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2 hurdles left for nursing home bill


© St. Petersburg Times, published May 3, 2001

TALLAHASSEE -- The fate of a heavily lobbied bill to end headline-grabbing judgments against nursing homes is headed into the final days of the legislative session.

TALLAHASSEE -- The fate of a heavily lobbied bill to end headline-grabbing judgments against nursing homes is headed into the final days of the legislative session.

The nursing home package, which includes a $4-million cap on punitive damages in most cases and a dramatic increase in staffing requirements, passed the House Wednesday. It must clear the Senate before heading to Gov. Jeb Bush for his signature.

"It's been a long, long, long journey," said bill sponsor Rep. Carole Green, R-Fort Myers. "My child may not be beautiful, but by golly it's a pretty darn good child."

This is the third year in a row lawmakers have tried to stem the flow of lawsuits against nursing homes and mandate higher standards for care. The fight pits nursing home operators, who complain that lawsuits are driving them into financial ruin, against trial attorneys, who argue that they wouldn't sue if nursing homes took better care of their residents.

A task force appointed by Gov. Bush last year failed to come up with a set of recommendations, and a heavily financed media campaign has saturated the airwaves with commercials urging the elderly and their families to contact lawmakers.

The bill has taken a number of twists and turns this year in the Legislature, including one Wednesday when Rep. Nancy Argenziano, a Dunnellon Republican, sent 25 pounds of cow manure to Associated Industries of Florida lobbyist Jodi Chase. Argenziano opposed Chase on the litigation element of the nursing home bill.

Argenziano voted against the bill Wednesday, saying she couldn't support the caps on punitive damages.

"To me, that is just giving relief to the very worst" nursing homes, Argenziano said.

Under the Senate bill, the state would set up an insurance pool to cover some nursing homes that could not find coverage elsewhere. Nursing home operators have complained that insurance companies are raising their premiums and leaving the state because of high lawsuit awards.

The House bill does not include the state insurance pool.

Both bills provide about $60-million to improve quality of care, although they spend it in slightly different ways. For example, the House version requires nursing homes to develop a policy for handling complaints from residents and their families.

And although both chambers eventually require the same level of staffing (about five or six residents per nursing assistant), the House bill requires that level sooner and has an interim deadline to boost staffing to about eight residents per assistant. House lawmakers would allow nursing homes that haven't been cited by the state for serious errors in the past 21/2 years to skip the interim deadline.

Sen. Ginny Brown-Waite, a Brooksville Republican and chief architect of the Senate bill, said she didn't think any of the bills' differences would threaten the package. Brown-Waite said she could live without a state insurance pool, for example, but thinks the labor market won't cooperate with the House's requirements on staffing.

"There's a (nursing assistant) shortage," Brown-Waite said.

The two versions differ little on litigation limits, although the House simply adopted the agreements worked out in the Senate, according to House Speaker Tom Feeney.

Some of those restrictions include:

Capping punitive damages between $1-million and $4-million for most cases. The plaintiff must prove that the nursing home was "primarily" motivated by unreasonable financial gain to qualify for the upper level. There's no cap on punitive damages in cases where the nursing home is found to have "intended" to harm the resident.

Requiring plaintiffs to give nursing homes 75 days' warning that they plan to sue. Both sides are urged to reach a settlement during that time. Attorney's fees are sharply curtailed, and the law is retroactive.

In addition to boosting staffing levels, the quality of care elements of the bill House members approved Wednesday include:

Requiring homes to have internal risk management policies and report residents' injuries to the state.

Homes that have been repeatedly cited by the state can lose their licenses, and increased licensing fees would pay for surprise inspections every quarter.

"This makes it easier to shut down bad facilities," Green said, the House sponsor.

Requiring a state study on the use of "granny cams,' surveillance cameras loved ones can use to keep an eye on their relatives from far away. It also restricts state approval of big increases in nursing home beds until 2006.

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