Meadowwood Nursing Home v. United States Department of Health

*This decision was originally issued as an “unpublished decision”
filed on March 2, 2004. On April 13, 2 004, the court designated the
opinion as one recommend ed for full-text publication.
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RECOMMENDED FOR FULL-TEXT PUBLICATION
Pursuant to Sixth Circuit Rule 206
ELECTRONIC CITATION: 2004 FED App. 0107P (6th Cir.)
File Name: 04a0107p.06
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
_________________
MEADOWWOOD NURSING
HOME,
Petitioner,
v.
UNITED STATES DEPARTMENT
OF HEALTH AND HUMAN
SERVICES, and TOMMY
THOMPSON, Secretary of
HHS,
Respondents.
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No. 02-4115
On Petition for Review from the Final Decision of the
Secretary of Health and Human Services.
No. A-02-65.
Argued and Submitted: February 3, 2004
Decided and Filed: March 2, 2004*
2 MeadowWood Nursing Home v. HHS No. 02-4115
**The Honorable Dan Aaron Polster, United States District Judge for
No rthern D istrict of Ohio, sitting by designation.
Before: DAUGHTREY and COLE, Circuit Judges;
POLSTER, District Judge.**
_________________
COUNSEL
ARGUED: Shirley Moscow Michaelson, OFFICE OF THE
CHIEF COUNSEL, Chicago, Illinois, for Respondents.
ON BRIEF: Shirley Moscow Michaelson, OFFICE OF THE
CHIEF COUNSEL, Chicago, Illinois, for Respondents.
Geoffrey E. Webster, Columbus, Ohio, for Petitioner.
_________________
OPINION
_________________
MARTHA CRAIG DAUGHTREY, Circuit Judge. By
means of the petition now before us, MeadowWood Nursing
Home seeks review of a civil monetary penalty imposed by
the Secretary of Health and Human Services (HHS) upon a
finding that MeadowWood had failed to comply with certain
Medicare/Medicaid regulations. A survey conducted by the
Ohio Department of Health on behalf of HHS turned up
several deficiencies in the facility, including MeadowWood’s
failure to maintain the nursing home as free of accident
hazards as possible, as required by 42 C.F.R. § 483.25(h)(1).
Waiving review of all other violations for which civil
penalties were imposed, MeadowWood now appeals only the
§ 483.25(h)(1) penalty assessed by the Centers for Medicare
and Medicaid Services, which was sustained by an
administrative law judge for the HHS Departmental Appeals
Board and then upheld by an appellate panel of the Appeals
Board. We conclude that the Secretary’s decision finding

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No. 02-4115 MeadowWood Nursing Home v. HHS 3
certain equipment in the facility unsafe is supported by
substantial evidence, and we therefore affirm.
PROCEDURAL AND FACTUAL HISTORY
MeadowWood Nursing Home is a 53-bed long-term-care
facility in rural southwestern Ohio. In July 1998, officials of
the Ohio Department of Health, acting on behalf of the
Centers for Medicare and Medicaid Services, conducted a
survey to determine whether the facility was in compliance
with the federal requirements for nursing homes participating
in Medicare/Medicaid programs. They discovered, among
other deficiencies, that at least 12 of the 53 beds in the facility
were unsafe due to malfunctioning side rails.
The two most serious cases involved residents designated
in the report as Resident 2 and Resident 3. Resident 2, a frail,
100-year-old man, was injured after he fell from a bed that
was known to have a side rail that collapsed easily. He was
nevertheless returned to the same bed and was still in it
almost a week later when the side rail again collapsed without
warning while it was being inspected by the surveyors.
Resident 3, who suffered from multiple mental impairments
but was physically strong and even violent at times,
experienced two falls from his bed. The first occurred when
a side rail collapsed as he shook it, and the second when the
bracket connecting the rail to the bed snapped altogether.
Resident 3 was then moved to a different bed that had a 3-4
inch gap between the side rail and the mattress, which created
a risk for entrapment.
As a result of the condition of these two beds and some 10
or 12 others, the Ohio Department of Health concluded that
MeadowWood was not in substantial compliance with 42
C.F.R. §483.25(h)(1), which requires that a facility “must
ensure that . . . [t]he resident environment remains as free of
accident hazards as is possible.” Among the remedies
proposed to HHS was the payment of a civil monetary penalty
at the “immediate jeopardy” level of $3,050 per day for the
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10-day period from July 23 through August 1, 1998.
“Immediate jeopardy” means a situation in which a facility’s
non-compliance has caused, or is likely to cause, serious
injury, harm, impairment, or death to a resident. 42 C.F.R.
§ 488.301. The report also recommended a reduced penalty
of $50 per day for 132 days from August 2 through
December 1, 1998. HHS suspended payment for new
Medicare/Medicaid admissions effective September 29, 1998,
and proposed to terminate its provider agreement with
MeadowWood in the absence of substantial compliance with
pertinent federal regulations.
MeadowWood disputed the findings of non-compliance and
filed a request for hearing in accordance with 42 C.F.R.
§§488.408(g). An administrative law judge held a four-day
hearing and sustained the imposition of the penalty.
MeadowWood then appealed to a three-member panel of the
Departmental Appeals Board, which affirmed the decision of
the administrative law judge. In its current petition for review
of these decisions, MeadowWood renews its arguments that
it was in substantial compliance, that there was no evidence
that its residents were in immediate jeopardy, and that it was
being held to a strict liability standard for events over which
it did not have notice or control.
DISCUSSION
Judicial review of decisions under 42 U.S.C. § 1320a-7a(e)
is limited to determining whether the findings are supported
by substantial evidence and whether the proper legal
standards were employed. “Substantial evidence is defined as
such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion. In our review, we do not
consider the case de novo, nor resolve conflicts in the
evidence, nor decide questions of credibility.” Myers v.
Secretary of Health & Human Services, 893 F.2d 840, 842
(6th Cir. 1990) (internal citations omitted).

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No. 02-4115 MeadowWood Nursing Home v. HHS 5
After careful review of the administrative record and the
record on appeal, we conclude that there was substantial
evidence to support the decision of the administrative law
judge to affirm the imposition of penalties under 42 C.F.R.
§483.25(h)(1). Moreover, we find no basis for
MeadowWood’s claim that it was held to a standard of strict
liability. In addition to the evidence supporting a finding of
immediate jeopardy with regard to two of the residents, the
administrative law judge found that 12 other beds were being
maintained in an unsafe condition, that nursing home aides
were not properly operating the beds, and that there was no
evidence of a routine maintenance program. The judge also
found that MeadowWood had not presented credible evidence
to the contrary.
In reviewing the decision of the administrative law judge,
the appeals panel likewise rejected the provider’s argument
that it was being held to a strict liability standard:
The sequence of the events relating to Resident 2
discredits MeadowWood's claims that only a strict
liability standard could lead to holding it responsible for
the failures of the bed rails because the events were
unpredictable. . . . Far from imposing a strict liability
standard, the ALJ's treatment of the allegations relating
to Resident 3 illustrates that he considered carefully
whether each accident or hazard presented foreseeable
risks that MeadowWood could practicably have
prevented.
We likewise conclude that the factual record is replete with
evidence that MeadowWood was on notice that the condition
of the beds in its facility posed a risk of injury to the residents
and could have taken steps to avoid the harm that befell at
least two of them as a result of the unsafe conditions that
existed in the nursing home. We thus find no merit to
MeadowWood’s attempt to re-cast what is essentially a
dispute of fact into a legal issue – indeed, we think that the
strict liability argument is essentially a red herring.
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Moreover, even without the deference normally accorded to
determinations by the Secretary in administrative proceedings
such as this, we conclude that the record contains substantial
evidence to sustain the decision to impose the remedies at
issue.
CONCLUSION
For the reasons set out above, we AFFIRM the decision of
the Secretary finding MeadowWood Nursing Home in non-
compliance with 42 C.F.R. § 483.25(h)(1) and imposing civil
monetary penalties therefor.

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