Editor’s Note: This story has been updated with comment from Putnam Center.

An appellate court has upheld a $1.2 million fine levied against a West Virginia nursing facility that failed to follow through on the extraction of one resident’s teeth.

The U.S. Court of Appeals for the Fourth Circuit determined Wednesday that the fine was not “arbitrary or capricious,” as the Putnam Center in Hurricane, WV, did not meet the “highest practicable quality of care” standard.

The Department of Health and Human Services first fined Putnam Center in 2014. Surveyors alleged the operator failed to secure dental treatment for a 62-year-old resident whose decaying teeth caused several other health problems, including infections from bacteria traveling into his lungs. The nursing facility’s medical director at the time deemed that the man had too many health issues to have his teeth extracted under a general anesthetic. Surveyors also alleged that the nursing home failed to schedule the extraction at a later date after the resident underwent a procedure that greatly improved his health, the court noted.

Putman Center contested the CMS finding of noncompliance from a survey that occurred in October 2014 and the large fine CMS imposed, because it believed the care it and his community-based physician provided to the resident was appropriate to his care and condition, said spokeswoman Lori Mayer.

Judge Stephanie Thacker concluded in her opinion that HHS properly interpreted its own quality of care standards in requiring Putnam Center to follow through and ensure that its resident received the dental procedure. Dissenting Judge Julius Richardson argued that HHS requires nursing facilities to provide “necessary” care, and he believed it was not necessary for the provider to set up a procedure when a resident was too sick to endure it.

“The Center is gratified that one Judge on the Court of Appeals recognized that the result in this case actually could be disruptive to resident care, and remains concerned that CMS and the majority of the Court misunderstood the physician orders and the relationships among the parties,” Mayer said in a statement.