Legal Eagle Eye Newsletter for the Nursing Profession (3)11 Aug 95


   Quick Summary: A nursing home cannot change the level of nursing care to which a patient is entitled, based on the terminal status of the patient.

   The facility contended that the department erred in concluding that any violations caused "imminent danger or substantial probability of resultant death or physical harm" to the five residents so as to constitute a Class I violation under the Iowa Code.

   The facility argued, in substance, that these residents were "terminal," that death in each case was imminent, and that any violation of department rules could not have caused an "imminent danger of their resultant death or physical harm." All five residents were "in a state of rapid deterioration progressing toward a natural death and, as such, their condition changes were expected events," according to the facility.  IOWA SUPREME COURT, 1995.


   The Supreme Court of Iowa considered an appeal from a ruling of the state Department of Inspections, which had found a nursing home guilty of multiple counts of Class I violations of Iowa’s nursing home licensing law with respect to the level of care given to five different nursing home patients.

   Under state law, a Class I violation of the nursing home licensing law is "one which presents an imminent danger or a substantial probability of resultant death or physical harm to the residents of the facility in which the violation occurs. A physical condition of one or more practices in a facility may constitute a Class I violation."

   The facts were shocking. One resident was admitted with a diagnosis of osteoporosis, compression fracture to a vertebral body, deafness and a hiatal hernia. She was sounding "gurgly," and was suctioned three times. However, the nursing staff did not record vital signs, nor was an adequate nursing assessment completed, according to the court record. The physician was never notified of the resident’s condition, until two days after the resident was found dead in bed at 8:10 PM.

   An expert witness on the standard of care for professional nursing practice testified on the department’s side of the case. The testimony was that professional nursing care, nursing assessment and physician notification were wholly inadequate or even entirely absent in the care of this patient. Even assuming this resident was in a terminal state of health, the standard of care for professional nursing practice would require ongoing notification of the physician of the resident’s status, as well as ongoing assessment of vital signs and auscultation and appropriate suctioning of the resident’s lungs.

   Another resident entered the facility with advanced coronary heart failure, renal failure, leukemia, anemia, atrial fibrillation and osteoporosis. He was difficult to awaken, and had 3+ edema in both feet. The facility should have notified the physician of his condition, so that better measures could have been taken to control his pain and make his last days more bearable, according to the court.

   A resident complained of feeling weak and shaky and stated he did not feel well. Continuing assessment was not carried out by the nursing staff. Vital signs had showed that he had a weak, rapid pulse and a temperature of only 91.5 degrees. He was taken by his family to a hospital, where he died. There should have been close monitoring, adequate nursing assessment and physician notification. Staceyville Community Nursing Home vs. Department of Inspections and Appeals of the State of Iowa, 528 N.W. 2d 557 (Iowa, 1995).