NURSING HOME MALPRACTICE: Nursing home not immune from COVID-based claims of estates of deceased patients under Public Readiness & Emergency Preparedness Act, motion to dismiss denied… Cavan/Watters.
Magistrate Cavan’s Findings & Recommendations.
This action was originally brought by the Estate of Robert Petersen in Yellowstone Co. State Court 1/18/22 against Canyon Creek Memory Care in Billings. Defendants removed to this Court invoking diversity and federal question jurisdiction and federal officer removal. Plaintiff then joined as Plaintiffs the Estates of Mary Ann Simons and Charlotte Guilford. Before the Court is Canyon Creek’s motion to dismiss.
In mid-20 Petersen, Simons, and Guilford were residents of Canyon Creek. Petersen and Guilford had dementia and Simons had complications following a stroke. The Estates allege that Canyon Creek failed to provide essential care, services, and duties owed to them which ultimately resulted in their deaths.
Plaintiffs allege that Canyon Creek failed to fulfill their duties to Petersen and Simons before and during a COVID outbreak: prior to the outbreak staff neglected him, did not regularly help him use the bathroom, groom him, bathe him, or consult with his healthcare power of attorney before changing his medications. Nonetheless, he was allegedly well-nourished, hydrated, and able to assist in daily activities. On 7/8/20 he tested positive for COVID but was asymptomatic. Plaintiffs allege that Canyon Creek was short-staffed and did not check on him regularly. He lost significant weight and eventually was unable to talk, swallow, or stand and was transported to the hospital due to fever, high heart rate, low blood pressure, and severe dehydration. Staff advised that he also suffered from confusion, deconditioning, and acute kidney injury caused by severe hydration. He also had pressure injuries to his sacrum and left hip. He died 9/18/20.
Simons tested positive for COVID 7/6 and was asymptomatic. At the request of her husband she was transported to the hospital where she was diagnosed with acute metabolic encephalopathy secondary to hypernatremia and acute kidney injury caused by severe dehydration. She also had pressure injuries to her sacrum and buttocks. She died 8/10/20.
Guilford became a Canyon Creek resident 6/30/20. On the day of her admission her representatives asked if there were COVID cases at Canyon Creek after observing a staff member in protective equipment. Staff responded that there were no COVID infections. Plaintiffs allege that had her representatives been informed that a resident had tested positive for COVID they would have removed her. Later in July they were told that she tested positive for COVID. She died from COVID complications 8/22/20.
The Estates allege (1) negligence as to Petersen and Simons, (2) negligence/negligence per se as to Petersen and Simons, (3) negligence as to Guilford, (4) negligent management, (5) negligent misrepresentation, (6) violation of the MCPA, (7) violation of the right to dignity under the Montana Constitution as to Petersen and Simons, and (8) punitives.
Canyon Creek moves to dismiss for lack of subject jurisdiction and failure to state a claim pursuant to Rules 12(b)(1) and 12(b)(6). It argues that it has immunity under the Public Readiness & Emergency Preparedness Act and thus the Court lacks jurisdiction. The Estates respond that PREPA does not provide complete immunity and argue that they have alleged sufficient facts to maintain the causes.
PREPA authorizes the Secretary of DHHS to issue a declaration that “a disease or other health condition or other threat to health constitutes a public health emergency.” 42 USC 247d-6d(b)(1) (2005). If such a declaration is issued, PREPA provides “a covered person” immunity from liability for “all claims for loss caused by, arising out of, relating to, or resulting from the administration to or the use by an individual of a covered countermeasure.” Immunity “applies to any claim for loss that has a causal relationship with the administration to or use by an individual of a covered countermeasure.” If immunity applies, an injured person may be compensated “for covered injuries directly caused by the administration or use of a covered countermeasure” from the “Covered Countermeasure Process Fund.”
In 3/20 the Secretary declared “the spread of SARS-CoV-2 or a virus mutating therefrom and the resulting disease, COVID-19” a public health emergency. The Declaration defines “covered countermeasures” to include:
(a) Any antiviral, any drug, any biologic, any diagnostic, any other device, any respiratory protective device, or any vaccine manufactured, used, designed, developed, modified, licensed, or procured:
I. To diagnose, mitigate, prevent, treat, or cure COVID-19, or the transmission of SARS-CoV-2 or a virus mutating therefrom;
“Administration” of covered countermeasures “extends only to physical provision of a countermeasure to a recipient, such as vaccination or handing drugs to patients, and to activities related to management and operation of programs and locations for providing countermeasures to recipients, such as decisions and actions involving security & queuing, but only insofar as those activities directly relate to the countermeasure activities.” The Declaration further provides that “whether immunity is applicable will depend on the particular facts and circumstances” and makes clear that “a liability claim alleging an injury not directly related to the countermeasure activities is not covered.”
The Estates have stated plausible claims which do not fall under PREPA. None of the claims alleges any injury as a result of administration of a covered countermeasure. While Petersen, Simons, and Guilford did contract COVID while at Canyon Creek, their claims related to Canyon Creek’s failure to care for them. As to Petersen and Simons, the Estates allege negligence for failing to provide sufficient nutrition and hydration, breaching duties owed under the Federal Nursing Home Reform Act, failing to provide adequately trained staff, and violating their right to dignity under the Montana Constitution. As to Guilford, the Estates allege negligence for failing to establish a system to prevent, identify, and control infections, failing to provide adequately trained staff, and misrepresenting that Canyon Creek was free of COVID infection. In short, the Complaint does not allege injury resulting from Canyon Creek’s administration or use of covered countermeasures; it alleges injury as a result of its inaction in providing essential care.
Canyon Creek argues that there is a “causal nexus” between the Estates’ injuries and its management of “their COVID-19 countermeasure program” including testing and use of personal protective equipment. It repeatedly points to a handful of paragraphs in the Complaint which reference countermeasures. But the paragraphs merely mention covered countermeasures, not that any injury resulted from administration of covered countermeasures. As several courts have recognized, “the mere mention of countermeasures in the complaint does not confer immunity.” Harris (ND Cal. 2022).
Canyon Creek points out, for example, that when Guilford’s representatives brought her to Canyon Creek “they observed a staff member wearing head-to-toe personal protective equipment.” But this goes to the Estates’ allegation that it misrepresented that there were no COVID cases at the facility, not to a failure to administer or use PPE. Nowhere in the Complaint do the Estates allege that its administration of PPE caused Guilford’s infection and ultimate death.
Canyon Creek also argues that the Estates “take issue with Canyon Creek’s decision to use their own COVID-19 testing and decline testing that was provided by the government.” It is true that the Complaint mentions that Canyon Creek declined the State’s free testing and that the National Guard was deployed to Canyon Creek to help provide care. However, they do not allege that Canyon Creek’s failure to test Petersen, Simons, or Guilford caused their injuries.
At most, the Complaint allegations can be construed to allege that Canyon Creek failed to employ testing. But “courts across the country” have “distinguished between malfeasance and nonfeasance and maintain that the Act is designed to protect those who employ countermeasures, not those who decline to employ them.” Walsh (ND Ill. 2022); Dupervil (ED NY 2021) (alleged failures by a nursing home to separate residents, enforce social distancing, restrict visitors, cancel group activities, ensure adequate staffing, enforce masking, and screen for COVID symptoms could not be found to be “administering or even prioritizing or purposefully allocating” a covered countermeasure under PREPA.
Nevertheless, it is possible for inaction claims to fall within PREPA. The Declaration provides: “Where there are limited Covered Countermeasures, not administering a Covered Countermeasure to one individual in order to administer it to another individual can” fall under PREPA. The example relates to a scenario where a limited countermeasure is administered to one who is more vulnerable to COVID rather than to one who is less vulnerable.
Accordingly, the great majority of courts have concluded that “there is only immunity for ‘inaction claims’ when the failure to administer a covered countermeasure to one individual has ‘a close causal relationship’ to the administration of that covered countermeasure to another individual.” Lyons (CD Calif. 2021).
Canyon Creek makes no argument to suggest that any covered countermeasure was not administered to Petersen, Simons, or Guilford because it was administered to others. In sum, none of the Estates’ claims allege that their injuries were caused by or related to Canyon Creek’s use or failure to use a covered countermeasure. Nor is it clear from the Complaint that the claims alleged are directly related to any countermeasure activity. Dismissal is thus inappropriate.
There is an exception to PREPA immunity where the injury occurs through willful misconduct, defined as “an act or omission that is taken (i) intentionally to achieve a wrongful purpose; (ii) knowingly without legal or factual justification; and (iii) in disregard of a known or obvious risk that is so great as to make it highly probable that the harm will outweigh the benefit.” The claimant must meet certain procedural and exhaustion requirements and the action must be filed in the DC District Court. Canyon Creek argues that the Estates’ punitives claim is a willful misconduct claim under PREPA and that it must be dismissed because they did not exhaust administrative remedies and did not file in the DC District Court. It points to a paragraph in the Complaint alleging that Canyon Creek was “intentionally understaffed” and staff were not appropriately trained. The Estates also allege that it acted “in conscious or intentional disregard” or “with indifference to the high probability of injury to Petersen, Simons, and Guilford.” However, they do not claim that it acted “intentionally to achieve a wrongful purpose” as required by §247d-6d(c)(1)(A). Maglioli (3rd Cir. 2021) (allegations of “conduct that was grossly reckless, willful, and wanton” constituted “standard language for a punitive-damages request,” not sufficient to allege intent to achieve a wrongful purpose). Accordingly, dismissal of the Estates’ punitives claim should be denied.
Judge Watters’s Order.
Canyon Creek objected to Judge Cavan’s findings & recommendations, arguing that Plaintiffs’ injuries resulted from administration of covered countermeasures under PREPA so that it is entitled to immunity and that the Court must give deference to an advisory opinion from DHHS Office of General Counsel which explains that the choice not to administer a covered countermeasure falls under PREPA and its immunity.
After a careful review of Canyon Creek’s objections and Plaintiffs’ response, the Court adopts Judge Cavan’s findings & recommendations in full. Canyon Creek is not entitled to immunity under PREPA. Its motion to dismiss is denied.
Estates of Peterson, Simons, and Guilford v. Canyon Creek, 44 MFR 293a/b, Cavan’s findings & recommendations 12/19/22, Watters’s adoption order 3/1/23.
John Heenan (Heenan & Cook), Billings, and Philip McGrady (McGrady Law), Whitefish, for the Estates; Oliver Goe & Daniel Hoven (Browning, Kaleczyc, Berry & Hoven), Helena, for Canyon Creek.