After being chartered in 1891 and opened to the public four years later, the New Orleans Home for the Incurables quickly became the kind of place where baskets containing babies would be left on the doorstep in the dead of night. Over time, it also offered refuge to individuals afflicted with terminal illnesses. Its original name was no accident, even if the sound of it today causes health professionals to cringe.
For almost nine decades, the home operated as a private, nonprofit, nondenominational facility of last resort. It remained that until 1978, when the state of Louisiana bought it. The state quickly dropped the "incurables" label and renamed it the New Orleans Home and Rehabilitation Center.
The institution's honeymoon with the state didn't last very long, however.
Several governors have tried to sell off or transfer the property. The task of pushing back fell upon then-state Sen. John Hainkel, whose district included the home. Thanks to Hainkel's longevity in the Legislature, he was able to keep the center open during his lifetime and protect it from deep budget cuts.
When Hainkel died in 2005, state lawmakers renamed the facility the John J. Hainkel Jr. Home and Rehab Center, known locally as the Hainkel Home. At the same time, Bobby Jindal, then a congressman from Jefferson Parish, also convinced Congress to rename the Hammond post office in Hainkel's honor.
Today the Hainkel Home is one of the few remaining options for Medicaid and Veterans Administration patients in the New Orleans area — but it has no champion with Hainkel's legendary clout. Jindal, now in his second term as Louisiana's governor, wants to shutter the facility and sell it off.
But last week, Team Jindal's efforts to shut down and sell the home — part of what the governor's critics claim is a calculated, sustained effort to sell off and/or privatize public health care facilities — were themselves shuttered by a higher order. U.S. District Judge Nannette Jolivette Brown issued a preliminary injunction barring Jindal's top health care administrator, Department of Health and Hospitals (DHH) Secretary Bruce Greenstein, from fast-tracking efforts to close the home.
In a 46-page opinion and order, Brown agreed with attorneys for the home that the state was moving improperly against the facility. Specifically, Brown prohibited Greenstein from terminating the facility's Medicaid provider agreement without first allowing the home's private, nonprofit operator to "exhaust all review and appeals regarding [its] nursing home license revocation and then only if supported by a final decision."
In addition, Brown's order prohibits Greenstein from requiring the Hainkel Home to notify its residents of any potential nursing home license revocation or termination of its Medicaid provider agreement "unless and until all administrative and judicial review and appeals have been exhausted, and only if a final decision supports such action."
"For the first time, someone has put the brakes on Bobby Jindal's war on public health care," said Hainkel Home attorney James Cobb. "This is a wonderful Thanksgiving Day gift for the home and its 82 residents, most of whom are frail, sick and elderly."
While the court victory was no doubt satisfying, the fight over the Hainkel Home's future is far from over. A preliminary injunction does not permanently bar action against the home — and Brown's order leaves open the possibility of administrative action by the state against the facility.
Still, Cobb is correct when he says Brown's order is the first time someone has been able to sidetrack Jindal's "juggernaut" against public health care facilities. The story leading up to the home's court victory last week offers a glimpse into how state health officials can use their sweeping regulatory powers to make life difficult for facilities not in their favor.
In June, the state DHH cited a number of violations at the home and moved to terminate the institution's Medicaid provider agreement and revoke its nursing home license.
The alleged violations, however, only went back to 2011, which is when the Legislature voted to lease the home to a nonprofit. Cobb, the home's attorney, says many of the deficiencies the state cited at the home were attributable to the transition process — and they have since been corrected. Cobb adds that prior to the lease agreement "the state had neglected the facility for years."
Without the home, 135 local jobs will be lost and more than 80 patients will have nowhere to go in the city. "These patients are disabled, sick, mentally challenged," Cobb says. "No one else wants them." The patients, mostly Medicaid funded, are difficult to place because of low Medicaid reimbursement rates. He adds that such patients also are challenging to discharge.
So why would the state want to shut down the Hainkel Home and displace patients like that?
There are whispers of a land grab, but that's unsubstantiated chatter. Some say it's part of an ongoing effort by the Jindal Administration to privatize state health care services, but the facility already is operated by a private nonprofit. Moreover, closure would cost the state $400,000 a year in rent from that operator.
On the other hand, the home's Medicaid patients could be transferred to the state-run facility in Jackson, La., 115 miles north of New Orleans in East Feliciana Parish. The Jackson facility is among the closest that could take the home's patients. Under this scenario, the state could capture a Medicaid revenue stream of $4.8 million a year — $155 per day for every patient — even though the Jindal Administration has made refusing additional Medicaid dollars a political badge of honor for the governor, who staunchly opposes President Barack Obama's Affordable Care Act.
Asked about possible relocations plans, DHH public information officer Ken Pastorick says that process would start with a meeting with residents [and] family members to provide information about the transfer process, other area nursing homes with available Medicaid beds, and eligibility questions. Such a meeting, however, is precisely what Judge Brown has barred Greenstein from requiring.
Meanwhile, state officials are quick to cite recent complaints and inspections when explaining why the home needs to be shuttered. The record, however, shows relatively minor deficiencies and no life-threatening problems. Consider the following time line:
• May 11, 2011: Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.
• June 13, 2011: The home was cited with 21 minor deficiencies, including incidents related to personal care, grooming and medicine orders. Home officials say some of the deficiencies were inherited from the state during the recent leasing process, all of them were easily corrected, and no residents were harmed in any way. The deficiencies were eventually cleared from the home's record.
• Oct. 19, 2011: One deficiency was noted because of a lack of content in the clinical record. Staff say it occurred when a nurse contacted a physician to pass along a complaint from a patient and did not record the physician's response. Home officials say a plan of correction was implemented. The deficiency was eventually cleared from the home's record.
• Oct. 28, 2011: Deficiencies were noted but later cleared by the state for restricting hours for bathing and "failing to request clarification of a physician's order for therapy." Home officials say they made patients aware that bathing could take place at any time and they identified the error in communications that led to the complaint. The violation has not occurred again.
• Dec. 2, 2011: Home officials admit to an "isolated incident" of a bath burn. They say training helped correct he error, as did a new boiler, which they say the state "refused" to replace prior to 2011. The related deficiencies were eventually cleared from the home's record.
• Dec. 9, 2011: Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.
• Dec. 21, 2011: The home was cited for a violation for "failure to report an investigation of alleged neglect." The deficiency was later cleared and home officials say the alleged violation did not occur the way DHH was initially led to believe.
• March 6, 2012: The home was cited with two deficiencies related to weight and nutrition. Officials say base weights of certain patients were not timely taken; new policies were implemented and the deficiencies have been cleared.
• April 18, 2012: Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.
• June 8, 2012: A deficiency was noted after a complaint of theft from a resident. The home's business office manager was terminated and the deficiency was cleared.
• Aug. 10, 2012: Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.
• Sept. 9, 2012: Hainkel Home underwent a complaint inspection by DHH. No deficient practices were identified.
Officials with the home's private operator say DHH has more or less been picking on the home and unfairly targeting its operations. They contend the state's efforts culminated when officials tried to close the home last June without due process, which is how the parties ended up in court. Judge Brown's order now requires the due process that the home's operators demanded.
Supporters likewise point to other facilities, such as Plaquemine Manor Nursing Home in Iberville Parish, which had deficiencies this year, in 2010 and in 2009. Those deficiencies allegedly put residents in "immediate jeopardy to their health or safety," attorney Cobb wrote in a federal court brief seeking Brown's order. The state has made no attempt to close the Plaquemine facility. Then there's Chateau Terrebonne in Houma, which "has an overall rating, a health inspection rating and a staffing rating of 'much below average,'" according to the same court documents.
On Nov. 10, DHH wanted to move forward with terminating the home's Medicaid provider agreement and revoking its nursing home license. But that date came and went with no action against the home — because at that time Judge Brown was still considering the home's request for a preliminary injunction.
The judge's decision last week means the state will have to start over in its attempt to shut down the home and sell it.
In addition to sparing the home's residents of the specter of having to relocate during the holiday season, Cobb says the most important aspect of Brown's ruling is that "the jobs of 130 New Orleans citizens will be saved.
"All of our employees are loving and caring, and to have them thrown out of a job during this holiday season would have been catastrophic for them all," Cobb says. "The larger question is, why is our state government at war with its own citizens and trying to create more unemployment in these hard times?"