Woman mistakenly pronounced dead "gasped for air" after being found by Iowa funeral home staff, report says

An Iowa care facility is facing fines totaling $10,000 after mistakenly pronouncing a 66-year-old resident dead and having her transported to a funeral home, where she woke up "gasping for air." 

A new report from the Iowa Department of Inspections and Appeals, released on Feb. 1, 2023 and first reported by CBS affiliate KCCI, details the series of events that led up to the woman being mistakenly pronounced dead. The unidentified resident, who had been at the Glen Oaks Alzheimer's Special Care Center since Dec. 2021, was moved into hospice care at the facility on Dec. 28, 2022, because of "senile degeneration of the brain." 

While in hospice care, comfort measures were taken. Over the course of several days, staff members recorded occurences of "diminished" lung sounds and minor seizures. On Jan. 3, 2023, the woman was pronounced dead at 6 a.m. after an employee identified as Staff C said that she "did not feel a pulse" and found the "resident was not breathing at that time." 

The staff member notified a licensed practical nurse. The woman's family was alerted and a local funeral home was called. 

A funeral director arrived shortly after 7:30 a.m., and with the assistance of another nurse, identified as "LPN D," the resident was placed in a body bag which was zipped shut. The funeral director left the facility shortly afterward. At 8:26 a.m., employees at Ankeny Funeral Home and Crematory unzipped the bag. 

They "observed (the resident's) chest moving and she gasped for air," the report states. 

The funeral home then called 911 and the care facility. When EMS responded, they were able to record a pulse and breathing, but there was no eye movement and no verbal response. 

That same day, the resident was returned to the care facility. She passed away early in the morning of Jan. 5, with her family at her side, the report said. 

"We have been in close communication with the family of the resident, and we just completed an investigation by the Department of Inspections and Appeals regarding the matter," Lisa Eastman, the facility's executive director, told CBS News. "We care deeply for our residents and remain fully committed to supporting their end-of-life care. All employees undergo regular training so they can best support end-of-life care and the death of our residents."

The facility faces two state violations from the DIA, which could result in a $10,000 fine. 

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