A lawsuit was filed against a home health agency by several elderly and disabled Medicare beneficiaries who had been receiving home health services.

   The lawsuit alleged the clients were essentially being "dumped" and abandoned by the agency as a result of recent changed to Medicare reimbursement rules. The clients contended the agency’s refusal to continue to provide medically necessary home health care services was based upon the simple fact the clients were all heavy service users and economically undesirable to the agency.

   The U.S. District Court for the Middle District of Tennessee validated the clients’ right to sue their home health agency. The court issued an immediate injunction against the home health agency prohibiting the corporation and its officers, agents, employees and attorneys from discontinuing home health services to the clients, pending a full trial on the legal issues, and the court referred the case to the attention of a special court magistrate for customized case management.

   The court had explicit testimony from a management employee of the agency that changes in Medicare reimbursement rules were the core reason the agency wished to drop certain unprofitable clients.

   The court noted that one client was insulin dependent. In the court’s judgment it was not appropriate for this client’s son, a sanitation worker with no medical training, to administer insulin shots to his mother. The court heard testimony from a nurse that in hospitals it is customary for two nurses to be involved in the task of drawing insulin to be administered to a patient. The fact this client needed insulin on a daily basis was just one example which impressed the court with the need for an immediate injunction to preserve the clients’ continued access to necessary services.

   The court was able to find multiple legal rationales for its decision. First, the clients fit the legal definition of homebound. The court relied on nursing testimony and nursing documentation to conclude the clients were by law homebound. The court did not see a need in this case to elaborate upon the legal definition of homebound status.

   Second, it is illegal discrimination for a home health agency to deny services to clients who are heavy users of care. The court looked to the Rehabilitation Act of 1973. That Federal law makes it illegal for any program receiving Federal funding to discriminate against disabled persons.

   There are well established legal precedents, the court said, that programs serving the educational needs of the developmentally disabled, that is, programs that serve only the disabled, may not discriminate among the disabled whom they serve based upon the severity of their disabilities. The court applied this rationale to the home health care field.

   Third, the home health agency had a contract with its clients to provide services. The agency had no legal right arbitrarily and unilaterally to suspend its own obligations under the contract, simply because it was no longer profitable, the court said.

   Fourth, the court ruled the clients had the right to sue for intentional infliction of emotional distress. Under the common law, this requires a finding the defendant’s conduct rose to level of being outrageous and utterly intolerable in civilized society. However, the court would defer to a jury’s decision whether or not to award damages.

   Lastly, the court ruled it was not necessary for the clients to bring in the Health Care Financing Administration (HCFA) as a defendant in the lawsuit. The lawsuit did not involve a decision by HCFA, only a decision by a private corporation which received HCFA funding through a state intermediary. According to the court, the complex procedural rules for challenging an administrative decision from HCFA were not hoops through which these clients had to jump in order to go forward with their lawsuit. Winkler v. Services, 36 F. Supp. 2d 1026 (M.D. Tenn., 1999).