CLARINDA, Iowa (AP) – Iowa officials say they’ve revised meal distribution policies at a state mental health institute after a patient fatally choked on food he shouldn’t have been served. The state Department of Human Services says food service procedures at Clarinda Mental Health Institute were not followed when a patient in the geriatric psychiatry program was given a peanut butter sandwich on Sept. 1 instead of pureed food. He was later found unresponsive and slumped over a dining table.

Officials say they began an internal investigation and at least one employee has been fired. DHS Director Charles M. Palmer says the incident was isolated. The Department of Inspections and Appeals surveyed the facility in early November. The Centers for Medicare & Medicaid Services also issued a civil penalty of more than $8,000.