Date: Jan 27, 2026

CMS Deficiency Reports and Conclusory Experts Do Not Establish “Recklessness” to Defeat Iowa’s COVID-19 Health-Care Immunity (Iowa Code § 686D.6)

I. Introduction

In Jacob M. Rose, individually and as of the Estate of Jack F. Rose and Jeremy P. Rose, individually v. Oakland Healthcare Management, LLC, d/b/a Oakland Manor, the Iowa Supreme Court applied Iowa’s “COVID-19 Response and Back-to-Business Limited Liability Act,” codified at Iowa Code chapter 686D, to wrongful-death and related claims arising from a nursing facility resident’s COVID-19 death.

The plaintiffs—Jack Rose’s sons, suing individually and through the estate—alleged Oakland Manor (a Medicaid-participating skilled nursing facility) recklessly and willfully failed to comply with federally recommended COVID-19 prevention practices. Their core evidentiary support at summary judgment consisted of a CMS Statement of Deficiencies (the “CMS Report”) and a nurse expert disclosure that largely tracked the CMS Report’s criticism. Oakland Manor invoked the Act’s civil-liability shield for COVID-19-related injuries and deaths, which can be overcome only by proof of “recklessness or willful misconduct.” The district court granted summary judgment for Oakland Manor, and the Iowa Supreme Court largely affirmed.

The case’s central issue was narrow but consequential: whether regulatory-deficiency findings and a conclusory expert opinion created a genuine issue of material fact on “recklessness” sufficient to pierce Iowa Code § 686D.6 immunity.

II. Summary of the Opinion

The Iowa Supreme Court held that the summary-judgment record did not generate a triable fact issue that Oakland Manor acted “recklessly or willfully” under Iowa Code § 686D.6(2). The CMS Report described inconsistent or incomplete infection-control practices (e.g., imperfect PPE use, missed hand hygiene, sanitation lapses, and an isolation area not fully sealed), but those deficiencies amounted—at most—to negligence (perhaps negligence per se), not recklessness.

The Court also held the plaintiffs’ expert showing was inadequate: the nurse’s opinion was conclusory, based only on the CMS Report and the death certificate, and lacked the factual detail and analytic bridge needed to support an inference of intentional conduct or conscious disregard of a known or obvious risk.

Procedurally, the Court affirmed summary judgment and dismissal. It affirmed the court of appeals only to the extent it affirmed dismissal on recklessness; it vacated the court of appeals’ additional causation analysis as unnecessary.

III. Analysis

A. Precedents Cited

1. Summary judgment standards and the “no speculation” rule

Kostoglanis v. Yates, 956 N.W.2d 157 (Iowa 2021) and Goodpaster v. Schwan's Home Serv., Inc., 849 N.W.2d 1 (Iowa 2014): The Court anchored its review in the familiar framework that summary judgment is proper when no genuine issue of material fact exists and the movant is entitled to judgment as a matter of law.
Iowa R. Civ. P. 1.981(5), Bitner v. Ottumwa Cmty. Sch. Dist., 549 N.W.2d 295 (Iowa 1996), and Rottinghaus v. Lincoln Sav. Bank (In re Est. of Franken), 944 N.W.2d 853 (Iowa 2020): Once the motion is properly supported, the resisting party must present competent evidence of specific facts—pleadings and general allegations do not suffice.
Parish v. Jumpking, Inc., 719 N.W.2d 540 (Iowa 2006) and Fees v. Mut. Fire & Auto. Ins., 490 N.W.2d 55 (Iowa 1992): The Court reiterated what “material” and “genuine” mean—facts that affect the outcome, and evidence that would allow a reasonable jury to find for the nonmovant.
Nelson v. Lindaman, 867 N.W.2d 1 (Iowa 2015) (quoting Hlubek v. Pelecky, 701 N.W.2d 93 (Iowa 2005)): The “speculation is not sufficient” maxim was pivotal here because the plaintiffs’ record invited inference piled on inference: protocol lapses → exposure → infection → death, without competent proof of the mental state required by § 686D.6(2).

2. Iowa’s established definition of recklessness

Martinez v. State, 986 N.W.2d 121 (Iowa 2023) (quoting Bell v. Cmty. Ambulance Serv. Agency, 579 N.W.2d 330 (Iowa 1998)) and McCornack v. Pickerell, 294 N.W. 746 (Iowa 1940): These decisions supplied the baseline principle that recklessness is categorically more culpable than ordinary negligence.
Penny v. City of Winterset, 999 N.W.2d 650 (Iowa 2023): The Court relied on Penny for the operative three-part formulation: (1) an intentional act of unreasonable character, (2) done in disregard of a known risk or one so obvious the actor should have known it, and (3) making harm highly probable. Penny also reinforced that recklessness sets a “high bar,” shaping how the Court assessed the thin evidentiary record.

3. Illustrative pandemic-era recklessness and persuasive authority from other jurisdictions

State ex rel. Clinton No. 1, Inc. v. Baker, 708 S.W.3d 474 (Mo. 2024) (en banc): The Court used this as a contrast case. There, a deliberate placement of a COVID-infected roommate into a contracted private room supported an inference of recklessness. By comparison, Oakland Manor’s record showed “lapses” and “inconsistent” execution, not a comparable deliberate decision that knowingly heightened risk.
The Court also cited a line of cases rejecting attempts to recharacterize protocol failures as heightened culpability sufficient to pierce COVID-immunity statutes: Kennestone Hosp., Inc. v. Turner, 914 S.E.2d 439 (Ga. Ct. App. 2025); Arbor Mgmt. Servs., LLC v. Hendrix, 875 S.E.2d 392 (Ga. Ct. App. 2022); Fluhr v. Anonymous Dr. 1, 234 N.E.3d 912 (Ind. Ct. App. 2024); Est. of Campbell v. Woodcliff Health & Rehab. Ctr., 318 A.3d 708 (N.J. Super. Ct. App. Div. 2024); Est. of Pierro v Carmel Richmond Healthcare & Rehab. Ctr., 241 N.Y.S.3d 299 (App. Div. 2025); Barbaro v. Eger Health Care & Rehab. Ctr., No. 150689/2022, 2024 WL 3405761 (N.Y. Sup. Ct. July 11, 2024); Hasan v. Terrace Acquisitions II, LLC, 194 N.Y.S.3d 445 (Sup. Ct. 2023); Crampton v. Garnet Health, 155 N.Y.S.3d 699 (Sup. Ct. 2021). Collectively, these authorities supported the Court’s conclusion that allegations of imperfect infection control generally sound in negligence absent evidence of conscious disregard or moral culpability.

4. Expert opinions and generating a recklessness inference

Feld v. Borkowski, 790 N.W.2d 72 (Iowa 2010): The Court treated Feld as the exemplar of what “enough” looks like—an expert supplying detailed, fact-driven analysis (there, physics-based) that supported an inference about intent/mental state. The comparison undercut the plaintiffs’ expert showing, which lacked investigation, detail, and reasoning beyond labels.
Penny v. City of Winterset, 999 N.W.2d 650 (Iowa 2023): The Court also invoked Penny to emphasize that expert testimony must rest on facts in the record and must actually support the inference claimed; mere conclusions do not.
Bristow v. Nemours Found., No. N21C-03-240, 2023 WL 4994093 (Del. Super. Ct. 2023): Used to reinforce that an expert’s use of the word “reckless” is not self-proving; the report must show the risk was apparent and consciously ignored.

5. The jury-inference checkpoint

Vipond v. Jergensen, 148 N.W.2d 598 (Iowa 1967): The Court cited this for the proposition that courts must examine whether the record supports a reasonable inference of recklessness. Here, it did not.

B. Legal Reasoning

Statutory structure controlled the dispute. Iowa Code § 686D.6(1) broadly immunizes health care providers from civil damages for COVID-19-related injury or death resulting from acts or omissions while providing or arranging health care, expressly including acts or omissions relating to PPE use or nonuse. Liability re-enters only under § 686D.6(2) for “recklessness or willful misconduct.” Because the parties agreed the immunity framework applied, the case turned entirely on whether the plaintiffs produced evidence meeting the exception.
The Court treated “recklessness” as a mental-state and probability-of-harm inquiry, not a regulatory-compliance scorecard. The CMS Report described a facility that attempted protocols but implemented them inconsistently. The Court characterized these as “failures of execution or consistency,” which align with negligence, not proof that the facility intentionally engaged in unreasonable conduct while consciously disregarding a known/obvious risk that made harm highly probable.
Regulatory deficiencies, without more, were not evidence of the required culpability. Even if CMS deficiencies could support negligence or “negligence per se,” the Court held they did not establish the heightened state of mind and high-probability-of-harm element inherent in recklessness. The Court emphasized that the legislature chose to remove civil liability for precisely these pandemic-era operational shortcomings, absent proof of reckless or willful misconduct.
The plaintiffs’ expert showing failed because it was conclusory and unmoored from a developed factual record. Unlike the expert in Feld v. Borkowski, the plaintiffs’ nurse expert conducted no independent factual investigation and relied only on the death certificate and CMS Report. The Court found the opinion offered labels (“negligent,” “wanton”) rather than a fact-based analysis supporting an inference of intentional conduct or conscious risk disregard. In the summary-judgment posture, that “ipse dixit” could not create a genuine issue of material fact on recklessness.
Disposition narrowed the appellate holding. Because failure to show recklessness was dispositive under § 686D.6(2), the Court declined to reach causation and vacated the court of appeals’ causation discussion as unnecessary to the judgment.

C. Impact

The decision meaningfully clarifies how Iowa Code § 686D.6 operates in practice:

CMS (or similar) deficiency reports are not, standing alone, a pathway around § 686D.6 immunity. They may describe substandard practices, but without evidence supporting the heightened mental state and high-probability harm elements, they will usually remain in the negligence lane.
Recklessness requires evidence of intentional unreasonable conduct and conscious disregard—operational imperfection is not enough. Plaintiffs will need discovery that speaks to decisions, knowledge, warnings, and deliberate choices (e.g., knowing placement decisions, knowingly ignoring an outbreak, knowingly refusing isolation), not merely after-the-fact audit findings of inconsistent compliance.
Expert testimony must do more than recite conclusions. Experts must connect record facts to the recklessness elements with a discernible methodology. Mere adoption of a report’s criticisms, without additional investigation or analysis, is unlikely to survive summary judgment.
Defense strategy in COVID-immunity cases is reinforced. Providers can focus summary judgment on the statutory exception’s mental-state requirements, potentially avoiding causation battles if the recklessness record is thin.

IV. Complex Concepts Simplified

Summary judgment: A pretrial ruling that ends a case when the nonmoving party cannot point to specific, admissible evidence creating a real factual dispute that a jury could resolve in its favor.
Statutory immunity (Iowa Code § 686D.6): A legislative shield that blocks civil-damages suits for COVID-19-related injuries or deaths tied to providing or arranging health care—unless the plaintiff proves a narrow exception.
Recklessness: More blameworthy than negligence. It involves an intentional act (or course of conduct) undertaken in conscious disregard of a known or obvious risk, making harm highly probable.
Negligence per se: A doctrine under which violating a statute or regulation can supply the “duty” and “breach” components of negligence. Even so, it does not automatically prove recklessness, because recklessness turns on a heightened mental state and degree of risk.
Ipse dixit: An expert’s “because I say so” conclusion—an opinion that asserts a result without showing the factual basis and reasoning needed to support it.

V. Conclusion

The Iowa Supreme Court’s decision establishes a practical rule for COVID-19 immunity litigation under Iowa Code § 686D.6: evidence of infection-control deficiencies—without concrete proof of intentional, consciously risk-disregarding conduct—does not create a jury question on “recklessness or willful misconduct.” A CMS deficiency report and a conclusory expert opinion, standing alone, are insufficient to pierce the statute’s liability shield. The opinion thereby reinforces the legislature’s policy choice to protect health care providers from pandemic-era civil liability except in truly aggravated, morally culpable cases.