Close up image of a caretaker helping older woman walk

A federal appeals court has upheld a $68,950 fine against a Texas nursing home penalized for the way it handled a resident’s transfer to hospice care.

The U.S. Court of Appeals for the Fifth Circuit ruled on Thursday that River City Care Center in San Antonio violated Medicare regulations in the way it cared for and transferred a resident requiring hospice care.

A resident suffered a pulmonary edema and congestive heart failure while at the facility, which significantly worsened her condition and required her to have supplemental oxygen, Bloomberg BNA reported.

The facility’s nursing staff allegedly tried to call the resident’s physician, but were unable to get in contact. The staff also failed to alert the resident’s sister, who was her designated contact, of her deteriorating condition. That lack of communication placed the resident in immediate danger, the Centers for Medicare & Medicare Services asserted, and landed the facility with a $4,050 per day civil monetary penalty.

The facility appealed the fine to an administrative law judge at the U.S. Department of Health and Human Services, as well as the department’s Departmental Appeals Board, which ruled in April 2015 that the civil monetary penalty was warranted.

A call to River City for comment was not returned by press time Monday.