Audit raises concerns at North Dakota Veterans Home, including choking death caused by improper meal

David Samson / Forum file photo By Staff reports Today at 11:22 AM Listen Comments Share Share this article News Reporting News Reporting Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. The Trust Project What is this? LISBON, N.D. — An audit of the North Dakota Veterans Home, located in Lisbon, identified several areas of concern including a choking death caused by a dietary plan not being followed by staff. The audit was conducted by the North Dakota State Auditor's Office for the biennium that ended June 30, 2025, and some key information from the audit was shared by press release Thursday, Nov. 12. ADVERTISEMENT After a resident died by choking when their physician-ordered dietary plan was not followed, according to the release, the auditor's office reviewed the veterans home's dietary processes. Because residents may have medical conditions that require a special diet, it's important that their meals match their doctor's orders — failing to do so can put their health at risk. An onsite visit by the auditor's office revealed that one resident was served the incorrect diet during lunch service because the dining system didn't match the doctor's orders, the release said. After the choking death, the auditor's office reviewed the evaluations of the three staff members who were involved. Two of the annual evaluations didn't mention disciplinary actions after the event, and both employees were rated as "meeting expectations." These evaluations are used to determine salary increases. The audit also uncovered $56,766 in overtime paid to one salaried administrative leadership staff member. A review of timesheets compared to computer log-in access logs showed inconsistencies in the hours the staff member reported and their computer activity, according to the release. An administrative assistant was also responsible for approving accounting transactions entered by the accounting manager, despite the assistant position lacking sufficient knowledge of the agency's operations to review transactions effectively, the release said. Anyone who approves "accounting transactions should have sufficient knowledge and understanding of accounting and agency operations," according to the release. ADVERTISEMENT During the audit period, the administrative assistant approved more than $9.7 million in expenditures. This is a developing story. Check back for updates. Comments Share Share this article News Reporting News Reporting Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. The Trust Project What is this? Tags Tags VETERANS GOVERNMENT AND POLITICS NORTH DAKOTA By Staff reports Our newsroom occasionally reports stories under a byline of "staff." Often, the "staff" byline is used when rewriting basic news briefs that originate from official sources, such as a city press release about a road closure, and which require little or no reporting. At times, this byline is used when a news story includes numerous authors or when the story is formed by aggregating previously reported news from various sources. If outside sources are used, it is noted within the story. Listen to this article Conversation ADVERTISEMENT What To Read Next North Dakota North Dakota readies for public charter school applications in early December 7h ago · By Robin Huebner North Dakota North Dakota receives $206M in rural health funds 22h ago · By Staff reports North Dakota US Border Patrol, regional agencies train together 22h ago · By Staff reports ADVERTISEMENT Get Local Must Reads Prep Third straight Dakota Bowl showdown awaits Loboes, Rockets 18h ago · By Paul Garcia II Local Jamestown man arrested after leading police on pursuit, police say 23h ago · By Staff reports Community JHS students to perform 'Game of Tiaras' 1d ago Local Jamestown parks commission to make decision to sell administrative, shop building 1d ago · By Masaki Ova