This Sunday’s Des Moines Register carried another front-page story by Tony Leys about the substandard treatment some patients have received since being transferred from the now-closed state mental health facility in Clarinda. Leys reported last month that eight former Clarinda patients were sent to nursing homes “rated ‘below average’ or ‘much below average’ on a federal registry,” and that two of the patients “died shortly after their transfers.”

“Transfer trauma” can endanger a frail person’s health even if the new facility offers excellent care. Unfortunately, the Perry Health Care Center’s handling of three former Clarinda patients left much to be desired, according to an Iowa Department of Inspections and Appeals report cited at length by Leys. Failure to monitor and care appropriately for one man led to severe dehydration and breathing problems, and eventually his hospitalization. The man died two weeks later. Staff carelessness caused a shower accident that broke a woman’s leg. A third woman did not receive a blood-clot prevention medication for six days in a row. Click through for many more depressing details. The whole 28-page inspector’s report is embedded at the bottom of the page. The company that owns the nursing home rejects the inspector’s findings and will appeal the fines, its manager told the Register.

From where I’m sitting, the nursing home is fortunate to face only $13,500 in fines for the long list of documented problems. I’m shocked that failure to administer a medication for six days, or to inform the prescribing physician that the patient had not received the drug, resulted in only a $500 fine (pages 24 and 25 of the report). Failing “to provide adequate supervision when transferring a resident from a shower chair,” leading to a broken leg, resulted in only a $5,000 fine (pages 16 to 23).  

Most stunning: the nursing home will receive only an $8,000 fine for repeated staff failures to properly assess or treat a man who was becoming lethargic and dehydrated. Nor did staff always provide supplemental oxygen as indicated when the man’s saturation levels dropped below 90 percent. The brother of the (now dead) man told Leys that a doctor at Mercy Medical Center “said she’d never seen a person so dehydrated in her life.”

Eight years ago, an Iowa nursing home received state and federal fines totaling $112,650 for failing to change a woman’s wound dressing for 25 days, resulting in gangrene and amputation of the affected leg. A settlement later reduced that fine to $75,397.

I don’t know how much discretion state inspectors have in assessing penalties. Iowa nursing homes can’t be fined at all for some of the most common health and safety violations, under a law Governor Chet Culver signed in 2009. The Iowa House and Senate had unanimously approved that bill, ignoring concerns raised by some advocacy groups, the Iowa Department of Elder Affairs, and the Iowa Department of Inspections and Appeals.

Leys reported that the woman who failed to receive her anti-clotting meds has moved “a more highly rated nursing home near Bloomfield, which specializes in treating elderly people with mental illnesses.” The woman whose leg was broken would like to move from the Perry facility but has no place to go.

What’s on your mind, Bleeding Heartland readers? This is an open thread: all topics welcome.

Ryan Foley’s August 3 story for the Associated Press was disturbing on several levels. A “Serious Mismanagement Report” described a “decade of dysfunction” at the Effigy Mounds National Monument in northeast Iowa. Between 1999 and 2010, “78 construction projects costing a total of $3.4 million were approved there in violation of federal laws meant to protect archaeological resources and historic sites.” Also troubling: National Park Service officials have suppressed the report’s publication and recently denied that it existed. They have commissioned another team to write a separate (less critical) review of Effigy Mounds operations. National Park Service deputy regional director Patricia Trap delivered some unintentional comedy when she said, “I’m not denying some serious mismanagement […] But also there were actions taken along the way that were actually appropriate management.” I’m so relieved to know that Effigy Mounds officials handled some matters appropriately in addition to the seventy-eight projects that failed to comply with federal law.

Iowa Public Radio’s Morning Edition with Clay Masters interviewed Foley about the mismanagement and next steps at Effigy Mounds. Click through for the audio and transcript.

The Des Moines Register published a front-page piece by Grant Rodgers on August 5 about the “uncertain future” for Iowa’s regional drug courts. Those courts steer defendants into treatment rather than prison, turning lives around at lower cost than incarceration. “Yet despite their popularity among prosecutors, judges and community leaders, several Iowa drug courts have experienced sluggish legislative funding – so much so that they now are in jeopardy,” Rodgers reports. What a classic case of penny-wise and pound-foolish budgeting by state legislators who brag to their constituents about fiscal responsibility. With an ending balance (surplus) of at least $300 million expected for Iowa’s budget in the 2016 fiscal year, it’s ridiculous that the drug court in Council Bluffs will shut down on October 1, with courts in Burlington and Ottumwa “at risk of closing” later this year.

The front page of today’s Sunday Des Moines Register features a depressing must-read by Tony Leys about former residents of the now-closed Iowa Mental Health Institute at Clarinda, which “cared for some of the frailest and most complicated psychiatric patients in the state.” Of the eighteen people who lived in the Clarinda facility earlier this year, eight

were transferred to four traditional nursing homes, all of which are rated “below average” or “much below average” on a federal registry. The four facilities are in the bottom 29 percent of Iowa nursing homes for overall quality, according to the Medicare registry. Two of those eight patients died shortly after their transfers.

I’ve enclosed excerpts from all of the above stories after the jump, but I recommend clicking through to read the articles in their entirety.

The nursing home industry already had too much political power in Iowa before Terry Branstad returned to the governor’s office. Since late 2010, Branstad has repeatedly demonstrated that he prefers a more lax inspection regime for residential care facilities, with fewer nursing home inspectors than state lawmakers are willing to fund.

But Branstad may have hit a new low this month, according to a story by Clark Kauffman in Monday’s Des Moines Register. Kauffman has reported extensively on substandard care in Iowa nursing homes. Following up on this year’s winners of the “Governor’s Award for Quality Care in Health Care Facilities,” Kauffman learned that one of the three honored facilities “was cited by inspectors seven weeks earlier for widespread unsanitary conditions and failure to meet residents’ nutritional needs.”

At this writing, I could not find the July 9 press release announcing the awards on the governor’s official news feed. I found it on the Department of Inspections and Appeals website and posted the full text after the jump.

I also enclosed excerpts from Kauffman’s report, but you should click through to read every disgusting detail about the Woodland Terrace in Waverly (Bremer County). I challenge Branstad or Lieutenant Governor Kim Reynolds to move any of their own beloved relatives to a home with such low standards of hygiene. It’s bad enough that Woodland Terrace wasn’t fined after the conditions inspectors found when they visited in May. To honor that facility is outrageous.

Regarding the other two award-winners, Kauffman noted that Prairie View Home in Sanborn did not have any violations during its most recent inspection, but Friendship Haven in Fort Dodge was cited in late 2013 “for failure to provide adequate incontinence care for residents; failure to adequately treat bedsores; and failure to keep food at the proper temperature before serving.”

The year’s not even half over, but I doubt any public figure will surpass the brazen chutzpah former Vice President Dick Cheney displayed in television appearances on two consecutive days this week. Cheney asserted that former Secretary of State Hillary Clinton should be “held accountable” for the terror attack in Benghazi, and that President Barack Obama has abused executive power. Look who’s talking! The guy who never faced any consequences for his central role in leading the country into war on false pretenses. The Iraq war killed nearly 4,500 U.S. military personnel in the theater, contributed to hundreds of veteran suicides in the past decade, and left thousands of Americans with life-altering physical injuries or PTSD (not to mention the hundreds of thousands of Iraqi casualties).  I don’t know why anyone would listen to anything Cheney has to say about anything, particularly about being held accountable.

A remarkable example of home-grown chutzpah came from Jerry Rhoads, who recently filed for bankruptcy protection for himself and two Iowa nursing homes he owns. One of the homes is on the federal government’s list of most troubled care facilities, according to Clark Kauffman’s piece in the Sunday Des Moines Register. But to hear Rhoads tell it, he’s an innocent victim of over-zealous inspectors:

“I don’t think I’m the bad guy,” Rhoads said Wednesday [May 14]. “I believe this is criminal, the way we have been treated. They have fined us over $100,000, and we lost another $1 million because of the hold they placed on new Medicaid admissions.” […]

“We’re not bad people, but the state has treated us like criminals.”

No, if the state were treating you like criminals, you’d be facing criminal charges and not just civil fines for substandard care that may have led to several deaths. After the jump I’ve posted some of the shocking details from Kauffman’s article.

Iowa has some outstanding nursing homes and skilled care facilities, but I would still recommend keeping a close eye on any loved ones receiving long-term care, given our state’s weak enforcement of violations and limited capacity for inspections.  

Happy St. Patrick’s Day to Bleeding Heartland readers who celebrate the occasion. This is an open thread; all topics are welcome. For a laugh, enjoy The Onion’s recent write-up of Iowa fashion week: “The big themes this season are ‘roomy,’ ‘loose,’ and ‘comfortable.'”

After the jump I’ve posted a few links about health and happiness, including details from Gallup’s 2012 report on well-being in the United States. Iowa ranked ninth on the “Gallup-Healthways Well-Being Index” but was not one of the “elite five states” that have shown consistently high levels of resident well-being over five years.

This week New Jersey’s Chris Christie became the eighth Republican governor to recognize that only a chump would turn down 100 percent federal funding to provide Medicaid coverage to low-income constituents. But Governor Terry Branstad doubled down on his determination not to allow Medicaid to expand in Iowa.

While some advocates are hoping Republican legislators will help pass a Medicaid expansion bill by a veto-proof majority, that scenario appears extremely unlikely. A prolonged standoff between Branstad and Iowa Senate Democrats seems unavoidable.

Thank Gannett for small favors: the successive rounds of newsroom layoffs at the Des Moines Register have spared Clark Kauffman. He’s been tenacious in covering flawed oversight of Iowa’s nursing homes. On Thursday, Kauffman reported on a recent act by Governor Terry Branstad that worries national advocates for senior citizens.

Remember when Republicans were saying that Washington was going to pull the plug on grandma? Little did we know, they were on to something.

The newly released Republican budget does indeed threaten grandma – by dismantling Medicare and ending the guaranteed health care that so many seniors' lives depend on.

If House Republicans and Budget Chairman Paul Ryan get their way, they would privatize Medicare – getting rid of the government guarantee that makes the program accessible for all elderly Americans. Under this “brave” and “courageous” Republican plan, seniors would get a voucher to purchase insurance on the private market. This may sound like a reasonable plan until you consider that privatizing Medicare would cost seniors significantly more, almost doubling their out-of-pocket costs to more than $12,000 a year and leaving many unable to afford health care at all.

When Governor Chet Culver took final action on the last two dozen bills from the 2009 legislative session, my biggest disappointment was his decision to sign Senate File 433, a bill that “eliminates a broad range of fines against Iowa nursing homes that fail to meet minimum health and safety standards.”

Governors rarely veto bills that pass out of the state legislature unanimously, as this one did. However, when Culver didn’t sign Senate File 433 right away, I hoped he was seriously considering the advice of the Iowa Department of Elder Affairs and the Iowa Department of Inspections and Appeals. Both of those state agencies opposed the bill.

Instead of listening to the public officials who have the most in-depth knowledge of nursing home regulations and violations, Culver sided with a corporate interest group:

Former state legislator John Tapscott, who now advocates for Iowa seniors, said the new law is an example of what the nursing home industry can buy with its campaign contributions.

“It only proves that our legislative leaders and governor are willing to sell out the most vulnerable of our citizens – the sick and elderly residing in nursing homes – for a few thousand campaign dollars,” he said.

Click “there’s more” to read about the substance of this bill and the winning strategy of the Iowa Health Care Association, which represents nursing homes. I couldn’t have written this post without an outstanding series of reports by Clark Kauffman of the Des Moines Register last November (see also here and here).