OCR Letter of Findings

DEPARTMENT OF HEALTH & HUMAN SERVICES
OFFICE OF THE SECRETARY

Office for Civil Rights, Region IX
7th Street, Suite 4-100
San Francisco, California 94103

Abby Tiller
Chief Executive Officer
A. T. Associates
1355 Willow Way, Suite 264
Concord, California 94520

[COMPLAINANT’S NAME REDACTED]

Dear Ms. Tiller and [Complainant]:

This is to advise you that the Office for Civil Rights (OCR) of the U. S. Department of Health and Human Services (HHS) has completed its investigation of the discrimination complaint filed by the Complainant, an African-American veteran of the United States Armed Forces. The Complainant alleges that the Oakridge Care Center, Inc., a skilled nursing facility, denied him admission based on his disability (HIV/AIDS) and his age (50), in violation of Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. Section 794 (Section 504), and the Age Discrimination Act of 1975, as amended, 42 U.S.C. Section 6101 et seq. (Age Discrimination Act).

The Oakridge Care Center, Inc. (OCC) (99 beds), the Berkeley Pines Care Center, Inc. (BPCC (36 beds), and the Pittsburg Care Center, Inc. (PCC) (49 beds) are all skilled nursing facilities owned by A. T. Associates, Inc. Abbey Tiller is the proprietor and chief executive officer of A. T. Associates.

Legal Authority

OCR conducted this investigation pursuant to its authority to enforce Section 504 and its implementing regulation, 45 CFR Part 84, which prohibit discrimination on the basis of disability, and the Age Discrimination Act and its implementing regulation, 45 CFR Part 91, which prohibit discrimination on the basis of age, by recipients of HHS funding. As recipients of HHS funds, OCC, BPCC, and PCC are subject to the requirements of Section 504 and the Age Discrimination Act.

Background

The Complainant had hip replacement surgery at the Veterans Administration Medical Center (VA) in San Francisco, California, and required post-operative rehabilitation at a skilled nursing facility. The VA determined that OCC, a skilled nursing facility in Oakland, where the Complainant lived, would be an appropriate placement. On or about June 15, 2004, a VA social worker provided OCC staff with information on the Complainant’s medical condition, HIV status, need for short-term recovery, and VA financial reimbursement eligibility.

On or about June 17, 2004, OCC staff returned the VA social worker’s call requesting that the Complainant be admitted by OCC. During the call, OCC staff left a message on the VA social worker’s answering machine stating that OCC would not accept the Complainant for admission because he was too young and HIV positive.

The Complainant was eventually admitted to another skilled nursing facility located in San Francisco. He filed this complaint with OCR on October 12, 2004.

A. T. Associates denies that it engaged in any discriminatory practices in refusing admission to the Complainant to OCC. A. T. Associates also denies that it violated Section 504 or the Age Discrimination Act.

In order to resolve this matter, A. T. Associates, Inc., on behalf of its facilities, OCC, BPCC, and PCC, has assured OCR of its intention not to discriminate against persons on the basis of HIV status or age. In addition, A. T. Associates, Inc., has provided documentation to OCR that it has voluntarily taken the following corrective actions:

Corrective Actions Taken

1. On August 15, 2005, September 7, 2005, and March 16, 2006, OCC provided training to its staff on universal precautions for infectious diseases.
2. Since 2006, OCC has admitted four patients with HIV/AIDS.
3. OCC has notified discharge planners at its major referral sources (Extended Care Information Network, the San Francisco VA Medical Center, Kaiser Permanente and other private facilities) that it has a nondiscrimination policy and that it admits otherwise qualified persons with HIV/AIDS.

4. On or about December 21, 2006, OCC placed the following policy in its brochure for prospective patients:

   Pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, and their implementing regulations, Oakridge Care Center does not discriminate in the provision of services and/or employment because of race, religion, color, national origin, disability, age [or] sex….

    

5. On August 22, 2006, A. T. Associates’ Chief Executive Officer, Abby Tiller, and her senior staff, received on-site technical assistance from OCR representatives.
6. A. T. Associates’ senior staff received additional technical assistance from OCR on December 20, 2006, January 5, 2007, and March 28, 2007.
7. On April 18, 2007, Ms. Tiller implemented the following policy at A. T. Associates, OCC, BPCC, and PCC:

Policy and Procedure for Admitting Residents with HIV

POLICY:

It is the policy of A. T. Associates, Berkeley Pines Care Center, Oakridge Care Center, and Pittsburg Care Center that we do not discriminate on the basis of race, color, national origin, age, or disability, including HIV/AIDS, and comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975.

PROCEDURE:

If the facility receives a referral for admission on a resident that has a diagnosis of HIV/AIDS, the facility must notify Abby Tiller, CEO, if the proposed referral is being denied. The facility must provide specific documentation or justification that the proposed denial of admission is based on legitimate nondiscriminatory factors, such as failure to meet nondiscriminatory eligibility criteria, and is not based solely on the individual’s HIV status.

The above-stated policy and procedure will be re-issued annually to all staff involved in decisions regarding admission at each facility. Any questions regarding this issue shall be addressed to the CEO, who will provide any training that is necessary.

There will be no less than an annual mandatory in-service given to all patient care staff regarding care for residents who carry blood-borne pathogens.

8. On August 8, 9, and 16, 2007, A. T. Associates required all employees of OCC, BPCC, and PCC to attend an annual mandatory in-service training, which included presentations on: (1) A. T. Associates’ nondiscrimination policy; (2) A. T. Associates’ policy and procedure for admitting persons with HIV/AIDS; (3) the use of universal precautions in patient care; and (4) the protection of the health information privacy of patients and applicants for admission to OCC, BPCC, and PCC.

Conclusions

As a result of the corrective actions taken by A. T. Associates, Inc., the Oakridge Care Center, Inc., the Berkeley Pines Care Center, Inc., and the Pittsburg Care Center, Inc., OCR has closed this case. These corrective actions do not address the Complainant specifically because he no longer requires care at a skilled nursing facility.

The closure of this case is not intended and should not be construed to cover any other issues regarding compliance with Section 504 or the Age Discrimination Act that may exist but were not specifically addressed during our investigation.

OCR shall place no restriction on the publication of the contents of this letter and may release this document and related materials consistent with the Freedom of Information Act, 5 U.S.C Section 522, and its implementing regulation 45 CFR Part 5.

Thank you for your cooperation. If you have any questions, please do not hesitate to contact Brock S. Evans, Senior Equal Opportunity Specialist, at (213) 534-1431, x104, or myself at (415) 437-8310.

Sincerely,

/s/ Michael F. Kruley 09/11/2007
Michael F. Kruley
Regional Manager