MUSCATINE — A Muscatine elder care facility was issued two Class one citations for negligent care practices for its residents, including one that allegedly resulted in the death of a resident.
For "practices that constitute a level of actual harm and immediate jeopardy," the Iowa Department of Inspections and Appeals Health Facilities Division fined Premier Estates of Muscatine a total of $17,000: $10,000 — the highest possible fine amount — for practices that resulted in the death of one resident and $7,000 for practices that resulted in a fractured hip of another.
"One resident died, and one resident was injured," said David Wernig, spokesperson for the Health Facilities Division, "We certainly don't fine (health facilities) specifically for the resident's death — I don't think anyone could calculate that cost. ... There was a care plan. We fine based on a facility's failure to take action to follow that care plan."
Premier Estates of Muscatine, 3440 Mulberry Ave., is licensed for up to 100 residents. At the time of the June 11 through 19 surveys, 63 people resided on the campus.
They received their last citation on August 31, 2017, a Class II citation for failure to respond with qualified staff. But as an order of magnitude, the $500 fine was relatively small.
A class one citation is issued when an investigation reveals that care practices at a health facility have a high probability of resulting in resident harm or death if left uncorrected, Wernig explained.
"(Class one citations) are not common," Wernig said. "There is a responsibility for the facility to take care of the resident, to protect the resident."
In both cases, the problem was not particular to choking or the fall; the problem was that despite dangers being known, a system was not implemented that mitigated the danger to the residents.
"There was a documented care plan," Wernig said. "Staff wasn't with the resident. Food wasn't cut up properly. That's a pretty egregious violation. ... In the other situation, they have a resident who is a known fall hazard and they are failing to provide adequate supervision to protect that individual. The care information was there to protect these residents."
'A choking hazard'
At 12:10 p.m. on May 3, 2018, a resident was eating lunch at Premier Estates of Muscatine. According to the facility's week 1 lunch menu for Thursday, the entree that day was Polish sausage.
According to an interview with a nurse present that day, they were aware that the resident was not able to feed himself so staff cut up the food and fed it to him. The resident reportedly was eating quickly. He took a bite of sausage and then asked for a drink of milk. The nurse gave it to him.
A few months ago in February a speech therapy treatment plan had been created for the resident who had been diagnosed with a difficulty swallowing. Despite this, Premier Estates of Muscatine's care plan did not include information regarding the resident's rapid eating or directions to encourage the resident to eat more slowly. It did not mention his documented difficulty swallowing.
That day the resident began showing signs of choking. The nurse began rubbing his back vigorously. While food did begin to fall from the residents mouth, his lips began turning blue. The resident was lifted onto the floor and staff members began attempting the Heimlich maneuver. After some time, one staff member remembered a piece of meat larger than an average bite — 1 to 1.5 inches in length by their estimate — came out of the resident's mouth.
911 was called, and within an hour, the resident was in the emergency room because of cardiac and respiratory arrest. The resident was pronounced dead two days later. The underlying cause listed was pulmonary aspiration, a condition in which food or liquid is breathed into the airway.
'A risk for falling'
Since Dec. 19, 2016, Premier Estates of Muscatine had known that one of their residents was at risk for falls.
Early care plans demonstrated the need for two staff members to assist with transfers and a clear pathway in her room. And while this seemed to work for a year, between February and May of 2018, the resident fell a total of 15 times. Each time she was found on the floor at the end of her bed.
It was determined that as a result of repeated falls for four months, the resident had fractured her left hip.
In a phone call Friday morning with the Journal, Jason Van Der Veer, administrator of Premier Estates of Muscatine, declined to comment on the death and injury his facility was cited for. But as of Friday, the Premier Estates of Muscatine is not contesting any findings in the July citation.
Beginning August 10, the State Medicaid Agency will deny payments for new Medicare and Medicaid admissions, at the advice of the Iowa Department of Inspections and Appeals. While someone could pay out-of-pocket to admit or be admitted into Premier Estates, Medicare and Medicaid monies can not be used for new admissions unless substantial compliance is achieved by Dec. 19, 2018.
The Iowa Department of Inspections and Appeals (DIA) is recommending that the Centers for Medicare and Medicaid Services impose a fine for the deficient practices cited against Premier Estates of Muscatine. To avoid being fined twice for the same violation, the DIA's $10,000 and $7,000 fines are held in suspension until Centers for Medicare and Medicaid Service decide whether to impose the same fine.
"We hope the lesson is learned by the facility that they have an obligation and responsibility to take care of the residents in their facility," Wernig said. "There needs to be some changes made. Hopefully the facility will receive the benefit of education and corrective action. The most serious state fine was issued. We hope the facility learns its lesson and makes lasting changes for the individuals in their care."