The Laws Nursing Homes in Alabama Must Follow

When an elderly loved one has been hurt or killed as a result of nursing home abuse or neglect, one frequent question people have is:  “What are the laws nursing homes must follow in Alabama?”

The injury lawyers at our firm get this question at least once a week. We will answer this question in this blog post and will cover all of the state laws and federal regulations that are relevant to nursing home abuse and neglect cases. It is easiest to break down this explanation by dividing it into two subtopics:

• federal regulations of the Nursing Home Reform Act (NHRA); and
• the Alabama Medical Liability Act (AMLA).

Federal Laws Nursing Homes Must Follow in Alabama (NHRA)

In the mid 1980s, the United States Congress requested that the National Academy of Medicine analyze nursing home performance, patient care, financial status, and other factors.  This effort was in response to several organizations claiming that substandard care in nursing homes was commonplace. As a result of this study, Congress took action. In 1987, Congress passed the Nursing Home Reform Act (NHRA) as part of a larger bill called the Omnibus Budget Reconciliation Act (OBRA ’87.)

The most important section of the NHRA is 42 CFR Section 483.  That code section imposes numerous requirements on nursing homes to provide adequate care, treatment, and assistance to nursing home residents.  While it is impossible to outline the full code section in a blog post, here are the key highlights that may be relevant in a lawsuit alleging nursing home abuse or nursing home neglect:

• 483.10 Resident Rights — pursuant to federal law, nursing home residents have a right to a dignified existence, no matter how sick or frail the resident may be.  The resident has the right to plan their own nursing care and have a voice in the process, such as choosing their attending physician and refusing experimental research. The resident has a right to privacy and to confidentiality of their health information, as well as a right to live in a safe environment.
• 483.12 Freedom from Abuse, Neglect & Exploitation — This provision requires nursing homes to not employ people who have a history of abuse. The code section prohibits nursing homes from using physical or chemical restraints that are not medically required. It also forces nursing homes to develop policies and procedures to prevent abuse and neglect.
• 483.20 Resident Assessment — At the time a resident is admitted, the nursing home must have physician orders for the resident’s immediate care. A comprehensive assessment of the resident must be done within 14 days of admission to note the resident’s basic information, their cognitive patterns, behavior patterns, their level of physical functioning, their diseases, medications, skin condition, and many other factors.
• 483.21 Comprehensive Care Planning — Once the resident is assessed and physician orders are received, a nursing home must develop a “plan of care.” A plan of care is a list of services and interventions needed so that the resident may maintain their highest practicable level of physical and mental well-being.
• 483.25 Quality of Care — This is perhaps the most important part of the Nursing Home Reform Act.  It requires nursing homes to provide proper care and treatment for issues involving pressure ulcers (i.e. “bedsores”), vision and hearing, impaired mobility, incontinence, nutrition deficits, and pain management, amongst many other issues.
• 483.85 Nursing Services — The facility must have sufficient nursing staff to maintain the highest practicable physical and mental well-being of each resident. A registered nurse must work at least eight consecutive hours every day in the nursing home and a RN must be designated as the “Director of Nursing.” Nursing aides (CNAs) must be proficient in the skills necessary to care for the needs of the residents.

If an Alabama nursing home fails to abide by these regulations, it can be cited by surveyors employed by the Alabama Department of Public Health (ADPH).  Part of the ADPH’s role is to inspect and investigate nursing home deficiencies and determine if corrective action is needed. In addition, the Center for Medicare and Medicaid Services has surveyors that track compliance with the federal regulations.

In addition, if a physical injury or death results from the violation of these regulations, then the regulations can be relevant evidence in a lawsuit against the nursing home. However, in order to win a lawsuit in Alabama against the nursing home for alleged neglect, the resident (or their family) must also prove the elements under the Alabama Medical Liability Act (AMLA.)

In the next section, we will cover the AMLA, which is a state-specific law that nursing homes must follow in Alabama.

State Laws Nursing Homes Must Follow in Alabama – “AMLA”

In the same year that the Nursing Home Reform Act passed (1987), the Alabama legislature passed the Alabama Medical Liability Act (AMLA).  In short, the AMLA made it much more difficult to successfully sue healthcare providers such as nursing homes.

To prevail in any type of lawsuit against a nursing home seeking compensation for neglect, abuse, or wrongful death, the plaintiff has the burden of proof to satisfy the elements of the AMLA.  If the plaintiff cannot meet his or her burden of proof, then the plaintiff will not win.

Let’s cover first the plaintiff’s “burden of proof.”

Burden of Proof in Cases Against Nursing Homes

In most civil cases seeking compensation for injuries or death, the plaintiff must only “reasonably satisfy” a judge or jury of the elements of their case.  This is the lowest burden of proof in the American legal system.

However, the AMLA changed the burden of proof for plaintiffs in cases against nursing homes.  Under the AMLA, the plaintiff’s burden of proof is “substantial evidence.” This is a higher burden of proof that is more close to the criminal burden of proof (“beyond a reasonable doubt.”)

Substantial evidence is that character of evidence that convinces an unprejudiced thinking mind of the truth of the fact to which the evidence is directed.

Breach of the Standard of Care

The plaintiff must prove by substantial evidence that the nursing home breached the “standard of care.” The standard of care is the level of “reasonable care, skill, and diligence, as other similarly situated health care providers in the same general line of practice ordinarily have and exercise in a like case.” Pruitt v. Zeiger, 590 So. 2d 236, 238 (Ala. 1991).

In order to provide substantial evidence of such a breach, the AMLA requires testimony of a “similarly-situated healthcare provider.”  In other words, a plaintiff cannot simply argue that a breach occurred. The plaintiff cannot simply point to the federal regulations.  Rather, the plaintiff must have an expert witness who has experience working in the nursing home industry.

Causation of Damages

Even if a breach of the standard occurred, a plaintiff cannot win a case against a nursing home unless there is expert testimony that the breach caused the plaintiff harm. The plaintiff must show by substantial evidence a “proximal causal connection” between the breach and the injury/death. Golden v. Stein, 670 So. 2d 904, 907 (Ala. 1995).

In many instances, it may be clear that the nursing home breached the standard of care, but will be difficult to prove the breach caused the resident’s injury or death.  For example, in cases involving strokes, heart attacks, or deaths by “natural causes,” it may be difficult or impossible to connect the breach to the harm. If it is impossible to do so, you cannot win a case against a nursing home.

Expert Testimony Requirement

As previously mentioned, expert testimony is almost always required in cases against nursing homes.  Someone with experience working in nursing homes during the year preceding the alleged negligence is qualified to provide this expert testimony.  The expert will review the nursing home medical records, photos, sworn statements, and the relevant federal regulations to determine whether a breach of the standard of care occurred.

In addition, expert testimony is usually needed to prove causation and, in most instances, that expert must be a medical doctor.  Therefore, in many nursing home cases, the plaintiff must have two expert witnesses to prevail: a nursing home expert and a medical doctor. However, in some cases, the resident’s own doctor may testify that the breach caused the harm. This is especially common in cases involving fractures from falls and pressure ulcers.

Let Us Review Your Alabama Nursing Home Case

If your loved one has been hurt or killed as a result of a nursing home’s failures to follow the law, contact us today to schedule a free consultation. We have decades of experience handling lawsuits against nursing homes throughout Alabama.