US District Court Allows Section 1983 Claim to Proceed Against Nursing Home

US District Court Allows Section 1983 Claim to Proceed Against Nursing Home

Karen Ann Houpt was a patient of Moss Rehab Elkins Park Acutecare, where she was receiving treatment for multiple conditions, including a pulmonary embolism. During the course of treatment, Ms. Houpt lost a substantial amount of weight and developed four pressure ulcers. On July 2, 2018, Ms. Houpt was discharged to Fair Acres Geriatric Center (“Fair Acres”), a nursing home owned and operated by the County of Delaware. At this time, she weighed approximately 200 pounds and had no pressure ulcers. 

By Oct. 10, 2018, Ms. Houpt weighed 175 pounds and by Jan. 9, 2019, she weighed 166 pounds. Moreover, by July 20, 2018, Ms. Houpt developed an "unstageable" pressure ulcer on her sacral area and, by Jan. 10, 2019, she had developed nine pressure ulcers. On Jan. 10, 2019, Ms. Houpt was discharged from Fair Acres, and died approximately three weeks later.

Bethany Ann Alexander, Ms. Houpt’s daughter, filed a wrongful death and survival action against Fair Acres in the United States District Court for the Eastern District of Pennsylvania at Civil Action No. 20-2550. Ms. Alexander claimed that Fair Acres’staff acknowledged Ms. Houpt's weight loss, and the development of pressure ulcers and failed to take reasonable and medically necessary steps to help her. Furthermore, Ms. Alexander alleged that Fair Acres concealed the extent of Ms. Houpt's injuries from her family and failed to timely refer her to a hospital once it was clear she required emergency care. Ms. Alexander claimed that the Fair Acres’ negligence was a proximate cause of Ms. Houpt’s death from sepsis, malnutritionand dehydration, which were caused by Fair Acres' policy and custom of "understaffing" and failing to give adequate medical care to its residents. In addition to negligence claims, Ms. Alexander brought two § 1983 claims against Fair Acres.

Fair Acres moved to dismiss wrongful death and survival claims under 42 U.S.C. § 1983, arguing the federal statutes and regulations cited by Ms. Alexander do not create an "individual right" that can be remedied through a § 1983 claim. Fair Acres also argued that Ms. Alexander did not allege facts sufficient to support a claim that Fair Acres acted with "deliberate indifference," as required for a § 1983 claim against a municipality.

The Court determined that Fair Acres' first argument was incongruent with United States’ Third Circuit Court of Appeal’s decision in Grammer v. John J. Kane Regional Centers-Glen Hazel, 570 F.3d 520, 532 (3d Cir. 2009). In Grammer, the Third Circuit Court of Appeals applied the test the U.S. Supreme Court has prescribed for determining whether Congress intended for a statute to confer "individual rights," such that injured parties may sue for noncompliance via § 1983. Id. at 525-26 (citing Blessing v. Freestone, 520 U.S. 329 (1997)Gonzaga Univ. v. Doe, 536 U.S. 273 (2002)). Ultimately, the Third Circuit Court of Appeals concluded that the Federal Nursing Home Reform Amendments ("FNHRA"), which sets out standards of care that medical facilities receiving federal funds must comply with, does "confer individual rights that are presumptively enforceable through § 1983." Grammer, 570 F.3d at 532

In addressing Fair Acres’ second argument, i.e., the Complaint did not sufficiently allege deliberate indifference, the court notedcircumstances in which "the acts of a government employee may be deemed to be the result of a policy or custom of the governmental entity for whom the employee works, thereby rendering the entity liable under § 1983." Robinson v. Fair Acres Geriatric Ctr., 722 F. App'x 194, 198 (3d Cir. 2018) (quoting Natale v. Camden Cty. Corr. Facility, 318 F.3d 575, 584 (3d Cir. 2003)). The circumstance particular to this case states "the policymaker has failed to act affirmatively at all, [though] the need to take some action to control the agents of the government is `so obvious, and the inadequacy of existing practice so likely to result in the violation of constitutional rights, that the policymaker can reasonably be said to have been deliberately indifferent to the need." Natale, 318 F.3d at 584 (quoting Bd. of Cty, Comm'rs of Bryant Cnty., Okla. v. Brown, 520 U.S. 397, 417 (1997) (Souter, J., dissenting)). Thus, the court held to prove deliberate indifference, Ms. Alexander must show that Fair Acres "continued [to adhere] to an approach that they know or should know has failed to prevent tortious conduct by employees." Id. (quoting Bryan Cty., 520 U.S. at 407). "Additionally, `for liability to attach in this circumstance, the identified deficiency in a [municipality's] training program must be closely related to the ultimate injury." Id. (quoting City of Canton v. Harris, 489 U.S. 378, 391 (1989)).

After analyzing the facts pled and the relevant law, the court denied Fair Acres’ motion to dismiss finding Ms. Alexander to have pled sufficient facts to support a showing or deliberate indifference and supporting a § 1983 claim. Specifically, Ms. Alexander alleged that Ms. Houpt's continuously worsening pressure ulcers were known to Fair Acres, and often ignored, and even actively concealed, resulting in a deadly blood infection. Thus, in the court’s view, it was reasonable to infer the care provider was deliberately indifferent to the resident’s needs. 

Fair Acres also asked the court to limit the amount of damages recoverable by Ms. Alexander, claiming there was no legal support requiring Fair Acres to pay Ms. Alexander's counsel fees and costs. The court disagreed holding that § 1983 permits recover of counsel fees and costs unless special circumstances would render such an award unjust. Curran v. Se. Pa. Transp. Auth., 109 F. Supp. 2d 394, 396 (E.D. Pa. 2000) (quoting Newman v. Figgie Park Enters., Inc., 390 U.S. 400, 402 (1968)). Therefore, the Court denied Fair Acres' motion to strike Ms. Alexander's claim for costs of suit and attorneys' fees at that time.


The United States District Court for the Eastern District of Pennsylvania allowed a Section 1983 claim against a nursing home to proceed. Ty Smith explains.