Amanda Cooke v. Iowa Department of Health and Human Services

Supreme Court of Iowa·Decided February 13, 2026·No. 24-2031·Published

Opinion

In the Iowa Supreme Court No. 24–2031

Submitted December 17, 2025—Filed February 13, 2026 Amanda Cooke,

Appellee,

vs.

Iowa Department of Health and Human Services, Appellant.

Appeal from the Iowa District Court for Polk County, Jeanie K. Vaudt, judge.

Iowa Department of Health and Human Services appeals a judicial review order reversing a founded child abuse assessment under Iowa Code section 232.68(2)(a)(4)(b). Reversed.

Oxley, J., delivered the opinion of the court, in which all justices joined.

Brenna Bird, Attorney General, and Tabitha J. Gardner (argued), Assistant Attorney General, for appellant.

Eric S. Mail (argued) and Eric D. Puryear of Puryear Law, P.C., Davenport, for appellee.

Oxley, Justice.

A five-month-old child died from anoxic brain injury after she was found with her face in a blanket. She had been placed down for a nap by Amanda Cooke, a state-registered childcare provider. To become a category “B” registered childcare provider, Cooke was required to comply with certain protocols, including specific “safe sleep” regulations and facility requirements. The Iowa Department of Health and Human Services (HHS) issued a founded child abuse assessment for denying the infant critical care by failing to provide proper supervision. Proper supervision is statutorily defined as the supervision “that a reasonable and prudent person would exercise under similar facts and circumstances.” Iowa Code § 232.68(2)(a)(4)(b) (2023).

On judicial review, the district court reversed the founded child abuse assessment on the basis that “a reasonable and prudent person” is an objective “generic person” standard that does not consider the training or knowledge of the particular person at issue. The district court remanded the case to HHS to reconsider the assessment under this revised standard.

HHS appealed. On our review, we agree with HHS’s application of Iowa law when it found that Cooke denied the child critical care under section 232.68(2)(a)(4)(b). We therefore reverse the district court.

I. Factual Background and Proceedings.

Cooke has been a category “B” registered childcare provider in Manchester since 2020. See Iowa Code § 237A.3A. She provided child daycare services in her home for families, some of whom received childcare assistance benefits from HHS. See id. § 237A.13. As a registered childcare provider, Cooke was required to follow HHS regulations.

For instance, Cooke was required—and agreed—to “follow safe sleep practices as recommended by the American Academy of Pediatrics for infants under the age of one.” Iowa Admin. Code r. 441—110.8(5)(a). The infant must be placed on their back to sleep on a firm mattress with a tight-fitted sheet. Id. r. 441—110.8(5)(a)(1)–(2). “No toys, soft objects, stuffed animals, pillows, bumper pads, blankets, or loose bedding shall be allowed in the sleeping area with the infant.” Id. r. 441—110.8(5)(a)(4). The registered childcare provider must actively monitor the sleeping infant by sight and sound. Id. r. 441—110.8(5)(a)(6). HHS conducts annual compliance visits at registered childcare providers’ homes to ensure that they know of and abide by these regulations.

One of the children in Cooke’s care, five-month-old Q.S., was dropped off by her mother at Cooke’s home around 6:00 a.m. on October 9, 2023—as was her customary drop-off time most days. Cooke played with Q.S. for about half an hour and then took Q.S. to the basement to put her down for her morning nap in a Pack ‘n Play. Typically, the Pack ‘n Play where Q.S. slept was placed in Cooke’s bedroom on the main floor. But Cooke’s husband was using a wheelchair while recovering from an injury at the time, and there was not enough room for the Pack ‘n Play in the bedroom. So Cooke temporarily used the basement for Q.S.’s naps, even though the basement was only supposed to be used for emergency tornado drills because it did not have the necessary exits to be used as part of the daycare. Cooke did not use any type of baby monitor in the basement and could not observe Q.S. by sight or by sound. Cooke could only check on Q.S. by going down to the basement.

Around 7:00 a.m., Cooke checked on Q.S. in the Pack ‘n Play. Q.S. was sleeping but fussed a bit when Cooke looked after her. Cooke returned to the basement around 8:30 a.m. to wake Q.S. up and feed her breakfast, but Q.S. did

not respond when Cooke rubbed her back. There was a large blanket in the Pack ‘n Play with Q.S., and Q.S. was rolled over on her stomach with her face up against the blanket. Cooke claimed that she left the blanket draped over the side of the Pack ‘n Play, with half of it hanging inside and the other half hanging outside. The blanket ultimately ended up inside the Pack ‘n Play covering Q.S.’s face.

Q.S. was limp and pale when Cooke turned her over. Cooke immediately started to perform CPR on Q.S. while her husband called 911. First responders and emergency medical personnel continued resuscitation efforts and transported Q.S. to Regional Medical Center in Manchester. She regained a heartbeat and was transferred to the University of Iowa Hospitals and Clinics, but she died the next day. Her cause of death was listed as “[a]noxic brain injury due to resuscitated cardiopulmonary arrest due to combined effects of positional asphyxia and smothering.”

HHS issued Cooke a notice of founded child abuse assessment on November 6 for denying critical care to Q.S. by failing to provide adequate supervision. HHS concluded that Cooke was required to be placed on the central child abuse registry because the risk to the child’s health and welfare was neither minor nor isolated and not unlikely to reoccur. Iowa Code § 232.71D(2), (3)(a)(2). HHS also revoked Cooke’s child care registration and her child care assistance provider agreement. Cooke timely appealed.

An administrative law judge (ALJ) issued a proposed decision upholding HHS’s determination to revoke Cooke’s childcare registration due to her failure to follow HHS’s safe sleep regulations. But it reversed the agency’s determinations that Cooke (1) denied critical care to Q.S. by failing to provide proper supervision; (2) failed her record check evaluation as a result of the denial

of critical care; and (3) needed to have her childcare assistance provider agreement revoked. With respect to the denial of critical care finding, the ALJ noted that Cooke’s actions must be measured against an objective “reasonable and prudent person” standard that did not consider her “greater training by virtue of her status as a registered day care provider.” The ALJ did not believe that a parent would be found to have denied critical care by leaving a blanket in their five-month-old child’s sleeping area. Reasoning that Cooke should be judged by the same objective standard, the ALJ concluded that Cooke likewise did not deny critical care.

The case proceeded to the HHS Director, who issued a final agency decision rejecting the ALJ’s proposed order and affirming HHS’s original child abuse determination. The Director reasoned:

[Cooke] had a higher duty of care than an ordinary individual due to her specialized knowledge and expertise. [Cooke] was employed and trained as a professional in providing a safe environment for a child. Her actions must be judged in comparison to a reasonable, trained professional in the same field, and what a reasonable, trained professional would have done in similar circumstances.

From there, the Director concluded that a reasonable and prudent person under similar facts and circumstances would not have violated safe sleep practices by leaving a blanket in close proximity to a five-month-old child who was also sleeping in an area of the house where the baby could not be monitored by either sight or sound. The Director therefore found that Cooke denied critical care by failing to provide proper supervision.

Cooke petitioned for judicial review in the Iowa District Court for Polk County. The only issue raised in district court was the proper legal standard for

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