What happens when you fracture your ankle and no one checks on your wound or changes your stocking for 25 days? Ruth Louden, an otherwise healthy 89-year-old, developed gangrene, leading to the amputation of her leg. Her health went downhill quickly, and she died within months. Federal officials hit the Friendship Manor nursing home in Grinnell with a fine of $112,650. But the owner, Tim Boyle, appealed the fine and has settled for $75,397.

If management had brought Friendship Manor into compliance with all regulations on patient care during the past year, reducing the fine might be justified. But according to Clark Kauffman of the Des Moines Register, another patient died last year because of an accident linked to an unsafe walkway at the facility. That’s not all:

• In November, state inspectors compiled a 45-page list of deficiencies at the home, including:

• Improper use of physical restraints.

• Failure to meet a professional standard of care.

• Failure to provide incontinence care.

• Failure to prepare food under sanitary conditions.

• Failure to adhere to infection-control guidelines.

Current protocols for nursing home inspections and fines don’t appear to be compelling this facility’s managers to meet reasonable standards of care. It may be cheaper for owners to accept the occasional federal fine (after appealing to get it reduced) than to bring conditions up to par.

Iowa nursing homes have less to fear than ever from state regulators. During last year’s legislative session, lawmakers voted unanimously to eliminate “a broad range of fines against Iowa nursing homes that fail to meet minimum health and safety standards.” Friendship Manor owner Tim Boyle heads the nursing home industry’s main lobbying group, which provided a a textbook case of how to buy influence at the Iowa statehouse.

Even now, some Iowa legislators think regulators are too tough on nursing homes. What a sorry state of affairs in a state with one of the highest proportions of elderly people in the population.

Normally, people who write laws want the rest of us to follow those laws. However, when enforcing a statute costs a corporate interest group more money, prepare to hear some whining about government officials doing their jobs. So it was last week, when the Iowa Legislature’s Administrative Rules Review Committee unanimously approved rules formulated by Iowa Department of Inspections and Appeals.

The rules expand the number of hospital workers who are considered mandatory reporters of abuse to include food service workers and housekeeping staff, and define “gross negligence” as a form of abuse.

Lobbyists for Iowa’s hospitals and nursing homes attended Tuesday’s meeting and argued against approval. They said the state inspectors’ definition of gross negligence would result in too many caregivers being branded as abusers. They argued that gross negligence requires a willful, deliberate effort to harm a patient. […]

Representatives of Iowa AARP, the Governor’s Developmental Disability Council and Iowa Protection and Advocacy argued that industry proposals would weaken protection for seniors.

Rep. Bruce Hunter, a Des Moines Democrat who managed legislation related to the proposed rules, addressed the committee and said the industry’s proposed definition of gross negligence was unworkable.

“It would make it very, very difficult, if not impossible, to prosecute somebody in a nursing home or a hospital,” he said. “Yes, we want to make prosecution difficult because dependent-adult abuse is a serious charge, but we don’t want to make it impossible.”

Democratic State Representative Marcella Frevert

expressed dismay that regulators seemed to have regressed from “educational and helpful” enforcement to a “gotcha mentality” of penalizing violators.

Frevert joined the rest of the committee in approving the inspections department’s proposals, but said the full Legislature should consider revisiting the issue in 2010. “So, this isn’t over,” she said.

Here’s an idea: let’s stop issuing tickets for speeding and running red lights in favor of more “educational and helpful” enforcement of traffic laws.

Seriously, those talking points about the “gotcha” mentality of nursing home regulators sound familiar. That’s because legislators from both parties have made the same points in the past. By an amazing coincidence, those legislators have taken expenses-paid trips to Washington courtesy of the Iowa Healthcare Association, which represents nursing homes.

This issue bears watching during the 2010 legislative session, because nursing home operators know their way around the capitol and are good at getting what they want. Legislators could do this group a favor by relaxing the rules on “gross negligence” in nursing homes, and it wouldn’t cost an extra dollar from the general fund.  

On Friday the House of Representatives approved The Wall Street Reform and Consumer Protection Act by 232 to 202. All three Iowa Democrats (Bruce Braley, Dave Loebsack and Leonard Boswell) voted for the bill. Tom Latham and Steve King joined their Republican colleagues, who unanimously voted no. A press release from Braley’s office summarized key provisions:

–      Creation of a Consumer Financial Protection Agency (CFPA) to protect Americans from unfair financial products and services.

–       Creation of an oversight council to identify and regulate large financial firms whose collapse would place the entire financial system at risk.

–       Establishes a process for dismantling institutions like AIG or Lehman Brothers that protects taxpayers and ends bailouts.

–       Enables regulators to prohibit excessive executive compensations.

The “unfair” financial products to be regulated by the Consumer Financial Protection Agency include mortgages, credit cards and “payday” lenders. I would particularly like to see a crackdown on payday lending. Those high-interest loans have been shown to trap low-income borrowers in a cycle of debt.

The bill also includes some regulation of the derivatives market for the first time, but it sounds as if those provisions didn’t go far enough:

Consumer advocates cheered the survival of the consumer protection agency but said the overall legislation fell short, especially in the regulation of complex investment instruments known as derivatives.

The legislation aims to prevent manipulation and bring transparency to the $600 trillion global derivatives market. But an amendment by New York Democrat Scott Murphy, adopted 304-124 Thursday night, created an exception for nonfinancial companies that use derivatives as a hedge against market fluctuations rather than as a speculative investment. The amendment exempted businesses considered too small to be a risk to the financial system.

A Democratic effort to make more companies subject to derivatives regulations and to end abusive-trading rules failed.

When the Obama administration first proposed a package of regulations, it called for regulations of derivatives without any exceptions. But a potent lobbying coalition that included Boeing Co., Caterpillar Inc., General Electric Co., Coca-Cola and other big companies persuaded lawmakers to dilute the restrictions.

“It’s a weakness in the bill and a win for Wall Street,” said Barbara Roper, director of investor protection for the Consumer Federation of America. “Hedge funds and others that are not bona fide hedgers of commercial risk will slip through this language.”

Although I’m disappointed that Congressional Democrats didn’t pass a stronger bill, I am disgusted by House Republican leaders who “met with more than 100 lobbyists” last week in a desperate attempt to derail any regulation of these practices.

Representative Boswell worked on the derivatives regulations, and a statement from his office on December 11 expressed pride in “the work that the Agriculture Committee did to bring greater oversight and transparency to the over-the-counter derivatives market while balancing the interests of Iowa’s farmers and business owners who utilize these markets to hedge operations costs and lock-in commodity prices for responsible business planning.”

After the jump I’ve posted part of this statement, which includes written remarks Boswell submitted regarding the derivatives regulations.