Nursing homes wield pandemic immunity laws to duck wrongful death suits
This is a KFF Health News story.
In early 2020, with reports of COVID-19 outbreaks making dire headlines, Trever Schapers worried about her father's safety in a nursing home in Queens.
She had delighted in watching her dad, John Schapers, blow out the candles on his 90th birthday cake that February at the West Lawrence Care Center in the New York City borough. Then the home went into lockdown.
Soon her father was dead. The former union painter spiked a fever and was transferred to a hospital, where he tested positive for COVID, his daughter said, and after two weeks on a ventilator, he died in May 2020.
But when Trever Schapers sued the nursing home for negligence and wrongful death in 2022, a judge dismissed the case, citing a New York state law hastily passed early in the pandemic. It granted immunity to medical providers for "harm or damages" from an "act or omission" in treating or arranging care for COVID. She is appealing the decision.
"I feel that families are being ignored by judges and courts not recognizing that something needs to be done and changed," said Schapers, 48, who works in the medical field. "There needs to be accountability."
The nursing home did not return calls seeking comment. In a court filing, the home argued that Schapers offered no evidence that the home was "grossly negligent" in treating her father.
More than four years after COVID first raged through many U.S. nursing homes, hundreds of lawsuits blaming patient deaths on negligent care have been tossed out or languished in the courts amid contentious legal battles.
Even some nursing homes that were shut down by health officials for violating safety standards have claimed immunity against such suits, court records show. And some families that allege homes kept them in the dark about the health of their loved ones, even denying there were cases of COVID in the building, have had their cases dismissed.
Schapers alleged in a complaint to state health officials that the nursing home failed to advise her that it had admitted COVID-positive patients from a nearby hospital in March 2020. In early April, she received a call telling her the facility had some COVID-positive residents.
"The call I received was very alarming, and they refused to answer any of my questions," she said.
About two weeks later, a social worker called to say that her father had a fever, but the staff did not test him to confirm COVID, according to Schapers' complaint.
The industry says federal health officials and lawmakers in most states granted medical providers broad protection from lawsuits for good-faith actions during the health emergency. Rachel Reeves, a senior vice president with the American Health Care Association, an industry trade group, called COVID "an unprecedented public health crisis brought on by a vicious virus that uniquely targeted our population."
In scores of lawsuits, however, family members allege that nursing homes failed to secure enough protective gear or tests for staffers or residents, haphazardly mixed COVID-positive patients with other residents, failed to follow strict infection control protocols, and brazenly misled frightened families about the severity of COVID outbreaks among patients and staff.
"They trusted these facilities to take care of loved ones, and that trust was betrayed," said Florida attorney Lindsey Gale, who has represented several families suing over COVID-related deaths.
"The grieving process people had to go through was horrible," Gale said.
A deadly toll
KFF Health News found that more than 1,100 COVID-related lawsuits, most alleging wrongful death or other negligent care, were filed against nursing homes from March 2020 through March of this year.
While there's no full accounting of the outcomes, court filings show that judges have dismissed some suits outright, citing state or federal immunity provisions, while other cases have been settled under confidential terms. And many cases have stalled due to lengthy and costly arguments and appeals to hash out limits, if any, of immunity protection.
In their defense, nursing homes initially cited the federal Public Readiness and Emergency Preparedness Act, which Congress passed in December 2005. The law grants liability protection from claims for deaths or injuries tied to vaccines or "medical countermeasures" taken to prevent or treat a disease during national emergencies.
The PREP Act steps in once the secretary of Health and Human Services declares a "public health emergency," which happened with COVID on March 17, 2020. The emergency order expired on May 11, 2023.
The law carved out an exception for "willful misconduct," but proving it occurred can be daunting for families – even when nursing homes have long histories of violating safety standards, including infection controls.
Governors of at least 38 states issued COVID executive orders, or their legislatures passed laws, granting medical providers at least some degree of immunity, according to one consumer group's tally. Just how much legal protection was intended is at the crux of the skirmishes.
Nursing homes answered many negligence lawsuits by getting them removed from state courts into the federal judicial system and asking for dismissal under the PREP Act.
For the most part, that didn't work because federal judges declined to hear the cases. Some judges ruled that the PREP Act was not intended to shield medical providers from negligence caused by inaction, such as failing to protect patients from the coronavirus. These rulings and appeals sent cases back to state courts, often after long delays that left families in legal limbo.
"These delays have been devastating," said Jeffrey Guzman, a New York City attorney who represents Schapers and other families. He said the industry has fought "tooth and nail" trying to "fight these people getting their day in court."
Empire State epicenter
New York, where COVID hit early and hard, is ground zero for court battles over nursing home immunity.
Relatives of residents have filed more than 750 negligence or wrongful death cases in New York counties since the start of the pandemic, according to court data KFF Health News compiled using the judicial reporting service Courthouse News Service. No other area comes close.
Chicago's Cook County, a jurisdiction where private lawyers for years have aggressively sued nursing homes alleging poor infection control, recorded 121 COVID-related cases.
Plaintiffs in hundreds of New York cases argue that nursing homes knew early in 2020 that COVID would pose a deadly threat but largely failed to gird for its impact. Many suits cite inspection reports detailing chronic violations of infection control standards in the years preceding the pandemic, court records show. Responses to this strategy vary.
"Different judges take different views," said Joseph Ciaccio, a New York lawyer who has filed hundreds of such cases. "It's been very mixed."
Lawyers for nursing homes counter that most lawsuits rely on vague allegations of wrongdoing and "boilerplate" claims that, even if true, don't demonstrate the kind of gross negligence that would override an immunity claim.
New York lawmakers added another wrinkle by repealing the immunity statute in April 2021 after Attorney General Letitia James noted the law could give nursing homes a free pass to make "financially motivated decisions" to cut costs and put patients at risk.
So far, appeals courts have ruled lawmakers didn't specify that the repeal should be made retroactive, thus stymying many negligence cases.
"So these cases are all wasting the courts' time and preventing cases that aren't barred by immunity statutes from being resolved sooner and clogging up the court system that was already backlogged from COVID," said attorney Anna Borea, who represents nursing homes.
Troubled homes deflect suits
Some nursing homes that paid hefty fines or were ordered by health officials to shut down at least temporarily because of their inadequate response to COVID have claimed immunity against suits, court records show.
Among them is Andover Subacute and Rehabilitation nursing home in New Jersey, which made national headlines when authorities found 17 bodies stacked in a makeshift morgue in April 2020.
Federal health officials fined the facility $220,235 after issuing a critical 36-page report on COVID violations and other deficiencies, and the state halted admissions in February 2022.
Yet the home has won court pauses in at least three negligence lawsuits as it appeals lower-court rulings denying immunity under the federal PREP Act, court records show. The operators of the home could not be reached for comment. In court filings, they denied any wrongdoing.
In Oregon, health officials suspended operations at Healthcare at Foster Creek, calling the Portland nursing home "a serious danger to the public health and safety." The May 2020 order cited the home's "consistent inability to adhere to basic infection control standards."
Bonnie Richardson, a Portland lawyer, sued the facility on behalf of the family of Judith Jones, 75, who had dementia and died in April 2020. Jones' was among dozens of COVID-related deaths at that home.
"It was a very hard-fought battle," said Richardson, who has since settled the case under confidential terms. Although the nursing home claimed immunity, her clients "wanted to know what happened and to understand why." The owners of the nursing home provided no comment.
No COVID Here
Many families believe nursing homes misled them about COVID's relentless spread. They often had to settle for window visits to connect with their loved ones.
Relatives of five patients who died in 2020 at the Sapphire Center for Rehabilitation and Nursing in the Flushing neighborhood in Queens filed lawsuits accusing the home's operators of keeping them in the dark.
When they phoned to check on elderly parents, they either couldn't get through or were told there was "no COVID-19 in the building," according to one court affidavit.
One woman grew alarmed after visiting in February 2020 and seeing nurses wearing masks "below their noses or under their chin," according to a court affidavit.
The woman was shocked when the home relayed that her mother had died in April 2020 from unknown causes, perhaps "from depression and not eating," according to her affidavit.
A short time later, news media reported that dozens of Sapphire Center residents had died from the virus – her 85-year-old mother among them, she argued in a lawsuit.
The nursing home denied liability and won dismissal of all five lawsuits after citing the New York immunity law. Several families are appealing. The nursing home's administrator declined to comment.
Broadening immunity
Nursing home operators also have cited immunity to foil negligence lawsuits based on falls or other allegations of substandard care, such as bedsores, with little obvious connection to the pandemic, court records show.
The family of Marilyn Kearney, an 89-year-old with a "history of dementia and falls," sued the Watrous Nursing Center in Madison, Connecticut, for negligence. Days after she was admitted in June 2020, she fell in her room, fracturing her right hip and requiring surgery, according to court filings.
She died at a local hospital on Sept. 16, 2020, from sepsis attributed to dehydration and malnutrition, according to the suit.
Her family argued that the 45-bed nursing home failed to assess her risk of falling and develop a plan to prevent that. But Watrous fired back by citing an April 2020 declaration by Connecticut Gov. Ned Lamont, a Democrat, granting health care professionals or facilities immunity from "any injury or death alleged to have been sustained because of the individual's or health care facility's acts or omissions undertaken in good faith while providing health care services in support of the state's COVID-19 response."
Watrous denied liability and, in a motion to dismiss the case, cited Lamont's executive order and affidavits that argued the home did its best in the throes of a "public health crisis, the likes of which had never been seen before." The operators of the nursing home, which closed in July 2021 because of COVID, did not respond to a request for comment. The case is pending.
Attorney Wendi Kowarik, who represents Kearney's family, said courts are wrestling with how much protection to afford nursing homes.
"We're just beginning to get some guidelines," she said.
One pending Connecticut case alleges that an 88-year-old man died in October 2020 after experiencing multiple falls, sustaining bedsores, and dropping more than 30 pounds in the two months he lived at a nursing home, court records state. The nursing home denied liability and contends it is entitled to immunity.
So do the owners of a Connecticut facility that cared for a 75-year-old woman with obesity who required a lift to get out of bed. She fell on April 26, 2020, smashing several teeth and fracturing bones. She later died from her injuries, according to the suit, which is pending.
"I think it is really repugnant that providers are arguing that they should not be held accountable for falls, pressure sores, and other outcomes of gross neglect," said Richard Mollot, executive director of the Long Term Care Community Coalition, which advocates for patients.
"The government did not declare open season on nursing home residents when it implemented COVID policies," he said.
Protecting the vulnerable
Since early 2020, U.S. nursing homes have reported more than 172,000 residents' deaths, according to Centers for Medicare & Medicaid Services data. That's about one in seven of all recorded U.S. COVID deaths.
As it battles COVID lawsuits, the nursing home industry says it is "struggling to recover due to ongoing labor shortages, inflation, and chronic government underfunding," according to Reeves, the trade association executive.
She said the American Health Care Association has advocated for "reasonable, limited liability protections that defend staff and providers for their good faith efforts" during the pandemic.
"Caregivers were doing everything they could," Reeves said, "often with limited resources and ever-changing information, in an effort to protect and care for residents."
But patients' advocates remain wary of policies that might bar the courthouse door against grieving families.
"I don't think we want to continue to enact laws that reward nursing homes for bad care," said Sam Brooks, of the Coalition for the Protection of Residents of Long-Term Care Facilities, a patient advocacy group.
"We need to keep that in mind if, God forbid, we have another pandemic," Brooks said.
Bill Hammond, a senior fellow at the Empire Center for Public Policy, a nonpartisan New York think tank, said policymakers should focus on better strategies to protect patients from infectious outbreaks, rather than leaving it up to the courts to sort out liability years later.
"There is no serious effort to have that conversation," Hammond said. "I think that's crazy."
