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Winner of 2022 Cowles Award Draws Attention to a COVID-19 Injustice

      The 2022 Carey Cowles Award goes to Alan Horowitz, JD, RN, for “The Long and Winding Road: Life Care Center–Kirkland’s Journey for Justice” (Caring for the Ages 2021;23[2]:16). The award recognizes the author of the most read/downloaded article of the year and was established in memory of Carey Cowles, Caring’s managing editor for four years, who passed away in 2018.
      Mr. Horowitz writes on legal issues for Caring as well as other long-term care publications. He has worked in law for 32 years and is currently Of Counsel at Arnall Golden Gregory LLP. His practice involves regulatory compliance concerning skilled nursing facilities, hospices, and home health agencies. He previously served as assistant regional counsel at the U.S. Department of Health and Human Services and has represented the Centers for Medicare & Medicaid Services. Earlier in his career, he was employed as a registered respiratory therapist and a registered nurse.
      The winning article addresses the adverse publicity around Life Care Center–Kirkland (LCCK), which was the first reported nursing home to have an outbreak of COVID-19 and was issued a citation by CMS at the “immediate jeopardy” level, resulting in a civil money penalty of $611,325. The state of Washington also imposed “conditions” on LCCK’s license and a “Stop Admissions” order.
      Mr. Horowitz told Caring that he wrote this article after being privy to the facts of this particular case. “It appeared to me that the folks at LCCK were really heroes,” he said. At the time of the outbreak, “there were mixed messages in terms of what CMS, the [Centers for Disease Control and Prevention], and the state departments of health were recommending.” Nevertheless, the staff at LCCK “were being very proactive, they did everything appropriately, and they really got slammed. I thought it was unfair for CMS to find immediate jeopardy level deficiencies and impose a civil money penalty.”
      Mr. Horowitz expressed there was a shared responsibility in this case and heaping the blame on LCCK was not helpful. “We learned a lot of lessons from COVID-19,” he said, “and I don’t believe the blame game is the most effective way to improve patient safety.”
      This theme is echoed in another Legal Issues column published in the June/July 2022 issue of Caring, in which Mr. Horowitz argued that we need to address systemic flaws rather than blame individual health care practitioners if we want to encourage patient safety. His article, “Medication Errors and Homicide: When Law and Medicine Collide,” was another of Caring’s most-read articles of 2022. Mr. Horowitz also recently presented on the “Legal Aspects of Medical Errors: To Disclose or Not to Disclose” at the EDGE conference.
      In conversation with Caring, Mr. Horowitz said, “Through COVID-19 we saw heroic acts in nursing homes on a daily basis — and while lip service is often paid, it has always troubled me when I see the system or individual entities pointing a finger and engaging in the blame and shame game rather than trying to find constructive solutions. That’s why I write these articles.”
      Mr. Horowitz also feels that all staff in long-term care “are not given the recognition that they so richly deserve,” particularly as they are caring for individuals with multiple comorbidities, cognitive impairment, distressed families, staffing challenges, and other less-than-perfect circumstances. “I think it takes a very special person to want to do that.”
      Caring’s editor in chief Elizabeth Galik writes that “Alan’s knowledge and personal experience with health care makes him well prepared to analyze and provide guidance on complex legal issues that impact [post-acute and long-term care] communities. Alan’s article obviously struck a chord with so many readers and helped to validate the challenging circumstances that were encountered during the COVID-19 pandemic.”
      On winning the Carey Cowles Award, Mr. Horowitz said, “I am truly humbled by this honor. I was introduced to AMDA more than ten years ago, and in getting to know some of the AMDA members over the years, I’m just so impressed with what they do. It’s a genuine privilege and an honor to be involved.”
      Stay tuned for Mr. Horowitz’s presentation with Karl E. Steinberg, MD, CMD, HMDC, and Patricia L. Bach, PsyD, MS, RN, at AMDA – The Society for Post-Acute and Long-Term Care Medicine’s Annual Conference in March 2023, entitled “Medical, Legal and Ethical Aspects of Medical Aid In Dying (MAID).”
      Tess Bird, DPhil, is the current managing editor of Caring for the Ages.