State: Nursing home where 11 Iowans died of COVID-19 kept ill staff working

An Iowa nursing home where 11 residents have died of COVID-19 is accused of allowing its employees to work while exhibiting symptoms of the virus.

According to the Iowa Department of Inspections and Appeals, Dubuque Specialty Care, a skilled nursing facility for seniors, was visited by inspectors the first week of June for a review of infection-control procedures.

While there, inspectors discovered the facility had allowed three workers with symptoms of the virus to continue working and, on two of the four days in which the inspectors were present, employees were observed working without personal protective equipment.

According to state records, 43 residents of the home have tested positive for COVID-19 and 11 of them have died. The home had a total of 48 residents during the recent inspection.

The records indicate one employee underwent COVID-19 screening on April 17, which indicated he or she had a cough at the time. The employee was allowed to work on April 17, April 19 and April 20. The worker called in sick on April 21, complaining of a sore throat and clogged sinuses, and two days later reported testing positive for COVID-19.

The home’s administrator told state inspectors the nurse who conducted the screening on April 17 felt the employee shouldn’t be working, but was overruled by the director of nursing who attributed the cough to allergies.

The worker who tested positive told inspectors she did not have a face shield to wear during the last four evening shifts that she worked at the home, though she felt ill at the time.

The home’s COVID-19 screening log shows that on April 27, the administrator had symptoms of a cough and shortness of breath but continued to work in the building. On May 2, the administrator tested positive for COVID-19.

The administrator told inspectors that after reporting her cough to the company’s director of quality assurance, she was instructed to hold her breath for 30 seconds and was then advised to monitor her symptoms while working.

A third employee, a nurse aide, showed signs of chills while undergoing screening on May 9, but was allowed to continue working. On May 17, the aide tested positive for COVID-19.

A social worker at the home told inspectors that at times she was tasked with conducting the COVID-19 screening, even though she didn’t know what the protocol was for responding to a staffer who gave affirmative answers to questions about the presence of symptoms. The business office manager also conducted screening, inspectors found. Training for the screening procedure apparently consisted of one email sent to the staff.

The home’s administrator conformed for inspectors that there had been a shortage of personal protective equipment for the staff “just before the first resident tested positive for COVID-19” on April 22.

Earlier this month, even with documented cases of COVID-19 in the home, and with state inspectors inside the facility, caregivers, dining room assistants and kitchen workers were observed working without personal protective equipment, the state alleges.

The Department of Inspections and Appeals has fined the home $10,000, but held that penalty in suspension so that the Centers for Medicare and Medicaid Services can review the case and determine whether a fine should instead be imposed at the federal level.

Dubuque Specialty Care is owned and managed by Care Initiatives, a West Des Moines corporation that owns 44 Iowa care facilities. The company reported $188 million in revenue in 2018, and CEO Miles King was paid a total of $669,000 in compensation that same year.

Care Initiatives is a tax-exempt 501(c)(3) organization, and is considered a charity by the Internal Revenue Service.

On June 18, Iowa Gov. Kim Reynolds signed a COVID-19 liability bill into law, granting nursing homes and other businesses immunity from COVID-19-related lawsuits, except under specific circumstances.

Exceptions are made for cases that result in hospitalization or death. Companies that knowingly place people in harm’s way can also be sued.

The Iowa Medical Society, which represents private physicians, argued the bill didn’t go far enough and should have included a hard cap for medical liability lawsuits. 

At the federal level, U.S. Sen. Chuck Grassley, R-Iowa, has also supported a measure shielding business owners from lawsuits related to COVID-19.