Nursing Home Abuse – Nursing Facility Investigation and Reporting Requirements – South Carolina Nursing Home Abuse Attorney Nathan Hughey

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South Carolina nursing home abuse lawyer Nathan Hughey has handled hundreds of nursing home cases and teaches other lawyers regarding the array of regulations applicable to nursing home and other cases.  Here, Charleston nursing home attorney Nathan Hughey summarizes the requirements for reporting suspected abuse or neglect, and what happens when a person or facility fails to do so.

Under South Carolina law:

  • A facility/ person MUST report suspected abuse

  • This reporting is designed to provide the best protection from additional abuse or neglect to that resident or others, via an immediate and full investigation which is impartial.

  • Failure to report is not only a big deal, it can be criminal.


Attorney Nathan Hughey - Over $28 million in verdicts and settlements

Attorney Nathan Hughey – Over $28 million in verdicts and settlements


S.C. Code. Ann.  43-35-25. Persons required to report abuse, neglect, or exploitation of adult; reporting methods.

A physician, nurse. . . caregiver, staff or volunteer of an adult day care center or of a facility, or law enforcement officer having reason to believe that a vulnerable adult has been or is likely to be abused, neglected, or exploited shall report the incident . . .  personally . . . within twenty-four hours or the next working day.

If a person fails to do so, in addition to fines and penalties, as well as potential civil liability, criminal prosecution is a possibility.

S.C. Code. Ann. 43-35-80. Action by Attorney General against person or facility for failure to exercise reasonable care; fine.

Notwithstanding any regulatory or administrative penalty  . . . and in addition to a private civil cause of action  . . .the Attorney General, upon referral from the Long Term Care Ombudsman Program or the Vulnerable Adults Investigations Unit, may bring an action against a person who fails .[to report abuse or to prevent abuse] . . and this failure results in the commission of abuse, neglect, exploitation, or any other crime against a vulnerable adult in a facility.



DHEC‘s Division of Nursing Homes surveys Nursing Facilities and Skilled Nursing Facilities that participate in the Medicare and Medicaid programs.  These facilities are surveyed with unannounced site visits.  Survey teams include nurses, pharmacists, social workers, dieticians, and generalists.  The Division is divided into four program areas, each concerned with respective Medicare/Medicaid federal regulations.

DHEC does this both with respect to operating a nursing home in South Carolina in the first place as period, as well as authority delegated to it by federal regulations which come into play upon accepting Medicare / Medicaid money  by CMS (Centers for Medicare and Medicaid Services (fed govt).

One such federal regulation reads:

483(b) Abuse The resident has the right to be free from verbal, sexual, physical and mental abuse, corporal punishment, and involuntary seclusion.

Abuse – “The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.” (See 42 CFR Part 488.301.)

DHEC conducts certifications, recertifications, revisits, and complaint investigations.  The facilities are required to submit plans of correction and fix their behavior.

The federal gov’t issues various documents on the severity of regulation violations.  These can result in the nursing home being put in a status of “immediate jeopardy”  Immediate Jeopardy is interpreted as a crisis situation in which the health and safety of individual(s) are at risk.   Specifically, the federal regulation reads “A situation in which the provider’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.” (See 42 CFR Part 489.3.)

Per the federal gov’t’s “Guidelines to Surveyors”, “The goal of the survey process is to ensure the provision of quality care to all individuals receiving care or services from a certified Medicare/Medicaid entity. The identification and removal of Immediate Jeopardy, either psychological or physical, are essential to prevent serious harm, injury, impairment, or death for individuals.” Also, in the words of the federal government:

“Only ONE INDIVIDUAL needs to be at risk. Identification of Immediate Jeopardy for one individual will prevent risk to other individuals in similar situations.

• Serious harm, injury, impairment, or death does NOT have to occur before considering Immediate Jeopardy. The high potential for these outcomes to occur in the very near future also constitutes Immediate Jeopardy.”


In considering what to do, the surveyors analyze:

After determining that the harm meets the definition of Immediate Jeopardy, consider the following points regarding entity compliance:

  1. The entity either created a situation or allowed a situation to continue which resulted in serious harm or a potential for serious harm, injury, impairment or death to individuals.
  2. The entity had an opportunity to implement corrective or preventive measures.


The NUMBER ONE thing listed as an immediate jeopardy trigger is:

Issue Triggers
A Failure to protect from abuse.
  1. Serious injuries such as head trauma or fractures;
  2. Non-consensual sexual interactions; e.g., sexual harassment, sexual coercion or sexual assault;
    1. Unexplained serious injuries that have not been investigated;
    2. Staff striking or roughly handling an individual;
    3. Staff yelling, swearing, gesturing or calling an individual derogatory names;
    4. Bruises around the breast or genital area; or Suspicious injuries; e.g., black eyes, rope marks, cigarette burns, unexplained bruising.


Investigation – A Nursing Home’s Duty

The investigation must be conducted in an impartial, objective manner to obtain accurate data sufficient to support a reasonable conclusion.

(The facility can’t conduct an impartial investigation of itself.)

WHO:  Who was involved in the Immediate Jeopardy situation:  staff, individuals receiving care and services, and others?

Does the individual(s) at risk have special needs?   Has this happened to other individuals?  If yes, how many?  Are there others to whom this is likely to occur?  If so, how many and who?  Which entity staff knew or should have known about the situation?

WHAT:  What harm has occurred, is occurring, or most likely will occur?

How serious is the potential/actual harm?  How did the situation occur?  What was the sequence of events?  What attempts did the entity make to assess, plan, correct, and re- evaluate regarding the potential/actual harm?  What did the entity do to prevent any further occurrences of the same nature?

WHEN:  When did the situation first occur?

How long has the situation existed?  Has a similar occurrence happened before?  Has the entity had an opportunity to correct the situation?  Did the entity thoroughly investigate the event?   Did you agree with the facility’s conclusion after their investigation?  Did the entity implement corrective measures to prevent any further similar situations?  Did they follow up and evaluate the effectiveness of their measures?

WHERE:  Where did the potential/actual harm occur?  Is this an isolated incident or an entity wide problem?

WHY: Why did the potential/actual harm occur?

Was the Immediate Jeopardy preventable?  Is there a system in place to prevent further occurrences? Is this a repeat deficient practice?  Is there a pattern of similar deficient practices?

The government also outlines the facility’s reaction, which in this case, was a failure to report:


Components of Immediate Jeopardy

1.   Harm

a.   Actual – Was there an outcome of harm?  Does the harm meet the definition of Immediate Jeopardy, e.g., has the provider’s noncompliance caused serious injury, harm, impairment, or death to an individual?

b.    Potential – Is there a likelihood of potential harm?  Does the potential harm meet the definition of Immediate Jeopardy; e.g., is the provider’s noncompliance likely to cause serious injury, harm, impairment, or death to an individual?

2.   Immediacy – Is the harm or potential harm likely to occur in the very near future to this individual or others in the entity, if immediate action is not taken?  (Refer to the SOM §3010(B)(6) for timelines during normal termination.)


a.   Did the entity know about the situation?  If so when did the entity first become aware?

b.   Should the entity have known about the situation?

c.   Did the entity thoroughly investigate the circumstances?

d.   Did the entity implement corrective measures?

e.   Has the entity re-evaluated the measures to ensure the situation was corrected?

Note:                     The team must consider the entity’s response to any harm or potential harm that meets the definition of Immediate Jeopardy. The stated lack of knowledge by the entity about a particular situation does not excuse an entity from knowing and preventing Immediate Jeopardy.  The team should use knowledge and experience to determine if the circumstances could have been predicted.  The Immediate Jeopardy investigation should proceed until the team has gathered enough information to evaluate any prior indications or warnings regarding the jeopardy situation and the entity’s response. The crisis situations in which an entity did not have any prior indications or warnings, and could not have predicted a potential serious harm, are very rare.

1.   Report/ Respond

The facility or system must assure that any incidents of substantiated abuse and neglect are reported and analyzed, and the appropriate corrective, remedial or disciplinary action occurs, in accordance with applicable local, State or Federal law.


Nursing Homes

Regulation Authority – 483.13(c)(1)(iii), 483.13(c)(2), 483.13(c)(4)

Survey Guidance – Surveyors determine if: The facility has procedures to report all alleged violations and substantiated incidents to the State agency and to all other agencies, as required, and to take all necessary corrective actions, depending on the results of the investigation; report to State nurse aide registry or licensing authorities any knowledge it has of any action by a court of law which would indicate an employee is unfit for service, and analyze the occurrences to determine what changes are needed, if any, to policies and procedures to prevent further occurrences.

This is an overview of laws designed to protect those vulnerable adults in our society from neglect at nursing facilities.  If you have a #nursinghomeabuse claim or #nursinghomeneglect claim, contact a #southcarolinalawyer such as Nathan Hughey.  Mr. Hughey is rated AV Preeminent, the highest rating possible, in terms of legal ability and ethics.