Criminal Probe Under Way in Irma Nursing Home Deaths

The eye of Hurricane Irma passes through Naples, Fla., on Sept. 10. (AP Photo/David Goldman)

HOLLYWOOD, Fla. (CN) — A South Florida nursing home where several residents died during a power outage from Hurricane Irma is blaming Florida Power & Light for the tragedy, claiming it failed to respond to reports of an impending medical emergency.

Eight residents of the Rehabilitation Center at Hollywood Hills died after air-conditioning failed during Hurricane Irma, prompting a criminal investigation.

The hurricane is believed to have knocked out a transformer that powered the nursing home’s air-conditioning system. When rescue crews were called to the 152-bed nursing home early Wednesday morning, Sept. 13, they encountered sweltering heat in the building. Residents were evacuated to Memorial Regional Hospital across the street.

Some residents were found dead inside the nursing home while others died after being transferred to Memorial Regional, Hollywood Police Chief Tomas Sanchez said at a news conference.

Memorial Regional’s emergency department director said that evacuated patients were treated for respiratory distress, dehydration and other “heat-related issues.”

The Rehabilitation Center at Hollywood Hills was one of dozens of medical centers, nursing homes and assisted living facilities across Florida that went without central air-conditioning in the days after the storm.

The law required such facilities to have a generator for essential healthcare functions like running medical devices. But it did not explicitly require air-conditioning generators, which often require higher surge ratings. Over the weekend, the governor’s office announced new emergency rules requiring assisted living facilities and nursing homes to have an emergency power system in place to maintain “comfortable temperatures for at least 96 hours following  a power outage.”

Sanchez said a criminal probe into the Rehabilitation Center is being conducted. Police have not released the precise cause of the deaths. Investigators are examining why the residents were not evacuated sooner, given that Memorial Regional is so close.

The Florida Agency for Healthcare Administration on Wednesday, Sept. 13, filed an emergency order to halt admissions to the nursing home. Gov. Rick Scott subsequently directed the agency to terminate the home’s status as a Medicaid provider.

Jorge Carballo, a head administrator for the home, said in a statement that the facility “diligently prepared for the impact of Hurricane Irma.”

“While our center did not lose power during the storm, it did lose one transformer that powers the air-conditioning unit. The center immediately contacted Florida Power & Light and continued to follow up with them for status updates on when repairs would be made,” Carballo said.

He continued: “In compliance with state regulations, the center did have a generator on standby in the event it would be needed to power life safety systems. The center also had seven days of food, water, ice and other supplies, including gas for the generator.

“Our staff continually checked on our residents’ well-being — our most important concern — to ensure they were hydrated and as comfortable as possible. We are devastated by these losses.”

On Sunday, Sept. 10, as the storm was raging through Florida, the nursing home contacted Florida Power & Light to report the air-conditioning power outage, Carballo said. He said FPL told administrators that it would address the matter, but the line workers did not show up.

An executive with the nursing home’s owner, Larkin Community Hospital, called the Department of Emergency Management hotline to ask for assistance on Monday, Sept. 11, and received word from the Florida Department of Health that the outage would be fixed, according to the nursing home’s narrative.

On Tuesday, the 12th, the Larkin executive contacted the Department of Health emergency hotline for help, but “was told there were many hospitals and healthcare facilities with FPL problems due to the storm,” the nursing home says.

Memorial Regional Hospital provided the nursing home with supplementary cooling units, which were put in place that Tuesday afternoon.

“Between 6 p.m. and 11 p.m., a physician’s assistant rounded on patients to check that the patients were stable in light of the current conditions. [Carballo] was constantly rounding as the administrator (as a non-medical person) during this time frame,” the nursing home says.

At 1:30 a.m. Wednesday the 13th, 911 emergency responders were called to treat a patient with an irregular heartbeat. Several patients were suffering deteriorating health, and between 1:30 and 5 a.m., fire rescue personnel treated a cascade of medical emergencies before evacuation commenced around 6:30 a.m.

According to the nursing home, FPL arrived that Wednesday morning to restore power to the air-conditioning, “hours after residents began having health emergencies.”

At this time, roughly half of FPL’s estimated 10 million customers were without power due to Hurricane Irma, according to the electric company.

An FPL spokesperson said the tragedy at Hollywood Hills “points to the need for having plans in advance” of natural disasters. He indicated that the facility had not been tagged as a “top-tier” priority for power restoration.

“We meet with the county officials in every county well in advance. We met with Broward [County] in early March. This facility was not listed [by the county] as a top-tier critical infrastructure facility,” the spokesperson said.

The governor’s office said in a statement that in the hours before the tragedy, the nursing home had been warned to call 911 immediately if the health of its residents was at risk. On Tuesday afternoon, the day before the evacuation, the facility “reported to the [Agency for Healthcare Administration] that they had power and access to fans and spot coolers,” the governor’s office stated.

It added: “The Rehabilitation Center at Hollywood Hills is responsible for the safety of their patients.”

The governor said: “I have directed the Agency for Health Care Administration and the Department of Children and Families to immediately work with local law enforcement to conduct an investigation, and if they find that anyone wasn’t acting in the best interests of their patients, we will hold them accountable to the fullest extent of the law.”

Public records show that the Rehabilitation Center at Hollywood Hills has been cited for health and safety violations in the past.

Among other issues, inspectors found in early 2016 that food shelves at the nursing home were coated with a “heavy buildup of a thick white food-like decaying matter,” and that one refrigerator had a 5-gallon container of expired egg salad in it.

Inspectors around that time also found that nursing home staff members referred to residents who needed assistance with eating as “feeders.” One resident had been left in a dark room for an extended period of time, with the TV off and no source of stimulation, according to the inspection report.

The inspectors found an inordinately high rate of medication errors. One inspection document stated that the facility had a temporary generator, but that managers had not complied with the Agency for Health Care Administration’s demand that they obtain plan approval for a permanent generator installation. The nursing home told the inspectors that it would promptly rectify the problem.

The Courthouse News Service database shows the nursing home has been sued at least three times in Broward County Court since 2015 for alleged negligence in handling its residents.

That number of claims is in line with the average number of negligence claims filed against large-scale nursing homes and assisted living facilities in Hollywood, Florida in the past two years, according to the database.

Among the most recent of the lawsuits against the Rehabilitation Center is a December 2016 complaint alleging that the nursing home allowed a resident to develop an infection that progressed into sepsis. The home’s defensive pleadings say that the resident’s “underlying condition … was the sole and/or contributing cause” of her illness, and that the attending staff had acted “within the professional standard of care.”

In August 2015, the nursing home was served with a wrongful death lawsuit from the estate of a man who died after he purportedly choked on food or a foreign object. The proceedings in Broward County Court were stayed as a result of bankruptcy proceedings initiated by High Ridge Management, the company that used to operate the nursing home and a nearby psychiatric facility known as Hollywood Pavilion.

High Ridge director and owner Karen Kallen-Zury, along with other High Ridge executives, was convicted of healthcare fraud in 2013 in a scheme to defraud Medicare. Federal prosecutors accused them of paying bribes and kickbacks to patient brokers to obtain Medicare beneficiaries as patients at Hollywood Pavilion, though they did not qualify for psychiatric treatment.

Darren Caruso, a healthcare executive who putatively ran the nursing home and Hollywood Pavilion after High Ridge assets went into receivership amid foreclosure proceedings, sued over his firing, claiming he was fired for drawing attention to misconduct by High Ridge staff members. He claimed that he noticed patient charts had been “illegally altered … to feign compliance” with federal and state regulations.

Caruso said he was illegally stripped of his CEO position, and fired in September 2014.

Larkin Community Hospital took over the nursing home upon acquiring it out of bankruptcy in 2015.

That entity’s head, Jack Michel, has had his own run-ins with federal prosecutors. They filed a civil action against him in 2004, claiming that he participated in a healthcare kickback scheme involving Larkin, and that after he acquired Larkin in 1998, he allowed patients to be admitted for medically unnecessary treatment.

Larkin settled the civil case for $15.4 million.

The tragedy at the Rehabilitation Center at Hollywood Hills invoked dark memories of Hurricane Katrina, during which hundreds of patients perished in nursing homes and hospitals affected by the storm.

More than 30 residents of St. Rita’s nursing home in St. Bernard Parish were believed to have drowned in the storm’s floodwaters.

St. Rita’s owners were cleared of negligent homicide charges in 2007.

Vendetta Craig, whose mother is recovering after being evacuated from the Rehabilitation Center at Hollywood Hills, said during a Wednesday news conference last week: “We throw our elderly away. They’re a cash crop.”

The family of one of the residents who suffered fatal medical complications at the Rehabilitation Center amid the AC system outage filed a lawsuit against the facility, Michel, Carballo and director of nursing Maria Colon.

Brought Friday by the family of 99-year-old decedent Albertina Vega, the Broward County lawsuit demands that the nursing home produce Vega’s medical records and copies of the home’s emergency management protocols.

The lawsuit also demands that the nursing home turn over surveillance video, storm preparation documentation, phone records, equipment maintenance logs, data on staff-to-patient ratios, and written copies of its emergency patient-transfer protocols, among other material.

The complaint was filed as a bill of discovery, and as such, it does not yet list any counts for monetary damages.

The lawsuit alleges: “Rather than taking significant proactive measures to safely remove its residents or establish a non-hazardous environment for the residents, the Rehabilitation Center at Hollywood Hills allowed [them] to swelter in the heat, and reside in unsafe and unsanitary conditions.”

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