Parsons et al v. Ryan et al

Filing 3596

ORDER Defendants' remedial plan for PM 44 at Tucson (Doc. 3585 ) is accepted. See attachment for details. Signed by Senior Judge Roslyn O Silver on 5/19/2020. (CLB)

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WO

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IN THE UNITED STATES DISTRICT COURT

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FOR THE DISTRICT OF ARIZONA

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Victor Antonio Parsons, et al.,
Plaintiffs,

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ORDER

v.

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No. CV-12-00601-PHX-ROS

David Shinn,

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Defendant.

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Pursuant to the Stipulation, Performance Measure 44 requires that “[i]nmates

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returning from an inpatient hospital stay or ER transport with discharge recommendations

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from the hospital shall have the hospital’s treatment recommendations reviewed and acted

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upon by a medical provider within 24 hours.” (Doc. 1185-1 at 24.) The Court found PM

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44 at Tucson substantially noncompliant on April 23, 2020. (Doc. 3574.) In compliance

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with Paragraph 36 of the Stipulation (Doc. 1185 ¶ 36), before the Court gains the power to

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enforce compliance, the Court is required to first provide Defendants an opportunity to

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develop a remedial plan to bring the measure into compliance. Defendants’ remedial plan

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for PM 44 is as follows:

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Basis of Non-Compliance:
Providers are not documenting rationale for changing medications and are
not placing consults within timeframe. Additionally, providers need to sign
off on nursing note forwarded to them for review.

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Corrective Action Plan:
This PM is monitored daily to determine if documentation was completed

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correctly. On identifying a non-compliant chart, the provider is alerted to the
discrepancies or need for further explanation, and documentation is entered
to ensure compliance. The SMD [Site Medical Director] discussed continued
vigilance at provider meetings on 08/27/2019 and 10/09/2019. The SMD
continued to provide the providers education on 03/10/2020 during a meeting
to help clarify lingering issues. The education provided included the
following: 1) All discharge recommendations must be reviewed and acted
upon within 24 hours; 2) Any deviations from recommendations to include
but not limited to medication orders and consult referrals must state a reason
for the deviation; 3) All consult recommendations must be entered within the
24-hour timeframe; and 4) Lab orders and medication orders must be entered
within the 24-hour timeframe. This education was provided via PowerPoint
presentation as well as email communication.
(Doc. 3585)

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The Stipulation requires the remedial plan be “approved by the Court.” While this

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may grant the Court the authority to reject a proposed remedial plan as insufficient, the

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Court will accept this remedial plan with the following observations.

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It has now been over five years since Defendants agreed to perform PM 44. But

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even before the Court found PM 44 at Tucson substantially noncompliant in April 2020,

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noncompliance was persistent. The Court is concerned that a remedial plan that simply

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provides education to healthcare staff about the fundamental requirements of PM 44 may

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not have a meaningful chance of success. If Defendants believe their remedial plan

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represents their best effort to bring this measure into compliance, the Court is not presently

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in a position to second-guess that belief. Like all other PMs, however, if this remedial plan

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does not prove successful, the Court is obligated by the terms of the Stipulation to pursue

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“all remedies provided by law” to bring PM 44 into compliance.

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IT IS ORDERED Defendants’ remedial plan for PM 44 at Tucson (Doc. 3585) is
accepted.
Dated this 19th day of May, 2020.

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Honorable Roslyn O. Silver
Senior United States District Judge

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