Huegel v. State, Dep't of Soc. & Health Servs.

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BLAKE HUEGEL, Appellant, v. STATE OF WASHINGTON DEPARTMENT OF SOCIAL AND HEALTH SERVICES, Respondent.

No. 59660-1-II

Court of Appeals of Washington, Division 2

November 21, 2024

UNPUBLISHED OPINION

GLASGOW, J.

WS, a vulnerable adult, lived in an adult family home, Vintage Years. WS's bed at Vintage Years was placed against a wall on one side and he had an upper bed rail installed on his bed on the other side. At WS's family's request Blake Huegel, a temporary caregiver at Vintage Years, then installed a lower bed rail on WS's bed.

An upper bed rail starts at the head of the bed, runs along the side of the bed, and is about three feet long. A lower bed rail is the same length and starts at the foot of the bed. When both an upper and a lower bed rail are installed, there is an approximately one-and-a-half-foot gap between them. The lower bed rail that Huegel installed was not medically approved and left WS only a narrow gap between bed rails to exit his bed. Within a day of Huegel installing the lower bed rail, WS fell while getting out of bed and died several days later from a subdural hematoma.

The Department of Social and Health Services (the Department) investigated Huegel and found that he abused a vulnerable adult by improperly using a mechanical restraint, the lower bed rail. During the investigation, Huegel admitted that he installed the lower bed rail on WS's bed without medical authorization and that he knew this violated regulations. After a hearing, an administrative law judge affirmed the abuse finding against Huegel. The Department's Board of Appeals (the Board) affirmed the administrative law judge's finding. The superior court affirmed the Board's order. Huegel appeals.

We conclude that the Board's unchallenged findings are verities on appeal. The Board appropriately considered hearsay evidence in this administrative proceeding, where hearsay is permitted if it is the type of evidence on which a reasonably prudent person would rely. And the three findings that Huegel challenges are supported by substantial evidence in the record, including Huegel's admissions during the investigation. The Board correctly applied the plain language of the abuse of a vulnerable adult standard because it includes the improper restraint of a vulnerable adult without medical authorization. The Board did not have to find that Huegel intended to injure WS. Finally, we recognize that the abuse finding has significant consequences, especially where WS's injuries were the result of an unfortunate accident. But under current law, placement on the registry of those who have abused vulnerable adults did not violate Huegel's procedural due process rights.

We affirm. We deny Huegel's request for appellate attorney fees.

FACTS

I. BACKGROUND FACTS

The following facts are drawn primarily from the unchallenged findings of fact in the Board's final order, which are verities on appeal. Postema v. Pollution Control Hr'gs Bd., 142 Wn.2d 68, 100, 11 P.3d 726 (2000).

Blake Huegel was a licensed certified nursing assistant working in adult long-term care. He had nine years of experience in long-term care and ran multiple adult family homes. Huegel occasionally assisted his brother, Cameron Huegel, at Vintage Years, an adult family home that Cameron operated in Battle Ground, Washington. At Vintage Years, Huegel acted as a "fill-in caregiver" when Cameron was unavailable. Verbatim Rep. of Proc. (VRP) at 213. Huegel completed a training in 2016 that explicitly included "[w]hat constitutes a restraint." Admin. Rec. (AR) at 3. Under Washington law, a restraint includes "any device attached or adjacent to the vulnerable adult's body that [they] cannot easily remove that restricts freedom of movement or normal access to [their] body." Former RCW 74.34.020(15) (2019).

A. WS's Admission to Vintage Years and Initial Assessments

WS, a 90-year-old man, began living at Vintage Years in November 2019 after falling at home and suffering severe injuries. Before WS entered the home, Vintage Years filled out a longterm care assessment for him. The care assessment noted that WS was "disoriented" and "attempted to get out of bed." AR at 6, 264. It recommended that caregivers should keep WS's bed low to the floor, remind WS to use a call signal when getting out of bed, and use a bed alarm. Vintage Years also completed a care plan for WS. The care plan did not mention bed rails, but it stated that WS was at risk for falls and that Vintage Years would keep his bed low to the ground.

In December 2019, WS attempted to get out of bed by himself and fell. He was taken to the hospital and treated for an injured hip before returning to Vintage Years in January 2020.

B. After WS's December 2019 Fall

In December, after WS's fall, a nurse at Vintage Years completed a bed rail assessment for WS. A "bed rail," also called a "side rail," is an assistive device that can be placed on beds to help residents reposition and maneuver in and out of bed. An upper bed rail starts at the head of the bed, runs along the side of the bed, and is about three feet long. A lower bed rail is the same length and starts at the foot of the bed. When both an upper and a lower bed rail are installed, there is an approximately one-and-a-half-foot gap between them. Many adult care facility residents use upper bed rails for mobility purposes; residents can use the upper rail to brace or steady themselves when turning over in bed, sitting up, or getting out of bed. When he lived at home, WS had upper bed rails on his bed.

The nurse, Cameron Huegel, and Polly Little, WS's daughter, all signed WS's bed rail assessment. The bed rail assessment noted that Little requested rails for WS for his "safety and mobility." AR at 10. The bed rail assessment included a section on the risks of bed rails, stating that "serious injuries can occur from falls if an individual climbs over the bed rails," and that bed rails "can induce agitation if the rail is perceived as a restraint." AR at 11. Little consented to these risks and indicated that she wanted to have upper bed rails placed on both sides of WS's bed. Ultimately, the bed rail assessment concluded that no bed rails should be used "[d]ue to positioning." AR at 12. This assessment contained no further explanation. This was the only bed rail assessment that Vintage Years conducted for WS.

During WS's follow-up visit from the December fall, his primary care provider, Dr. Gregory Hallas, noted that WS's behavior had changed significantly, including increased agitation. In Dr. Hallas' report, which he faxed to Vintage Years, he ordered "bed rails"-without distinguishing between upper and lower bed rails-as recommended medical equipment for WS "to improve bed mobility." AR at 10.

At some point after the bed rail assessment and follow-up visit, Little and Stephen Slack, WS's son, brought the upper bed rails that were previously installed on WS's bed at home to Vintage Years. Huegel installed the upper bed rails on WS's bed at Vintage Years.

After the bed rail assessment, Vintage Years also completed another long-term care assessment for WS in January 2020 because of his changed condition after the fall. The long-term care assessment noted that WS's dementia had worsened and that he had not walked since the fall. It listed bed rails as a possible form of special equipment, but did not mention bed rails in WS's assessment or care plan.

When he returned to Vintage Years from the hospital, WS became more agitated and disruptive. He would often call out or attempt to get out of bed, requiring intervention from staff. At some point in early February 2020, Little brought lower bed rails that she had purchased to Vintage Years.

Slack, WS's son, asked Dr. Hallas for recommendations that could help with WS's behavior, and Dr. Hallas referred WS to a geriatric psychology specialist and increased his evening dose of medication. On February 10, Vintage Years faxed Dr. Hallas's clinic a note stating that WS's behaviors had worsened, and he was upsetting other residents and attempting to hit staff. The note requested "a bed rail order faxed to us as soon as possible, please." AR at 216. A nurse at the clinic wrote in WS's medical record that she called Deanna Williams, WS's primary caretaker, on February 12 and told her that Vintage Years could not install additional bed rails without a doctor's order. The nurse told Williams, "having full sets of bedrails on bed can potentially cause increase risk of injury as [WS] can fall over bed/siderails to ground, increasing height distance to ground compared with 1 rail on each side of bed." Id.

The nurse then forwarded a note to Dr. Hallas, asking, "If OK with bed rails, please clarify: 2 rails on each side (4 in total/bed) OR 1 rail on each side (2 total/bed)?" Id. This sparked an internal conversation at the clinic about WS's treatment, and on February 12, Dr. Hallas wrote, "Bed rails are restricted to a certain coverage-I do not know what that is and cannot advise anything other than that." AR at 217. About an hour later, another nurse wrote Dr. Hallas, "OK to order 2 upper bed rails for safety" and attached a federal website outlining the definition of "restraint." Id. Based on WS's medical records, the clinic had no further communication with Vintage Years on February 12.

C. WS's February 2020 Fall

In the meantime, on or around February 12, someone installed the lower bed rail Little brought for WS's bed, though there is a factual dispute as to who installed it. It is undisputed that on the night of February 12, WS had upper and lower bed rails on one side of his bed, and the other side of the bed was pushed against a wall.

In the evening of February 12, Williams found WS on the ground. Williams...