Hospice providers that care for hundreds of Iowans in the final stages of a terminal illness are now being inspected by the state on a schedule of one visit every 20 years. Patient advocates say that sort of inspection cycle "doesn't even pass the laugh test," and puts Iowans at risk of substandard care. It's one example of how Iowa is turning a blind eye to critical elements of the state's heath care system. With few inspection records and little government oversight to rely on, the selection of medical providers has become a high-stakes gamble for patients. Patient care advocates say the lack of oversight creates enormous risks for patients. Lawmakers are loathe to impose any additional rules or standards on businesses, including those that provide medical care, even though some in the industry are open to more regulation.