Friendship Manor, a nursing home facility in Grinnell, Iowa, was hit recently with one of the largest fines ever imposed against an Iowa nursing home - $112,650.00. The history of events leading up to the levy of the fine is tragic.
Ruth Louden was an active 89 year old woman, who lived alone in an apartment in Grinnell, Iowa. She still drove herself and had recently returned from a trip to California, where she traveled by herself to visit with her daughter. Unfortunately, on February 16, 2008, she fell at home, injuring her left ankle. The injury? A minor bone fracture. While any injury would be serious for a woman of her age, Ruth's injury was relatively minor and did not even require a cast. Instead, doctors put her leg in a medical stocking and a brace and sent her to Friendship manor for short-term therapy. Friendship Manor was where things began going wrong.
The staff at Friendship Manor had written orders to monitor the circulation in Ruth's leg and to check her skin every shift for signs of redness or swelling. Ruth complained to facility staff of "horrible" and "excruciating" pain for the next four weeks. The staff provided Ruth with pain medication but never pulled back her stocking to examine her leg and never evaluated the cause of the pain.
On March 20 - a month after Ruth's fall - a physical therapy aide noticed that Ruth's leg smelled like "rotting meat". Blood was seeping through the stocking. Ruth was taken to the hospital and physicians there found that the wound dressing that had been put on a month earlier looked like it had never been touched. Ruth was diagnosed with gangrene and doctors wanted to amputate her leg. It was her leg or her life. Ruth's leg was amputated below her knee, however, she died on June 24, 2008.
Iowa's Department of Inspections and Appeals investigated and found that during Ruth's stay at Friendship Manor - 25 days - no one ever removed her stocking to check her leg and no physician ever examined her. Sadly, Ruth's doctors told state inspectors that Ruth's bone fracture was nearly "nonexistent" and that her amputation was avoidable. The owners of the facility were fined $4,050 for each day of Ruth's stay at the facility and, due to other problems, a $150 per day fine was imposed for 76 days that the facility failed to correct identified problems.
Friendship Manor is no stranger to serious problems. In May 2007, the facility lost its Medicaid funding and it was fined $2,500 after a resident was injured in a fall. In February 2008, the facility was slapped with a $350 fine for failing to provide rehabilitation services to residents due to short staffing.
Friendship Manor is owned and managed by two for-profit South Dakota companies. Their president is Tim Boyle. Boyle, a real estate developer, has appealed the fine arguing that the facility was under doctors' orders to keep the stocking on Ms. Louden's leg. Doctors informed state inspectors that facility staff would be expected to understand that temporary removal of the stocking would be necessary to examine the leg.
Interestingly, Boyle is the board president of The Iowa Healthcare Association and is using his position to tell legislators that the Iowa Department of Inspections and Appeals is "too aggressive in its enforcement of health and safety regulations". He has prepared written presentations for legislators and using his position as board president, is stating that the "inspections department is flogging nursing homes and blocking seniors' access to health care, in part by imposing huge fines against the owners and prohibiting new admissions until care problems are addressed". The executive director of The Iowa Healthcare Association, Steve Ackerson, is using the incident involving Friendship Manor as part of the pitch to Iowa legislators - while omitting Friendship Manor's alleged negligence that triggered the record-breaking fine.
Friendship Manor is claiming financial hardship stating that "this fine threatens the existence of the facility", but has failed to provide any financial information to back up that claim.
