitor utilized the expertise of professionals in the District including Howard University's Department of Nutritional Sciences, Georgetown University's School of Nursing, the Lt. Joseph P. Kennedy Institute, and George Mason University's College of Nursing. Experts from these institutions were consultants to the Court Monitor and not only shared their valuable expertise for the benefit of the residents, but demonstrated a commitment to the District's most vulnerable and poor by wanting to help.
38
IT

Advocates
Advocates and advocacy organizations, like the monitoring role, must also be proactive. But they must know their clients well. Therefore, they must visit their clients at the bedside in the facilities so they can speak with effectiveness, credibility, and authority. The needs of the defenseless, the weak and vulnerable demand that advocates shun timidity and passivity and interact directly with their clients, otherwise, advocacy organizations exist to maintain their own bureaucratic structures.
Federal and Tnral Surveyors
When Court monitoring ceases, then the protection of the defenseless reverts to the original government oversight authority, federal and local surveyors. In the instance of D.C. Village, these government surveyors failed the residents year after year, survey after survey, for the terrible conditions that I found at D.C. Village could only exist as a product of years of neglect and abuse. So not only did the Defendants exhibit the internal and external systems breakdown identified earlier in this Report, but the federal and local surveyors also exhibited a systems breakdown by their inability to enforce improved conditions at D.C. Village for years. Appallingly, these conditions would have continued even to this day had it not been for the United States Department of Justice bringing these abuses to the Court's attention under the Civil Rights of Institutionalized Persons Act (CRIPA). The Ombudsman Program identified abuses at D.C. Village for years.
Coincidentally, a September 1996 United States General Accounting Office (GAO) Report entitled, Medicaid: Oversight of Institutional Care for the Mentally Retarded Should Re Strengthened, recommends that the Health Care Financing Administration (HCFA) develop an enhanced monitoring program in facilities and strengthen enforcement mechanisms to remedy violations that are cited in the same institutions year after year in federal and state surveys. Although this GAO Report addresses deficiencies in the oversight of public facilities for individuals with mental retardation and other developmental disabilities, I can say it also aptly
39

applies to the failure of effective federal and local government survey oversight, the results of which I witnessed in my year at a Nursing Home called D.C. Village. The District surveyors failed in part due to the inherent conflict of interest in policing their own. The penalty for citing abuses could have resulted in a loss of government funding, therefore the District surveyors would be inclined to overlook or downplay serious violations of rights, as noted in the GAO Report. Although HCFA and local surveyors cited D.C. Village over the years, care did not improve until proactive monitoring was in place with the backing of a courageous and compassionate U.S. District Court Judge.
Furthermore, I believe the protection of the residents rights would be well served if HCFA developed an objective, neutral, and independent enhanced monitoring program with strengthened enforcement mechanisms that would hold not just an institution accountable for violations of civil rights, but individuals criminally responsible if abuses continue — from the bedside nurse to elected government officials if necessary.
The present enforcement mechanisms of termination of funding to the facility, financial penalties to the institution, or halting admissions are not effective as weapons to improve care, as I witnessed in my year at D.C. Village. There must be swift and active correction of wrongs, if not corrected, termination of employment, and if needs be, imprisonment for those responsible for denying individuals their civil rights.
An "enhanced monitoring" program should include yearly training in effective and aggressive monitoring, as outlined above under Monitoring Role, and include a review, analysis, and evaluation of each monitor's present duties.
Finally, part of an enhanced monitoring program for federal and local regulators must include a mechanism to demand an accountability of government funds earmarked for the defenseless, vulnerable and poor. For example, at D.C. Village there was enormous waste of funds. The federal government matched the District's handsome reimbursement rate, which was one of the highest in the country at nearly $240 a day per resident, yet it seems that neither the
40

federal government, in this instance HCFA, nor the District's own Medicaid Offices and Department of Regulatory Affairs ever demanded an accountability for its generous funding. There certainly was no evidence that these millions of dollars ever benefitted the needs of the residents at the bedside. However, an overabundance of staff and administrators, for example, six medical doctors (including the Medical Director), eighteen therapeutic recreation staff, five pharmacists, and nurse aides padded on the night shift, all comported with the District of Columbia's arcane, and self-serving Personnel Office policies.
It is hoped that,others may learn from this case about how wrongs can be righted through the intervention of justice and the Court, but perhaps more importantly, how to protect the civil rights of the defenseless before the situation ever escalates to Court action.
CONCLUSION
In my year at D.C. Village, I saw in the residents' eyes the product of years of neglect and abuse. United States of America v. The District of Columbia, si. al., Civ. No. 95-948 (TFH) Re: D.C. Village Nursing Home restored dignity and respect to these individuals. As each resident went out the front door to their new homes they did so bravely and with dignity.
The 269 residents of D.C. Village would have tragically and needlessly continued to suffer and die, but due to the courage and compassion of one U.S. District Court Judge, The Honorable Thomas F. Hogan, the guidance of the U.S. Department of Justice and the PlaintiffIntervenor for the Ombudsman program, and through the constant presence of the Court in the lives of the residents, they are now free, their civil rights have been returned to them. I am now confident that they will have better and happier lives. For those who did not have the physical stamina to withstand the transfer, dignity was restored to them as they faced their final weeks, days and even hours, a dignity at death that would have been denied them without the intervention of the Court.
Summary: Mr. KB.
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On the day the last residents left D.C. Village, Mr. KB. sat in his wheelchair, waiting, alone in the day room on his dark and empty unit, with a stoic, sad, and resigned expression on hisface. I sat down with Mr. KB. and he held out his hand and I held his hand. Mr. KB. was among the many residents at D. C. Village who never smiled, sat alone in their wheelchairs and left staring into walls, and rarely had human interaction. I told Mr. KB. that his new nursing home, which he had visited, was on a beautiful river where residents sit outside and people go fishing. Mr. KB. 's eyes lit up, and he whispered in a very soft voice, "I used to go fishing."
I told Mr. KB. that I would visit him in his new home and he said in a voice unaccustomed to attention, "you will?, really?, thank you. "
Today, Mr. KB. sits on the patio deck by the beautiful river with other residents. He smiles now with a peaceful expression and his eyes sparkle when he says, "I am very happy here, I love it."
On behalf of the residents of D.C. Village, thank you Judge Hogan for your courage and honor and thank you to the United States Department of Justice for its compassionate oversight.
Also, thank you to Ms. Elma Holder, the founder of the National Citizens' Coalition for Nursing Home Reform, who is responsible for the federal law and regulations, that with Judge Hogan's Court Orders so helped me help the residents of D.C. Village.
To the residents of D.C. Village Nursing Home, the most dignified and brave among us, thank you for the lessons you have taught us all.
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APPENDIX A
CHRONOLOGY of MAJOR EVENTS United States of America v. The District of Columbia, si. al.
Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home

CHRONOLOGY of MAJOR EVENTS
United States of America v. The District of Columbia, et al. Civ. No. 95-948 TFH, Re: D.C. Village Nursing Home

(The Court Orders appear in Appendix B The Court Monitor's submissions to the Court appear in Appendix Q

May 19,1995
June 19 1995
June 21,1995 June 29,1996 July 5, 1995 July 6, 1995 July 25, 1995 July 31, 1995 August 1,1995

United States files Complaint against the District of Columbia pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA) alleging that the civil rights of the residents of D.C. Village had been and continued to be violated.
United States files Motion for a Preliminary Injunction to Enjoin Dangerous and Life-Threatening Practices and to F.nsure Basic Care, flflTvices and Treatment, profiling appalling abuses of the D.C. Village residents. Attorneys for the United States are Mr. Richard J. Farano and Mr. David Deutsch.
Long Term Care Ombudsman intervenes in this case. Attorney for the Plaintiff-Intervenor is Mr. William Isaacson.
Defendants oppose United States and Plaintiff-Intervenor pleadings. Attorneys for the Defendants are Ms. Barbara Mann and Mr. Garland Pinkston.
District of Columbia agrees to settle case on terms identified in the United States proposed order accompanying the preliminary injunction.
Judge Hogan files Stipulated Order to Remedy the United States' and the Ombudsman's Motions for a Preliminary Injunction. Parties sign and agree to comply with terms.
Defendants request Court to modify the Stipulated Order of July 6 to limit
the authority of the Monitor.
Judge Hogan denies Defendants' request to modify terms of July 6 Order
Judge Hogan appoints Dr. Harriet A. Fields as Court Monitor to oversee Defendants compliance with the Court Order and to advise the facility on how to comply with federal and District law and regulations.

August 15,1995

The Mayor and the City Council of the District of Columbia announce closure of D.C. Village Nursing Home

September 5,1995 Monitor first submission to the Court, Preliminary Status Report

September 12,1995 Status Hearing in U.S. District Court before Judge Hogan

September 13,1995 United States files motion to expand Monitor's duties to include oversight of the transfer and outplacement process.

September 21,1995 Monitor submits letter to Judge Hogan supporting the United States motion.

September 28,1995 Defendants oppose expansion of Monitor's duties.

October 16,1995

Monitor submits Status Report detailing systems overview, failure to comply with Court Order of July 6, concerns and recommendations on how to comply with the Court Order and improve care for the residents.

October 20,1995

Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan grants United States motion to expand the duties of the Monitor to oversee the outplacement of the residents; addresses identified systems deficiencies raised in the Monitor's October 16,1995 Status Report.

November 7, 1995 Judge Hogan files Order Modifying Stipulated Order of July 6, 1995 expanding Monitor's duties to oversee the outplacement process.

November 30,1995 Monitor submits Status Report to Court detailing deficiencies in the outplacement process to date with recommendations and action steps.

December 4, 1995

Status Hearing in U.S. District Court before Judge Hogan addressing concerns raised in Monitor's November 30 Report. Judge Hogan issues verbal order to the Defendants to turnover vendor list to Monitor.

December 6, 1995 Monitor submits letter to Judge Hogan detailing chronic non-payment of vendors.

December 7,1995 United States files pleadings addressing issues in Monitor's Report and letters to the Court.

December 10, 1995

Monitor submits letter to Judge Hogan detailing "patterns detrimental to the residents' well-being with recommendations to immediately rectify, and alerting the Court to the illegal depositing of the residents Personal Needs Allowance into the D.C. Treasury.

December 11,1995 United States files pleadings requesting the Court to hold Defendants in contempt for failure to comply with Court Orders and deficiencies cited in Monitor's December letters to the Court.

December 14,1995 Plaintiff-Intervenor files pleadings for further remedial relief pursuant to Monitor's submissions.

December 12,1995 Status Hearing in U.S. District Court before Judge Hogan discussing Monitor's December letters to the Court and the United States and Plaintiff- Intervenor Pleadings.

December 20,1995

Status Hearing in U.S. District Court before Judge Hogan reviewing Monitor's submissions and Plaintiffs pleadings. Judge Hogan finds the District of Columbia in contempt of the Court Orders and suggests possible remedies not monetary, but perhaps imprisonment and appointing others to operate the nursing home.

December 22,1995

Judge Hogan files Court Order granting the Plaintiffs motions for contempt and further relief. Judge Hogan also raises concerns about the "counsel for the Defendants factual and legal misrepresentations to [the] Court."

January 17,1996

Monitor submits Status Report to the Court recommending a new management team in order to protect the residents rights, health, safety, and welfare.

January 18,1996

Status Hearing in U.S. District Court before Judge Hogan reviewing Monitor's Report and Defendants' 30-Day Compliance Report. Defendants announce creation of a management team to oversee outplacement and the assignment of Ms. Sue Brown from the District's Department of Human Services as outplacement transition team coordinator.

February 1,1996

Monitor submits letter to Judge Hogan requesting that the Court suspend the outplacement and detailing continuing concerns with specific recommendations to remedy the situation.

February 2,1996

Status Hearing in U.S. District Court before Judge Hogan reviewing Monitor's Report and letter, the United States and Plaintiff-Intervenor's pleadings, and the Defendants' response.

February 21,1996

Monitor submits letter to Judge Hogan outlining continuing concerns with the outplacement process and communications with the District of Columbia Financial Responsibility and Management Assistance Authority. Ms. Corrie Kemp of the District's Central Referral Bureau

replaces head of the D.C. Village Department of Social Services and has direct responsibility for overseeing the discharge process.

February 23,1996

Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan finds the District of Columbia still in contempt and grants the United States and Plaintiff-Intervenor's motions to suspend outplacement until the Ombudsperson, Ms. Sarodel Childs, and the Monitor determine that the outplacement of the residents complies with the Court Orders.

February 23,1996 Judge Hogan files Court Order.

March 19,1996

Monitor submits letter to Judge Hogan regarding the death of Mr. L.R., a resident with mental retardation who had been profiled in nearly every submission of the Monitor to the Court.

April 3,1996

Monitor submits letter to Judge Hogan outlining: the outplacement process in compliance with the Court Orders and Ms. Catherine Carroll from the District's Commission of Public Health assignment to coordinate the outplacement of residents with mental illness; Monitor's visits to residents recently outplaced; the District's chronic non-compliance of payment of vendors; and some residents' Personal Needs Allowance still remaining in the D.C. Treasury.

April 4,1996

Status Hearing in U.S. District Court before Judge Hogan addresses Monitor's letter and serious concerns relating to payment of vendors and the residents' Personal Needs Allowance. Mr. Garland Pinkston informs Judge Hogan of his intention to withdraw from the case as counsel for the District.

April 25, 1996

Monitor submits letter to Judge Hogan detailing outplacement process and Ms. Peggy Graves of the District's Department of Human Services assignment to coordinate the outplacement of the residents into independent living sites in the community; Monitor's visits to residents recently outplaced; Defendants continued non-compliance of payment of vendors and vendor contract approval process.

April 26,1996

Status Hearing in U.S. District Court before Judge Hogan addresses Monitor's letter to the Court and the United States and PlaintiffIntervenor's pleadings; Judge Hogan's raises serious concerns regarding Defendants apparent further contemptuous conduct and possible false statements regarding status of certain vendor payments and contracts and possible misrepresentations of the role of the D.C. Financial Responsibility and Management Assistance Authority. Mr. William Earl joins counsel for the District.

April 26,1996
April 29,1996
May 9,1996 May 10,1996 May 17,1996
May 22,1996 May 22,1996 May 31,1996 June 16, 1996 June 17,1996 June 24, 1996 June 28,1996

Judge Hogan files Order for a representative from the D.C. Financial Responsibility and Management Assistance Authority who is familiar with payments and contracts for D.C. Village and a representative from the District's Department of Human Services who is familiar with payments and contracts for D.C. Village to appear before the Court on Monday, April 29.
Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan grants motions of the United States and the Plaintiff-Intervenor and finds the District again in contempt of the Court for failure to comply with payment of vendors provision.
Monitor submits letter to Judge Hogan profiling: outplacement process for the residents, identifying areas of concern; Monitor's visits to residents outplaced; and continuing concerns with vendor payments.
Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan imposes sanctions on the District for the violations of the Court Orders and for being in contempt of the Court.
Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan finds the District in continuing contempt of the Court and refers the counsel for the Defendants, the Corporation Counsel, to the Grievance Committee of the Court for "continued and repeated misrepresentations" to the Court.
Monitor submits letter to Judge Hogan profiling outplacement issues with remaining residents.
Status Hearing in U.S. District Court before Judge Hogan discussing outplacement and vendor payment issues.
Status Hearing in U.S. District Court before Judge Hogan addressing outplacement and vendor payment issues.
Monitor submits letter to Judge Hogan profiling outplacement, remaining outplacement issues, and vendor payment issue.
• Status Hearing in U.S. District Court before Judge Hogan addresses remaining outplacement concerns and non-payment of vendor and United States Pleading.
Last resident discharged from D.C. Village.
Monitor submits letter to Judge Hogan concerning non-payment of
5

July 1,1996
July 15,1996
August 7,1996
Augustll, 1996
August 13,1996 August 22,1996 January 21, 1997 January 1997 January 30,1997

vendor.
Status Hearing in U.S. District Court before Judge Hogan. Judge Hogan finds the District in violation of the Court Orders for failure to pay vendor for services to residents with mental retardation and gives the District until July 15 to make a payment for services rendered.
Status Hearing in U.S. District Court before Judge Hogan discusses interest monies due the residents on their Personal Needs Allowance held in the D.C. Treasury and payment of vendor. Judge Hogan "Ieave(s) the contempt finding on the record."
Status Hearing in U.S. District Court before Judge Hogan. Defendants report vendor paid and intention to secure an auditor's accounting of monies due the residents. Defendants request termination of appointment of the Monitor.
Monitor submits letter to Judge Hogan detailing remaining outplacement concerns before it can be determined from outplacement visits that Defendants are in compliance with outplacement provisions of the Court Orders.
United States and Plaintiff-Intervenor submit pleadings opposing Defendants' motion.
Judge Hogan files Order denying Defendants' motion.
Monitor submits Final Report.
Auditors submit report on accounting of interest monies due residents on their Personal Needs Allowance.
Status Hearing in U.S. District Court before the Honorable Thomas F. Hogan.

 
 District of Columbia live database - Docket Report

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CLOSED, TYPE-E
U.S. District Court District of Columbia (Washington, DC) CIVIL DOCKET FOR CASE #: 1:95-cv-00948-TFH

USA v. DC, et al Assigned to: Chief Judge Thomas F. Hogan Demand: $0 Cause: 28:1391 Personal Injury Plaintiff UNITED STATES OF AMERICA
V. Defendant DISTRICT OF COLUMBIA

Date Filed: 05/19/1995 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: U.S. Government Plaintiff
represented by David Deutsch U.S. DEPARTMENT OF JUSTICE Civil Rights - Special Litigation 950 Pennsylvania Avenue, NW Room 1744 Washington, DC 20530-0001 (202) 514-6270 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard James Farano U.S. DEPARTMENT OF JUSTICE 950 Pennsylvania Avenue, NW PAB Room 5020 Washington, DC 20530-0001 (202) 307-3116 Fax: (202) 514-0212 Email: richard.farano@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann 903 Hamilton Street, NE Washington, DC 20011-6425 (202) 269-3793 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Garland Pinkston, Jr. OFFICE OF CORPORATION COUNSEL, D.C. 441 Fourth Street, NW Suite 1060N

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District of Columbia live database - Docket Report
Defendant MARION BARRY Mayor of the District of Columbia
Defendant VERNON HAWKINS Interim Director
Defendant
2 of 24

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Washington, DC 20001-4600 (202) 727-3885 TERMINATED: 04/26/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Johnson Earl, Jr. OFFICE OF ATTORNEY GENERAL DC 441 Fourth Street, NW Washington, DC 20001-2714 (202) 724-6152 Email: william.earl@dc.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Garland Pinkston, Jr. (See above for address) TERMINATED: 04/26/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Johnson Earl, Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Garland Pinkston, Jr. (See above for address) TERMINATED: 04/26/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Johnson Earl, Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
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District of Columbia live database - Docket Report
FRANCES BOWIE Acting Administrator, Mental Retardation/Developmental Disabilities Administration
Defendant ALBERTA BRASFIELD Executive Director, D.C. Village
Movant HARRIET FIELDS Court-Appinted Moniter
Intervenor Plaintiff DISTRICT OF COLUMBIA LONG-TERM CARE OMBUDSMAN
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represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Garland Pinkston, Jr. (See above for address) TERMINATED: 04/26/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Johnson Earl, Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Garland Pinkston, Jr. (See above for address) TERMINATED: 04/26/1996 LEAD ATTORNEY ATTORNEY TO BE NOTICED
William Johnson Earl, Jr. (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by HARRIET FIELDS Suite 604 1722 19th Street, NW Washington, DC 20009 PRO SE
represented by Michael Robert Schuster AMERICAN ASSOCIATION OF RETIRED PERSONS 601 E Street, NW Bldg A10-400 Washington, DC 20049 (202) 434-2333 LEAD ATTORNEY ATTORNEY TO BE NOTICED
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V. Intervenor Defendant DISTRICT OF COLUMBIA
Intervenor Defendant MARION BARRY
Intervenor Defendant VERNON HAWKINS
Intervenor Defendant FRANCES BOWIE
Intervenor Defendant ALBERTA BRASFIELD

William A. Isaacson BOIES, SCHILLER & FLEXNER LLP 5301 Wisconsin Avenue, NW Suite 800 Washington, DC 20015 (202)237-2727 Fax: (202) 237-6131 Email: wisaacson@bsfllp.com LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Barbara J. Mann (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED

Date Filed 05/19/1995

#

Docket Text

1 COMPLAINT filed by plaintiff USA (ks) (Entered: 05/22/1995)

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05/19/1995 05/19/1995 05/24/1995 06/19/1995 06/21/1995 06/22/1995 06/22/1995 06/22/1995 06/22/1995 06/22/1995 06/23/1995 06/27/1995 06/28/1995 06/28/1995
06/29/1995 06/29/1995

SUMMONS (5) issued for defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD (ks) (Entered: 05/22/1995)
CASE REFERRED by Judge Hogan to Magistrate Judge Alan Kay for full case management. (ks) (Entered: 05/24/1995)
2 ORDER by Judge Thomas F. Hogan : vacating the referral of this case to the Magistrate Judge (N) (ks) (Entered: 05/24/1995)
3 MOTION filed by plaintiff USA for preliminary injunction to enjoin dangerous and life-threatening practices and to ensure basic care, services and treatment ; Exhibits (blj) (Entered: 06/20/1995)
4 MOTION filed for D.C. LONG-TERM CARE to intervene as a plaintiff ; EXHIBIT (COMPLAINT) (ks) (Entered: 06/22/1995)
6 ATTORNEY APPEARANCE for movant D.C. LONG-TERM CARE by William A. Isaacson (ks) (Entered: 06/28/1995)
7 ATTORNEY APPEARANCE for defendants by Barbara J. Mann (ks) (Entered: 06/28/1995)
8 ATTORNEY APPEARANCE for movant D.C. LONG-TERM CARE by Michael Robert Schuster (ks) (Entered: 06/28/1995)
13 ORDER by Judge Thomas F. Hogan : exhibit lists by all parties due 7/3/95 ; motion hearing set for 1:30 7/5/95 ; witness lists by all parties due 6/30/95 ; (N) (gew) (Entered: 06/29/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: continued until 7-5-95 at 1:30 pm for preliminary injunction hearing. Anneliese Thomson (gew) (Entered: 07/06/1995)
5 MOTION filed by movant D.C. LONG-TERM CARE for preliminary injunction , and petition for a monitor ; Exhibits (4) (ks) (Entered: 06/27/1995)
9 WAIVER OF SERVICE returned executed by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD . Date waiver sent: 5/22/95; attachments (5) (blj) (Entered: 06/28/1995)
10 NOTICE OF FILING by plaintiff USA that they do not oppose the motion to intervene (ks) (Entered: 06/29/1995)
14 ORDER by Judge Thomas F. Hogan : defendants shall file an opposition to plaintiff's motion for preliminary injunction by 06/28/95 at 2:00 pm; plaintiff shall file any reply to the defendants' opposition to the motion for preliminary injunction by 07/03/95; all other provisions of the Court's June 22, 1995 order remain in full effect (N) (gew) (Entered: 06/29/1995)
11 RESPONSE by defendant DC in opposition to motion for D.C. LONG-TERM CARE to intervene as a plaintiff [4-1] . (ks) (Entered: 06/29/1995)
12 RESPONSE by defendant DC in opposition to motion for preliminary injunction [5-1] and for a monitor [5-2] by D.C. LONG-TERM CARE, and motion for preliminary injunction [3-1] by USA; Exhibits A thru V (Bukly) (ks) (Entered:

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06/30/1995 06/30/1995 06/30/1995 06/30/1995 07/03/1995 07/03/1995
07/05/1995 07/05/1995 07/05/1995
07/06/1995
07/07/1995 07/13/1995 07/21/1995 07/21/1995 07/21/1995
07/24/1995 07/25/1995

06/29/1995)
15 WITNESS LIST by movant D.C. LONG-TERM CARE (ks) (Entered: 07/03/1995)
16 WITNESS LIST by plaintiff USA (ks) (Entered: 07/03/1995)
17 WITNESS LIST by defendant DC (ks) (Entered: 07/03/1995)
18 EXHIBIT list for the DISTRICT OF COLUMBIA (dot) (Entered: 07/03/1995)
19 WITNESS LIST by movant D.C. LONG-TERM CARE (ks) (Entered: 07/05/1995)
20 REPLY by plaintiff USA to response to motion for preliminary injunction to enjoin dangerous and life-threatening practices and to ensure basic care, services and treatment [3-1] by USA; Declaration (1); List of Exhibits (ks) (Entered: 07/05/1995)
22 REPLY by movant D.C. LONG-TERM CARE to response to motion for D.C. LONG-TERM CARE to intervene as a plaintiff [4-1] (ks) (Entered: 07/06/1995)
23 MOTION filed by movant D.C. LONG-TERM CARE for protective order (ks) (Entered: 07/06/1995)
MOTION for PRELIMINARY INJUNCTION HEARING before Judge Thomas F. Hogan; Case settled; OTBP Reporter: Anneliese Thomson (gew) (Entered: 07/07/1995)
21 STIPULATED ORDER by Judge Thomas F. Hogan : remeding the United States' and the Ombudsman's Motions for a preliminary injunction. (N) (gew) (Entered: 07/06/1995)
28 INTERVENOR'S COMPLAINT against defendants (ks) (Entered: 07/25/1995)
24 NOTICE OF FILING by plaintiff USA, movant D.C. LONG-TERM CARE of nomination of Court Monitor; Attachment (ks) (Entered: 07/14/1995)
25 ANSWER TO COMPLAINT [1-1] by defendants. (ks) Modified on 07/26/1995 (Entered: 07/24/1995)
26 RESPONSE by defendants to the nomination of Court monitor [24-1] by D.C. LONG-TERM CARE, USA (ks) (Entered: 07/24/1995)
29 ANSWER TO INTEVENOR'S COMPLAINT [28-1] by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD . (ks) (Entered: 07/25/1995)
27 MOTION filed by defendant DC to clarify the duties of the monitor in the Order of Court appointing the monitor ; Exhibits (3) (ks) (Entered: 07/25/1995)
30 ORDER by Judge Thomas F. Hogan : granting motion for D.C. LONG-TERM CARE to intervene as a plaintiff; directing that Intervenor Plaintiff's Complaint shall be deemed filed as of this date. [4-1] (N) (gew) Modified on 07/26/1995 (Entered: 07/26/1995)

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07/27/1995 07/27/1995 08/01/1995 08/15/1995 08/15/1995 08/29/1995 09/06/1995
09/06/1995
09/06/1995 09/11/1995

31 RESPONSE by plaintiff USA in opposition to motion to clarify the duties of the monitor in the Order of Court appointing the monitor [27-1] by DC . (bm) (Entered: 07/28/1995)
32 RESPONSE by plaintiff-intervenor D.C. LONG-TERM CARE in opposition to motion to clarify the duties of the monitor in the Order of Court appointing the monitor [27-1] by DC . (bm) (Entered: 07/28/1995)
33 ORDER by Judge Thomas F. Hogan : denying motion to clarify the duties of the monitor in the Order of Court appointing the monitor [27-1] by DC; that Dr. Harriet Fields is hereby appointed as Monitor pursuant to the July 6 order. (N) (dot) (Entered: 08/01/1995)
34 NOTICE OF FILING by defendant DC the compliance report pursuant to paragraph F of the consent Order entered July 6, 1995; Attachments (5) BULKY (blj) (Entered: 08/16/1995)
35 MEET AND CONFER STATEMENT/REPORT PURSUANT TO L.R. 206(d) filed by plaintiff USA, intervenor-plaintiff D.C. LONG-TERM CARE; Declaration (1) (ks) (Entered: 08/16/1995)
36 MEET AND CONFER STATEMENT/REPORT PURSUANT TO L.R. 206(d) filed by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD . (blj) (Entered: 08/30/1995)
37 ORDER by Judge Thomas F. Hogan : directing the Clerk of the Court to pay $6,444.57 to Dr. Harriet Fields, 1722 19th Street, N.W. #604, Washington, D. C. 20009; this sum shall be drawn from the $50,000 fund established by separate order today. Payment shall be made within ten days of receipt of the defendant's initial deposit. directing the defendants to replenish the fund with the full amount paid by the Clerk within fourteen days of the entry of this order. (N) (gew) (Entered: 09/07/1995)
38 ORDER by Judge Thomas F. Hogan : adopting the Monitor's proposed budget with the following terms: Within one week of the entry of this Order, defendants shall deposit $50,000 into the Registry of this Court as interim payment of costs incurred by the Monitor. This deposit and all other deposits pursuant to this order, shall be held in the Court Registry Investment System and shall be subject to the standard registry fee imposed on depositors. Within fourteen days of the entry of each order authorizing payment, the defendants shall replenish the fund with the full amount paid by the Clerk in oder to restore the fund's total to $50,000. This order adopting the Monitor's budget may be amended should the parties notify the Court that the problems addressed in the stipulated order have been resolved sooner than anitcipated. (See Order For Further Details) (N) (gew) (Entered: 09/07/1995)
39 BUDGET REPORT FOR COURT MONITORING ACTIVITIES BY HARRIET A. FIELDS, ED.D., R.N. - LET THIS BE FILED - FIATED BY JUDGE THOMAS F. HOGAN (gew) (Entered: 09/07/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 09/13/1995)

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09/12/1995 09/12/1995
09/13/1995 09/13/1995 09/13/1995
09/15/1995 09/20/1995 09/22/1995 09/22/1995
09/26/1995 09/28/1995 09/28/1995 10/02/1995

40 STATUS REPORT by Non Party HARRIET FIELDS; Let This Be Filed and Fiated by Judge Thomas F. Hogan. (gew) (Entered: 09/13/1995)
41 ORDER by Judge Thomas F. Hogan : status hearing set for 10/20/95 ; directing plaintiffs to file a proposed order regarding modification of the Monitor's responsibilities by 9/13/95 ; defendant shall file and opposition to this order by 09/20/95 ; directing the defendants to pay the sum of $6444.57 to Dr. Harriet Fields, 1722 19th Street N.W., Apt. #604, Washington, D. C. 20009 by 09/15/95; the Court will grant no extensions; this order replaces the Court's order of September 6, 1995; granting defendants' oral motion for an extension of time until 09/20/95 to deposit the $50,000 required by the Court's 09/06/95 order. (N) (gew) (Entered: 09/13/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 09/13/1995)
42 MOTION filed by plaintiff USA to clarify the Duties of the Monitor (ks) (Entered: 09/14/1995)
43 SUPPLEMENTAL MEET AND CONFER REPORT PURSUANT TO L.R. 206(d) filed by plaintiff USA, and defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD . (ks) (Entered: 09/14/1995)
44 COMPLIANCE REPORT (30-DAY) by defendants; attachments. BULKY PLEADING (bm) (Entered: 09/18/1995)
45 MOTION filed by defendant to extend time nunc pro tunc within which to file an adequate and timely response to plaintiff's motion for an enlargement of time (blj) (Entered: 09/21/1995)
46 RESPONSE (OPPOSITIONS) by defendants to motion to clarify the Duties of the Monitor [42-1] by USA (blj) (Entered: 09/25/1995)
47 ORDER by Judge Thomas F. Hogan : granting motion to extend time nunc pro tunc within which to file an adequate and timely response to plaintiff's motion for an enlargement of time [45-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; defendant shall file a response to plaintiff's motion not later than 5:000 pm on September 22, 1995. (N) (gew) (Entered: 09/26/1995)
DEPOSIT in the sum of $50,000.00 by defendants pursuant to Order filed 9/6/95 (ks) (Entered: 09/27/1995)
48 ATTORNEY APPEARANCE for defendants by Garland Pinkston Jr. (ks) (Entered: 09/29/1995)
49 RESPONSE (OPPOSITIONS) by defendants to the September 21, 1995 letter of the monitor (blj) (Entered: 09/29/1995)
50 ORDER by Judge Thomas F. Hogan : Plaintiff-Intervenor shall file a response to U. S. motion to clarify the duties of the Monitor by 10/10/95 ; United States shall file a response due 10/16/95 ; (N) (gew) (Entered: 10/03/1995)

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10/02/1995 10/10/1995 10/13/1995 10/13/1995 10/18/1995 10/20/1995
10/20/1995 10/20/1995 10/24/1995 10/26/1995 11/07/1995
11/15/1995 11/28/1995

51 ORDER by Judge Thomas F. Hogan : pretrial conference set for 3/29/96 ; , Case assigned to the Complex track (track three). (N) (gew) (Entered: 10/03/1995)
52 MEMORANDUM by intervenor-plaintiff D.C. LONG-TERM CARE in support of motion to clarify the Duties of the Monitor [42-1] by USA; Attachments (3) (blj) (Entered: 10/12/1995)
53 STATUS REPORT by defendant 30 day compliance report pursuant to Court Order entered 7/6/95; Attachment (1); Exhibits (3) large bulky vols. (blj) (Entered: 10/17/1995)
54 REPLY MEMORANDUN by plaintiff USA in support of its motion to clarify the Duties of the Monitor [42-1] by USA.; attachments (2) (blj) (Entered: 10/17/1995)
55 RESPONSE (OPPOSITIONS) by defendants to plaintiff-intervenor's memorandum and the reply of the USA's in support of the motion to clarify the duties of the monitor (blj) (Entered: 10/19/1995)
56 ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $8808.64 to Dr. Harriet Fields, 1722 19th Street, N>W>, #604, Washington, D. C. 20009; Funds for this payment shall be drawn from the account establishe by the defendants' deposit. (N) (gew) (Entered: 10/23/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) Modified on 11/16/1995 (Entered: 10/23/1995)
58 ATTORNEY APPEARANCE for plaintiff USA by David Deutsch (blj) (Entered: 10/24/1995)
57 TRANSCRIPT filed for date(s) of 10/20/95. Reporter: Anneliese J. Thomson (blj) (Entered: 10/24/1995)
59 MEMORANDUM by intervenor-plaintiff D.C. LONG-TERM CARE in support of proposed Order of the United States (blj) (Entered: 10/27/1995)
60 ORDER by Judge Thomas F. Hogan : MODIFYING STIPULATED ORDER OF JULY 6, 1995; this order supplements the Stipulated Order of 07/06/95 which shall remain in full force and effect until dismissed or othewise modified by the Court. (N) (gew) (Entered: 11/13/1995)
61 EXHIBIT list of defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD; fourth 30 day compliance report; attatchments (2) vols. (blj) (Entered: 11/16/1995)
62 ORDER by Judge Thomas F. Hogan : directing the Clerk of Court to pay the sum $2,400.00 to Lucilla Consultants Services, 167 Hall Drive, Sugarland, TX, 77478, for services rendered from September 19 through September 29, 1995. Funds for this payment shall be drawn from the account established by the defendants'deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen day of entry of this order. (N) (gew) (Entered: 12/01/1995)

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11/28/1995
12/01/1995 12/01/1995 12/04/1995 12/07/1995 12/07/1995 12/07/1995 12/11/1995 12/11/1995 12/12/1995 12/14/1995 12/15/1995 12/15/1995 12/15/1995 12/15/1995

63 ORDER by Judge Thomas F. Hogan : directing the Clerk of the Court to pay the sum of $10,603.51 to Dr. Harriet Fields, 1722 19th Street, N.W., Suite #604, Washington, D.C. 20009, for services rendered and expenses incurred from October 1 through October 31, 1995. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amound paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 12/01/1995)
64 NOTICE OF FILING by defendants submission to the Court memorandum of Harvey I. Sloane, M.D.; exhibit (1) (blj) (Entered: 12/04/1995)
65 MOTION filed by defendants to alter or amend the consent order entered 7/6/95 [21-1] (blj) (Entered: 12/04/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 12/08/1995)
66 TRANSCRIPT filed for date(s) of 12/4/95. Reporter: Anneliese J. Thomson (blj) (Entered: 12/07/1995)
67 MOTION filed by plaintiff USA for order holding defendants in contempt ; Attachments (6) (blj) (Entered: 12/08/1995)
70 LETTER to Judge Hogan dated October 6, 1995, from Harriet Fields, Court Monitor modifying Stipulated Order of July 6, 1995. (gew) (Entered: 12/12/1995)
68 MOTION filed by plaintiff USA for further remedial relief pursuant to the monitor's submissions ; attachments (2) (blj) (Entered: 12/12/1995)
69 MEMORANDUM by intervenor-plaintiff D.C. LONG-TERM CARE in support of the monitor's report; attachments (3) (blj) (Entered: 12/12/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Donald Jacobsen (gew) (Entered: 12/15/1995)
71 MOTION filed by intervenor-plaintiff D.C. LONG-TERM CARE for emergency injunctive relief and in support of the monitor's report (blj) (Entered: 12/15/1995)
72 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD (30) day compliance report; Exhibits (2) vols. (bulky) (blj) (Entered: 12/15/1995)
73 RESPONSE (OPPOSITIONS) by defendant DC to motion for order holding defendants in contempt [67-1] by USA; attachments (blj) (Entered: 12/18/1995)
74 NOTICE OF FILING by intervenor-plaintiff D.C. LONG-TERM CARE submits that she has withdrawn her motion for emergency injunctive relief, dated 12/14/95 (blj) (Entered: 12/18/1995)
75 MOTION filed by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD to extend time to file an adequate and timely response to plaintiff's motion for further remedial relief pursuant to the Monitor''s submissions, plaintiff-intervenor's memorandum in supporr of the Monitor's report and to respond to the inquiry of the Court concerning the

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12/18/1995 12/18/1995 12/19/1995 12/19/1995 12/19/1995 12/20/1995 12/22/1995 12/22/1995 12/29/1995 01/03/1996 01/16/1996
01/16/1996

handling of patient accounts (blj) (Entered: 12/18/1995)
76 TRANSCRIPT filed for date(s) of 12/12/95. Reporter: Donald J. Jacobsen (blj) (Entered: 12/19/1995)
77 RESPONSE (OPPOSITIONS) by defendant DC to memorandum in support of the Monitor's report, and the Monitor's 12/6/95, and 12/10/95 letters [69-1] by D.C. LONG-TERM CARE, motion for further remedial relief pursuant to the monitor's submissions [68-1] by USA (blj) (Entered: 12/19/1995)
78 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submits to the Court, memorandum; exhibit (1) (blj) (Entered: 12/20/1995)
79 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit to the Court, the affidavit of Cecelia J. Bollers; affidavit (1) (blj) (Entered: 12/20/1995)
80 REPLY by plaintiff USA to defendants' opposition to their motions for contempt and for further remedial relief response [77-1] by DC; attachments (blj) (Entered: 12/20/1995)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliiese Thomson (gew) (Entered: 12/21/1995)
81 TRANSCRIPT filed of status call for date(s) of 12/20/95. Reporter: Anneliese Thomson (ks) (Entered: 12/26/1995)
82 ORDER by Judge Thomas F. Hogan : granting motion for further remedial relief pursuant to the monitor's submissions [68-1] by USA (N) (gew) (Entered: 12/29/1995)
83 MOTION filed by defendants to extend time to file the report and complete the medical assessments for an additional five (5) days (ks) (Entered: 01/02/1996)
84 ORDER by Judge Thomas F. Hogan : granting motion to extend time to file the report and complete the medical assessments for an additional five (5) days [83-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC brief due 1/8/96 ; (N) (gew) (Entered: 01/04/1996)
85 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum $5,918.52 to Quality Care Assurance, 820 East Park Avenue, Suite E200, Tallahassee, Florida 32301, for services rendered and expenses incurred from August 24 to September 29, 1995. Funds for this payment shall be drawn from the account establishe by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. Payment of the consultants retained by the Monitor shall be addressed in separate orders. (N) (gew) (Entered: 01/17/1996)
86 COMPEMSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $12,881.89 to Dr. Harriet Fields, 1722 19th Street Northwest #604, Washington, DC, 20009, for services rendered and expenses incurred from November l through November 30, 1995. (gew) (Entered: 01/17/1996)

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01/16/1996
01/16/1996 01/16/1996 01/16/1996 01/17/1996 01/18/1996 01/18/1996 01/18/1996
01/18/1996 01/22/1996 01/22/1996 01/26/1996

87 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $1,329.80 to Anne Marie Barnett, 7 Lytle Lane, Leonardtown, MD 20650, for services rendered and expenses incured from September 22 through October 10, 1995. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. Payment of the consultants retained by the Monitor shalll be addressed in separate orders. (N) (gew) (Entered: 01/17/1996)
88 MOTION filed by plaintiff USA, intervenor-plaintiff D.C. LONG-TERM CARE to modify the scheduling order to extend discovery deadlines (blj) (Entered: 01/17/1996)
89 NOTICE OF FILING by defendants submit the bi-weekly report concerning outplacement of residentws with mental retardation from 12/29/95 - 1/12/96, and medical assessments for (3) pusuant to Court's Order entered 12/22/95; attachments (blj) (Entered: 01/17/1996)
90 MOTION filed by defendant to extend time nunc pro tunc to 1/17/96 file the report and complete the medical assessments required and pursuant to Court's Order entered 1/3/96 (blj) (Entered: 01/17/1996)
91 NOTICE OF FILING by defendants submit the December, 1995 30 day compliance report; attachments, and (2) vols. (blj) (Entered: 01/18/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 01/19/1996)
92 NOTICE OF CHANGE OF ADDRESS by David Deutsch representing plaintiff USA . New address: U.S. Department of Justice, Suite 1744, 10th & Pennsylvania Ave., N.W. Washington DC 20530, (202) 514-6270. (blj) (Entered: 01/22/1996)
95 ORDER by Judge Thomas F. Hogan : granting motion to extend time nunc pro tunc to 1/17/96 file the report and complete the medical assessments required and pursuant to Court's Order entered 1/3/96 [90-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (gew) (Entered: 01/23/1996)
96 ORDER by Judge Thomas F. Hogan : discovery closes 8/16/96 ; pretrial conference set for 8/30/96 ;expert witness reports due 6/17/96 ;expert counter witness list due 7/17/96 ; (N) (gew) (Entered: 01/23/1996)
93 NOTICE OF FILING by defendants submit the resume of A. Sue Brown; attachment (1) (blj) (Entered: 01/23/1996)
94 MOTION filed by defendants to extend time to 2/29/96 to complete the mental health evaluations required under the Court Order entered 12/22/95 (blj) (Entered: 01/23/1996)
97 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit their bi-weekly report concerning outplacement of residents, period from 1/13/96 through 1/26/96; attachment (blj) (Entered: 01/29/1996)

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01/30/1996
02/01/1996 02/02/1996 02/02/1996 02/05/1996 02/09/1996 02/09/1996 02/09/1996 02/12/1996
02/15/1996 02/20/1996 02/21/1996 02/21/1996
02/23/1996
02/23/1996

98 RESPONSE by defendant DC to the inquiries of the Court and the Status Report of the Monitor filed 1/17/96 [91-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; Exhibits (12) (Bulky) (ks) (Entered: 01/31/1996)
99 MOTION filed by plaintiff USA to assure full compliance with existing Court Orders ; exhibits (4) (dot) (Entered: 02/02/1996)
101 MEMORANDUM by intervenor-plaintiff D.C. LONG-TERM CARE in support of the monitor's January 17, 1996 report demonstrating that defendants remain in contempt of court; exhibits (4) (blj) (Entered: 02/06/1996)
STATUS HEARING before Judge Thomas F. Hogan : Continued to 02/16/96 at 9:30 am Reporter: Anneliese Thomson (gew) (Entered: 02/07/1996)
100 TRANSCRIPT filed of status call for date(s) of 2/2/96. Reporter: Anneliese Thomson (ks) (Entered: 02/06/1996)
103 STATUS REPORT by defendants submit their most recent bi-weekly report for 1/27/96 - 2/9/96; attachment (1) (blj) (Entered: 02/12/1996)
104 RESPONSE by defendant in opposition to motion to assure full compliance with existing Court Orders [99-1] by USA . (blj) (Entered: 02/12/1996)
105 RESPONSE by defendants to memorandum in support of the monitor's 1/17/96 report [101-1] by D.C. LONG-TERM CARE (blj) (Entered: 02/12/1996)
102 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit to the Court the exhibits and proposed order inadvertently omitted from their opposition to the motion of plaintiff; exhibits (8) (blj) (Entered: 02/12/1996)
106 SUBMISSION OF 30 DAY COMPLIANCE REPORT by defendants (7th) pursuant to Court's Order of 7/6/95; (Bulky-One Large Volume) (ks) (Entered: 02/15/1996)
107 TRANSCRIPT filed for date(s) of 1/18/96. Reporter: Anneliese J. Thomson (blj) (Entered: 02/21/1996)
108 REPLY by plaintiff USA to response to motion to assure full compliance with existing Court Orders [99-1] by USA (blj) (Entered: 02/22/1996)
109 REPLY by intervenor-plaintiff D.C. LONG-TERM CARE in support of Monitor's 1/17/96 report demonstrating that defendants remain in contempt of court [91-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; exhibits (5) . (blj) (Entered: 02/22/1996)
110 ORDER by Judge Thomas F. Hogan : directing that the outplacement of D. C. Village residents is temporarily suspended until defendants come into full compliance with the existing Court orders detailed in the Court's 12/22/95 Order. (N) (gew) Modified on 07/10/2002 (Entered: 02/26/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 02/28/1996)

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02/27/1996 02/27/1996 02/28/1996 02/29/1996 02/29/1996 03/08/1996 03/11/1996 03/11/1996 03/11/1996
03/18/1996 03/19/1996
03/22/1996 04/03/1996 04/04/1996 04/04/1996 04/05/1996

111 TRANSCRIPT filed of status call for date(s) of 2/23/96. Reporter: Anneliese Thomson (ks) (Entered: 02/28/1996)
112 MOTION filed by DC defendants to extend time to 2/27/96, nunc pro tunc to file their Bi-Weekly Report ; EXHIBIT (SUBMISSION TO THE COURT) (ks) (Entered: 02/28/1996)
179 RESPONSE by plaintiff USA to in opposition to response [174-1] by ALBERTA BRASFIELD, FRANCES BOWIE, HAWKINS, MARION BARRY, DC; attachments (2) (blj) (Entered: 07/01/1996)
113 ORDER by Judge Thomas F. Hogan : granting motion to extend time to 2/27/96, nunc pro tunc to file their Bi-Weekly Report [112-1] by MARION BARRY, DC (N) (ks) (Entered: 02/29/1996)
114 REPORT (Bi-Weekly) by defendants pursuant to Order filed 12/22/96, filed nunc pro tunc to 2/27/96 (ks) (Entered: 02/29/1996)
DEPOSIT by defendants in the sum of $13,003.51 into the Registry of the Court pursuant to Order filed 11/28/95. (ks) (Entered: 03/14/1996)
115 BI-WEEKLY REPORT by defendants for the period from 2/23/96 through 3/8/96 pursuant to Order entered on 12/22/96; Report (ks) (Entered: 03/12/1996)
116 MOTION filed by defendants to extend time to 3/11/96, nunc pro tunc to file their Bi-Weekly Report to the Court (ks) (Entered: 03/12/1996)
117 ORDER by Judge Thomas F. Hogan : granting motion to extend time to 3/11/96, nunc pro tunc to file their Bi-Weekly Report to the Court [116-1] by FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (gew) (Entered: 03/15/1996)
118 COMPLINACE REPORT eighth (30-DAY) by defendants; (bulky) (blj) Modified on 03/18/1996 (Entered: 03/18/1996)
119 ORDER by Judge Thomas F. Hogan : granting motion to extend time to 3/18/96, nunc pro tunc to file their Bi-Weekly Report to the Court [116-1] by FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (dcn) (Entered: 03/20/1996)
120 BI-WEEKLY REPORT by defendants for the period of 3/8/96 through 3/22/96 pursuant to Court's Order of 12/22/95; attachment (blj) (Entered: 03/25/1996)
DEPOSIT in the sums of $8,808.64 and $20,130.21 into the Registry of the Court by defendants pursuant to Court's Order of 9/6/95 (ks) (Entered: 04/04/1996)
121 MOTION filed by defendants for order to pay a certain provider of services to D.C. Village (ks) (Entered: 04/05/1996)
STATUS HEARING before Judge Thomas F. Hogan : Continued to 04/26/96 at 9:30 am Reporter: Anneliese Thomson (gew) (Entered: 04/12/1996)
122 BI-WEEKLEY REPORT by defendants to the Court for the period from 3/22/96 through 4/5/96 pursuant to Court' Order of 12/22/96; Attachment (ks) (Entered: 04/08/1996)

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04/11/1996 04/12/1996 04/12/1996 04/15/1996 04/16/1996
04/16/1996
04/16/1996
04/16/1996
04/17/1996 04/17/1996 04/19/1996

123 TRANSCRIPT filed of status call for date(s) of 4/4/96. Reporter: Anneliese Thomson (ks) (Entered: 04/12/1996)
124 MOTION filed by intervenor-plaintiff D.C. LONG-TERM CARE for contempt sanctions ; exhibits (5). (dot) (Entered: 04/15/1996)
125 MOTION filed by plaintiff USA for further relief to remedy defendants' continuing contempt ; exhibits (8). (dot) (Entered: 04/15/1996)
126 REPORT by defendant DC of their ninth 30 Day Compliance Report for March, 1996; Attachments (Bulky- one large brown folder) (ks) (Entered: 04/16/1996)
128 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk pay the sum of $13,775.73 to Dr. Harriet Fields, 1722 19th St., NW, #604, Washington, D. C. 20009, for services rendered and expenses incurred from December 1, through December 31, 1995. Funds for this payment shall be drawn from the account established by the defendants' deposit. (gew) (Entered: 04/19/1996)
129 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $2414.28 to Lucilla Consultants Services, 167 South Hall Drive, Sugarland, Texas, 77478, for services rendered and expenses incurred from 01/03/96 to January 6, 1996, and from January 26, 1996 to January 28, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. (N) (gew) (Entered: 04/19/1996)
130 ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $2000.00 to the Georgetwon University School of Nursing, 3700 Reservoir Roaad, N.W., Washington, DC 20007, Attn: Christine V. Powell, for services rendered on November 7,14,18 and 22, 1995. Funds for this payment shall be drawn from the account established by the defendants' deposit. (gew) (Entered: 04/19/1996)
134 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk pay the sum of $270.00 to Wendy J. Lereah, 6305 Youngs Branch Drive, Fairfax Station, VA 22039, for services rendered on 11-20-27, 1995, on January 8,15,16,30, and 31, 1996, and on February 12-13, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. (gew) (Entered: 04/22/1996)
127 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk of the Court pay the sum of $150.00 to Jennie P. Barrett, 5314 Esabella Court, Fairfax, VA 22032, for services rendered on February 13,14,19,20, and 21, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. (N) (gew) (Entered: 04/19/1996)
131 ORDER by Judge Thomas F. Hogan : granting motion for order to pay a certain provider of services to D.C. Village [121-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (gew) (Entered: 04/19/1996)
132 BI-WEEKLY REPORT by defendants for the period from April 5, 1996 through April 19, 1996 pursuant to the Court Order entered December 22, 1995; attachment (1) (blj) (Entered: 04/22/1996)

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04/19/1996 04/24/1996 04/25/1996 04/25/1996 04/26/1996
04/26/1996 04/26/1996 04/26/1996 04/29/1996 04/29/1996 05/03/1996 05/06/1996 05/06/1996 05/08/1996 05/09/1996

133 RESPONSE by plaintiff USA to defendants' motiom for an order to pay National patient care systems; exhibits (2) (blj) (Entered: 04/22/1996)
135 RESPONSE by defendant DC to motion for further relief to remedy defendants' continuing contempt [125-1] by USA, and motion for contempt sanctions [124-1] by D.C. LONG-TERM CARE Exhibits (2) (blj) (Entered: 04/25/1996)
136 REPLY by plaintiff USA to response to motion for further relief to remedy defendants' continuing contempt, and for contempt sanctions [125-1] by USA; attachments (2) (blj) (Entered: 04/26/1996)
137 REPLY by intervenor-plaintiff D.C. LONG-TERM CARE in support of her motion for contempt sanctions [124-1] by D.C. LONG-TERM CARE (blj) (Entered: 04/26/1996)
138 ORDER by Judge Thomas F. Hogan : that a representative from the District of Columbia Financial Responsibility and Management Assistance Authority who is familiar with and reponsible for the payments and contracts associated with D.C. Village appear for a status hearing set for 2:30 4/29/96; that the defendants shall designate a representative from the District of Columbia Department of Human Services who is familiar with and responsible for the payments and contracts associated with D.C. Village. The Court suggests that the Interim Administrator for Long Term Care may be the appropriate designee. the designee shall appear before the Court at 2:30 p.m. on 4/29/96. (N) (dot) (Entered: 04/26/1996)
139 TRANSCRIPT filed for date(s) of 4/26/96. Reporter: Anneliese J. Thomson (blj) (Entered: 04/29/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 04/29/1996)
140 ATTORNEY APPEARANCE for defendants by William Johnson Earl Jr. (blj) (Entered: 04/30/1996)
141 NOTICE OF FILING by defendants, submission to the Court. (dot) (Entered: 04/30/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Continued to 05/10/96 at 2:00 pm. Anneliese Thomson (gew) (Entered: 05/01/1996)
142 NOTICE OF FILING by defendants most recent Bi-Weekly Report for the period from 4/19/96 through 5/3/96 under I.A. of the court order entered 12/22/96. (dot) (Entered: 05/06/1996)
143 MOTION filed by defendants for order to pay certain providers of services to D.C. Village (ks) (Entered: 05/07/1996)
144 TRANSCRIPT filed of motions hearing for date(s) of 4/29/96. Reporter: Anneliese Thomson (ks) (Entered: 05/07/1996)
145 RESPONSE by plaintiff USA to motion for order to pay certain providers of services to D.C. Village by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (blj) (Entered: 05/09/1996)
146 ORDER by Judge Thomas F. Hogan : granting motion for order to pay certain providers of services to D.C. Village [143-1] by ALBERTA BRASFIELD,

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05/09/1996 05/09/1996 05/09/1996 05/10/1996 05/13/1996 05/15/1996 05/15/1996 05/16/1996
05/16/1996
05/16/1996 05/16/1996 05/17/1996 05/17/1996 05/20/1996 05/21/1996

FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; the total amount to be paid to identified vendors is $59,841.04 (N) (lpp) (Entered: 05/09/1996)
147 PROPOSED FINDINGS OF FACT and Conclusions of Law by intervenor plaintiff M. ANNE HART (ks) (Entered: 05/10/1996)
148 STATUS REPORT by defendants submit their most recent D.C. Village list of invoice/voucher payment and due dates; attachments; declaration (1) (blj) (Entered: 05/10/1996)
149 REPLY by defendants to response of plaintiff to the motion to pay certain providers of services to D.C. Village (blj) (Entered: 05/10/1996)
MOTION HEARING before Judge Thomas F. Hogan Reporter: Anneliese Thomson (gew) (Entered: 05/14/1996)
DEPOSIT in the sum of $19,510.01 by defendants pursuant to Court's Orders (blj) Modified on 05/15/1996 (Entered: 05/15/1996)
150 NOTICE OF FILING by defendants submit their tenth (10th) 30 day complinace report; attachments (bulky) (blj) (Entered: 05/16/1996)
151 TRANSCRIPT filed of motions hearing for date(s) of 5/10/96. Reporter: Anneliese Thomson (ks) (Entered: 05/16/1996)
152 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit to the Court, the D.C. Village payment process recently implemented; attachment (blj) (Entered: 05/17/1996)
153 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit their most recent bi-weekly report April 19, 1996 through May 3, 1996; attachment (blj) (Entered: 05/17/1996)
154 SUPPLEMENTAL REPLY by defendants to response of plaintiff to the motion to pay certain providers of services to D.C. Village; affidavit (1); declaration (1); attachment (1) (blj) (Entered: 05/17/1996)
155 AMENDED PROPOSED FINDINGS OF FACT in support of her motion for contempt sanctions; attachments (2) (blj) (Entered: 05/17/1996)
156 TRANSCRIPT filed for date(s) of 5/17/96. Reporter: Anneliese J. Thomson (blj) (Entered: 05/20/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 05/20/1996)
157 TRANSCRIPT filed for date(s) of 5/17/96. Reporter: Anneliese J. Thomson (blj) (Entered: 05/21/1996)
158 OBJECTIONS by defendants to plaintiff-intervenor's amended proposed findings of fact [155-1] (blj) (Entered: 05/22/1996)

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05/22/1996 05/22/1996 05/23/1996
05/24/1996 05/31/1996
05/31/1996 06/11/1996 06/13/1996
06/14/1996 06/14/1996 06/17/1996 06/17/1996 06/17/1996
06/19/1996

STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 05/24/1996)
161 NOTICE OF FILING by non-party Wayne Casey, and Jeanette Michael report of D.C, Village list of invoice/voucher payment and due dates "Let this be filled" (fiat) Judge Hogan (blj) (Entered: 05/29/1996)
159 RESPONSE by plaintiff USA to defendants objection to plaintiff-intervenor's amended proposed findings of fact [158-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; attachment (1) (blj) (Entered: 05/24/1996)
160 REPLY MEMORANDUM by intervenor-plaintiff D.C. LONG-TERM CARE in support of her motion for contempt sanctions [124-1] by D.C. LONG-TERM CARE (blj) (Entered: 05/28/1996)
162 NOTICE OF FILING by defendants DC, MARION BARRY, VERNON HAWKINS, FRANCES BOWIE, ALBERTA BRASFIELD submit their most recent bi-weekly report for period fron 5/17/96 through 5/31/96 (blj) (Entered: 06/03/1996)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: Anneliese Thomson (gew) (Entered: 06/12/1996)
163 MOTION filed by defendants to extend time to respond to intervenor's interrogatories nos. 1-2 (blj) (Entered: 06/12/1996)
164 RESPONSE by intervenor-plaintiff D.C. LONG-TERM CARE to motion to extend time to respond to intervenor's interrogatories nos. 1-2 [163-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC; attachment (blj) (Entered: 06/14/1996)
165 NOTICE OF FILING by defendants submit their (11th) 30 day compliance report; attachment 1 vol. (bulky) (blj) (Entered: 06/17/1996)
166 NOTICE OF FILING by defendants their most recent bi-weekly report for the period 5/31/96 through 6/14/96; attachment (blj) (Entered: 06/17/1996)
167 NOTICE OF FILING by plaintiff USA submission in response to the Monitor's findings on delinquent vendor pauments to GUCDC; Attachments (2) (blj) (Entered: 06/18/1996)
168 MOTION SECOND) filed by intervenor-plaintiff D.C. LONG-TERM CARE for contempt sanctions ; Attachments (3) (blj) (Entered: 06/18/1996)
STATUS HEARING before Judge Thomas F. Hogan : Continued to 07/01/96 at 10:00 am; Intervenor's Exhibits 1,2 and 3 filed with the Court and filed in Civil Jacket; Reporter: Anneliese Thomson (gew) Modified on 06/19/1996 (Entered: 06/19/1996)
169 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $7,507.89 to Dr. Harriet Fields, 1722 l9th Street, N.W., Suite #604, Washington, D. C. 20009, for services rendered and expenses incurred from March l, through March 31, 1996. The defendants are reminded that the Court's September 6, 1995 order requires them to replenish the fund with the full

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06/19/1996 06/19/1996
06/19/1996 06/21/1996
06/25/1996 06/26/1996 06/27/1996 06/27/1996

amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 06/19/1996)
170 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $600.00 to Frieda Butler, 6 Kerwood Court, Silver Spring, Md. 20904, for services rendered on April 11 and 18, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 06/19/1996)
171 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $10,148.82 to Dr. Harriet Fields, 1722 l9th Street, N.W. #604, Washington, D. C. 20009, for services rendered and expenses incurred from February l through February 29, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 06/19/1996)
172 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $410.00 to Jennie P. Barrett, 5314 Esabella Court, Fairfax, VA, 22032, for services rendered in March and April, 1996. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 06/19/1996)
173 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $5,258.00 Howard University, Department of Nutritional Sciences, 6th & Bryant Street, N.W., Annex 1, Washington, DC 20059, for services rendered. Funds for this payment shall be drawn from the account established by the defendants' deposit. The defendants are reminded that the Court's September 6, 1995 order requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. Upon receipt of the next invoice from the Monitor, the Court will reevaluate the repensihment policy in light of the estimated duration of this case. (gew) (Entered: 06/21/1996)
174 RESPONSE by defendant in opposition to second motion for contempt sanctions [168-1] by D.C. LONG-TERM CARE; declarations (unsigned) (2) (blj) (Entered: 06/26/1996)
175 TRANSCRIPT filed of status hearing for date(s) of 6/17/96. Reporter: Anneliese Thomson (ks) (Entered: 06/27/1996)
176 NOTICE OF FILING by defendants submit the executed declarations of A. Sue Brown and Jeanette A. Michael in support of their opposition to plaintiff-intervenor's second motion for contempt sanctions; attachments (2) (blj) (Entered: 06/28/1996)
177 MOTION filed by intervenor-plaintiff D.C. LONG-TERM CARE for order to schedule status conference to determine attorneys' fees and costs ; Exhibit (1)

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06/27/1996 07/01/1996 07/02/1996 07/08/1996 07/12/1996 07/12/1996 07/15/1996 07/15/1996
07/15/1996
07/18/1996 07/30/1996
07/30/1996

(blj) (Entered: 06/28/1996)
178 REPLY by intervenor-plaintiff D.C. LONG-TERM CARE to response to her second motion for contempt sanctions [168-1] by D.C. LONG-TERM CARE; exhibit (1) (blj) (Entered: 06/28/1996)
STATUS HEARING before Judge Thomas F. Hogan : status hearing set for 1:30 7/15/96 ; motions heard and taken underadvisement. Reporter: William McAllister (dot) (Entered: 07/01/1996)
180 NOTICE OF FILING by defendants submit their twelfth (12) and final 30 day compliance report; attachments (4) (bulky) (blj) (Entered: 07/03/1996)
181 TRANSCRIPT filed for date(s) of 7/1/96. Reporter: William D. Mc Allister (blj) (Entered: 07/09/1996)
184 MOTION filed by defendants for order to pay Georgetown University Child Development Center for certain services provided to D.C. Village Exhibit (1) (blj) (Entered: 07/15/1996)
185 NOTICE OF FILING by defendants answers, and responses to intervenor's interrogatories nos. 1 and 2; attachments (blj) (Entered: 07/15/1996)
STATUS CALL before Judge Thomas F. Hogan: DC's payment to Georgetown University Child Dvelopment Center (GUCDC) discussed; imposition of fine stayed; status call set for 1:30 p.m. on 8/7/96. (OTBP) Reporter: Anneliese Thomson (bm) Modified on 07/15/1996 (Entered: 07/15/1996)
182 ORDER by Judge Thomas F. Hogan: granting motion by defendant for an order to pay Georgetown University Child Development Center for services provided to D.C. Village; Defendants shall, within not more then twenty (20) days after entry of this court order, pay to Georgetown Univeristy Chiled Development Center (GUCDC) in the amount of $145,092.29 for services provided to D.C. Village (N) (bm) (Entered: 07/15/1996)
183 STIPULATION filed and fiated by Judge Thomas F. Hogan that defendants shall respond to plaintiff-intervenor's motion for attorney's fees and expenses not later than ten (10) business days after receipt of plaintiff-intervenor's answers and responses to defendants' informal discovery request dated 7/2/96. (N) (bm) (Entered: 07/15/1996)
186 TRANSCRIPT filed for date(s) of 7/15/96. Reporter: Anneliese J. Thomson (blj) (Entered: 07/18/1996)
187 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $12,966.52 to Dr. Harriet Fields, 1722 19th Street, N.W., #604, Washington, D. C. 20009, for services rendered and expenses incurred from January 1 through January 31, 1996; reminding defendants that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (gew) (Entered: 08/02/1996)
188 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $11,314.23 to Dr. Harriet Fields, 1722 19th Street, N.W., Suite 604, Washington, D. C. 20009, for services rendered and expenses incurred from

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07/30/1996
08/06/1996 08/07/1996 08/09/1996 08/13/1996 08/13/1996 08/22/1996
08/22/1996 08/22/1996 09/10/1996 09/17/1996 09/25/1996

April 1 through April 30, 1996; reminding the defendants that the Court's order of September 6, 1996 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 08/02/1996)
189 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $600.00 to Frieda Butler, 6 Kerwood Court, Silver Spring, Md 20904, for services rendered on March 7 and 28, 1996; reminding the defendants that the Court's order of September 6, 1995 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 08/02/1996)
DEPOSIT in the sum of $23,924.71 by defendants pursuant to Court's Order of 9/6/95 (blj) (Entered: 08/07/1996)
STATUS HEARING before Judge Thomas F. Hogan : Continued to 10/04/96 at 9:30 am and 10/18/96 at 9:30 am for status call and attorneys fees. Reporter: Anneliese Thomson (gew) Modified on 08/14/1996 (Entered: 08/14/1996)
190 MOTION filed by defendants to terminate the appointment of the monitor ; attachment (blj) (Entered: 08/12/1996)
191 RESPONSE by intervenor-plaintiff D.C. LONG-TERM CARE to motion to terminate the appointment of the monitor [190-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (blj) (Entered: 08/14/1996)
192 RESPONSE (OPPOSITIONS) by plaintiff USA to motion to terminate the appointment of the monitor [190-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (blj) (Entered: 08/14/1996)
193 ORDER by Judge Thomas F. Hogan : vacating order [187-1]; the clerk shall pay the sum of $12,655.27 to Dr. Harriet Fields, for services rendered and expenses incurred from 1/1-31/96; funds shall be drawn from the account established and shall be replenished with 14 days of entry of this order (N) (lpp) (Entered: 08/23/1996)
194 ORDER by Judge Thomas F. Hogan: Monitor's reports to the Court from 9/5/95 to 6/28/96 shall be filed as a part of the docket in this case.(N) (lpp) (Entered: 08/23/1996)
195 ORDER by Judge Thomas F. Hogan : denying motion to terminate the appointment of the monitor [190-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (lpp) (Entered: 08/23/1996)
DEPOSIT in the sum of $11,914.23 pursuant to court order dated of 9/6/95 by defendant's (blj) (Entered: 09/11/1996)
DEPOSIT by defendants' in the sum of $12,655.27 pursuant to the Court's of of 9/6/95 (blj) (Entered: 09/17/1996)
196 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $12,045.30 to Dr. Harriet Fields, 1722 19th Street, N.W., #604,

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10/21/1996 10/21/1996 11/08/1996 11/26/1996 12/10/1996 01/21/1997 01/23/1997
01/23/1997 01/23/1997 01/23/1997

Washington, D. C. 20009, for services rendered and expenses incurred from May 1 through May 31, 1996; also directing the Clerk to pay the sum of $1200.00 to Dr. Harriet Fields, same address as above, for services rendered and expenses incurred by Dr. Freida Butler, nursing home systems expert consultant to the Monitor. Funds for these payments shall be drawn from the accouont established by the defendants' deposit. The defendants are reminded that the Court's order of 09/06/95 requires them to replenish the fund with the full amount paid by the Clerk within fourteen days of entry of this order. (N) (gew) (Entered: 10/01/1996)
197 COMPENSATION ORDER by Judge Thomas F. Hogan : dircting the Clerk of the Court to pay the sum of $1,945.53 to Dr. Harriet Fields, 1722 19th Street, Suite #604, Washington, D. C. 20009, for services rendered and expenses incurred from July 1 through July 31, 1996. (gew) (Entered: 10/21/1996)
198 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk of the Court to pay the sum of $12,742.03 to Dr. Harriet Fields, 1722 19th Street, N.W., Washington, D. C. 20009, for services rendered and expenses incurred from June 1 through June 30, 1996. (N) (gew) (Entered: 10/21/1996)
199 ORDER by Judge Thomas F. Hogan : the Clerk shall pay the sum of $1,200.00 to Dr. Frieda Butler, c/o Dr. Harriet Fields for services rendered and expenses incurred as expert consultant to the Monitor (N) (lpp) (Entered: 11/12/1996)
DEPOSIT by defendants in the amount of $14,687.56 pursuant to the Courts orders of 10/21/96; attachments (blj) (Entered: 11/27/1996)
200 CONSENT directing the District of Columbia to make payment of the sum of $84,752.62 to Kaye,Scholer, Fierman, Hays & Handler,LLP, counsel for plaintiff-intervenor for legal representation herein. (gew) (Entered: 12/11/1996)
201 LETTER dated 1/21/97 to Judge Hogan, from Harriet A. Fields of the Final Report by Court Monitor harriet A. Fields (Bulky-One large Folder) "Let this be Filed" (fiat) JUDGE HOGAN (ks) (Entered: 01/21/1997)
202 COMPENSATION ORDER by Judge Thomas F. Hogan: directing the Clerk shall pay the sum of $9,512.60 to Dr. Harriet Fields, 1722 19th Street, NW, Suite 604, Washington, DC 20009, for services rendered and expenses incurred from 8/1 and 8/31/96; the Clerk shall pay the sum of $1,500.00 to Dr. Frieda Butler, 6 Kerwood Court, Silver Spring, MD 20904, for services rendered during the month of 9/96. (N) (bm) (Entered: 01/24/1997)
203 ORDER by Judge Thomas F. Hogan: sealing the page entitled "Georgetown University Interdisciplinary Habilitation Team," located in the Monitor's final report at Appendix C as an attachment to the Monitor's letter of 6/28/96 (N) (bm) (Entered: 01/24/1997)
204 NOTICE OF FILING by defendants of the Reconciliation of Patient Accounts for the period from 6/1/92 through 7/31/96; Attachments (Three (3) large expandable folders). (ks) (Entered: 01/27/1997)
205 NOTICE OF FILING by Non Party HARRIET FIELDS pursuant to Court's Order dated 1/23/97, Appendix C (1) page, an attachment to the Monitor's letter of 1/28/96, be placed under seal; (APPENDIX C, FILED UNDER SEAL IN ROOM 1800) (blj) (Entered: 01/29/1997)

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02/13/1997 02/21/1997 02/21/1997
02/21/1997 02/21/1997 02/28/1997 03/04/1997 03/05/1997 03/07/1997
03/07/1997
03/14/1997
05/14/1997 05/14/1997

206 NOTICE OF FILING by defendant DC submitting the addendum, consisting of Exhibits I through IV, to the D.C. Village Reconciliation of Patient Accounts. (tw) (Entered: 02/14/1997)
STATUS HEARING before Judge Thomas F. Hogan : Reporter: PATRICIA J. YERKES (gew) (Entered: 02/26/1997)
208 COONSENT ORDER by Judge Thomas F. Hogan : granting motion of plaintiff-intervenor's motion for payment of interest on personal needs allowances to the D. C. Village residents,including the consent of the parties and the Court's finding that payment of interest to the residents of D. C. Village in the amount of $14,232.18 is required by law. (N) (gew) (Entered: 03/03/1997)
209 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $15,159.00 to Dr. Harriet Fields, 1722 l9th St., N.W., #604, Washington, D. C. 20009, for services rendered and expenses incurred from September l through September 30, 1996. (N) (gew) (Entered: 03/03/1997)
210 COMPENSATION ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $14,432.28 to Dr. Harriet Fields, 1722 19th St., N.W., #604, Washington, D. C. 20009, for services rendered and expenses incurred from October l through October 31, 1996. (N) (gew) (Entered: 03/03/1997)
207 NOTICE OF FILING by defendant DC its proposed judgment and order (blj) (Entered: 03/03/1997)
211 TRANSCRIPT filed for date(s) of 2/21/97. Reporter: Patricia J. Yerkes (blj) (Entered: 03/06/1997)
212 OBJECTIONS by defendant DC to the 2/21/97 compensation request of the monitor (blj) (Entered: 03/06/1997)
213 AMENDED ORDER by Judge Thomas F. Hogan : directing the Clerk to pay the sum of $15,159.00 to Dr. Harriet Fields, 1722 19th Street, N. W. #604, Washington, D.C. 20009, for services rendered and expenses incurred from October 1 through October 30, 1997 (N) (Paid by Clerk 09/09/97) (gew) Modified on 09/16/1997 (Entered: 03/11/1997)
214 AMENDED ORDER by Judge Thomas F. Hogan : directing the Clerk of the Court to pay the sum of $14,432.28 to Dr. Harriet Fields, 1722 19th Street, N.W. #604, Washington, D. C. 20009, for services rendered and expenses incurred from September 1 through September 31, 1996. (N) (Paid by Clerk 09/09/97) (gew) Modified on 09/16/1997 (Entered: 03/11/1997)
215 ORDER by Judge Thomas F. Hogan : directing the Clerkto pay the sum of $6,770.63, representing $6,362.25 as compensation for the monitor, $300.00 for clerical work and $108.38 for other expenses to Harriet Fields, Ed,D., R.N., 1722 19th Street, N>W>, #604, Washington, D. C. 20009, for the period from November 1, 1997 through February 20, 1997. (N) (gew) (Entered: 03/14/1997)
216 FINDINGS OF FACT and Conclusions of Law by Judge Thomas F. Hogan. (jeb) (Entered: 05/14/1997)
217 ORDER by Judge Thomas F. Hogan: dismissing as moot complaints [1-1] of plaintiff and plaintiff-intervenor without prejudice; directing that pursuant to the

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District of Columbia live database - Docket Report

https://ecf.dcd.uscourts.gov/cgi-bin/DktRpt.pl?719619152439715-L_92...

05/20/1997 05/23/1997 05/23/1997

Court's 5/10/96, bench order, defendants shall pay as compensatory damages $100.00 to each peson who was a resident of D.C. Village on 12/20/95 and $49,258.00 to the Office of the District of Columbia Long Term care Ombudsman;directing that the defendants shall make such payments within 10 days; directing that the consent order relating to interest payments to former residents of D.C. Village shall be a part of this final judgment. (N) (jeb) (Entered: 05/14/1997)
218 MOTION filed by defendant DC, defendant MARION BARRY, defendant VERNON HAWKINS, defendant FRANCES BOWIE, defendant ALBERTA BRASFIELD to extend time to June 29, 1997, to comply with the court Order entered May 14, 1997 (lkn) (Entered: 05/21/1997)
219 ORDER by Judge Thomas F. Hogan : granting motion to extend time to June 29, 1997, to comply with the court Order entered May 14, 1997 [218-1] by ALBERTA BRASFIELD, FRANCES BOWIE, VERNON HAWKINS, MARION BARRY, DC (N) (lpp) (Entered: 05/29/1997)
220 ORDER by Judge Thomas F. Hogan : Pursuant to the Court's 5/10/96, bench order, defendants shal ay as compensatory damages $100.00 to each person who was resident of D.C. Village on 12/20/95, and $49,258.00 to the Office of the District Columbia Long Term care Ombudsman; interest payments to former residents of D.C. Village shall be a part of this final judgment , dismissing without prejudice as moot the complaints of plaintiff and plaintiff -intervenor [1-1] (N) (lpp) (Entered: 05/29/1997)

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