Judge: Iowa nurse was justified in quitting ‘unsafe’ nursing home

An Iowa judge has ruled that a nurse was justified in quitting her job at a Lee County nursing home due to concerns that staffing levels were unlawful and were unsafe for residents.

State records indicate Kristin Pullins had worked for the Montrose Health Center since 2018 as a full-time registered nurse. In early 2020, the home was purchased by Montrose Health Center Operations, a for-profit entity owned by Solon real estate developer Mark Holtkamp and Solon construction company executive Kevin Kidwell.

According to the findings of an administrative law judge, two licensed nurses were typically assigned to work the floor at any given time prior to the home being purchased. After the home changed hands, staffing was allegedly cut back to leave one licensed nurse on staff, essentially doubling Pullins’ workload.

In late January 2021, Pullins noticed a resident exhibiting symptoms of a stroke but was allegedly advised by Director of Nursing Amy Derr to hold off providing treatment for one hour until the night nurse reported for duty. A few weeks later, Derr received a report regarding an allegation of abuse in the facility, but didn’t report it to the state for three days, which prompted a complaint by Pullins to the Iowa Board of Nursing. Around that same time, Pullins filed a separate complaint involving two nurses who, she said, had forced a patient out of bed.

In February, Pullins had several conversations with her employer about staffing levels in the home. According to Pullins, Derr and Administrator Mallory Hymes promised to increase staffing, but failed to follow through. During one of the conversations, Hymes allegedly told Pullins, “Go find a job. You’ll come crying back in two weeks.”

On Feb. 20, Pullins was assigned to care for 36 residents, three of whom sustained falls that day. Pullins later told Iowa Workforce Development judge she felt like the situation placed her nursing license in jeopardy since she was required to perform periodic neurological checks on each of the three residents who had fallen but also had to provide care for others. A week later, Pullins resigned, giving the home one month’s notice of her expected last day at work.

Pullins applied for unemployment benefits, which the home challenged. Noting that Pullins provided the names of four other nurses who had quit in the week  in February, Administrative Law Judge Sean Nelson ruled that although Pullins had voluntarily left her job, she was entitled to unemployment benefits.

“A reasonable person would find (Pullins’) working conditions intolerable,“ Nelson wrote in his decision, adding that Pullins “credibly described working conditions in which she feared she could not provide adequate care to all the employer’s residents. (She) also credibly testified to other incidents occurring at the facility that a reasonable employee could find as unlawful and unsafe.”

Hymes, Holkamp and Derr could not be reached for comment.

Infected workers cared for residents

Last fall, state inspectors alleged the Montrose home placed residents of the home in immediate jeopardy by failing to mitigate the spread of COVID-19 and by placing residents who had tested positive and negative in the same room, even though at least eight vacant rooms were available.

The home also was alleged to have let workers who were known to be positive for COVID-19 care for residents who had yet to contract the virus.

By the time inspectors visited the facility in late October, 21 of the home’s 28 residents had tested positive for the deadly virus.

According to state records, Hymes told inspectors the facility had so much difficulty covering shifts that she had decided to let asymptomatic workers who were known to have the virus work with residents who had tested positive. Soon after, other staff began reporting symptoms of COVID-19 on the screening forms used by the facility.

To cover the home’s overnight shift, Hymes reportedly texted two employees and asked them to cover the shift. Both employees refused. Hymes then allowed another employee to work, although that individual had just tested positive for the virus.

When inspectors asked Hymes why infected residents were sharing rooms with residents who were negative for the virus, she allegedly stated her “corporate office” indicated it was not necessary to separate them since the negative residents had already been “exposed” to the virus.

In four separate instances, residents who didn’t have the virus but were forced to share a room with a COVID-positive resident subsequently tested positive for the virus.

State inspectors determined the care facility had placed its residents in “immediate jeopardy” — the formal designation for a serious violation that can result in the denial of federal Medicare and Medicaid funding. After the home took corrective action by separating positive residents from negative residents, the seriousness of the violation was downgraded by the Iowa Department of Inspections and Appeals.

State records indicate DIA proposed, but did not impose, a $7,250 fine as a result of the violations. That state fine was held in suspension by DIA to let the Centers for Medicare and Medicaid Services consider whether it, instead, would impose a federal fine.

CMS’ website indicates it has imposed no fines at all against the facility.