Chuck Grassley

United States Senator from Iowa





Grassley Presses CMS on Failure to Ensure Nursing Home Abuse, Neglect Are Reported to Law Enforcement

Sep 01, 2017

WASHINGTON – Sen. Chuck Grassley today pressed the Centers for Medicare and Medicaid Services (CMS) on why it has failed to ensure that nursing home abuse and neglect cases are reported to law enforcement, as required.  Grassley also pressed the agency for its lack of urgency in responding to an early alert from the agency watchdog on this problem.  Three of 134 incidents of abuse and neglect in 33 states identified by the Department of Health and Human Services Office of Inspector General were in Iowa.  
“These early findings are extremely troubling and call into question why, for so many years, CMS has failed to take proper steps to ensure that SNFs [Skilled Nursing Facilities] followed the law and protected patients,” Grassley wrote to CMS Administrator Seema Verma.  “Our nation’s most vulnerable people must be protected, not ignored.”
The inspector general’s early alert found that 28 percent of the 134 potential incidents of abuse or neglect in 33 states may not have been reported to law enforcement, as required.  Three of the 134 potential incidents were in Iowa.  Grassley followed up with the inspector general and learned that only one of the three Iowa cases was reported to law enforcement.  It’s unclear whether the case was prosecuted.
The early alert recommends CMS take immediate action to ensure that such incidents are identified and reported.  However, CMS is not taking immediate action.  “CMS recently declared that it will take action on the IG’s recommendations when the IG finalizes its review,” Grassley wrote.  “In light of the potential for substantial harm in delaying implementation of the IG’s recommendations, why wait?”
Grassley’s letter is available here

The following is from the Department of Health and Human Services Office of Inspector General in response to Grassley on the Iowa cases:

We were not able to determine if the one case referred to law enforcement was prosecuted.
The following information obtained from hospital records is specific to Medicare beneficiaries residing in Iowa skilled nursing facilities (SNF).
Incident A
The beneficiary visited a primary care physician (PCP) for an examination due to bleeding of an unknown source over the last couple of weeks.  While being treated by the PCP, the beneficiary stated that they were sexually assaulted by a SNF staff member.  The beneficiary returned to the SNF and the SNF immediately ordered the beneficiary to be transferred to the hospital in order to begin an investigation.  
The hospital asked why the beneficiary was transferred to the emergency room and if the other party was another resident or a staff member.  The beneficiary stated that they were sexually assaulted by a staff member.  According to the beneficiary, the last sexual encounter with the staff member occurred 3 weeks prior to the hospital visit.  The beneficiary did not want to undergo another examination due to physical discomfort.  Additionally, the hospital indicated that no evidence could be collected due to the amount of time that elapsed between the hospital visit and the sexual encounter.
The State and police department were notified.  As a result, the State launched an investigation and the police took a statement from the beneficiary.  In addition, the SNF indicated that the staff member would be kept away from the beneficiary until completion of an investigation.
Incident B
The beneficiary stated that they were fondled “in [the] private area” by a staff member while showering.  The beneficiary told the staff member to stop what the staff member was doing but did not tell anyone else until 2 days after the incident.
The hospital performed a sexual assault nursing examination.  The examination showed that the beneficiary was scratched.  Specifically, the exam found that the beneficiary had three raised red areas.  
The nursing assessment indicated that there was no risk of abuse or neglect for this patient.  The hospital record does not indicate if law enforcement was contacted.  However, an advocate was contacted.  The hospital record also notes that a member of the SNF staff was present in the room with the beneficiary.  The beneficiary was deemed safe to return to the SNF. 
Incident C
The beneficiary stated that rape occurred two weeks prior to the hospital visit.  The beneficiary refused to provide any detail regarding the alleged rape.  Furthermore, the beneficiary would not give the hospital verbal permission to provide medical treatment.  The hospital record also indicates that the beneficiary was being treated at another hospital during the time of the alleged rape.
The hospital record does not indicate if the State or law enforcement were contacted.
The OIG determined that incidents A and B involve injuries that may have been caused by potential abuse or neglect.   However, the OIG was unable to determine whether potential abuse or neglect existed for incident C without further investigation.