Florida Nursing Home Listed Dead Resident as ‘Resting in Bed,’ State Says

This post was originally published on this site

A state agency has found that the Florida nursing home where eight residents died after it lost air-conditioning following Hurricane Irma “presents a danger to every person on its premises” and must close after staff at the facility failed to call 911 for its overheated patients, even as their temperatures began spiking as high as 109.9 degrees Fahrenheit.

The agency also rebuked the nursing home for entering normal vital signs, or mildly elevated temperatures, into the medical records of several residents after they had already been evacuated or, in one case, had already died. Those entries, it said, were made “under dubious circumstances.”

The state investigation, conducted by the Agency for Health Care Administration, found that as patients in the overheated nursing home began suffering from respiratory or cardiac distress in the early hours of Sept. 13, the medical staff at the nursing home “overwhelmingly delayed” calling 911 or evacuating patients to the air-conditioned hospital that sits nearly next door.

“This facility failed its residents multiple times throughout this horrifying ordeal,” the agency secretary, Justin Senior, said in a statement. “It is unfathomable that a medical professional would not know to call 911 immediately in an emergency situation.”

He added, “No amount of emergency preparedness could have prevented the gross medical and criminal recklessness that occurred at this facility.”

In a sharply worded response, a lawyer for the nursing home contested the agency’s findings, saying that its staff had been constantly monitoring residents and that “there was no indication based on actual conditions” that a 911 call, or an evacuation, was necessary before residents began to fall ill.

Eight of the residents died that day, either at the home, known as the Rehabilitation Center at Hollywood Hills, or at Memorial Regional Hospital. More than 100 were taken to Memorial and other hospitals, and many have now been moved to new nursing homes.

Local authorities said that a ninth former resident died on Tuesday, but the medical examiner has not yet determined whether the heat played a role in the death of that resident, Carlos Canal, 93.

According to the agency’s order suspending the Center’s license, issued on Wednesday, the facility’s medical records were “replete with late entries,” meaning updates that were supposed to describe medical indicators such as blood pressure and temperature at a certain point in time, but were added later.

“The facility also entered late entries into medical records claiming safe temperatures for patients,” Mr. Senior said in the statement, “while those same patients were across the street dying in the emergency room with temperatures of over 108 degrees Fahrenheit.”

In one instance, at 4:42 a.m., a nurse wrote that a 78-year-old resident’s temperature was 101.6 degrees. But the resident had arrived at the hospital’s emergency room in cardiac arrest 10 minutes earlier, with a temperature that the hospital recorded at 108.3 degrees. She could not be saved.

Others who died had body temperatures of 109.9, 108.5 and 107.

In another case, which the agency described as “very egregious,” someone at the nursing home described a 84-year-old patient as “resting in bed” with breathing that was “even and unlabored.”

By the time that update was added, the person had already died.

But in a statement, Kirsten K. Ullman, a lawyer for the nursing home, said the late entries into residents’ medical records were not significant, since workers often wait until the end of their shift to update records. Since the home was emptied before the end of the early shift on Sept. 13, some entries could not be made until residents had already left, she wrote.

“Late entries document care given during the shift, but which was not documented due to circumstances” beyond the home’s control, Ms. Ullman wrote.

The alarming body temperatures cited by the agency, some of which were taken at the hospital, were much higher than those documented by the nursing home staff while the residents were still there, she wrote.

“The caregivers at Hollywood Hills responded to the conditions with which they were faced in real time,” she wrote. “It is only based on hindsight of outcome that the reasonable actions taken at the time are being criticized.”

The agency had already temporarily stopped the facility from accepting any new patients, but on Wednesday, it moved to close it down entirely. Gov. Rick Scott has also ordered the agency to cut off the home’s ability to participate in Medicaid, and the Hollywood Police Department and the Florida Department of Law Enforcement have opened a criminal investigation.

On Tuesday night, the Rehabilitation Center filed a complaint in court against the health care agency with the accusation that two orders from last week that temporarily shut it down were “improperly issued” and violated its rights.

In its complaint, the facility reiterated what officials at the nursing home have insisted over the past week, and what public records released by the state validate: that the staff there tried to tell state officials and the power company multiple times that they needed help restoring the home’s air-conditioning system, which had stopped working after the hurricane knocked out a vital transformer.