One result of a six-year investigation into nursing operations in Missouri was a Corporate Integrity Agreement that affects Cathedral Rock's New Mexico nursing homes.

The agreement was signed Jan. 6, 2010, by CEO C. Kent Harrington and the Office of Inspector General of the U.S. Department of Health and Human Services.

The U.S. Department of Health and Human Services has used the agreements more frequently to monitor companies even after criminal and civil litigation is concluded, said Barb Frederickson, a senior counsel for HHS in its Office of Inspector General.

A Baltimore physician with wide experience in nursing homes, Dr. David Lawrence Jackson has been appointed monitor and will visit all the New Mexico homes and report to the government on quality of care. Jackson is a medical consultant and adjunct professor of medicine at Johns Hopkins University.

Richard W. Westling, Cathedral Rock attorney, said unlike state survey teams that inspect annually, "the federal monitor has complete access to facilities anytime. There is an external person who is staying on top of patient care. He has a lot of authority in terms of getting information, he can go on-site, he has the ability to have an eyeball on the situation to assess problems."

The oversight lasts five years. If the company fails to cooperate, there are a variety of stipulated penalties, Frederickson said.

Among the requirements in the 43-page document are that Cathedral Rock communicate required staffing levels to all employees and create a policy to report concerns about inadequate or underqualified nursing-home staffing.

The full document, "Corporate Integrity Agreement between the Office of Inspector General of the Department of Health and Human Services and Cathedral Rock Corporation," is available at The New Mexican's Web site, www.santafenewmexican.com.