The Maryland Department of Health is failing in its duty to regularly inspect nursing facilities in the state and investigate complaints from residents, allowing dangerously poor quality care to go undetected, according to a lawsuit filed in federal court in Baltimore.
The complaint, filed Wednesday by five anonymous nursing home residents with mobility impairments and complex health needs, accuses the state health department of discriminating against residents with disabilities, who are particularly vulnerable to neglect and mistreatment when a facility’s poor performance isn’t corrected.
The lawsuit, filed by the Public Justice Center in Baltimore on the residents’ behalf, contains haunting stories from the residents, who are identified with pseudonyms to avoid retaliation from the facilities where they live.
One resident, a 61-year-old Black man whose arms and legs are paralyzed, said he has been confined to his bed since March 2023 — with the exception of some medical appointments — because his facility has failed to provide him with a wheelchair and other mobility assistance. Other residents described laying on soiled linens or wearing incontinence briefs for hours while waiting for them to be changed.
“Plaintiffs must rely on nursing staff assistance on a daily basis to leave their rooms and interact with others, to take a shower, for toileting and incontinence care, to receive needed pain medicine, and even to have a drink of water,” the lawsuit said.
“Where that care is lacking,” the complaint continued, “Plaintiffs experience higher levels of harm, including skin problems such as skin breakdown and pressure sores, falls, and seclusion relative to residents without mobility impairments. They experience personal loss of dignity when their hygiene and incontinence needs are not met by the nursing facility.”
In response to a request for comment, health department spokesman Chase Cook said the department is “committed to providing the best care to Maryland residents.”
The department, he said, does not have any further comment on active litigation.
The people who filed the lawsuit aren’t seeking money, said Debra Gardner, legal director at the Public Justice Center. Instead, they want the court to bring the health department into compliance with state and federal law by requiring it to conduct yearly investigations of nursing facilities and to investigate complaints on a timely basis.
“The complaint does not seek financial remedies on behalf of individuals,” Gardner said. “It challenges systematic failures of the state to do its job to require nursing facilities to do their job and to therefore protect the safety, the health, the welfare, the quality of life, the longevity of life of nursing facility residents with mobility impairments.”
The lawsuit is a proposed class action, meaning the residents are seeking to represent a larger class of people with mobility impairments who are living in nursing facilities that accept Medicaid and Medicare.
While the lawsuit doesn’t allege discrimination based on race, Gardner noted that Black people are disproportionately likely to be on medical assistance, have mobility impairments and live at low performing nursing facilities that are poorly supervised by the state.
Under state and federal law, Maryland’s health department is required to conduct annual inspections of its 225 licensed nursing facilities that care for people on Medicaid or Medicare. However, according to the lawsuit, more than 100 Maryland facilities have gone four years without an inspection. Maryland is one of four U.S. states that have neglected annual inspections of more than 70% of its nursing facilities, the complaint said. Only Kentucky does worse, it said.
The health department’s failure to regularly inspect facilities with a history of resident abuse and neglect and other deficiencies is particularly concerning, the lawsuit said, as the department may not find out about new problems unless a resident makes a complaint.
A backlog of uninvestigated complaints has ballooned at the health department, the lawsuit alleges. Over the past three fiscal years, Maryland’s health department reported about 13,173 complaints and facility-reported incidents — including serious allegations of harm to residents. Less than half of these complaints have been investigated, according to the lawsuit.
State law requires the health department to start investigating the most serious complaints within 48 hours and others involving resident harm within 10 business days. However, according to the lawsuit, the department regularly allows all but the most serious complaints to wait for the facility’s next annual inspection. That means some residents wait months or even years for the department to investigate complaints that they were harmed by abuse or neglect.
Last spring, the wife of a resident named in the lawsuit filed a complaint with the health department that alleged her husband did not receive incontinence care for more than 15 hours on April 16, 2023, and employees at his nursing facility did not respond in a timely manner to his call bell. The health department has not yet investigated her complaint, according to the lawsuit.
The lawsuit includes other allegations of mistreatment and neglect faced by Herman Dressel, the resident’s pseudonym. Dressel, a 57-year-old white man diagnosed with left-side weakness from a stroke, struck his head and had to be admitted to a hospital in March 2023 after an employee tried to move him out of bed with a mechanical lift — a job that requires two people. His dental health also has deteriorated, the lawsuit said, because facility employees have told him they don’t have time to help him brush his teeth.
“When Mr. Dressel requests facility staff assistance to change his incontinence brief, he is frequently told that if staff assist him into his bed for the change, he will have to remain in bed for the rest of the day,” the lawsuit said. “Because he does not want to be stuck in bed for the day, he now puts a towel inside his brief to capture urine during the day and avoid the need to change the brief. This means that he must tolerate the urine-soaked towel all day instead.”
The health department’s failure to investigate timely complaints from nursing home residents is a “chronic and well-documented problem,” the lawsuit said. In 2018, the General Assembly tried to address the problem by passing legislation that required the health department to increase staffing in the unit responsible for nursing home complaints and inspections.
In response to the legislation, the health department released a seven-year staffing plan, where 20 new inspector positions would be added between fiscal years 2020 and 2024. However, according to the lawsuit, the unit responsible for nursing home complaints and inspections remains understaffed and many nursing facilities continue to go without inspection.
Baltimore Sun reporter Madeleine O’Neill contributed to this article.
