Opinion ID: 899913
Heading Depth: 3
Heading Rank: 1

Heading: Negligent Failure to Monitor/Enforce

Text: The DHHR defendants maintain that the circuit court erred in failing to find them entitled to qualified immunity inasmuch as respondents have alleged a simple negligence case against them and failed to produce evidence that they violated a clearly established law. Respondents argued below that the DHHR defendants were generally negligent in their “enforcement and monitoring duties,” as pertained to DEAF, based almost exclusively on the WVA report which was critical of the DHHR defendants’ oversight of the facilities within its purview.18 The DHHR defendants counter that the WVA investigator conceded during her deposition that, in spite of these criticisms, she did not investigate DHHR and had uncovered no evidence that the DHHR defendants had failed to comply with any of its regulatory requirements as pertained to DEAF. As noted above, there is no question that respondents’ complaint is grounded exclusively in negligence, alleging that the DHHR defendants negligently 18 Under the “Recommendations” section of its report, WVA stated that it finds that service providers are not being adequately monitored to enforce compliance with the requirements of the WVDHHR Medicaid Title XIX MR/DD Home and Community Based Waiver Program. As a result individuals using the [Program] are at an increased risk of neglect. [The DHHR defendants] are responsible to monitor and enforce compliance for the [Program]. Inadequate enforcement and monitoring of service providers are placing very vulnerable individuals at increased risk of abuse, neglect and death. 14 failed to provide proper oversight and enforcement of applicable laws. To that end, this Court has held generally: In the absence of an insurance contract waiving the defense,19 the doctrine of qualified or official immunity bars a claim of mere negligence against a State agency not within the purview of the West Virginia Governmental Tort Claims and Insurance Reform Act, W. Va. Code § 29–12A–1, et seq., and against an officer of that department acting within the scope of his or her employment, with respect to the discretionary judgments, decisions, and actions of the officer. Syl. Pt. 6, Clark v. Dunn, 195 W.Va. 272, 465 S.E.2d 374 (1995) (emphasis added) (footnote added). However, once the “judgments, decisions, and actions” of a governmental official are determined to be discretionary, the analysis does not end. Rather, even if the complained-of actions fall within the discretionary functions of an agency or an official’s duty, they are not immune if the discretionary actions violate “clearly established laws of which a reasonable official would have known”: “A public executive official who is acting within the scope of his authority and is not covered by the provisions of W. Va. Code 29-12A-1, et seq. [the West Virginia Governmental Tort Claims and Insurance Reform Act], is entitled to qualified immunity from personal liability for official acts if the involved conduct did not violate clearly established laws of which a reasonable official would have known. . . . Syllabus, State v. Chase Securities, Inc., 188 W. Va. 356, 424 S.E.2d 591 (1992). Syl. Pt. 3, in part, Clark, supra.20 19 The Paynes do not assert that the insurance policy at issue waives any immunities. 20 Although this particular syllabus point is phrased in terms of the immunity of “public executive official,” it has equal application to a suit solely against State agencies (continued . . .) 15 Our analysis requires, therefore, an examination of the DHHR defendants’ oversight and enforcement duties and obligations relative to behavioral health centers to assess whether they derive from discretionary “judgments, decisions, and actions” and if whether, even so, their actions or inactions violated any “clearly established law.”21 West Virginia Code § 27-9-1 (1977) (Repl. Vol. 2008) is the enabling statute for the legislative rules set forth in West Virginia Code of State Rules Title 64, Series 11 governing “Behavioral Health Centers Licensure” and provides that hospitals, centers, or institutions providing care or treatment of the mentally ill or intellectually disabled must first be licensed by the DHHR.22 Significantly, West Virginia Code § 27-9-1 further provides that “[t]he secretary [of the DHHR] may make such terms and regulations in regard to the conduct of any licensed hospital, center or institution, or part of any licensed hospital, inasmuch as the State’s immunity is “coterminous” with that of the official whose acts are at issue: [T]he immunity of the State is coterminous with the qualified immunity of a public executive official whose acts or omissions give rise to the case. . . . Syl. Pt. 9, in part, Parkulo, 199 W. Va. 161, 483 S.E.2d 507. As discussed infra, authority for regulation of behavioral health centers is vested with the Secretary of the DHHR. W. Va. C.S.R. § 64-11-2.2. 21 See n.8, supra. 22 The 2010 amendment to West Virginia Code § 27-9-1 made minor clarifications to the statute, none of which are relevant to the issues herein. 16 center or institution, as he or she thinks proper and necessary.” (emphasis added). As such, the determination as to how facilities under Title 64, Series 11 must operate and conduct their daily affairs and to what extent commensurate regulatory oversight for such operation and affairs falls on the DHHR and its subsidiary agencies lies entirely with the discretion of the Secretary of the DHHR. As noted above, the “terms and regulations” promulgated for the licensure and conduct of behavioral health centers are set forth in West Virginia Code of State Rules § 64-11-1 et seq. However, in terms of the DHHR’s oversight and monitoring of behavioral health facilities, the regulations require only that a center is inspected upon application for an initial, renewal, or provisional license and thereafter, at least once every two years or once a year for residential facilities. W. Va. C.S.R. §§ 64-11-4.1.f.1 and 64-11-4.3.c.23 The DHHR “may” conduct unannounced inspections in response to a complaint, but is not required to do so. W. Va. C.S.R. § 64-11-4.4.b. The inspections are to include, but are not limited to “[o]bservation of service delivery . . . [r]eview of life safety and environment . . . [r]eview of clinical and administrative records; and . . . [i]nterviews with consumers (with the consumer’s consent), staff and administrators.” W. Va. C.S.R. §§ 64-11-4.3.b.1 through 4. 23 West Virginia C.S.R. § 64-11-4.1.f.1 provides “[n]either an initial, renewal or a provisional license shall be issued unless an inspection has been made.” West Virginia C.S.R. § 64-11-4.3.c provides “[e]ach licensed Center is inspected at least once every two (2) years, except for residential treatment facilities that are inspected at least once a year.” 17 The DHHR is required to issue a report within ten working days of an inspection, which then triggers an obligation on behalf of the facility to submit to the DHHR a signed, written “plan of correction” to address any deficiencies identified in the report; the plan is to include “[a]ction taken or procedures proposed to correct the deficiencies and prevent their reoccurrence [and] . . . [d]ate of completion of each action taken or to be taken[.]” W. Va. C.S.R. §§ 64-11-4.3.f and 64-11-4.6.a.1 through 3. The regulations provide that “[t]he Secretary shall approve, modify or reject the proposed plan of correction in writing” and, critically, “[t]he Secretary may determine if corrections have been made.” W. Va. C.S.R. §§ 64-11-4.6.b and 64-11-4.6.f. Following the inspection and any plans of correction, “the Secretary shall, if there is substantial compliance with this rule,” issue an initial, provisional, or renewal license. W. Va.