Nurses Charged in Deaths of 12 Nursing Home Residents
Three nurses have been charged with manslaughter and tampering with evidence in the deaths of 12 nursing home residents. The charges come after a 2 year criminal investigation and more arrests are expected.
On Monday, August 26, 2019, three nurses turned themselves in on arrest warrants for the heat-related deaths of 12 nursing home residents. Eight people died on September 13, 2017, at the Rehabilitation Center at Hollywood Hills, after power-outages following Hurricane Irma caused temperatures to soar inside the facility. Several other residents died in the following weeks. The nursing home’s administrator was also charged. All four individuals are charged with manslaughter and tampering with evidence.
The Details
Hurricane Irma hit south Florida on Sunday, September 10, 2017, and caused extensive damage. A transformer, powering the facility’s air conditioning system, blew when a tree fell. The nursing home’s residents were moved to halls, next to fans and spot coolers in response to rising temperatures inside the facility. There were calls made between nursing home employees, state authorities and Florida Power and Light about the air conditioning failure. According to a report from then Gov. Rick Scott’s office, the state advised facility managers multiple times to call 911 if a situation placing a resident in danger arose. However, it was not until after the nursing home’s first 911 call reporting a person in cardiac arrest, three days later, that assistance arrived.
Timeline
The Sun-Sentinel published an article providing a timeline of events on Wednesday, September 13, based on multiple sources. Victims ranged in age from 57 to 99 years old.
3:00 am- 911 call patient in cardiac arrest
4:00 am- 911 called patient in respiratory distress
4:00 am- Patient with breathing problems taken to hospital
4:20 am- 911 called patient in cardiac arrest
4:30 am to 4:45 am- 911 called, patient in cardiac arrest, with 911 still onsite two more patients go into cardiac arrest
5:00 am- hospital employee checks on nursing home and 3 residents found dead
6:30 am - All residents evacuated
It was determined the deaths of 12 patients was caused by heat exposure. The victims ranged in age from 57 to 99 years old.
No Back-up Generator
The rehabilitation center had previously been cited for failing to maintain an emergency generator. The generator was still not in working order when the hurricane hit. Although fans and portable A/C units were used, an engineering expert testified in a deposition that the A/C units were insufficient and actually made the conditions worse. Temperatures on the second floor possibly reached between 100 F and 110 F degrees, far above the 81 F state law limit. When paramedics arrived, many patients were suffering from fever as high as 109 F, or a heat stroke.
Extensive Investigation
The criminal investigation, spanning two years, continues with additional arrests expected in the future. More than 500 people were interviewed and 1,000 pieces of evidence collected, along with 55 computers. Police also collected and reviewed more than 400 hours of video. Other factors contributing to the tragedy include:
Nursing home staff failed to evacuate residents despite being across the street from a fully-functioning hospital.
The facility was not on the “high priority” list with Florida Power and Light for unknown reasons
Temperatures of residents were not routinely assessed and monitored.
Crime scene photos show hand-held gauges recording temperatures inside the facility at 95 and 96 degrees.
Video from inside the facility validated a lack of patient assessment and monitoring.
The facility reported into a statewide monitoring database 17 times since September 7th, however never requested assistance or report the need for evacuations.
Facility advised by the Department of Public Health on Monday, September 10th, to call 911 if they had any reason to believe residents were not safe.
Nurse Behavior
Police officials stated, when announcing the criminal charges, the deaths were all avoidable and due to the behavior and inactivity of facility employees. Officials have also said documentation had been falsified with late added entries to give a false depiction of what actually happened. Questions have also been raised around the employees' preparation for responding during an emergency situation.
Nurse One worked at the facility for less than 3 months but had only worked a total of ten days
Nurse Two was only scheduled periodically
Charge Nurse (in charge of building) had been on the job for about a week
Attorneys for the nursing home reported to the Sun-Sentinel that the facility was fully staffed before and after the hurricane with experienced employees.
A Case of “Waiting on the Cavalry”?
More details will emerge as the criminal investigation continues. Do you think the employees were doing all they could, hanging on until the transformer was repaired? Also, do you think the facility’s administrations lack of preparation contributed to the delayed notification of 911 emergency services?
In a State of Emergency following a natural disaster, 911 isn't who you call to report a need to evacuate, they'll redirect you to the relevant incident command center. The nursing home reportedly made multiple calls to both the State disaster response and even the governor, and were told to hang-tight until they're able to restore power.
A nursing home in this situation can't simply ship all their residents to a hospital, particularly one that by reporting at the time was severely overburdened already, it's either the State disaster management or FEMA that can approve an evacuation and direct the hospital to take x number of residents.
Reportedly, the majority of these patients who didn't survive were there as hospice patients, it's certainly unfortunate that it wasn't possible to keep these patients more comfortable, but it seems a bit silly to say that because actively dying patients didn't survive a natural disaster, it must be because the nurses committed crimes.
It has not been stated in any of the articles I have read that the facility ever requested evacuation from the state. It is possible that if they had, they would not be facing charges. If any executive or administrator told them not to request evacuation or transfer of the more vulnerable patients, they should be charged.
I was not suggesting that 911 should have been called to evacuate patients. I am saying the nurses did not monitor the patients well enough to recognize the developing crisis in some patients, and call 911 for them. I believe I read that three patients coded within 2 hours. We know there are clinical signs that happen before these occur.
I also have not read anywhere that the majority of the deaths were among hospice patients. Besides, it wouldn't matter if they were. Hospice aims to provide a calm, pain-free death. Dying because your temperature elevates to 109 F is pretty much the opposite.
I sympathize with these nurses and feel that they were placed in a very difficult situation. The director of nursing and administrator should have been onsite. Nurses this new to the facility should not have been left to manage this alone. I would not be surprised to learn that these nurses had been pressured to refrain from asking for evacuation. Ultimately though, your license and more importantly, your patients are your responsibility. I'm not comfortable with the thought of them going to jail, yet I am also uncomfortable with nurses abdicating their responsibility to their patients' safety. I am glad I will not be on the jury.
Good grief, why wouldn't you call 911 if your residents were stuck in 100+ degree temperatures for 3+ days? It's basic common sense and human decency, which isn't something that you need a nursing license to possess.
What? Did you read anything about this?
Why didn't the decision-makers who knew that their air conditioning system was not adequate, and who then knew that it wasn't working at all not make appropriate plans to evacuate, beginning with those at highest risk? Why do 3 people have to be in a position to try to notice when one of a hundred people might be starting to overheat? How is that possible? What does it look like? Line them all up in the hall and blast them with fans and personal AC units, skip the med cart BS, skip the treatments, skip all the godforsaken paperwork for once, and just patrol the line and repeatedly take their temperatures or something? Keep them awake 24/7 so that you don't have to figure out if people are sleeping vs cooking to death? THIS WAS A SAUNA. Everyone already knew that.
I don't have enough information to form an opinion about the 3, but what about this: You arrive at work with everyone (admin, owner, your local and state governments, the power companies, etc., etc., etc.) already knowing that there is a major problem. These people and entities know that a bunch of frail elderly are sitting in a sauna with broken air conditioning; that is the already-existing, basic backdrop of this.
Do you really think you just walk in and say, "Well this sucks! I'm calling 911 and telling them to evacuate all of these patients"?
Now, supposedly there is some kind of footage of the nurses' severe lack of attention to duty such that murder charges are in order. If that's the case, that's one thing: If they were "playing cards" or outside smoking while people were cooking to death, fine, let them answer for their actions. But if they were just trying to keep up with their basic general duties in sweltering heat while higher-ups pretended that space coolers would fix the problem and the electric company couldn't see fit to have the facility on it's priority list, then this is just a matter of scapegoating for people in more powerful positions.
1 hour ago, Devnation said:
I believe I read that three patients coded within 2 hours. We know there are clinical signs that happen before these occur.
I believe you and some others are significantly underestimating how difficult it might be to recognize signs while they are still subtle, in a bunch of elderly people who are sitting or lying around in sweltering heat (which multiple decision-makers are already aware of). I fully believe that the frequency/intensity of nursing care that might have been helpful would not have been remotely possible. Like a limited check/assessment and VS q hour. It's just not happening.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
2 hours ago, Devnation said:
I sympathize with these nurses and feel that they were placed in a very difficult situation. The director of nursing and administrator should have been onsite. Nurses this new to the facility should not have been left to manage this alone. I would not be surprised to learn that these nurses had been pressured to refrain from asking for evacuation. Ultimately though, your license and more importantly, your patients are your responsibility. I'm not comfortable with the thought of them going to jail, yet I am also uncomfortable with nurses abdicating their responsibility to their patients' safety. I am glad I will not be on the jury.
So this is a quote from another article I read about this situation. “ An attorney for Colin said the employees called both the power company and then-Gov. Rick Scott (R-Fla.), who had given his cell number to nursing homes, but received no assistance.”
Colin was the nursing supervisor. It seems the 4 nurses charged are nursing supervisor, the nurse administrator, and 2 other nurses. Say what you might about calling 911 sooner, etc. But if there were only 4 nurses for 140 patients and 3 of them barely knew the facility and the policies, I have no idea how they would be able to keep up with the assessments of 140 people. Frankly we’re they all familiar hats to the place I don’t know how they could keep up with full assessments of 140 people. 15 minutes for each assessment X 140 people is 35 hours of work alone. When do they help people pee, chart (because we all learned in Katrina that charting still must be done or loose your license), pass meds, help them eat. And you know, the nurses are also working in 100 degrees of heat themselves. Of the 4 nurses there did any have disaster training? It is unreasonable statement, to me, for any of us to say they “abdicated their responsibility to their patients’ safety.” With the little we know.
We know they were in a natural disaster, that the facility had been sited for not keeping up with safety codes, that the nurses did try to get help (they called the electrical company and the governor), and in the poor conditions they were understaffed to the point they could not keep up with the rapidly increasing acuity of their patients.
I feel like, in our profession, the expectations are a little off. I am paraphrasing something I read about the police but I think it rings true in nursing. It went something like this, “You expect me, the layperson, to remain calm when an officer is pointing a gun at ME, but they are the ones who are the trained professionals.”
We expect nurses to always do what is best for the patient, but it is so easy to see the best course of action when the dust settles. In the middle of it, one really relies on their training. Under duress people do what they are trained to do, crisis is really not when people are best known for thinking through each course of action. It is reacting, not being proactive. If none of them had disaster training then I really feel they were doing their best. It is unreasonable for those who have worked in the ER or other high crisis areas to have expectations of other nurses who may have never had that sort of training. There is evidence they were trying to get help, just because they didn’t do it in a manner that would make sense to those of us who had disaster training doesn’t mean they abdicated their nursing duty.
During Hurricane Harvey, our facility had staff spend the night the whole week, the DON and administrator were readily available as they spent the night in their offices. Staff brought their dogs or cats if they had to.
The timing of these deaths are concerning. These calls seemed to have come all at once in the early morning. Ongoing assessment is important, but I wonder how many of these residents were showing signs of distress before they expired. When stuff hits the fan, everyone is going to protect their license. I had a patient who's air conditioner broke, I got there and she was sweating, I called the senior apt. complex maintenance, made sure they came to fix it, called her son, and called back to check if it was working. I know from experiencethat heat is unbearable, it comes down to making a decision that the DON or someone may tell you not to do. Maybe the facility DON or administrator didn't want to get cited or in trouble for some reason. Surely they knew the temperature guidelines.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
1 hour ago, fibroblast said:
During Hurricane Harvey, our facility had staff spend the night the whole week, the DON and administrator were readily available as they spent the night in their offices. Staff brought their dogs or cats if they had to.
The timing of these deaths are concerning. These calls seemed to have come all at once in the early morning. Ongoing assessment is important, but I wonder how many of these residents were showing signs of distress before they expired. When stuff hits the fan, everyone is going to protect their license. I had a patient who's air conditioner broke, I got there and she was sweating, I called the senior apt. complex maintenance, made sure they came to fix it, called her son, and called back to check if it was working. I know from experiencethat heat is unbearable, it comes down to making a decision that the DON or someone may tell you not to do. Maybe the facility DON or administrator didn't want to get cited or in trouble for some reason. Surely they knew the temperature guidelines.
Your point is? So during hurricane Harvey you and faculty had to stay at the facility and what? The storm blew over, you guys were never out of electricity or running water....or you actually had a crisis occur and handled it how? Just because you stayed at the facility during a potential natural disaster does not mean your experience is relative to an actual disaster. Glad your DON was prepared and you were working for a good employer...but where is the experience?
You know from experience heat is unbearable and helped ONE person in a NON DISASTER avoid heat sickness....? Okay multiply that by 35 people in need at one time and family unable to get to the patient because of blocked roads, emergency vehicles not able to get there for the same reason, being on hold with 911 for an hour or more and not knowing when/if they are going to show up. 35 people is minimum of what one nurse would have been responsible for in this scenario. Tell me how you are going to keep accurate timely assessments on 35 people, chart, and ensure their needs are met and still try to get a hold of help. Oh, and YOU are also working in said 100 degree temperatures.
None of the nurses accused in this article have said they didn’t realize what kind of trouble their patients were in. The argument is that they are being prosecuted for not doing enough. That they should have called 911 when, instead, they called the power company and the governor who had publicly given out his phone number for nursing homes to call during this crisis. I don’t know why they did not call 911, maybe because in scenarios like this one when you watch the news you quickly learn that EMS is inundated with calls and it may be days before they get to you. Which is exactly what happened in Houston during Harvey.
And let’s say instead of your prepared DON you are working for the slum lords of DONs. Obviously by the documented lack of compliance with basic safety standards PRIOR to this storm that is what we are working with here.
It does not matter IF you ever would or would not choose to work in such a dump. For your assessment of the situation to be accurate you have to say that is the situation you are working under. You can tell the DON no, you can call 911 your self, but you still have 35+ people with immediate needs, you still have to chart, and you are still suffering from working in 100 degree temperatures your self. You cannot leave because that is abandonment. How many times have you managed care for 35+ people at once with an unknown amount of assistance...or possibly no assistance at all? We are talking potential one on one care for 35+ people!!!!!!!!!!!!! I will call you a liar if you say that you would find a way or that they just needed to call for help.....they did call for help, they didn’t get any!!!!!!!!
The worst situation I ever worked was a post op ortho floor that was 8-1 no techs, no aids, no secretaries.... total one to one care. I found that nearly unsurvivable and that was just their standard practice (of course they had really high turn over rates), and I had air conditioning, running water, active phones and computers.
Look we all agree that patients needlessly lost their lives here. But I honestly don’t know how ANY of us can find it just that 4 nurses have been arrested for AGGRAVATED MANSLAUGHTER with the information that has been printed in the articles. All the articles have said is that the nurses tampered with evidence and should have done more. The nurses have all said that they did try to contact help and that they did the best they could in the situation. No actual evidence on either side has been presented and yet several people on here already pointing fingers and shaking their heads at these nurses. Soooooooooooo disturbing! You, without ANY EVIDENCE have convicted these nurses of MANSLAUGHTER!!!! HELLO????!!!!!!!!
Your point is? So during hurricane Harvey you and faculty had to stay at the facility and what? The storm blew over, you guys were never out of electricity or running water....or you actually had a crisis occur and handled it how? Just because you stayed at the facility during a potential natural disaster does not mean your experience is relative to an actual disaster. Glad your DON was prepared and you were working for a good employer...but where is the experience?
You know from experience heat is unbearable and helped ONE person in a NON DISASTER avoid heat sickness....? Okay multiply that by 35 people in need at one time and family unable to get to the patient because of blocked roads, emergency vehicles not able to get there for the same reason, being on hold with 911 for an hour or more and not knowing when/if they are going to show up. 35 people is minimum of what one nurse would have been responsible for in this scenario. Tell me how you are going to keep accurate timely assessments on 35 people, chart, and ensure their needs are met and still try to get a hold of help. Oh, and YOU are also working in said 100 degree temperatures.
None of the nurses accused in this article have said they didn’t realize what kind of trouble their patients were in. The argument is that they are being prosecuted for not doing enough. That they should have called 911 when, instead, they called the power company and the governor who had publicly given out his phone number for nursing homes to call during this crisis. I don’t know why they did not call 911, maybe because in scenarios like this one when you watch the news you quickly learn that EMS is inundated with calls and it may be days before they get to you. Which is exactly what happened in Houston during Harvey.
And let’s say instead of your prepared DON you are working for the slum lords of DONs. Obviously by the documented lack of compliance with basic safety standards PRIOR to this storm that is what we are working with here.
It does not matter IF you ever would or would not choose to work in such a dump. For your assessment of the situation to be accurate you have to say that is the situation you are working under. You can tell the DON no, you can call 911 your self, but you still have 35+ people with immediate needs, you still have to chart, and you are still suffering from working in 100 degree temperatures your self. You cannot leave because that is abandonment. How many times have you managed care for 35+ people at once with an unknown amount of assistance...or possibly no assistance at all? We are talking potential one on one care for 35+ people!!!!!!!!!!!!! I will call you a liar if you say that you would find a way or that they just needed to call for help.....they did call for help, they didn’t get any!!!!!!!!
The worst situation I ever worked was a post op ortho floor that was 8-1 no techs, no aids, no secretaries.... total one to one care. I found that nearly unsurvivable and that was just their standard practice (of course they had really high turn over rates), and I had air conditioning, running water, active phones and computers.
Look we all agree that patients needlessly lost their lives here. But I honestly don’t know how ANY of us can find it just that 4 nurses have been arrested for AGGRAVATED MANSLAUGHTER with the information that has been printed in the articles. All the articles have said is that the nurses tampered with evidence and should have done more. The nurses have all said that they did try to contact help and that they did the best they could in the situation. No actual evidence on either side has been presented and yet several people on here already pointing fingers and shaking their heads at these nurses. Soooooooooooo disturbing! You, without ANY EVIDENCE have convicted these nurses of MANSLAUGHTER!!!! HELLO????!!!!!!!!
Also where is the Florida Nursing Board on this issue. Do they refuse to protect us or provide any legislative protection bills for healthcare workers who are caught up in disaster situations? Are we just out there with our hineys hanging out when disaster strikes? The hospital is not going to just accept people because they are too hot. How do 4 nurses evacuate 140 residents efficiently? If the State of Florida does not support healthcare workers than maybe we shouldn't work in that State! As far as I am concerned it is not safe to practice nursing in the State of Florida. No safe patient/nurse ratios, no responsibility of facility owners, if you show up to help then you can and will be prosecuted!
The mission of the Florida Nursing board is not to protect nurses. It is to protect the public.
It has not been stated in any of the articles I have read that the facility ever requested evacuation from the state. It is possible that if they had, they would not be facing charges. If any executive or administrator told them not to request evacuation or transfer of the more vulnerable patients, they should be charged.
I was not suggesting that 911 should have been called to evacuate patients. I am saying the nurses did not monitor the patients well enough to recognize the developing crisis in some patients, and call 911 for them. I believe I read that three patients coded within 2 hours. We know there are clinical signs that happen before these occur.
I also have not read anywhere that the majority of the deaths were among hospice patients. Besides, it wouldn't matter if they were. Hospice aims to provide a calm, pain-free death. Dying because your temperature elevates to 109 F is pretty much the opposite.
I sympathize with these nurses and feel that they were placed in a very difficult situation. The director of nursing and administrator should have been onsite. Nurses this new to the facility should not have been left to manage this alone. I would not be surprised to learn that these nurses had been pressured to refrain from asking for evacuation. Ultimately though, your license and more importantly, your patients are your responsibility. I'm not comfortable with the thought of them going to jail, yet I am also uncomfortable with nurses abdicating their responsibility to their patients' safety. I am glad I will not be on the jury.
It's the State's Emergency management that initiates an evacuation, the facility's responsibility is to keep the Disaster response system aware of their conditions so that a determination regarding evacuation can be made, which they did. Facility administrators, who were on-site, as well as staff made numerous calls and repeat calls to the appropriate authorities in the days prior to sudden increase in temperatures on the second floor and even reportedly tried to chase down a FPL truck on foot when they saw one drive by. But an LTC cannot unilaterally decide to send all of their patients to a hospital as an evacuation measure.
The usual plan is to "shelter in place" unless conditions become so severe that a full evacuation is warranted. Per the investigation into what happened, conditions were reasonable in the days following the storm, it wasn't until early in the morning of the 13th that conditions changed suddenly, which then resulted in a full evacuation of the facility. And given their ratios and the baseline health status of these patients, I don't think it's true that they clearly should have noticed acute changes quicker than they did. According to reporting "the majority of those who died had been under hospice care or otherwise gravely ill. " And as I stated before, it's still a tragedy that these patients died from heat exposure regardless of being end-of-life, but I don't agree that the staff were grossly negligent.
This is a case of where I would have lost my job instead of my license because I would have sounded the alarms on everybody. If I would have had to call the news to get those patients out of there so be it. Plus, if it was too hot for the patients to the point where they were coding that means it was also too hot for the staff. I'm not working in exhaustive heat.
Devnation
49 Posts
It has not been stated in any of the articles I have read that the facility ever requested evacuation from the state. It is possible that if they had, they would not be facing charges. If any executive or administrator told them not to request evacuation or transfer of the more vulnerable patients, they should be charged.
I was not suggesting that 911 should have been called to evacuate patients. I am saying the nurses did not monitor the patients well enough to recognize the developing crisis in some patients, and call 911 for them. I believe I read that three patients coded within 2 hours. We know there are clinical signs that happen before these occur.
I also have not read anywhere that the majority of the deaths were among hospice patients. Besides, it wouldn't matter if they were. Hospice aims to provide a calm, pain-free death. Dying because your temperature elevates to 109 F is pretty much the opposite.
I sympathize with these nurses and feel that they were placed in a very difficult situation. The director of nursing and administrator should have been onsite. Nurses this new to the facility should not have been left to manage this alone. I would not be surprised to learn that these nurses had been pressured to refrain from asking for evacuation. Ultimately though, your license and more importantly, your patients are your responsibility. I'm not comfortable with the thought of them going to jail, yet I am also uncomfortable with nurses abdicating their responsibility to their patients' safety. I am glad I will not be on the jury.