Hollywood nursing home where a dozen elders died ‘made it worse,’ state expert testifies
March 22, 2018 10:02 PM
Updated 8 hours 30 minutes ago
After Hurricane Irma knocked out the air conditioning at a Hollywood nursing home with a history of questionable living conditions, workers set up portable coolers to chill the sweltering air.
The Rehabilitation Center at Hollywood Hills usually required 125 tons of cooling capacity to keep its residents safe. But the nine functioning portable “chillers” administrators installed could muster only about 15 tons, not nearly enough.
And the coolers actually made things “worse” in the home because they weren’t properly ventilated and pushed additional heat into a confined space, an engineering expert testified last month in Tampa. The result: 12 elders overheated and died.
The testimony, released late Thursday, came during ongoing litigation between the state health care agency and the nursing home over the loss of its license to operate.
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“They actually produce more heat than they cool,” said William Scott Crawford, an engineer hired by the state to evaluate the deadly disaster. He added: “Essentially, the capacity of the spot coolers was insufficient to cool the space in the patient areas.”
Most of that extra heat ended up flowing toward the second floor, according to Crawford, who has expertise in designing cooling and ventilation systems for long-term care facilities. Second-floor temperatures would likely have gone above 95 degrees, he said. At least 10 of the residents who died lived on the second floor, some with internal temperatures approaching 110 degrees.
Crawford’s 81-page deposition, and several other records, were released by the Agency for Health Care Administration, which placed a halt on admissions to the nursing home in September, an action the home is appealing.
Reached Thursday night, Julie Allison, an attorney for the nursing home’s owner, Jack Michel, said she had not yet seen AHCA’s release, and would review the agency’s statement and records before commenting. Michel declined to comment.
Jeffrey Nova’s 70-year-old mother, Gail Nova, died on the second floor. He found out about his mother’s death when a reporter called him at 9:30 a.m. on Sept. 13 asking for a comment. “I never heard from the facility. Not that day. Not in the days following,” Nova said. “But they kept sending me monthly bills.”
He didn’t seem surprised by any of the information released by AHCA.
“There was negligence from management all the way down to the staff. There was a level of no care,” he said. “Everyone that was part of that facility was truly guilty.”
In response to allegations that the center’s staff made the second-floor heat level even worse, he said it was in line with what he already knew.
“They used the minimal steps hoping that things would improve. And unfortunately people died,” Nova said.
The Hollywood Police Department is investigating the 12 deaths as homicides, although no criminal charges have been filed. After the storm, Gov. Rick Scott ordered that all nursing homes and assisted-living facilities maintain backup generators to prevent similar tragedies, and the Florida Legislature formalized the order as a new law.
Both sides of the dispute have engaged in public finger-pointing since the tragedy.
The nursing home has said it begged Scott and Florida Power & Light for help as the powerful storm lashed South Florida.
Nursing home managers said that after the facility lost power to the air conditioning unit, they called Scott’s personal cell phone repeatedly — as the governor had instructed them to do during hurricane planning meetings — and left messages. Nothing came of it.
While the nursing home wouldn’t comment Thursday, some of the records offer a glimpse into the home’s legal position.
One of the rehab center’s lawyers, Geoffrey D. Smith of Tallahassee, seemed to suggest in a series of questions that the decision to shut down the 152-bed home was politically motivated, and that health regulators took action to punish the home’s owners and not protect residents.
“Did anybody in the entire process inform you that the governor had directed the agency to issue a moratorium on admissions,” Smith asked Arlene Mayo-Davis, an AHCA field office manager, in a Dec. 1, 2017, deposition. “No,” she replied.
Later, Smith asked Mayo-Davis to clarify precisely what motivated the enforcement action. “Is it that you think that the people, the caregivers, are incompetent, or is it because you think that it’s more of a punitive measure — that, as a regulatory agency you have to say, ‘well, when something this bad happens then there has to be a sanction?’ ”
Smith also suggested in another deposition that the deaths may have resulted more from a chaotic evacuation than from the sweltering heat.
“Do you know, as residents were awoken, how that occurred?” Smith asked Mayo-Davis. “Do you know who woke them up or was it sort of a gentle, you know, ‘Get up, Mrs. Jones, we’re going to have to leave,’ or was it, you know, kind of a sound-the-alarms and lots of yelling and ‘Let’s get up and get — you got to get out of here, you got to get out of here now’?”
“We used the information that we could gather as quickly as possible for the health and safety of the residents that were admitted there and for the health and safety of future residents,” Mayo-Davis said.
Florida revoked the rehabilitation center’s operating license in October, charging the facility’s administrators with intentional neglect for failing to keep the building cool — a charge the owners denied. Hearings in the nursing home’s appeal began about two weeks ago in Fort Lauderdale.
In another deposition released Thursday, Molly McKinstry, AHCA’s deputy secretary for quality assurance, said she was concerned that nursing home officials did not react with enough urgency to the extreme temperatures in their facility.
Measures “were not in place to protect people appropriately,” McKinstry said. “So whether it was evacuation or some other measure that could have been considered, we worked with many other facilities after the storm had passed that were scrambling to find backup generators … and we did not see that same level of activity in our discussions with [the Rehabilitation Center at Hollywood Hills].”
Eight residents died on Sept. 13, three days after the AC went out. The nursing home was eventually evacuated, with the elders moved across the street to Memorial Regional Hospital. Four other residents died later.
Lawyers for the home also appear to be suggesting that the rehab center was not the only facility in Florida in which resident health deteriorated as a consequence of power outages. When interviewed by Smith, Mayo-Davis said she believed there was at least one other investigation involving a nursing home or ALF in which one or more residents were hospitalized for excessive heat. Mayo-Davis added: “I’m not aware of any deaths” other than at Hollywood Hills.
Lawyers for the home have been seeking Department of Health death certificate records from throughout the state for the period surrounding Hurricane Irma.
An AHCA inspection from shortly after the storm cited the home for putting residents in “imminent danger” by failing to maintain a safe and clean environment and denying them adequate and appropriate health care.
Before the Hollywood nursing home was thrust into the national spotlight, state and federal health inspectors documented deplorable conditions at the facility that corroborate horror stories relayed by family of patients.
Some elders sat in soiled diapers while others received showers about every 10 days. They were served meals that were not prepared according to doctors’ orders or kept in sanitary conditions, and they slept in linens that may have been contaminated with dust and trash, documents show. Medical records were poorly kept, if at all.
The nursing home’s average rate was about $315 a day in 2015, according to state records, about 30 percent higher than the Florida average of $240.