Judge finds nursing home resident was illegally dumped in hospital E.R.

State agency says eviction was justified but carried out incorrectly

The agency that oversees nursing homes in Iowa has reversed a judge's finding that an Iowa nursing home was unjustified in evicting a resident by dumping the man at a hospital and leaving him homeless during the COVID-19 pandemic. (Photo courtesy of the Iowa Department on Aging and Long-Term Care Ombudsman's Office)

The agency that oversees nursing homes in Iowa has reversed a judge’s finding that an Iowa nursing home was unjustified in evicting a resident by dumping the man at a hospital and leaving him homeless during the COVID-19 pandemic.

The Department of Inspections and Appeals found, however, the eviction was carried out without adequate notice.

According to state records, Pearl Valley Rehabilitation and Nursing admitted a man in his early 50s, identified in state records only as S.M., in 2016. Previously, the man had lived in a group home and been hospitalized due to paranoia, a bipolar disorder and schizophrenia.

Last fall, the home discharged S.M. to a UnityPoint Trinity Medical Center, against his will, citing his alleged “verbal aggressiveness” and his use of foul language with other residents. A police officer was called to the home to facilitate the eviction.

According to state records, the nursing home had served S.M. with an emergency involuntary discharge notice shortly after he confronted the assistant director of nursing, swearing at her and pointing his finger in her face. It was then that he was taken to Trinity Medical Center’s emergency room and dropped off.

At the hospital, a psychiatrist determined S.M. was not a danger to himself or others and didn’t meet the criteria for inpatient psychiatric care. S.M. was medically cleared for discharge, but because he was homeless, he was allowed to remain at the hospital.

S.M. appealed his discharge and the matter went before an administrative law judge for a hearing at which evidence and testimony was collected.

Administrative Law Judge Laura Jontz then issued a proposed order stating Pearl Valley had violated state and federal regulations in at least four respects: the discharge was not mandated by the resident’s health needs; the discharge plan did not “provide for the orderly and safe transfer or discharge” of the resident; the discharge notice didn’t specify the date of discharge; and the home didn’t complete the federally required resident assessment before or after the resident was discharged.

“Pearl Valley involuntarily discharged S.M. to a hospital E.R. during a pandemic without any plan for his future housing and care. Pearl Valley attempted to get S.M. out of its facility by way of a hospital E.R., knowing S.M. would eventually be discharged and homeless,” Jontz said in her ruling. “Even if S.M. requires psychiatric services beyond that provided by Pearl Valley, the facility must still develop a safe and orderly discharge plan.”

The home’s actions, Jontz found, forced the hospital to keep S.M. in a hospital room, during the pandemic, so that he wouldn’t be “living on the street.” She added that although S.M’s “mental health diagnoses may be exacerbated by reasons related to the pandemic, and may require additional time and energy from overworked staff,” his eviction was not based on medical reasons and S.M. posed no threat to himself or to others.

Jontz’s proposed order reversed the discharge, stated that S.M. had “the right to be transferred back” to Pearl Valley, which he considered his home.

In cases of this type, however, the rulings of an administrative law judge are subject to review by the director of the Iowa Department if Inspections and Appeals, the state agency that regulates nursing homes in Iowa.

DIA Director Larry Johnson reviewed Jontz’s ruling and without referencing the regulatory requirements for either an assessment or a plan for a safe and orderly discharge, he found there were only “two legal issues” to be decided in the case: whether S.M. posed a threat to himself or others, and whether the home gave S.M. adequate notice of his discharge.

“The record establishes S.M. is a threat to himself,” Johnson found. He said the imaginary knife wounds and sulfuric-acid burns that S.M. claimed to have sustained in the home, “coupled with the unfounded reasons behind them, are alarming. Declining psychiatric treatment is also a harm and threat to himself … Therefore, an emergency involuntary discharge is appropriate.”

Johnson agreed with Jontz that Pearl Valley had failed to provide adequate notice of the discharge because it didn’t state the actual date of the discharge in the written notice.

His decision opened the door for Pearl Valley to readmit S.M. and then discharge him with a properly dated notice. The home’s administrator, Dale Gould, declined to say this week whether S.M. is back at Pearl Valley, stating, “I’m not able to respond to questions.”

Stefanie Bond, spokeswoman for DIA, said that if Pearl Valley tried a second time to involuntarily discharge S.M., it would have to file a notice with the department. “Our understanding is the resident returned to the facility and no additional involuntary discharge was issued,” she said.

Iowa’s former long-term care ombudsman, Deanna Clingan-Fischer, warned Iowans five years ago of an increase in so-called “hospital dumping” — the practice of evicting nursing home residents by transferring them to a hospital for treatment with no prospect of returning. At the time, Fischer said while regulations required facilities to at least issue a notice of discharge and inform the ombudsman of evictions, “this step is failing to occur with alarming frequency, either because staff do not fully understand the involuntary discharge process or because residents do not fully understand their rights.”

Last June, the long-term care ombudsman’s office stated involuntary discharges and “hospital dumping” continued to be a major concern in Iowa. Unwarranted discharges and evictions were the No. 1 source of complaints to the ombudsman the previous year, the office reported.