Estate of Smith v. Heckler - 747 F.2d 583 (10th Cir. 1984)

Rule:

The Secretary of Health and Human Services has a duty to establish a system to adequately inform herself as to whether the facilities receiving federal money are satisfying the requirements of the Title XIX of the Social Security Act, 42 U.S.C.S. §§ 1396-1396, including providing high quality patient care. This duty to be adequately informed is not only a duty to be informed at the time a facility is originally certified, but is a duty of continued supervision. 

Facts:

Plaintiffs, seeking relief under 42 U.S.C. § 1983 (1982), brought this class action on behalf of medicaid recipients residing in nursing homes in Colorado. They alleged that the Secretary of Health and Human Services (Secretary) has a statutory duty under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396-1396n (1982), commonly known as the Medicaid Act, to develop and implement a system of nursing home review and enforcement designed to ensure that medicaid recipients residing in medicaid certified nursing homes actually receive the optimal medical and psychosocial care that they are entitled to under the Act. The plaintiffs contended that the enforcement system developed by the Secretary is "facility-oriented," not "patient oriented" and thereby fails to meet the statutory mandate. The district court found that although a patient care or "patient oriented" management system is feasible, the Secretary does not have a duty to introduce and require the use of such a system.

Issue:

Did the trial court err in finding that the Secretary does not have a statutory duty to develop and implement a system of nursing home review and enforcement which focuses on and ensures high quality patient care?

Answer:

Yes.

Conclusion:

The court reversed and remanded the case. In so doing, the court held that (1) the trial court erred in finding that the Secretary did not have a statutory duty to develop and implement a system of nursing home review and enforcement that focuses on and ensures high quality patient care, (2) the enforcement mechanism promulgated by the Secretary had not satisfied that duty, and (3) mandamus was an appropriate remedy to compel performance.