As Gov. Scott, nursing home point fingers, death toll climbs to 9

Four days after the owners of a Hollywood nursing home released a detailed time line casting blame for the deaths of eight elders on Florida health administrators and a local utility, Gov. Rick Scott’s administration issued a time line of its own — declaring that the Rehabilitation Center at Hollywood Hills “failed to do their basic duty to protect life.”

The time line, and a release of 159 pages of records, fueled an ongoing finger-pointing war between the nursing home and Scott, who was himself a healthcare executive before running for office.

As the parties fought, the death toll rose: Late Tuesday, the Hollywood Police Department reported that a ninth resident from the nursing home, identified as 93-year-old Carlos Canal, had died.

Canal joined eight others who perished the morning of Sept. 13, when a partial power outage, combined with the failure of portable air coolers, turned the home into a deadly hothouse. The deaths are the subject of a criminal investigation by the Hollywood Police Department, together with administrative reviews by two state agencies, the Agency for Health Care Administration and the Department of Children & Families.

The nursing home is adjacent to a private psychiatric facility, Larkin Community Hospital Behavioral Health Services, and the two are affiliated with a troubled South Miami Hospital called Larkin Community Hospital. The nursing home and psychiatric facility sit across a parking lot from Memorial Regional Hospital, to which many of the 142 residents were evacuated after several began to succumb to the heat.

“No amount of finger pointing by the Hollywood Hills Rehabilitation Facility … will hide the fact that this healthcare facility failed to do their basic duty to protect life,” Scott said in a prepared statement late Tuesday. “This facility is failing to take responsibility for the fact that they delayed calling 911 and made the decision to not evacuate their patients to one of the largest hospitals in Florida, which is directly across the street.

“The more we learn about this, the more concerning this tragedy is. Through the investigation, we need to understand why the facility made the decision to put patients in danger, whether they were adequately staffed, where they placed cooling devices and how often they checked in on their patients.”

On Tuesday, nursing home owners challenged efforts by the governor and health regulators to shut the home down.

Nursing Home deaths 02 EKM

Hollywood’s police chief, Tom Sanchez, speaks to reporters Wednesday morning, Sept. 13 , 2017, the day eight residents of the Rehabilitation Center at Hollywood Hills died amid stifling heat. On Tuesday, another man died, raising the toll to nine. The deaths are under a criminal investigation.

Emily Michot emichot@miamiherald.com

Calling the home “devastated by the lives lost,” Hollywood Hills asked a judge in Tallahassee to prevent health regulators from going forward with a halt to all new admissions, and a suspension of the rehab center’s reimbursement under Medicare and Medicaid, federal insurance programs for elderly and poor people. Together, the insurers are the lifeblood of most long-term care facilities.

Operators of the nursing home could not be reached for comment late Tuesday.

Scott’s time line begins on Sept. 5, when the rehab center, along with every other facility in the state, was told to begin updating health regulators on efforts to prepare for the potentially disastrous Hurricane Irma in a digital database called “FL Health STAT.” All hospitals, nursing homes and assisted living facilities were to provide updates on their efforts twice daily.

Three days later, the governor’s time line says, administrators at the rehab center participated in a conference call on hurricane preparedness hosted by Scott, Agency for Health Care Administration Secretary Justin Senior and the state’s surgeon general, Celeste Philip. The home “did not report any issues,” the time line says. On Saturday, Sept. 9, the rehab center made one report to the state’s database, at 3:19 p.m. The update said the home was operational, and no concerns were reported.

Irma made landfall on Sunday. At 12 a.m., 7:30 a.m., 10:30 a.m. and 1:30 p.m., the home “did not report any changes,” the governor’s office says, and “did not report any issues” on a conference call with Scott and health administrators at 2:30 p.m.

Thirty minutes later, the nursing home said in its earlier time line, the home’s air conditioning system lost power.

“This was not reported to the state,” the governor’s office wrote in response.

At 6:51 p.m. Sunday night, the home reported to the database “that everything was operational, including heating and cooling,” the state’s time line said.

The governor’s time line suggests the nursing home did not raise a red flag until 5:37 p.m. on Monday, Sept. 11, when someone called the Florida Emergency Information Line, described by the state as a toll-free hotline activated at the time of an emergency for Floridians seeking information. “This line is an information line for Floridians and is not meant to replace 911,” the governor’s office wrote.

The nursing home “reported issues involving air conditioning but did not, at any time during the call, report or indicate that conditions had become dangerous or that the health and safety of their patients was at risk,” the governor’s time line said.

On Sept. 12, Larkin’s CEO, Natasha Anderson, left two messages on the governor’s private cellphone, which Scott had released publicly so that administrators could report emergencies. The calls were forwarded to administrators at AHCA and the Department of Health, and Broward County reported concerns about the home to the state Division of Emergency Management. “Included in [the county’s] report was a note that the [home] is running on generator power without air conditioning, which is adversely affecting patients,” and that Florida Power & Light had been asked to “ensure priority status” for the home.

An AHCA worker spoke at 4:17 p.m. that day with Jorge Carballo, the nursing home’s administrator, the time line said. Carballo, reported that the home’s “chiller” was not working, but staffers had installed “spot coolers and fans,” the time line said. “Carballo did not, at any time during the call, report or indicate that conditions had become dangerous or that the health and safety of their patients was at risk,” the time line said.

It was at 3 a.m. on Sept. 13 that the home’s first resident from the nursing home was taken to Memorial. Soon, three patients were “discovered deceased within the facility.”

A time line written by Broward County, and included in the documents released by the state Tuesday said that at 7 a.m. on Sept. 13, a nurse superintendent from Memorial Regional called the county’s emergency command center and informed them that “the facility was being evacuated.” Thirteen minutes later, the hospital called to clarify that it was actually the nursing home that had been evacuated “and the memorial staff were on the scene providing life-saving CPR.”

“The nurse also indicated that some patients were exhibiting very high body temperatures,” the time line reads.

By that point, county operators had called 911 “which indicated that they had not previously been notified of the emergency.”

When the county’s Medical Examiner’s Office was called, two nursing home residents already had died, and a third was being removed from a ventilator. The ME, Craig Mallak, dispatched two investigators to the scene,”whereupon three other individuals were found deceased.”

By 9:15 a.m., the county’s time line said, emergency managers were told “that up to 10 people may be in critical condition.”

After receiving what the governor’s office describes as “unconfirmed reports of an incident at the Rehabilitation Center at Hollywood Hills,” AHCA’s secretary, Justin Senior, called the CEO of Larkin Community Hospital, Sandra Sosa-Guerrero, at about 8:30 a.m. on Sept. 13.

Senior’s hand-scrawled note includes what is likely her explanation: “Electricity; but not to chiller’ had spot coolers.”

He then adds ominously: “Doesn’t know about loss of life.”

Did Senior ask her about it? Did she respond? He jots in the margin: “3 people, rumor.”

The state’s time line says that Sosa-Guerrero would have the owner of Larkin Community Hospital and the Rehabilitation Center of Hollywood Hills, Dr. Jack Michel, call him. Michel “confirmed that while the facility had power, they did not have air conditioning but had about 20 spot coolers,’” the state time line says.

“Dr. Michel also reported three unconfirmed deaths at the facility and that he would add his medical director, Dr. Brian Ibrahim, to the call.”

In the next line of his notes, Senior offers a report: “Everyone evacuated to Memorial. 140 residents 2d floor of facility. 3 confirmed 3 more.”

Ibrahim then reportedly joined the call and told him “there were no major health issues between 11 p.m. and midnight the night before and that a physician’s assistant went through the facility that night before and found no elevated temperatures after checking the core temperatures of all the facility’s patients,” the state time line says. “He also reported that the facility believed the temperature had never exceeded 80 degrees.”

Herald writer Caitlin Ostroff contributed to this report.