What happens when you fracture your ankle and no one checks on your wound or changes your stocking for 25 days? Ruth Louden, an otherwise healthy 89-year-old, developed gangrene, leading to the amputation of her leg. Her health went downhill quickly, and she died within months. Federal officials hit the Friendship Manor nursing home in Grinnell with a fine of $112,650. But the owner, Tim Boyle, appealed the fine and has settled for $75,397.

If management had brought Friendship Manor into compliance with all regulations on patient care during the past year, reducing the fine might be justified. But according to Clark Kauffman of the Des Moines Register, another patient died last year because of an accident linked to an unsafe walkway at the facility. That’s not all:

• In November, state inspectors compiled a 45-page list of deficiencies at the home, including:

• Improper use of physical restraints.

• Failure to meet a professional standard of care.

• Failure to provide incontinence care.

• Failure to prepare food under sanitary conditions.

• Failure to adhere to infection-control guidelines.

Current protocols for nursing home inspections and fines don’t appear to be compelling this facility’s managers to meet reasonable standards of care. It may be cheaper for owners to accept the occasional federal fine (after appealing to get it reduced) than to bring conditions up to par.

Iowa nursing homes have less to fear than ever from state regulators. During last year’s legislative session, lawmakers voted unanimously to eliminate “a broad range of fines against Iowa nursing homes that fail to meet minimum health and safety standards.” Friendship Manor owner Tim Boyle heads the nursing home industry’s main lobbying group, which provided a a textbook case of how to buy influence at the Iowa statehouse.

Even now, some Iowa legislators think regulators are too tough on nursing homes. What a sorry state of affairs in a state with one of the highest proportions of elderly people in the population.