“Substantial Compliance”

Sexual Assault

Deputy Editor Clark Kauffman has worked as an investigative reporter and editorial writer at the Des Moines Register and the Quad-City Times. He wrote an article for Iowa Capital Dispatch about a bizarre ruling by an Iowa judge. Northgate Care Center of Waukon failed to keep a resident safe from sexual assaults. The fine to the facility was only $11,791. However, Administrative Law Judge Leslie A. Weyn struck the fine. The Judge defended the facility because the assailant “was not known to be homosexual or to engage in homosexual behaviors”.

Huh? She does not understand dementia, assaults, or foreseeability. Terrible decision.

The judge assumed the facility could not reasonably anticipate the sexual assault of a resident because previously the sexual predator only attacked woman. How stupid. For several months, the attacker aggressively exposed himself to others, asking, “What does a guy have to do to get a boner around here?”

Subsequent to this hypersexual and aggressive behavior, the sexual predator assaulted his intellectually disabled roommate. This was predictable therefore it was preventable.

The victim did not want his roommate to do what he had done, that he did not like what had happened, and that his roommate had used force against him.

The state of Iowa imposed no fines. CMS imposed a fine of $11,791 for failure to protect residents from harm. However, she decided that Northgate was “in substantial compliance” with safety regulations that require to protect residents from harm. The facility got away with no fine at all. Incredible.


CMS admits that it only informs the public of fines against those facilities if, and when, the owners choose to pay the fines. CMS’ “normal process” in cases of unpaid fines is to refer the matter to an administrative contractor who will initiate collection by offsetting Medicare payments owed to the home.

Toby Edelman is senior policy attorney for the nonprofit Center for Medicare Advocacy. She is an expert in nursing home operations. She says this policy contradicts the agency’s position of reporting fines once imposed. Toby states:

“So much of the information they report on their Care Compare website is inaccurate. It’s just ridiculous.”

CMS’ Care Compare site is promoted as a tool to provide the general public with accessible information on quality-of-care issues in nursing homes. Experts and advocates believe the site contains misleading or incomplete information.

Given the CMS policy of not disclosing unpaid fines, it’s not clear what action, if any, CMS has taken against facilities cited for major violations. Toby complains:

“So a lot of the the most serious penalties are never publicly reported. There is so much inaccurate information that’s being put out through that website.”

Hopefully, they will fix the policy and update the information available to the public. Consumers need accurate and timely information to choose a safe nursing home.