Wyatt v. Iowa Department of Human Services

744 N.W.2d 89, 2008 Iowa Sup. LEXIS 6, 2008 WL 162243
CourtSupreme Court of Iowa
DecidedJanuary 18, 2008
Docket06-0351
StatusPublished
Cited by11 cases

This text of 744 N.W.2d 89 (Wyatt v. Iowa Department of Human Services) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wyatt v. Iowa Department of Human Services, 744 N.W.2d 89, 2008 Iowa Sup. LEXIS 6, 2008 WL 162243 (iowa 2008).

Opinion

APPEL, Justice.

In this case, the central issue is whether a nurse who seeks to muffle the screams of a distressed patient in order to protect the health of another seriously ill patient commits an assault under Iowa’s dependent abuse statute and as a result, has earned a place on Iowa’s dependent adult abuse registry. This case has caromed through the *91 legal system, suffering a seemingly unending series of reversals and appeals.

We now settle the matter. No assault occurred under the facts of this case. Therefore, the decision of the court- of appeals is vacated and the decision of the district court, including expunging Wyatt’s name from the dependent adult abuse registry, is affirmed.

I. Factual and Procedural History.

Kim Wyatt is a registered nurse employed by the University of Iowa Hospitals and Clinics. On May 12, 2004, Wyatt was assigned to the neuroscience unit, a stressful unit for medical staff under even the best of circumstances. On that day, Wyatt attended to a patient who suffered from a subarachnoid hemorrhage, a neurological condition that rendered the patient highly susceptible to stimuli such as light and noise. Patients with this condition who are exposed to excess stimuli can suffer ruptured aneurysms so severe as to cause paralysis or death. As a result, such patients are typically kept in darkness in private rooms without television, radios, telephones, or other sources of stimulation. Wyatt believed her patient’s condition was particularly acute in light of the level of pain medication that had been prescribed by physicians. The level was twice as high as normally prescribed.

In a room adjacent to Wyatt’s patient, E.W. was hospitalized. E.W. was an eighty-two-year-old man admitted for evaluation as a possible candidate for brain surgery to remove a tumor from his frontal lobe. E.W. also suffered from a heart condition, hypertension, and was prone to bouts of dementia. This combination of ailments made E.W. a difficult patient who resisted all invasive medical procedures. As a result, he was often placed in restraints for his own protection and the safety of hospital staff.

While Wyatt was attending her patient, two nurses and a nursing assistant attempted to administer an IV to E.W. E.W. resisted, and began screaming, “Help me, help me.” Wyatt and another nurse, responding to the commotion, ran into the room. By the time she entered, Wyatt found four staff members attempting to restrain E.W.

Faced with the chaotic situation, Wyatt became concerned that the commotion could harm her subarachnoid patient in the next room. Seeking to abate the threat and protect her patient by muffling the shouts, Wyatt grabbed a pillow and placed it over E.W.’s mouth, below his nose.

One of the nurses present in E.W.’s room objected to the use of the pillow and asked Wyatt to- discontinue her efforts. Upon a second request, .Wyatt removed the pillow. No one ran a stopwatch in the room, but those present estimated that the incident lasted between ten and thirty seconds. There were no signs that the pillow caused E.W. physical or respiratory distress. The patient had no memory of the incident, and thus voiced no complaint as to this course of treatment.

Another treating nurse, however, filed a report with Melissa Gross, the nurse manager of the unit, the following morning. After investigating the matter, Gross concluded that dependent adult abuse had not occurred. Gross’s conclusion rested on her belief that Wyatt did not intend to abuse E.W. and that no harm resulted from her actions. Based on her investigation, Gross found that Wyatt’s sole intent was to protect her subarachnoid patient, not to harm E.W. The associate director of clinical practice, Ellen Cram, agreed with Gross’s assessment. Although Wyatt received a favorable performance review by her supervisors after the incident, the hospital elected to file a report with the *92 Iowa Department of Inspections and Appeals (DIA) as a possible instance of dependent adult abuse.

DIA investigated the matter and determined that Wyatt had committed dependent adult abuse by unreasonably punishing and assaulting E.W. DIA thus released Wyatt’s name to the Department of Human Services (DHS) for placement on the dependent adult abuse registry. Wyatt appealed her inclusion on the registry.

After an evidentiary hearing, an administrative law judge (ALJ) issued a comprehensive proposed decision. In the proposed decision, the ALJ made findings of fact and conclusions of law. In the findings of fact, the ALJ found that Wyatt was not trying to hurt, punish, harm, cause fear, or offensively contact E.W. when she placed the pillow over his mouth. He concluded that Wyatt’s only concern was for the safety of her patient.

In the conclusions of law, the ALJ noted that under Iowa Code section 235B.2(5)(a)(1)(a) (2003), dependent adult abuse includes “assault of a dependent adult.” The ALJ further noted that under the applicable administrative rule, assault under this Code provision is the same as criminal assault defined in Iowa Code section 708.1. Iowa Admin. Code r. 441-176.1. He went on to note that while language in Bacon v. Bacon, 567 N.W.2d 414 (Iowa 1997), suggested that assault might be a general intent crime, this court overruled such an approach and declared assault a specific intent crime in State v. Heard, 636 N.W.2d 227, 231 (Iowa 2001). In light of Heard, the ALJ determined that negligent assault is not recognized by Iowa law. Based on the evidence in the record, the ALJ concluded that Wyatt did not commit dependent adult abuse and ordered that the report be expunged.

The March 10, 2005 decision of the ALJ was not mailed to the attorney for DIA. The decision itself notes that it was copied to the attorney through local delivery. The attorney for DIA, however, stated that she did not receive a copy of the proposed decision by mail or by hand delivery and was unaware of the decision until March 29, 2005, when counsel received a phone inquiry from the appeals division asking whether an appeal had been filed. Subsequently, counsel for DIA filed an appeal of the ALJ’s decision to DIA’s director on the following day.

The administrative rules of the department require that appeals be filed within fifteen days of the issuance of a proposed decision. Wyatt thus sought dismissal of the appeal as untimely, noting that a copy of the proposed decision was provided to the Health Facilities Division within DIA and to the DIA file. The director nevertheless refused to dismiss the appeal, noting that the DIA file is not the respondent’s attorney’s file for purpose of legal representation and notice, and noted that the department has not rigidly applied filing deadlines when technical irregularities are present. Good cause thus existed, according to the director, to excuse the filing, even assuming that it was untimely.

Approximately one month later, the director reversed the ALJ’s decision. In so doing, the director accepted most of the factual findings of the ALJ.

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Bluebook (online)
744 N.W.2d 89, 2008 Iowa Sup. LEXIS 6, 2008 WL 162243, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wyatt-v-iowa-department-of-human-services-iowa-2008.