Court Opinion

ID: 9405350
Source: CourtListenerOpinion
Date Created: 2023-06-28 00:00:36.64897+00
Date Added: 2024-06-11T17:20:21.448261
License: Public Domain

Case: 21-60892       Document: 00516802223             Page: 1      Date Filed: 06/27/2023

              United States Court of Appeals
                   for the Fifth Circuit
                                                                                 United States Court of Appeals
                                                                                          Fifth Circuit

                                    ____________                                        FILED
                                                                                    June 27, 2023
                                     No. 21-60892                                  Lyle W. Cayce
                                    ____________                                        Clerk

   Copperas Cove LTC Partners, Incorporated,

                                                                               Petitioner,

                                           versus

   United States Department of Health and Human
   Services,

                                                                             Respondent.
                    ______________________________

              Appeal from the Department of Health & Human Services
                               Agency No. A-18-117
                   ______________________________

   Before Jones, Dennis, and Willett, Circuit Judges.
   Edith H. Jones:*
          Copperas Cove LTC, a nursing home, challenges a fine imposed by
   the Centers for Medicare and Medicaid Services (CMS). Having carefully
   reviewed this appeal in light of the briefs, oral argument, and record, we are
   constrained to DISMISS the petition for review. The Administrative
   Procedure Act’s strictures on judicial review and the latitude afforded the

          _____________________
          *
              Pursuant to 5th Circuit Rule 47.5, the court has determined that this opinion
   should not be published and is not precedent except under the limited circumstances set
   forth in 5th Circuit Rule 47.5.4.
Case: 21-60892      Document: 00516802223           Page: 2     Date Filed: 06/27/2023

                                     No. 21-60892

   Administrative Law Judge (ALJ) and Departmental Appeals Board are not
   overcome here. But we witness a tragic outcome. A severely disabled 35-
   year-old resident of the facility was removed from the only home he had
   known since age seven—a home that, if imperfect in some ways, had never
   failed regulatory scrutiny in the past.
            In 2016, a state survey team found that Copperas Cove was not in
   compliance with certain Medicare requirements. Most of these violations
   stemmed from its treatment of Resident #5, a long-term resident with severe
   cerebral palsy, severe mobility impairment, severe intellectual disabilities,
   macular degeneration, lack of safety awareness, and a history of inappropriate
   behavior with staff and other residents. The survey team flagged several
   violations that had not been mentioned during years of previous surveys.
   Copperas Cove was fined and Resident #5 relocated to another facility. The
   nursing home tried and failed to convince the ALJ, and then the Appeals
   Board, that the fine should be reduced or eliminated. It now petitions to this
   court.
            Copperas Cove argues that the Appeals Board should have reviewed
   the ALJ decision using a “preponderance of the evidence” standard. Yet its
   argument confuses the standard of proof initially applied by an ALJ with that
   applied by the Appeals Board. When reviewing the ALJ’s decision, the
   Appeals Board guidelines and precedent limit its review to determining
   whether: “(1) factual findings in the decision are supported by ‘substantial
   evidence’ in the record as a whole; (2) the decision’s necessary legal
   conclusions are correct (that is, are consistent with applicable statutes and
   regulations); and (3) a ‘prejudicial error of procedure . . . was committed.’”
   See Guidelines – Appellate Review of Decisions of Administrative Law Judges
   Affecting a Provider’s Participation in the Medicare and Medicaid Programs,
   “Completion          of        the        Review           Process,”      ¶(c),
   https://www.hhs.gov/about/agencies/dab/different-appeals-at-dab/

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Case: 21-60892      Document: 00516802223           Page: 3    Date Filed: 06/27/2023

                                     No. 21-60892

   appeals-to-board/guidelines/participation/index.html; Glenoaks Nursing
   Ctr., DAB No. 2522, at 6 (2013); Douglas Bradley, M.D., DAB No. 2663, at 5
   (2015). Moreover, Copperas Cove’s suggestion that this scheme of review
   violates procedural and substantive due process lacks merit.
          Copperas Cove also attacks the factual basis for its purported
   regulatory violations. But each finding, whether this court may disagree or
   not, was supported by substantial evidence. See 42 U.S.C. § 1320a–7a(e).
   First, the Appeals Board found that Copperas Cove chemically restrained
   Resident #5 in violation of 42 C.F.R. § 483.13(a) (Oct. 2016).             CMS
   presented evidence that Copperas Cove significantly increased Resident #5’s
   Risperidone prescription without (a) any medical diagnosis for the conditions
   that Risperidone is meant to treat or (b) any showing that the dosage was
   necessary for safety purposes.       Second, the Appeals Board found that
   Copperas Cove involuntarily secluded Resident #5 in violation of 42 C.F.R.
   § 483.13(b). The CMS surveyor and Copperas Cove staff stated that the
   nursing home would seclude Resident #5 in his room “for its convenience,
   so that it could meet the needs of other residents without having to monitor
   him.” Third, it follows that Copperas Cove failed to “implement written
   policies and procedures that prohibit mistreatment,” 42 C.F.R. § 483.13(c)
   (Oct. 2016), since that requirement stipulates that facilities “must [n]ot use
   . . . involuntary seclusion.” Id. § 483.13(c)(1)(i) (Oct. 2016). Fourth, the
   Appeals Board found that Copperas Cove did not comply with the National
   Fire Protection Association’s Life Safety Code Standard 19.7.1.1, which
   requires a written plan for the evacuation of all persons in the event of a fire.
   42 C.F.R. § 483.70(a)(1)(i) (Oct. 2016) (requiring compliance with the Life
   Safety Code). Copperas Cove’s written evacuation plan did not identify
   severely disabled residents who could not protect themselves in the event of
   a fire. These evidentiary challenges fail.

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                                    No. 21-60892

          Copperas Cove’s allegations of procedural error are likewise lacking.
   It cites the Texas Rules of Evidence to object to testimony offered by the
   CMS surveyor, even though those rules are inapplicable to agency
   proceedings. 42 C.F.R. § 498.61. Its allegation that it was not allowed to
   question the CMS surveyor about her qualifications is false; the record shows
   that the ALJ simply advised counsel that exploring her background would not
   be helpful if the facts about which she testified were undisputed. And contra
   Copperas Cove’s claims, the record demonstrates that both the ALJ and the
   Appeals Board gave due consideration to evidence from Resident #5’s
   physician in making their determinations. Similarly, the ALJ and the Appeals
   Board considered—and found unhelpful—the testimony of Dr. Pearl
   Merritt, Copperas Cove’s expert witness.
          Copperas Cove argues that CMS is equitably estopped from
   enforcement insofar as Copperas Cove’s manner of caring for Resident #5
   was ongoing for many years, and previous CMS surveys never flagged the
   violations that the agency now identifies. But as it stated in its opinion, the
   Appeals Board has “held that neither it nor an ALJ is authorized to grant a
   non-federal party relief from a CMS enforcement action based on equitable
   defenses or doctrines.” The nursing home’s mode of care would not entitle
   it to estoppel in any case. The fact that previous surveyors overlooked
   noncompliance in the past—or even orally authorized it—does not estop the
   government from enforcement in the future. F.D.I.C. v. Royal Park No. 14,
   Ltd., 2 F.3d 637, 641 (5th Cir. 1993).
          Last, Copperas Cove asserts, in a conclusory fashion, that the
   penalties assessed are unreasonable. However, it fails to address any of the
   factors relevant to civil penalties specified in the federal regulations. See
   42 C.F.R. § 488.438(f). And it does not dispute that the per-day fine was
   only a fraction of the maximum amounts allowed under the regulations. As
   such, its challenge fails.

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Case: 21-60892   Document: 00516802223         Page: 5   Date Filed: 06/27/2023

                                No. 21-60892

         For the foregoing reasons, the petition for review is DISMISSED.

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