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Hospital kicked into crisis mode when it discovered tragedy unfolding at nursing home across street

South Florida Sun Sentinel - 9/15/2017

Sept. 15--They came in one after the other. Three patients with "extraordinarily high" body temperatures were rushed into the emergency room at Memorial Regional Hospital from the nursing home across the street.

"It set off a red flag," Judy Frum, the hospital's chief nursing officer, said Thursday. "We walked over to see if we could offer assistance."

Frum quickly came to the conclusion that had apparently eluded nursing home administrators:

"I thought it was an extreme situation and we had to get people out," Frum said.

What Frum and others from Memorial found at The Rehabilitation Center at Hollywood Hills sent them into crisis mode. The scene at the nursing home was chaotic: Sweltering heat filled the building, where the air conditioning had been knocked out since Sunday.

The seniors looked dehydrated and in distress. They were warm to the touch.

Fire-rescue workers were going room to room to check their conditions, triaging patients, based on the severity of their needs, according to radio transmissions archived by the audio streaming website Broadcastify.

Within 10 minutes, they found three people dead. Within 20, the number rose to five.

Rescue workers started calling for help from other agencies.

Hospital staff ferried stretchers and wheelchairs across the street to bring patients to cool sanctuary at the emergency room.

They were the lucky ones.

Eight of the residents -- ages 70 to 99 -- didn't make it.

When asked for a comment Thursday on the new details, administrators at the nursing home referred the Sun Sentinel to Natasha Anderson, CEO of the Larkin Behavioral Health Services psychiatric hospital, which is in the same building as the nursing home.

Anderson was at the nursing home until Monday, when she left on a shift change. She said officials at the home were told by FPL that utility workers were going to come Monday and Tuesday but never did. Staff used spot coolers, fans and gave residents water and ice, she said.

"We made every effort to prepare for the storm's arrival and we did everything to comply with state and federal requirements," she said.

Despite filing four status updates on Monday and Tuesday, the nursing home never reported to a state health department online database that patients were at risk, said a spokeswoman for the Agency for Health Care Administration.

"At no time did the facility report that conditions had become dangerous," Mallory McManus said in an email.

Broward County officials said the home alerted them about the situation on Tuesday, but when asked if it had any medical needs or emergencies, it did not request help.

The potential for tragedy posed by nursing home residents trapped in a building for days without air conditioning was not unforeseen. After Hurricane Wilma in 2005, Florida lawmakers proposed legislation dealing with the issue, but it died in committee. Shortly after that, Florida nursing home experts and providers attended a summit on disaster planning. One of the lessons learned from Wilma, according to their final report: nursing homes should consider "generator powered air-conditioning."

On Thursday, there were not many answers about how the situation at the Hollywood Hills center turned fatal.

Hollywood police have begun a criminal investigation and were interviewing witnesses on Thursday who had been in the home at 1200 North 35th Ave.

Authorities obtained a search warrant and were expected to begin combing the building for evidence either late Thursday or early Friday, said Raelin Storey, a spokeswoman for the city of Hollywood.

At this early stage of the investigation, officials said they were still working on coming up with an accurate timeline of how the crisis unfolded.

Dr. Craig Mallak, Broward's medical examiner, provided a preliminary list of the victims and the time and location where they were pronounced dead -- all on Wednesday:

-- Albertina Vega, 99, discovered dead at the facility at 2:55 a.m. by staff.

-- Carolyn Eatherly, 78, pronounced dead at hospital at 5 a.m.

-- Manuel Mario Mendieta, 96, pronounced dead at the nursing home by Fire-Rescue at 5:46 a.m.

-- Gail Nova, 70, pronounced dead at hospital at 6:49 a.m.

-- Bobby Owens, 84, pronounced dead by Fire-Rescue at the nursing home at 6:57 a.m.

-- Miguel Antonio Franco, 92, pronounced dead at the nursing home by Fire-Rescue at 6:59 a.m.

-- Estella Hendricks, 71, pronounced dead at hospital at 7:53 a.m.

-- Betty Hibbard, 84, pronounced dead at hospital at 3:09 p.m.

Mallak said he could not release any further details because of Hollywood's ongoing investigation.

The first death -- of Vega -- apparently set off no alarms, at least outside the nursing home. Officials were not notified of the death, city spokeswoman Storey said.

Vega had a Do Not Resuscitate Order (DNR) in place when she died and her remains were initially taken to a funeral home, Storey said.

After police learned of the other deaths and began their investigation, the Broward Medical Examiner's Office picked up Vega's remains from the funeral home to conduct an autopsy.

Storey said the nursing home had some power but the air conditioning was not fully functioning.

Authorities say that a total of 145 residents were evacuated from the nursing home after they became aware "that a crisis was unfolding at the facility."

Detectives, state and federal regulators are investigating what happened in the home during and after the storm.

Sen. Bill Nelson wrote to federal officials on Thursday urging them to "hold those responsible for the deaths ... accountable and ensure that sufficient safeguards are in place to prevent a similar tragedy from happening in the future."

"I am even more troubled that there was a functioning hospital across the street from the nursing home, and yet these residents remained trapped in extreme temperatures for multiple days," Nelson wrote. "Failure to transfer them to a hospital some 50 yards away is unforgivable."

The 152-bed nursing home has a history of "higher than average deficiencies, below average ratings, and inadequate emergency preparedness plans," Nelson wrote.

Nelson said it was unclear if the home's generator was working during Hurricane Irma, noting that an unannounced inspection in 2016 found it had a temporary generator that failed to meet code requirements.

Hollywood officials said every aspect of operations at the nursing home is under investigation.

"We are looking at the temperature in the facility, the staffing in the facility," Storey said.

Nursing home staff knew the air conditioning was not working on Sunday and set up fans to try to cool residents, according to an agency complaint outlining the emergency action.

Between 1:30 a.m. and 5 a.m. on Wednesday, several residents were in respiratory or cardiac distress, according to the complaint.

The building was served by two transformers -- one for the building and the second for the air conditioning. The transformer serving the building came back after the storm. However, the one used to power the air conditioning was damaged by a falling tree and was not functioning on Wednesday morning.

The home had one generator, to power "critical" needs such as oxygen machines, but it did not power the air conditioning, the nursing home's administrator Jorge Carballo said Wednesday through a representative.

By close of business Thursday, officials said 39 Florida nursing homes were still without power, down from 150 the day before.

Florida long-term care experts and providers attending a 2006 hurricane summit on disaster planning listed "generator powered air-conditioning" as something worth considering.

Their final report also said prioritized power grids had not been revised in a long time, and nursing homes needed to let their utility companies know they had "patients dependent on power" to run ventilators, dialysis machines, oxygen and feeding tubes.

A University of South Florida survey of 297 nursing homes, according to the report, found 76 percent of them lost power at least once in the 2004 and 2005 storm seasons, when multiple hurricanes raked the state. And in 2004, about 80 percent of generators failed due to poor maintenance, running out of fuel, and other issues, the report said.

A bill introduced during the 2006 Florida legislative session would have encouraged but not mandated that each nursing home in the state have an emergency power backup and provide help to residents evacuated from other homes, if needed.

The bill would have reimbursed nursing homes up to half of the cost of entering into a contract for an emergency generator. Homes located in 10 counties, including Broward, Palm Beach and Miami-Dade, were eligible.

"We wanted the nursing home population to be protected from loss of power during a storm," said Dan Gelber who sponsored the bill in the House of Representatives. "We wanted the state to start to worry about this."

The bill passed the House of Representatives with only one vote against it but died in the state Senate in May 2006.

"I fully expect that they will deal with it now I just wish they would have dealt with it beforehand," Gelber said.

Staff writers Anthony Man, Larry Barszewski, Diane Lade, John Maines and the Associated Press contributed to this report.

pmcmahon@sunsentinel.com, 954-356-4533 or Twitter @SentinelPaula

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