Wyatt v. Iowa Dept. of Human Services

• Decision Date: 18 January 2008
• Docket Number: No. 06-0351.,06-0351.
• Parties: Kim WYATT, Appellee v. IOWA DEPARTMENT OF HUMAN SERVICES and/or Iowa Department of Inspections and Appeals, Appellants.
• Court: Iowa Supreme Court

744 N.W.2d 89

Kim WYATT, Appellee v. IOWA DEPARTMENT OF HUMAN SERVICES and/or Iowa Department of Inspections and Appeals, Appellants.

No. 06-0351.

Supreme Court of Iowa.

January 18, 2008.

Thomas J. Miller, Attorney General, and John R. Lundquist, Assistant Attorney General, for appellants.

Vernon P. Squires and Nikki J. Johnson of Bradley & Riley, PC, Cedar Rapids, for appellee.

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 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 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 ALT 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 decision. In so doing, the director accepted most of the factual findings of the ALL He concluded, however, that "assault" was a general intent crime and all that was required was intended physical contact that a reasonable person would consider insulting or offensive. The director, moreover, rejected assertions of justification, concluding, without elaboration, that there were "several options" that could have been considered and implemented to mitigate the stimuli. Finally, he noted that the use of the pillow was not part of any care plan and that if the course of action chosen was an approved method of patient care it would have been so reflected in the record.

Wyatt sought judicial review of the director's decision in the district court. The district court held that Iowa law did not recognize "negligent assault" and found that the record did not show that Wyatt acted with the specific intent to assault E.W. under applicable law. As a result, the district court reversed the director's decision.

DIA appealed the decision of the district court, and we referred the case to the court of appeals. The court of appeals reversed the district court, finding that Wyatt committed an intentional assault. We granted further review.

II. Standard of Review.

Determination of the statutory requirements for dependent adult abuse has not been explicitly vested in the agency's discretion. Mosher v. Dep't of Inspections & Appeals, 671 N.W.2d 501, 509 (Iowa 2003). As a result, our review is for corrections of errors of law. Iowa Code § 17A.19(10)(c).

III. Discussion.

A. Timeliness of Appeal. The first issue is whether DIA's appeal of the proposed decision was timely. A proposed decision becomes final unless an appeal is made within the time provided by agency rule. Iowa Code § 17A.15(3). Iowa Administrative Code rule 481-10.25(1) provides that a request for review of a proposed decision shall be made within fifteen days of the issuance of the proposed decision. Issuance, moreover, is defined as "the date of mailing of a decision or order or date of delivery if service is by other means." Iowa Admin. Code r. 481-10.1.

In this case, the proposed decision dated March 10 indicates...