‘You are out!’ Nursing home knowingly locked man outside overnight

A Dubuque nursing home deliberately locked a wheelchair-bound resident out of the building for 11 hours until the man called for a taxi at 4 a.m. and was taken to a hospital, according to state officials.

State inspection records indicate the administrator at the Dubuque Specialty Care nursing home had been in the job for three days when he implemented a no-smoking policy on June 22. The policy barred residents from going outside to smoke anywhere on company property. Residents were still allowed to smoke, but only if they summoned friends or family to take them off-site to do it.

At 5 p.m. that day, a few hours after the staff was informed of the policy, a male resident of the home became upset when he was told he could no longer smoke outside the building. “I’m getting the hell out of here,” he reportedly told the staff.

A nurse asked him to sign papers acknowledging that he was leaving the skilled-nursing facility against medical advice, telling him once he exited the building, he wouldn’t be let back in and was no longer the responsibility of Dubuque Specialty Care.

A staff member then let the man outside. He sat in his wheelchair at the end of the driveway to the home, waiting for a ride from a friend. He eventually migrated to a location on the sidewalk across the street from the facility. He remained there until 4 a.m. the next day, eventually calling a taxi service. He then fell and soiled himself while trying to get into the taxi. The driver summoned an ambulance, and the man was taken to a hospital.

Staff took the man's water, sweatshirt

During the man’s 11 hours outdoors, Dubuque Specialty Care failed to provide him with food, transfer assistance, treatments or any of his medications, which included insulin, placing him in immediate jeopardy, state inspectors later reported.

Those same inspectors interviewed a licensed practical nurse who was on duty the night of the incident, and she alleged the administrator had said, “We can no longer allow them to smoke. If they have a ride, they can go somewhere else, but they cannot smoke near the grounds.” The nurse told inspectors the resident in question was upset and swearing so he wheeled himself out of the building with the help of an employee who unlocked the door for him.

The nurse said she called the man’s power of attorney to say the resident was considered discharged from the facility. “Afterwards, I checked, and he was sitting out front in his manual wheelchair in front of the facility sign,” the nurse told inspectors. “I feel like the no-smoking (policy change) was very abrupt.”

Another nurse told inspectors, “I got a phone call from a gentleman across the street in the condominiums. He went and checked on (the resident) and he offered him a glass of water.”

At about 10 p.m., a nurse asked a certified nurse aide to go outside, check on the man, and take him a sweatshirt since it was getting cool outside, telling the aide, “He’s still human.” The aide brought the man the sweatshirt, which he accepted, and a beef stick from the nurse’s dinner, which he rejected.

Another nurse aide told inspectors she went outside to offer the man water, although some of her colleagues had advised against it. “The nurses directed me to stay away from him,” she said, according to the inspectors’ reports. “They were worried about losing their jobs. ‘You are going to get fired if they find out you are out there,’ is what they said.”

‘Technically … we were not responsible’

“We did not ask him to come back inside because the administrator had told us we could not,” one nurse reportedly told inspectors. “The administrator told me if he went out, he was not allowed back.”

“No, I did not tell staff residents were not allowed back in the building,” the administrator allegedly said when interviewed by inspectors. But he added that residents had “signed something on admission” indicating they would not smoke on the property. “Technically, he discharged from the facility, so we were not responsible for him,” the administrator said, according to the inspectors’ reports.

The reports do not identify the administrator by name.

Two days after that interview, the administrator was questioned again by inspectors. On that occasion, he allegedly stated the staff and residents had all misunderstood the policy and that residents had, in fact, been allowed to go outside.

“I learned about (the man) being outside all night the next morning,” he allegedly said. “I followed up with our admissions coordinator the next day. I had her check on him, and I think he is currently in the hospital.”

The admissions coordinator denied that, telling inspectors the administrator never directed her to follow up with the hospital or check on the man’s well-being.

‘If you go out that door, you are out!’

Inspectors also interviewed the resident who had been left outside. He reportedly stated the facility’s director of nursing had angrily told him that if he signed out and left the property to go smoke, he was considered discharged. “The administrator sat in on the conversation for a little bit, but it was all the director of nursing,” the man reported.

He also told one of the state’s regional long-term care ombudsmen that the director of nursing had said to him, “You ain’t going nowhere. If you go out that door, you are out!” He said the director of nursing later drove by him in a car, warning him, “You better not put one foot on my property.”

The man told inspectors that after being taken to the hospital, he was given pain pills and discharged. He ended up at a hotel, he said, and was doing well there for a few days until he started to feel weak, which he attributed to his lack of insulin. He then went back to the hospital.

The Iowa Department of Inspections and Appeals is holding in suspension a $20,000 state fine against the home. With that fine held in suspension, federal officials have the ability to impose a fine of their own, although there’s no public record of that happening as yet.

According to the website of the Centers for Medicare and Medicaid Services, the last federal fine imposed by the agency against Dubuque Specialty Care was for $650 in 2021. The year before, the home was fined more than $58,000 by CMS.

Dubuque Specialty Care currently has another new administrator, Brandy Feller, who said Monday that she has been with the facility for only a month. She referred all questions on the June incident to the home’s corporate owner, Care Initiatives of West Des Moines.

The Iowa Capital Dispatch was unable to reach anyone at the Care Initiatives office.

In the past five and a half years, the Iowa Board of Nursing Home Administrators has taken public disciplinary action against an Iowa-licensed administrator on only two occasions — most recently in 2020.

The board’s website says that by law the board must consist of nine individuals — four who are licensed nursing home administrators, three who are licensed members of a caregiving profession, and two who are members of the general public.

However, the board’s website also indicates the board currently consists of six members: a nurse, a counselor and four nursing home administrators, with no members of the public represented.

Sheri Cord, a secretary with the Professional Licensing and Regulation Division of the Iowa Department of Health and Human Services, said Monday that “There are some vacancies on this board and new members have not yet been appointed.”

Iowa Capital Dispatch is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: info@iowacapitaldispatch.com. Follow Iowa Capital Dispatch on Facebook and Twitter.