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The “Reasonable Licensee” Defense – When Things Go Wrong Despite A Health Facility’s Reasonable Steps To Do Things Right

The California Court of Appeal gave licensees of health care facilities good news by expanding the scope of the “reasonable licensee” defense when the California Department of Public Health (CDPH) issues a citation and imposes penalties.

In its November 2019 RSCR Inland, Inc. v.  State Department of Public Health decision, the court held that a licensed health “facility may succeed in dismissing a citation by demonstrating the it did what might reasonably be expected of a licensee, acting under similar circumstances, to comply with the regulation or statue that allegedly was violated.”

CDPH unsuccessfully argued that the scope of the defense should be limited to emergency situations and special circumstances. The case involved a residential long-term health care facility where a patient took his own life after repeating that he wanted to die. While the two individual direct care staff members perhaps neglected to take all steps that may have prevented the patient’s death, the evidence supported that the facility and its staff did what might be reasonably expected to comply with applicable regulations. Such actions included creating and informing direct care staff of the patient’s nursing care plan, implementing a specific behavior plan, taking precautionary steps, and following a reporting protocol.  

Essentially, the case stands for the proposition that an adverse outcome should not result in an automatic citation and civil penalty by licensing authorities. The “reasonable licensee” defense is the appropriate check to make sure that a licensee is evaluated on their operational compliance and reasonable actions to comply with the law. Facility operators may want to review their policies, training and protocols in light of a “reasonableness” standard in case they may need to rely on this defense in the future.

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