On September 3, 2020, Special Agents from the Federal Bureau of Investigation, Department of Health and Human Services Office of Inspector General, and Internal Revenue Service, along with investigators from the Pennsylvania Attorney General’s Office, carried out search warrants at two long-standing facilities. of long-term care in western Pennsylvania.1 The raids, which took place at the Brighton Rehabilitation and Wellness Center, near Pittsburgh, and a sister facility, Mt. The Lebanon Rehab and Wellness Center, in Allegheny County, followed up on the statement by the State Attorney General, Josh Shapiro, on August 12, 2020, that the Brighton facility was “one of the subjects of our criminal negligence investigations in homes. of care during the pandemic. “2 The number of these investigations, in Pennsylvania and elsewhere, is expected to increase as critical assessments of facility readiness, compliance with infection prevention and control requirements, and patient care increase. While public scrutiny has largely focused on long-term care facilities, which accounted for more than 40% of the country’s COVID victims,3 the current crisis also requires a closer look at the regulatory structures that govern the nursing home sector.
Brighton Rehab, a 589-bed facility in the epicenter of one of the nation’s deadliest outbreaks, has seen nearly 450 cases and dozens of deaths.4 and is the subject of multiple state and federal investigations, including the unauthorized use of hydroxychloroquine to treat COVID patients.5 The history of the facility’s systemic problems, however, raises questions about the effectiveness of state investigative agencies and the role that lax or lack of oversight may have played in the death toll in nationwide nursing facilities.
An investigation of Brighton Rehab by TribLIVE reporters found numerous persistent problems and a history of official confusion or inaction which included: three years of inspection reports showing severe deficiencies in patient supervision, management and care; thirty months on a federal checklist for underperforming nursing homes; 40% to 50% less care time per patient than other facilities in Pennsylvania and across the nation; inspection reports issued days apart in April that painted radically different pictures of infection control and other problems at the facility, with one report showing severe deficiencies, another none; and claims by county officials that there had been little communication between the owners and the county, particularly after the wave of deaths from COVID-19 began.6
Previously, during the pandemic, the Centers for Medicare and Medicaid Services (CMS) announced that they would suspend normal investigation activities and conduct only two types of investigations: (1) complaints and incidents that are identified as immediate danger and (2 ) infection control polls.7 This was found by an analysis of 171 infection control investigations conducted between March 25 and April 21, 2020 130, or 76%, of the surveys did not identify an infection control problem at alland that, of the 41 polls that cited a shortage, 30 or 73% found “no damage”. Of the remaining 11 investigations, 8 initially cited a lack of immediate danger, each of which was removed or reduced to a deficiency of “no harm” during the investigation, and only 3 investigations led to an immediate danger finding. one of which was the Life Care Center of Kirkland, the first nursing facility in the country where COVID was identified.8 Because the facilities were selected based on their history of infection control issues, the survey results clearly raise more questions than answers.
As pressure builds to assign responsibility for COVID infections, qualified nursing facilities will be at the forefront, but inevitably, there will be questions and a possible review of the patchwork of state and federal regulations governing the industry to follow.