Question

The defendant in State v. Cunningham, the owner and administrator of a residential care facility, housed 30 to 37 mentally ill, intellectually disabled, and senior residents. The Iowa Department of Inspections and Appeals conducted various surveys at the defendant’s facility between October 1989 and May 1990. All of the surveys except for one resulted in a $50 daily fine assessed against the defendant for violations of the regulations. On August 16, 1990, a grand jury filed an indictment charging the defendant with several counts of wanton neglect of a resident in violation of Iowa Code section 726.7 (1989), which provides, “A person commits wanton neglect of a resident of a health care facility when the person knowingly acts in a manner likely to be injurious to the physical, mental, or moral welfare of a resident of a health care facility. … Wanton neglect of a resident of a health care facility is a serious misdemeanor.” The district court held that the defendant had knowledge of the dangerous conditions that existed in the healthcare facility but willfully and consciously refused to provide or to exercise adequate supervision to remedy or attempt to remedy the dangerous conditions. The residents were exposed to physical dangers and unhealthy and unsanitary physical conditions and were grossly deprived of much-needed medical care and personal attention. The conditions were likely to and did cause injury to the physical and mental well-being of the facility’s residents. The defendant was found guilty on five counts of wanton neglect. The district court sentenced the defendant to 1 year in jail for each of the five counts, to run concurrently. The district court suspended all but 2 days of the defendant’s sentence and ordered him to pay $200 for each count, plus a surcharge and costs, and to perform community service. A motion for a new trial was denied, and the defendant appealed. The Iowa Court of Appeals held that there was substantial evidence to support a finding that the defendant was responsible for not properly maintaining the nursing facility, which led to prosecution for wanton neglect of the facility’s residents. The defendant was found guilty of knowingly acting in a manner likely to be injurious to the physical or mental welfare of the facility’s residents by creating, directing, or maintaining hazardous conditions and unsafe practices; fire hazards and circumstances impeded safety from fire. The facility was not properly maintained (e.g., findings included broken glass in patients’ rooms, excessive hot water in faucets, dried feces on public bathroom walls and grab bars, insufficient towels and linens, cockroaches and worms in the food preparation area, no soap available in the kitchen, at one point only one bar of soap and one container of shampoo found in the entire facility). Dietary facilities were unsanitary and inadequate to meet the dietary needs of the residents. There were inadequate staffing patterns and supervision in the facility, and improper dosages of medications were administered to the residents. The defendant argued that he did not “create” the unsafe conditions at the facility. The court of appeals disagreed. The statute does not require that the defendant create the conditions at the facility to sustain a conviction. The defendant was the administrator of the facility and responsible for the conditions that existed.

Discussion Questions

Do you agree with the court’s finding? Discuss your answer.

Discuss how both ethics and the law are intertwined in this case.

Answer 1

1. Yes, I do agree with the court's finding. Because it is the responsibility of the dependant to appoint an appropriate number of staff to take care of the facility. He is responsible for an adequate amount of supplies in the facility. The residents are mentally ill, intellectually disabled and senior residents. Broken glasses, excessively hot water, unsanitary conditions can harm them and the other residents in the facility. Lack of hygienic practices and inadequate food supply may fail to provide the nutrition required for the residents. Moreover, the lack of supplies for personal hygiene and unsanitary conditions may cause various communicable diseases among the residents. Lack of staffing in a facility where there are mentally ill and intellectually disabled residents may sometimes cause injury and suicidal attempts. Improper dosages of medications again can harm the residents.

2. In this case, neglect, lack of justice, patient rights were the ethical principles that were not followed. The state laws are also intertwined with these ethical principles as the law states "A person commits wanton neglect of a health care facility when a person knowingly acts in a manner likely to be injurious to the physical, mental or moral welfare of the resident of a facility.