Chapter 400 in the state of Florida: Has nursing home litigation gone too far?

In response to public concerns about neglect and abuse, the state of Florida has enacted Chapter 400, which includes statutes and regulations delineating the civil rights of nursing home residents. By authorizing attorneys' fees and punitive damage awards, this legislation greatly increases the legal exposure and potential liability of nursing homes in Florida by associating civil rights with biomedical outcomes and social concerns. Any adverse outcomes, such as pressure ulcers, falls, or malnutrition, even in the most rapidly and hopelessly deteriorating resident, may constitute a licensee's violation of the resident's rights under Chapter 400 and thus provide the pretext for claims of negligent care on the part of the nursing home. By equating the often inevitable development of these geriatric syndromes with negligent care, any "injury,", large or small, can translate into high returns for plaintiff attorneys. Here we describe the critical components of Chapter 400 and discuss the potential impact of this legislation on the delivery of chronic care of the frail elderly.