Babka v. Iowa Dep't of Inspections

• Decision Date: 14 April 2021
• Docket Number: No. 19-1522,19-1522
• Citation: 967 N.W.2d 344
• Parties: Elizabeth BABKA, Petitioner-Appellant, v. IOWA DEPARTMENT OF INSPECTIONS AND APPEALS, Respondent-Appellee.
• Court: Iowa Court of Appeals

967 N.W.2d 344

Elizabeth BABKA, Petitioner-Appellant,

v.IOWA DEPARTMENT OF INSPECTIONS AND APPEALS, Respondent-Appellee.

No. 19-1522

Court of Appeals of Iowa.

Filed April 14, 2021

David L. Brown and Tyler R. Smith (until withdrawal) of Hansen, McClintock & Riley, Des Moines, for appellant.

Thomas J. Miller, Attorney General, and Anagha Dixit, Assistant Attorney General, for appellee.

Heard by Bower, C.J., and Vaitheswaran and Greer, JJ.

GREER, Judge.

It was alleged registered nurse Elizabeth Babka committed dependent adult abuse. Following a contested hearing, an administrative law judge (ALJ) issued a proposed decision that concluded Babka had not committed abuse. On appeal, the director of the Iowa Department of Inspections and Appeals (DIA) adopted all the facts of the proposed decision but came to the opposite conclusion—that Babka did commit dependent adult abuse. This legal determination came with no reference to relevant legal authority and was silent on how the same facts led to a different legal conclusion. Babka appealed the decision, which the district court affirmed on judicial review.¹

As she did at the district court, Babka argues the facts do not support a legal determination she committed dependent adult abuse.² See Iowa Code § 17A.19(10)(m). She also maintains the director's decision failed to meet the statutory requirements for a final decision under Iowa Code section 17A.16(1). And she argues that, under the circumstances here, the director's failure makes the decision unreasonable, arbitrary, capricious, and an abuse of discretion, as it is unclear what legal authority the director relied on, how he interpreted that authority, and to what facts the interpretation was applied to reach the decision. See id . § 17A.19(10)(n).

I. Background Facts and Prior Proceedings.

The DIA received a complaint alleging Babka committed dependent adult abuse against a patient, V.U., during Babka's overnight shift in the psychiatric ward on December 31, 2017.³ Specifically, it was alleged Babka assaulted and unreasonably punished V.U.

Following an investigation, the DIA issued a "founded" report⁴ of dependent adult abuse in May 2018. It concluded, "Video evidence documents that Babka grabbed [V.U.] by the arms, lifted her up out of the recliner and forced the resident out of the chair towards her room. Further, when [V.U.] wouldn't stay in her room, Babka administered an inappropriate medication and placed [V.U.] in seclusion."

Babka appealed, and a contested two-day hearing took place before an ALJ in September 2018. In the November 2018 proposed decision, the ALJ reversed the DIA's determination Babka engaged in dependent adult abuse and the order to put Babka's name on the dependent adult abuse registry. In reaching this conclusion, the ALJ found:

V.U., the alleged dependent adult victim in this case, is a 66-year-old woman who was admitted ... on Friday, December 22, 2017. She has been diagnosed with bipolar disorder

, ... sleep apnea, insomnia, among other conditions....

....

V.U. was in a "manic" state .... Staff nursing notes, called "Progress Notes—Encounter Notes," reflect V.U. was getting very little sleep and her agitation was increasing ....

....

Patient Tech [Sabrina] Barnes had worked with V.U. a few days since V.U.’s admission on Friday, December 22, 2017. Ms. Barnes was aware that V.U. had not slept much on previous nights, and would often wander around the unit. V.U. would walk "laps" around the unit, then sit down and color for a while, or rest in a recliner, then get up back up and sometimes go to her room, and then come out again. Previous night staff had let V.U. sleep in a recliner out in the "dayroom," which is near the nurse's station. The nurse's station is behind glass. Patient Tech Barnes believed that [V.U.] slept maybe "15 minutes here and there."

....

... Babka worked the 7 p.m. to 7 a.m. shift on December 30-31, 2017. Ms. Babka and Registered Nurse Daphne Booth were the license[d] nurses assigned to ... that shift. They divided up responsibility for the 17 patients on the unit, with Babka taking responsibility for V.U. Ms. Barnes was the Patient Tech assigned to work with them.

....

V.U. had been assigned to a room with a roommate, but a private room had been ordered for her beginning that night shift. Babka and Nurse Booth told V.U. at the beginning of their shift that she had a private room now and they wanted her to sleep in her room that night.

....

Staff allow residents to walk around the unit and watch television in the "dayroom," until 11 p.m.—when the television is turned off. Babka and the other staff did not have a problem with V.U. being in the day room after 11 p.m., so long as she was quiet....

At some point another resident—a male diagnosed with dementia—fell

asleep on the couch in the dayroom. The male resident had a roommate. That patient was assigned to Nurse Booth that shift, and she did not want him disturbed because if awakened, he would get very upset and aggressive.

Between midnight and 2 a.m. V.U. kept moving about the unit. Sometimes she would sit in a recliner in the dayroom for about 15 minutes at a time, but then would get up again and loudly demand medication. [A] little before 2:30 a.m., Babka noticed that V.U. was rocking in the recliner and appear to be getting really drowsy. The video footage of the area does not show V.U.’s face.

Babka walked up to V.U. and told her to the effect, "Why don't you go lie down in your bed." The video shows Babka standing in front of V.U. and talking to her, but there is no audio. Babka denies that she woke V.U. up. She told the DIA Surveyor that V.U. was "dozing." ....

V.U. did not like what Babka said to her, and started yelling and cursing at her. Babka called Nurse Booth to come over and help her with V.U.

V.U. started threatening [Babka] and Nurse Booth. Nurse Booth and Babka "nicely" told V.U. that she needed to go to her room, that they would sit with her and get her some food. They reminded her that she had a private room.

V.U. responded by yelling and screaming, questioning why the man on the couch could stay out in the dayroom, but she could not. Nurse Booth told V.U. that she needed to calm down and that she could go to her room on her own, or they would assist her. When V.U. did not respond, Nurse Booth said to the effect, that she would count to 3, and if V.U. did not get up on her own, they would go "hands on" and get her up. V.U. responded to the effect, "Go ahead and do it, bitches."

At that point—as verified by the video—Babka and Nurse Booth bent over and each put an arm under V.U.’s arms and stood V.U. up. At some point V.U. made a clenched fist and stomped on Nurse Booth's foot. When they tried to walk V.U. forward, she dropped her weight and they lowered her to the floor. Nurse Booth stepped away and called security.

....

The video shows that V.U. then got up on her own and started to move toward the recliner. Babka blocked her from returning to the chair and pointed her toward her room. About 2:41 a.m., the video shows Babka walking V.U. down to her room. Another camera shows Patient Tech Barnes at 2:44 a.m. covering up the man on the couch with a blanket.

Shortly after that, the video shows V.U. leaving her room and walking down the hall. Security Guard Erik Nelson takes V.U.’s hand and she calmly walks back [to] her room.

V.U. kept wanting to leave her room. She told a security guard who came to assist that Babka "would not give me my meds."

Babka told V.U. that she had given her all the Seroquel

that she could give her that day, and all she had left to give was Haldol—and that she could take it by mouth or via a shot. V.U. replied that she would just take the shot. Security Guard Nelson held V.U.’s hand, and she cooperated with the shot. Babka gave V.U. the Haldol shot in her upper left arm.

Babka noted in V.U.’s medication records that she gave her the Haldol injection at 2:46 a.m. Although Babka testified she gave V.U. a choice, she charted that she [g]ave the injection after V.U. "refused" oral medication.

V.U. remained in her room for about 15 to 20 minutes, but then came out and resumed yelling at staff. She was redirected back to her room. She stayed in her room a little longer after Patient Tech Barnes brought her a radio.

At 3:29 a.m., V.U. came out to the dayroom and star[ted] yelling. She refused to be redirected....

Babka then gave V.U. two choices—she could return to her room or she could go to an open seclusion room to calm down. V.U. picked the seclusion room, however as she walked her over to the seclusion room, she changed her mind and wanted to go towards the dayroom. Babka told her no, she had already picked the seclusion room and she had to stay in there until she calmed down. She walked V.U. into the seclusion room and left.

The seclusion room was not locked at that time.... Staff considered this "open door quiet room."

During the next 20 minutes Babka was busy with other patients. Nurse Booth stood by the seclusion room door. According to Nurse Booth, at one point V.U. was "running at me and trying to push me while she was in the seclusion room. Granted I was standing in the doorway." .... Patient Tech Barnes testified that when V.U. was put in the seclusion room, she was "banging around in there and screaming." Nurse Booth asked [Babka] why she just didn't call the doctor and get some medication for V.U.

[Babka] called Dr. Ouyang a little before 5 a.m. on December 31, 2017. She told the doctor that V.U. had been yelling and attempting and threatening to hit staff.

Babka documented on a "Psychiatric Restrain/Seclusion Summary" that she called Dr. Ouyang at 4:58 a.m. and told him of V.U.’s behavior that night and what PRN's had been administered to her.... [The doctor] gave an oral order for V.U. to have a Thorazine

injection. He also gave an oral order for V.U. to be in locked seclusion until [she] could control her behavior.

V.U. cooperated when Babka gave her a shot. She testified that she gave V.U. the...