Opinion ID: 1714853
Heading Depth: 2
Heading Rank: 1

Heading: Cause. Robbins asserts the record is insufficient to support his discharge in accordance with the regulatory framework just described. The claim is without merit, legally or factually.

Text: Iowa Code section 135C.23 sets the requirements for admission or residence in a health care facility. The statute provides: A health care facility shall not knowingly admit or retain a resident: a. Who is dangerous to the resident or other residents. .... c. Whose condition or conduct is such that the resident would be unduly disturbing to other residents. Iowa Code § 135C.23(2) (emphasis added). Moreover, a health care facility must transfer or discharge a resident with dangerous or disturbing behavior when the [facility] cannot control the resident's dangerous or disturbing behavior. Id. Complimenting these statutory mandates, Iowa Administrative Code rule 481-58.40(1) prohibits involuntary discharge or transfer from a facility except for the resident's welfare or that of other residents. The administrative code defines welfare as follows: Welfare of a resident or that of other residents refers to their social, emotional, or physical well-being. A resident might be transferred or discharged because his/ her behavior poses a continuing threat to himself/herself (e.g., suicidal) or to the well-being of other residents or staff (e.g. his/her behavior is incompatible with their needs and rights).... Iowa Admin. Code r. 481-58.40(1)(b). The ALJ, affirmed by the department director, found Robbins ran his wheelchair into other residents, restrained their freedom of movement, and directed abusive language toward them, all of which infringed upon the rights and well-being of other residents. We are bound by these findings, as they are substantially supported by the record. See Gaffney, 540 N.W.2d at 433. The sworn testimony of Heritage Acres staff members recounted Robbins' recent and recurring episodes of pushing tray tables and carts into other residents, intimidating them, and even striking an elderly female resident with his fist. Given this behavior, Robbins cannot escape the department's legal conclusion under Iowa Code section 135C.23(2)(c) that his aggressive acts were unduly disturbing to other residents. According to the administrative regulations, his behavior was clearly incompatible with the safety of other residents whom he accosted as they passed through the facility's common areas. Moreover, the facility was hampered in its ability to ensure Robbins' safety where his aggressive noncompliance with staff prevented the proper use of a mechanical lift for transfer from his wheelchair to his bed. See Iowa Code § 135C.23(2)(a); Iowa Admin. Code r. 481-58.40(1). Clearly Robbins' discharge was warranted under this record, and the district court correctly upheld the department's conclusions on this ground. B. Notice. Next, in a somewhat puzzling challenge, Robbins contests the sufficiency of his notice of discharge, claiming Heritage Acres failed to notify his responsible party. The term responsible party is defined by administrative rule: Responsible party means the person who signs or cosigns the admission agreement required in 58.13(135C) or the resident's guardian or conservator if one has been appointed. In the event that a resident has neither a guardian, conservator nor person who signed or cosigned the resident's admission agreement, the term responsible party shall include the resident's sponsoring agency, e.g., the department of social services, Veteran's Administration, religions [sic] groups, fraternal organizations, or foundations that assume responsibility and advocate for their client patients and pay for their health care. Iowa Admin. Code r. 481-58.1(19). The record reveals that Robbins signed his own admission agreement without a cosigner, pays his own bills, and does his own banking. No guardian or conservator has been appointed for him, nor does the record disclose the need for one. Robbins offered no evidence that an agency, group, or organization has assumed responsibility for him. Thus the ALJ and district court both found that Robbins is his own responsible party for purposes of receiving notice. Robbins nevertheless asserts that three subparagraphs in administrative rule 481-58.40(1) require notification of a responsible party in addition to the resident. Specifically, he points to rule 58.40(1)(f), which requires that notice of the discharge hearing shall be sent to the licensee, resident, responsible party, and ... ombudsman. (Emphasis added.) Likewise, under rule 58.40(1)(i), a copy of the notice must be personally delivered to the resident and other copies sent to the department, the resident's responsible party, physician, the person or agency responsible for the resident's placement, maintenance, and care in the facility, and the ... ombudsman. (Emphasis added.) Finally, under rule 58.40(1)(l), the resident's discharge must be discussed with the resident, the resident's responsible party, and the person or agency responsible for the resident's placement, maintenance, and care in the facility. (Emphasis added.) Robbins' argument that these three rules required notification beyond what Heritage Acres provided fails for two reasons. First, the general notice provision of rule 48158.40(1)(c) contemplates alternative service to the resident or responsible party, not both. There is no dispute that Robbins, the resident, received notification. Thus the general rule's requirement was not only met, but exceeded, because Robbins' sister and son were also notified. See State v. Stradt, 556 N.W.2d 149, 151 (Iowa 1996) (statutory provisions read, not in isolation, but in conformity with overall statutory scheme). Second, the subparagraphs on which Robbins relies are ancillary to the general notice requirement in 58.40(1)(c) and would apply here if there were a responsible party to notify. Robbins, however, has failed to identify who that responsible party would be. As aptly noted by the district court, [o]ne would think if the party was responsible, the party would also be readily identifiable. Although Robbins' counsel hints on appeal that Robbins was perhaps incompetent to receive notice of his discharge, the record furnishes no support for such a claim. The transcript reveals that Robbins was engaged in the proceedings and fully understood their import. In the absence of a finding of incompetence under Iowa Code section 229.27, an individual hospitalized or detained for treatment of mental illness is not presumed incompetent. Iowa Code § 4.1(15)(1995); see id. § 4.1(21A)(1997).