Iowa DIA Again Fails to Assess Triple Nursing Home Fines
Earlier this month, the Department of Inspections and Appeals (DIA) cited an Iowa nursing home for violations in connection with a resident’s death.
This was not the first time Lantern Park, a long-term care facility located in Coralville, was cited for high-profile violations. In fact, it was the second high-level violation at this facility in less than four months.
Under state law, the DIA is required to triple a fine whenever a high-level violation is repeated during the same year. This did not happen following the second violation at Lantern Park.
Lantern Park Cited for Violations
Lantern Park received two high-level violations in the same year for failing to provide required nursing services. The first incident at Lantern Park occurred in January 2023. The second incident occurred just two months later and contributed to a resident’s death.
Failure to Suction a Resident’s Airway
In the first incident, which occurred earlier this year, the facility failed to suction a tracheotomy resident’s airway as needed. According to the resident, this resulted in multiple hospitalizations.
According to an article in the Iowa Capital Dispatch, the resident said, “It makes me feel like they don’t care if I can breathe or not.”
Failure to Follow Up and Obtain Treatment for a Resident’s UTI
In the second incident at Lantern Park, the facility failed to examine a patient suffering from a known urinary tract infection (UTI). This resident’s UTI was confirmed by lab tests. Despite the test results, however, the staff at Lantern Park neglected to further assess or treat this resident for over three days. The facility also neglected to notify her doctor of the infection and her condition.
When the woman’s daughter visited the facility three days later, she found her mother unresponsive. The facility called for an ambulance to take her to the hospital. According to the ambulance crew that attended her, this resident had been left in urine-soaked clothing and bedding for hours.
When the woman was examined at the hospital, the diagnosis included a UTI with sepsis. Her white blood cell count was 24.6, a significant elevation from what a normal white blood cell range of 4.5 to 11. The woman’s body temperature soared to 105.8 degrees, and she died later that same day.
UTIs can quickly lead to sepsis without medical treatment. Typically a round of antibiotics begins to clear up an infection within days. However, once a UTI leads to sepsis, the infection can spread through the bloodstream and cause internal organs to shut down. Once sepsis develops, it could lead to septic shock in as little as 12 to 24 hours.
Iowa DIA Explanation of Fines
The DIA has three classifications of violations – Level 1, which is the highest, presents an imminent danger to residents. Level 2 can affect the health, safety and security of residents but is not considered an “imminent danger.” Level 3 applies to violations that present a lesser risk than either level 1 or level 2 violations. Fines also vary for each of these levels, increasing for the higher profile violations.
For repeat-offenders of a level 1 violation, the DI must “treble the penalties” of the fines for any recurrence of the violation within a 12-month period.
Iowa Dispatch asked the DIA why it did not triple the fines. The DIA’s response was to update a post on its website. Initially the post indicated $10,000 for the nursing services fine. However, the DIA updated that amount to $30,000. Another fine, for safety violations, remained at $10,000, as originally posted.
Is This a Pattern of the DIA?
In 2020 the Rowley Memorial Masonic Home in Perry had been fined $7,250 for violations that contributed to a resident’s death. According to the law, that fine should have correctly been $21,750, or triple the amount of the first violation.
Earlier this year, Mount Pleasant’s Arbor Court care facility was assessed a $17,500 fine. However, this was the second violation within a 12-month period for Mount Pleasant. Again, the fine for this violation should have been tripled. In this instance, the DIA claimed an error led to the original fine being doubled instead of tripled. The correct fine against Mount Pleasant should have been $26,250.
State Fines Are More Symbolic Than Reality
Once a facility is cited and subsequently fined, those penalties are held in suspension. The Centers for Medicare and Medicaid Services (CMS) then reviews the case and considers what federal penalties should be imposed.
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