NDNY: Nursing Home Reform Amendments enforceable under § 1983

The Northern District of New York held that the Nursing Home Reform Amendments (FNHRA), 42 U.S.C. § 1396r et seq, confer rights enforceable under 42 U.S.C. § 1983. Pantalone v. County of Fulton, 2011 WL 1457935 (N.D.N.Y. Apr. 15, 2011).

Judge Hurd, appointed by President Clinton, wrote the opinion.

Daniel J. Pantalone, a resident at Fulton County Residential Health Care Facility, was injured when he was insecurely fastened into a lift in the shower. He fell out of the lift and heard his knee pop. He remained in pain and in bed for two days before given any medical treatment. At that time, an x-ray revealed that he had a broken leg and “an unexplained left ankle fracture.”

Mr. Pantalone filed suit under 42 U.S.C. § 1983 against Fulton County and its facility alleging the nursing home had violated rights provided by the FNHRA. He claimed that the nursing home had violated 42 U.S.C. § 1396r(b)(1)(A) and 42 U.S.C. § 1396r(b)(4)(A)(i). Both provisions require that nursing homes “must” provide high quality care for their residents. Mr. Pantalone also brought a pendant state claim for negligence. The defendants argued that the § 1983 claim should be dismissed because the FNHRA does not provide a private right that can be remedied through a § 1983 lawsuit.

The court agreed that it would have to dismiss the plaintiff’s § 1983 lawsuit if the FNHRA did not provide a private right enforceable under § 1983. Section 1983 only provides a private remedy for violations of a federal right when Congress intended that the federal right be enforceable by a private remedy. Gonzaga University v. Doe, 536 U.S. 273 (2002). The issue before the court was therefore whether the FNHRA provided a private right that could be enforceable under § 1983.

The District court first found that the Second Circuit had not yet decided whether the FNHRA provides a private right enforceable under § 1983. The First and Third Circuits have both held that the FNHRA does allow for § 1983 remedies. Grammer v. John J. Kane Reg’l Ctrs.-Glen Hazel, 570 F.3d 520 (3d Cir. 2009); Rolland v. Romney, 318 F.3d 42 (1st Cir. 2003). The only Second Circuit opinion to mention the issue did not analyze the question and also was non-precedential. Prince v. Dicker, 29 F. App’x 52, 54 (2d Cir. 2002).

The court next examined whether the FNHRA could be enforced via § 1983. Citing Blessing v. Freestone, it considered three factors.

First, the court examined whether the FNHRA was intended to benefit the plaintiff, or if it was merely an instruction to the institution. Relying on the prevalence of the word “residents” in the FNHRA, the court found that the FNHRA provisions were intended to benefit residents such as Mr. Pantalone. The FNHRA requires facilities to provide a certain level of care to residents, and that requirement focuses on individuals.

Second, the court analyzed whether the right that Mr. Pantalone claimed was “so ‘vague and amorphous’ as to strain judicial competence through enforcement.” The court found that the right was enforceable by courts. The provisions require that nursing homes “must” provide for the well being of residents. The mandatory instructions leave nursing homes with little discretion. The court also reasoned that federal courts have significant experience with evaluating the quality of services. Consequently, the rights in FNHRA were not too vague for courts to enforce them.

Third, the FNHRA imposes a binding obligation on states. The court again cited the prevalence of the word “must” in the statute.

All three of the Blessing factors were satisfied, and the plaintiff was entitled to a rebuttable presumption that FNHRA provides an enforceable private right. Next the court found that the FNHRA does not foreclose a § 1983 remedy. There is nothing in the statute to indicate that Congress specifically intended that § 1983 not be available to plaintiffs.

Finally, the court considered whether there was a remedial scheme in the FNHRA that would indicate Congressional intent that § 1983 remedies not be available. The court concluded that there were not sufficient enforcement procedures within FNHRA to “obviate the need for a § 1983 action.” The court noted that Congress passed the FNHRA to respond to abuse and neglect in nursing homes, and that a private remedy accords with Congress’ intent in passing the FNHRA.

Therefore, the rights in the FNHRA were enforceable through § 1983. The court denied the defendants’ motion to dismiss the claim.

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