Opinion ID: 1722720
Heading Depth: 2
Heading Rank: 2

Heading: A. Authority of Commissioner to Inspect

Text: Clay County Manor asserts that the inspection team exceeded its authority on July 26 and 27, 1989, in inspecting the nursing home under the facts presented. We disagree. Both state and federal statutes and regulations give the Department broad power to inspect nursing homes. In order for states to receive Medicaid funds, the Department must have a procedure in place to review the appropriateness and quality of care and services furnished to patients and residents. 42 U.S.C. § 1396a(a)(33)(A). Federal law also requires the Department to make on-sight inspections as often as necessary if there is a compliance problem. 42 C.F.R. §§ 431.610(g)(3)(i), 456.602(a) (1988). There is no question that the state inspection team in the instant case had the authority under federal law to determine at what intervals the inspections would be carried out based on the quality of care and services being provided in [the] facility and the condition of recipients in the facility. 42 C.F.R. § 456.606 (1988). Federal law makes it clear that the states may [r]esurvey providers or suppliers as frequently as necessary to ascertain compliance and confirm the correction of deficiencies. 42 C.F.R. § 488.20(b)(1) (1988). State law likewise vests the Department with broad powers to inspect nursing homes. T.C.A. § 68-11-210(a)(1) requires the Department to inspect every nursing home at least once each year by the duly appointed representative of the department. Although the Department is required to make or cause to be made only such inspections necessary to carry out the various obligations imposed ... by applicable state and federal law, state law also mandates that the department shall conduct such on-sight inspections and investigations as may be necessary to safeguard and ensure, at all times, the public's health, safety and welfare. T.C.A. § 68-11-210(b)(3)(D). The Department is further required to conduct inspections and investigations necessary to appropriately respond to complaints received from the public. T.C.A. § 68-11-210(b)(3)(E). It is clear under both state and federal law that the Department has the authority to conduct as many inspections as it deems necessary to safeguard the public's interest in ensuring proper care and treatment of elderly persons in nursing homes and to ascertain the facility's compliance with state and federal law. Accordingly, we hold that the Department had the authority for conducting the inspections on July 26 and 27, 1989. This conclusion is buttressed by the fact that the state inspection conducted in January, 1989, along with the federal inspection in June, 1989, uncovered significant deficiencies at Clay County Manor related to patient care. Also relevant are the new complaints received by the Department after the federal inspection in June which came to the attention of Dr. Alsup and prompted her to personally lead the inspection team to Clay County Manor in July. The Department has a strong interest in safeguarding the health, safety, and welfare of the nursing home residents. It has statutory authority to conduct, as often as it deems necessary, inspections of a facility such as Clay County Manor with its history of deficiencies. Having the ability to conduct unannounced inspections is obviously necessary to assure adequate patient care and treatment. Giving a facility the right to screen inspections before they occur by requiring an inspection only in response to a specific complaint, and by requiring the inspectors to disclose the details of the complaint prior to the inspection, would seriously interfere with meaningful enforcement of state and federal standards of care. Accordingly, our reading of the relevant state and federal law convinces us that the state's authority to inspect is not limited to those instances where there has been a specific complaint, nor is the state required to reveal in advance what the inspectors are looking for. Giving to Medicaid contractors the right to unilaterally specify which areas or subjects will and will not be open to inspection by state health officials would reduce effective monitoring and enforcement to a fiction. Vulnerable patients would suffer the consequences and, at the same time, Medicaid contractors who receive substantial state and federal funds, would not be held accountable in any meaningful way for their expenditure of public funds. [4]