Fla. nurs­ing home de­fends its post-Irma ac­tions

Cen­ter where 8 died says it reached out to gov­er­nor

The Washington Post - - FRONT PAGE - BY AARON C. DAVIS, KATIE ZEZIMA AND MARK BER­MAN

The night be­fore Hur­ri­cane Irma be­gan roar­ing over Florida, staffers at the Re­ha­bil­i­ta­tion Cen­ter at Hol­ly­wood Hills locked the doors, shut­tered the win­dows and turned the tem­per­a­ture down to about 67 de­grees — a buf­fer, ad­min­is­tra­tors thought, to keep the build­ing cool in case the power went out.

It wouldn’t last long. About 3 p.m. on Sun­day, the lights flick­ered, nurs­ing-home ex­ec­u­tives say. The power stayed on, but a jan­i­tor soon noticed a problem: The mas­sive chiller used to serve the 152-bed fa­cil­ity was spew­ing warm, muggy air.

The fol­low­ing evening, Natasha An­der­son, one of the ex­ec­u­tives, called a pri­vate phone num­ber for Gov. Rick Scott (R) seek­ing ur­gent help, An­der­son said. It was the first of three such calls, she said, to a num­ber that of­fi­cials con­firmed Scott gave out to nurs­ing homes as an emer­gency backup in plan­ning calls be­fore the storm.

“Re­peat­edly, I was told that our case was be­ing es­ca­lated to the high­est level,” An­der­son said.

Yet, she said, no one came — and nurs­ing-home of­fi­cials did not con­sider the cri­sis ur­gent enough to bring pa­tients to the hos­pi­tal across the road.

By noon Wed­nes­day, eight res­i­dents were dead. Their deaths are be­ing in­ves­ti­gated as crim­i­nal homi­cides, and the nurs­ing home has been closed.

The ac­count the nurs­ing-home ex­ec­u­tives pro­vided to The Post of­fers new de­tails of the de­te­ri­o­rat­ing con­di­tions in­side the fa­cil­ity. But it also is con­tra­dicted by law en­force­ment and state of­fi­cials on key points, in­clud­ing how ag­gres­sively the nurs­ing home

had sought as­sis­tance and pre­cisely when staffers called 911 as a pa­tient went into car­diac ar­rest.

At­tempts to as­sign blame abound.

The Florida Depart­ment of Health said that “at no time” did the nurs­ing home “re­port that con­di­tions had be­come dan­ger­ous or that the health and safety of their pa­tients was at risk.”

“It’s shock­ing that these trained med­i­cal pro­fes­sion­als put pa­tients’ lives in need­less jeop­ardy. The fact is that this fa­cil­ity never called 911,” said Mara Gam­bineri, a spokes­woman for the depart­ment. “The Re­ha­bil­i­ta­tion Cen­ter at Hol­ly­wood Hills is re­spon­si­ble for the health and safety of their pa­tients.”

The gov­er­nor’s com­mu­ni­ca­tions di­rec­tor, John Tupps, wrote in an email that “Every call made to the Gov­er­nor from fa­cil­ity man­age­ment was re­ferred to the Agency for Health Care Ad­min­is­tra­tion and the Florida Depart­ment of Health and quickly re­turned.” Tupps did not re­spond to a fol­lowup email ask­ing if the gov­er­nor’s of­fice had a record of the three calls in ques­tion from the nurs­ing home.

The tragedy at Hol­ly­wood Hills showed that for bil­lions of dol­lars and count­less hours spent pre­par­ing for Florida’s next in­evitable hur­ri­cane, the life­line for one of the na­tion’s largest con­cen­tra­tions of the el­derly and dis­abled re­mained ten­u­ous in the af­ter­math of Irma.

The sur­vival of res­i­dents at the home rested not just on the state’s vaunted $3 bil­lion “smart grid,” in­tended to limit power out­ages and tar­get re­pair ef­forts, or on lists of crit­i­cal in­fra­struc­ture where restor­ing power is a top pri­or­ity. Sur­vival also de­pended on phone tag be­tween nurs­ing-home ad­min­is­tra­tors, state of­fi­cials and util­ity providers.

Sev­eral ex­ec­u­tives of a lim­ited li­a­bil­ity cor­po­ra­tion that con­trols the nurs­ing home de­clined to com­ment, in­clud­ing the prin­ci­pal owner, Florida res­i­dent Jack Michel.

But the nurs­ing home made An­der­son avail­able for an hour-long in­ter­view, as well as a com­pany of­fi­cial who spoke on the con­di­tion of anonymity un­der ground rules set by Hol­ly­wood Hills. The of­fi­cials pro­vided an in­ter­nal time­line of at­tempts to reach state of­fi­cials and its util­ity provider.

“Nurses, doc­tors, ad­min­is­tra­tors, staff — ev­ery­one was do­ing ev­ery­thing that they could,” An­der­son said. “We were wait­ing and wait­ing for help that never came.”

The nurs­ing home and an ad­join­ing psy­chi­atric fa­cil­ity are con­nected to the power grid by two lines, the of­fi­cials said. One pro­vides elec­tric­ity to most of the fa­cil­ity, in­clud­ing lights, oxy­gen ma­chines, ven­ti­la­tors and the kitchen. The other sup­plies a cen­tral air-con­di­tion­ing sys­tem.

When the warm air be­gan pour­ing out of vents Sun­day, ex­ec­u­tives con­tacted Florida Power and Light within 45 min­utes, say­ing the line ap­proach­ing the fa­cil­ity from the north ap­peared to have been down, ac­cord­ing to their time­line. An­der­son said the nurs­ing home heard from the util­ity Monday that it would be com­ing that day. It never did, she said. The nurs­ing home pro­vided ticket num­bers for ser­vice re­quests that it had placed with FP&L be­gin­ning Sun­day. The Post was able to con­firm two of the re­quests us­ing state records and the util­ity’s web­site.

The power com­pany Friday ex­pressed “our deep­est sym­pa­thies” but said in a state­ment that “we are lim­ited in what we can say” due to the on­go­ing in­ves­ti­ga­tions. The com­pany did not an­swer ques­tions re­gard­ing the calls the nurs­ing home said were made.

Hol­ly­wood Hills had in the days be­fore the storm ob­tained eight “spot chillers” that could be run us­ing a gen­er­a­tor. Each had two “arm­like” fun­nels that di­rect cool air. An ex­haust vent from each ma­chine re­leas­ing warmer air was routed up­ward, to the drop ceil­ing on each floor.

With the power oth­er­wise still on at the nurs­ing home, they were plugged into wall outlets. Staffers on Monday also went search­ing for por­ta­ble fans and spent $900 to put one in each res­i­dent’s room.

Af­ter 5:30 p.m., more than 24 hours af­ter the air con­di­tion­ing stopped work­ing and with fore­casts for higher tem­per­a­tures in the days ahead, An­der­son said she first called the gov­er­nor’s cell­phone and left a mes­sage: “162 pa­tients, el­derly, some on oxy­gen. We need the air con­di­tion­ing re­stored.”

Be­tween then and 10 p.m. on Monday, An­der­son said she re­ceived two re­turn calls from state of­fi­cials say­ing they were work­ing on the re­quest.

On Tues­day, there was still no sign of an elec­tric crew. An­der­son said she con­tin­ued mak­ing calls at about 10 a.m. Staffers and fam­ily mem­bers of pa­tients, who by that time were be­gin­ning to worry, made calls to FP&L.

El­lie Pina, daugh­ter of Mirelle Pina, a 96-year-old res­i­dent at the fa­cil­ity, said she and oth­ers re­peat­edly called FP&L and were ig­nored. Pina said that by Tues­day at noon it was ex­tremely hot.

“It was like 110 de­grees in there, it was un­bear­able. Not even the fans were help­ing them,” she said. “The heat was amaz­ing.”

“I told Florida Power and Light the gen­er­a­tors were go­ing to give up soon. And it hap­pened. I told my hus­band peo­ple were go­ing to die in there. And it hap­pened,” she said, recit­ing her ticket num­ber for ser­vice.

Pina said the staff had put pa­tients, clothed in as lit­tle as pos­si­ble, in the hall­ways close to the cool­ing units.

The com­pany of­fi­cial who spoke on the con­di­tion of anonymity said that each of the chillers had a ther­mome­ter and that the read­ings up­stairs showed tem­per­a­tures in the low 80s — “82 or 83, it was hold­ing steady,” the of­fi­cial said.

Pa­tients’ tem­per­a­tures were checked on each eight-hour shift, and for the last time Tues­day eve- ning by a physi­cian as­sis­tant who made rounds. None of the peo­ple who gave ac­counts of the sit­u­a­tion were present af­ter 11 p.m. Tues­day night.

Ac­cord­ing to the time­line pro­vided by the nurs­ing home, the first 911 call was placed at about 1:30 a.m. to re­port a pa­tient in car­diac dis­tress.

In an email Friday, of­fi­cials with the city of Hol­ly­wood and its po­lice depart­ment said the first 911 call came later, at 3:01 a.m.

By 4:45 a.m., ac­cord­ing to the time­line pro­vided by the nurs­ing home, five pa­tients had been in car­diac ar­rest or res­pi­ra­tory dis­tress and were treated by paramedics.

Randy Katz, chair­man of the depart­ment of medicine at Me­mo­rial Re­gional Hos­pi­tal, across the street, said that around 6 a.m. one of the se­nior nurses walked over to Hol­ly­wood Hills. She made a call: These pa­tients needed to be evac­u­ated, im­me­di­ately, he said.

Pa­tients looked to be in dis­tress. The sec­ond floor was ex­tremely hot. “There’s no rea­son pa­tients that age with chronic med­i­cal is­sues should be in a fa­cil­ity with­out air con­di­tion­ing,” Katz said.

The hos­pi­tal ac­ti­vated what is called a mass-ca­su­alty event. Hos­pi­tal staffers rushed to Hol­ly­wood Hills, look­ing for pa­tients and get­ting them out as soon as pos­si­ble.

“Our staff lit­er­ally went room to room and evac­u­ated the build­ing,” he said.

The sick­est pa­tients were rolled to the emer­gency room across the street on stretch­ers, with some be­ing treated for de­hy­dra­tion, res­pi­ra­tory is­sues in­clud­ing res­pi­ra­tory fail­ure, heat ex­haus­tion or in­fec­tion and high fevers.

“The tem­per­a­tures dur­ing the day out­side are in the mid-90s. I’m go­ing to guess you can prob­a­bly add an­other 10 de­grees to that,” Katz said of the tem­per­a­ture in­side.

In a state­ment later in the day, Scott called the sit­u­a­tion “un­fath­omable” and vowed that the state would hold ac­count­able any­one not act­ing in the best in­ter­ests of their pa­tients.

As nurs­ing-home ex­ec­u­tives be­gan ar­riv­ing at the build­ing later Wed­nes­day morn­ing, they were in­structed to stay be­hind a po­lice line, say­ing the fa­cil­ity was a crime scene.

By 2 p.m., An­der­son said, with de­tec­tives the only ones re­main­ing, the air con­di­tion­ing was turned back on.

CARLINE JEAN/SOUTH FLORIDA SUN-SEN­TINEL/AS­SO­CI­ATED PRESS

Jan­ice Con­nelly of Hol­ly­wood, Fla., sets up a me­mo­rial to se­nior cit­i­zens who died at an area nurs­ing home af­ter Hur­ri­cane Irma.

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