A swift policy change that resulted in an unhappy resident could spell big trouble for an eastern Iowa nursing home. It all happened late one afternoon this summer and ended with the man, who was wheelchair-bound, being taken to the hospital just over an hour before sunrise.

Wednesday, June 22, the administrator of the nursing home, who had just started his job that Monday, instituted a smoking ban on the entire property. Residents could still smoke, but only if they found a family member or friend to take them off the property to do it.

Late in the afternoon of June 22, an unnamed male resident asked to go outside to smoke. He was told he couldn't. That's when the Iowa Capital Dispatch says the man told the staff of Dubuque Specialty Care, "I'm getting the hell out of here."

Before he left, the man had to sign papers that confirmed he was leaving against the medical advice of Dubuque Specialty Care and that once he did, they'd no longer be responsible for him or allow him to return inside.

At approximately 5 p.m., the man took his wheelchair to the end of Dubuque Specialty Care's driveway and sat while he waited for a ride. The high temperature in Dubuque on June 22 was 86 degrees.

Iowa Capital Dispatch says that at some point the man moved across the street. At around 4 a.m. the next morning, 11 hours after he'd first gone outside, the man called a cab. When he fell out of his chair attempting to get into the taxi, the driver called an ambulance. The man also soiled himself when he fell. He was released by the hospital after receiving pain pills and went to a hotel where he stayed for a few days before having to return to the hospital.

A nurse from Dubuque Specialty Care told state inspectors after the incident that, after the man went outside, she called his power of attorney to let them know the man was no longer considered to be a resident.

According to Iowa Capital Dispatch, state inspectors said, "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."

During the 11 hours the man spent outside, a nurse was notified by the resident of a nearby condo that he'd taken the man water. Another nurse asked an aide to give the man a sweatshirt and to offer him a beef stick as the temperature cooled that night. A third nurse said she, herself, went outside to provide water for the man. She told inspectors, "The nurses directed me to stay away from him. 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.”

The administrator of Dubuque Specialty Care, who was not been named and reportedly no longer works there, gave a differing account from other staff members. He first told inspectors he didn't tell staff that residents couldn't come back inside but also said, "Technically, he discharged from the facility, so we were not responsible for him.

Just days later, the administrator said that both the staff and residents had not understood the new no-smoking policy and that they actually could go outside. He also told inspectors that he didn't know the man had been outside throughout the night until the next day, and that he told the admissions coordinator to check on him. The admissions coordinator says she was not asked to check on the man or to call the hospital.

A $20,000 fine against Dubuque Specialty Care is being held in suspension by the Iowa Department of Inspections and Appeals. That allows a federal fine to be levied involving the incident. Thus far, that doesn't appear to have happened. If it does, it would be the third straight year the facility received a federal fine. The Centers for Medicare and Medicaid Services fined the facility $650 last year and $58,000 in 2000, according to Iowa Capital Dispatch.

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