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?
I know California has that mandated ratio for each nurse. They should do that for all states. Nurses are really held on so much responsibility sometimes too much than what they should.
California ratios are in acute care. I don't know about SNF.
I thought long and hard about the various comments. I decided I needed more facts so I read the STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS Case Report which I have excerpted below (in italics). While I don't feel jail time is in order, I do believe that some criminal charge is appropriate, and that they should all lose their licenses. Also, as I said before, there should be others in management at the defendant's table as well.
TLDR: The nursing home staff NEVER asked for evacuation, despite communicating among themselves that the patients were in danger. They only called EMS after patients were already in distress. Evacuation was initiated by the hospital next door and EMS after three patients were sent to the hospital (and subsequently died). Video and chart evidence suggests patients were neglected. There is ample evidence that charts were falsified afterwards to hide neglect.
"15. Although multiple experts testified at the final hearing that 'shelter in place until it is no longer safe to do so' is the standard of care in the nursing home industry during a hurricane, no testimony was presented to show that Hollywood Hills undertook an evaluation at any time after the loss of A/C whether it was more dangerous to relocate or evacuate patients versus continuing to stay in place indefinitely while waiting on restoration of power to the A/C."
"29. Hollywood Hills staff members communicated with each other before, during, and after the storm on a group messaging service, 'WhatsApp,' which included key members of the Hollywood Hills management and staff, including Mr. Carballo, DON Castro, Mr. Williams, and others. These messages reveal there were increasing concerns about the impact of the conditions in the facility by at least the morning of Tuesday, September 12, 2017. At 9:40 a.m. on Tuesday morning, Mr. Carballo ordered no more resident admissions until the A/C was restored and asked the staff to secure more fans. 30. Shortly thereafter at 9:58 a.m., Jocelyn Rosario, director of housekeeping and building services, informed the messaging group that the 'patients don't look good' and 'we need fans.' Despite this alarming message, Hollywood Hills' management and supervisors did not follow up with staff present at the facility to determine which patients showed signs of distress from the heat.
"32. Later that morning, Ms. Tellechea, nursing supervisor for the day shift, notified the group that the residents 'had a difficult night.' She advised that the facility continued to be without A/C and ice, and suggested that staff try to buy ice for the residents.4/ Ms. Tellechea also stated that it was too hot in the facility to conduct normal therapy operations. Again, no Hollywood Hills management or supervisors responded to this warning or directed specific actions be taken to protect the patients."
Minutes after this message was sent, the first patient coded.
"40. By Tuesday, September 12, 2017, Hollywood Hills was aware of the rising temperature and the potential dangers posed to the residents--some of whom had already been identified as impacted by the conditions in the facility. Despite clear evidence that the heat was affecting the residents, Hollywood Hills failed to document any efforts to provide extra care or monitoring to the residents, nor was the staff instructed on how to monitor and care for the residents more effectively, or to prepare for possible evacuation of the facility."
"September 13, 2017, Events Prior to the Evacuation 41. HFR Crew 31 returned to Hollywood Hills in the early morning of September 13, 2017, responding at 3:07 a.m. to a report of a resident with cardiac arrest who was not breathing and did not have a pulse. Additional HFR backup also responded to assist. The HFR crews vividly testified about the hot conditions in the facility. One first responder described the temperature inside the facility as 'ungodly hot'...HFR measured Resident 1 to have a tympanic temperature of 107.5 degrees. Lt. Parrinello and Firefighter Wohlitka testified that they had never seen a patient with a temperature that high...Less than thirty minutes after transporting Resident 1 and leaving MRH, HFR Crew 31 was dispatched back to Hollywood Hills...When HFR found Resident 2, she was nonverbal, had labored breathing, was hot to the touch, had vomit in her mouth, and had a tympanic temperature of 107.5 degrees. The credible testimony and documentation from HFR contrast sharply with Hollywood Hills staff notes that Resident 2 was 'awake and alert' without any vomiting or other signs of distress."
If you read nothing else, please read this part:
"The experienced MRH staff had never seen multiple patients with temperatures in excess of 105 degrees, like those at Hollywood Hills. In light of the escalating situation, the nurses became extremely concerned for the safety of the residents and walked over to the Hollywood Hills facility to assess the situation firsthand.
56. Ms. Meltzer credibly described the conditions in Hollywood Hills facility when she exited the elevator to the second floor as, 'there was like a blast of heat like when you open your car door at the end of the day after it's been sitting out.'
57. MRH staff and HFR vividly described the scene at Hollywood Hills on September 13, 2017, to include Hollywood Hills staff visibly sweating from the heat and overwhelmed by the number of critical patients. Staff was heard shouting, 'they are dropping like flies.' Patients were disoriented and visibly uncomfortable inside the facility. One resident was found in a fetal position on a mattress with no sheet, in a diaper 'saturated with urine and feces,' hot and visibly sweating.
58. HFR and MRH first responders quickly recognized that the residents were in extreme distress and it was not safe for them to remain inside the facility. After Resident 4 was found deceased, HFR and MRH staff concluded that other patients were potentially in danger. 59. Earlier that morning, Hollywood Hills staff members had discouraged HFR from checking on other residents. Staff members told HFR that they conducted rounds and every resident was within normal limits. However, given the unfolding events, Lt. Parrinello rejected the contention by Mr. Colin, night shift supervisor, that the staff had already checked on the other patients and that everyone was okay, telling him, 'you told me that before and now we have multiple deceased patients so with all due respect I don't trust your judgment and we're going to check on everyone ourselves.'"
"60. HFR and MRH staff all agreed that evacuation of the Hollywood Hills facility was necessary to protect the residents. HFR Battalion Chief Robert Ladwig assumed command and was in charge of operations at the commencement of the evacuation."
This is crap and these overinflated charges seem to be an attempt to placate the family and place blame. This seems more of an administrative issue than a nursing / clinical issue.
Where was the doctor?
Was he / she called? What was the doctors recommendation?
What was the recommendation of administration in this matter? Did the nurses follow through on this recommendation?
Events like this are quite eye opening , and unfortunately they serve to keep great clinical staff out of nursing homes - which are notorious for being under staffed, LITIGIOUS , limited resources, and high nurse to patient ratios.
It is over-inflated, some were hospice and we do not know how many were comatose, actively dying. If death was hastened by one minute by heat the families who did not take them home will sue. Given it was heat rather than a hurricane where were the families taking them home? While I am sure they were not all aware of this scenario don't different residents get visits such that there would be a number of visitors at any given time because, of what I've heard (of) SNF facilities they crawl with complaining family members.
Again given it was not a hurricane/earthquake/totally flooded out where was the rest of staff? God, I hope that the tiny number of staff all of whom were new to facility is not all they used!
Specializes in Surgical Specialty Clinic - Ambulatory Care.
5 hours ago, Devnation said:
I thought long and hard about the various comments. I decided I needed more facts so I read the STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS Case Report which I have excerpted below (in italics). While I don't feel jail time is in order, I do believe that some criminal charge is appropriate, and that they should all lose their licenses. Also, as I said before, there should be others in management at the defendant's table as well.
TLDR: The nursing home staff NEVER asked for evacuation, despite communicating among themselves that the patients were in danger. They only called EMS after patients were already in distress. Evacuation was initiated by the hospital next door and EMS after three patients were sent to the hospital (and subsequently died). Video and chart evidence suggests patients were neglected. There is ample evidence that charts were falsified afterwards to hide neglect.
"15. Although multiple experts testified at the final hearing that 'shelter in place until it is no longer safe to do so' is the standard of care in the nursing home industry during a hurricane, no testimony was presented to show that Hollywood Hills undertook an evaluation at any time after the loss of A/C whether it was more dangerous to relocate or evacuate patients versus continuing to stay in place indefinitely while waiting on restoration of power to the A/C."
"29. Hollywood Hills staff members communicated with each other before, during, and after the storm on a group messaging service, 'WhatsApp,' which included key members of the Hollywood Hills management and staff, including Mr. Carballo, DON Castro, Mr. Williams, and others. These messages reveal there were increasing concerns about the impact of the conditions in the facility by at least the morning of Tuesday, September 12, 2017. At 9:40 a.m. on Tuesday morning, Mr. Carballo ordered no more resident admissions until the A/C was restored and asked the staff to secure more fans. 30. Shortly thereafter at 9:58 a.m., Jocelyn Rosario, director of housekeeping and building services, informed the messaging group that the 'patients don't look good' and 'we need fans.' Despite this alarming message, Hollywood Hills' management and supervisors did not follow up with staff present at the facility to determine which patients showed signs of distress from the heat.
"32. Later that morning, Ms. Tellechea, nursing supervisor for the day shift, notified the group that the residents 'had a difficult night.' She advised that the facility continued to be without A/C and ice, and suggested that staff try to buy ice for the residents.4/ Ms. Tellechea also stated that it was too hot in the facility to conduct normal therapy operations. Again, no Hollywood Hills management or supervisors responded to this warning or directed specific actions be taken to protect the patients.”
“Although multiple experts testified at the final hearing that "shelter in place until it is no longer safe to do so" is the standard of care in the nursing home industry during a hurricane, no testimony was presented to show that Hollywood Hills undertook an evaluation at any time after the loss of A/C whether it was more dangerous to relocate or evacuate patients versus continuing to stay in place indefinitely while waiting on restoration of power to the A/C.”
Because the nursing home didn’t have a protocol to do so. There was no protocol for A/C outages, just plans for other ‘emergencies’ such as complete power outage, flooding, high winds etc.
“ At 11:00 a.m. on Monday, Broward County issued the "all clear" alert. Hollywood Hills reopened its facility to families and visitors. Multiple health care providers, including physicians, nurses, other clinical staff, and EMS personnel, were in the facility on Monday. There were no complaints to AHCA or the Department of Children and Families ("DCF") regarding the climbing temperatures within Hollywood Hills. This is significant because licensed health care providers, including physicians, nurses, and paramedics, are required by Florida law 14 to report any dangerous conditions potentially affecting nursing home residents. 23. On Monday afternoon, the Alpha team began to be relieved by the Bravo team. Each Alpha team clinician had to be replaced with a Bravo team clinician. Instructions about monitoring patients closely, continuously offering hydration, and reporting any changes to the nursing supervisor were given to the Bravo team. However, the nursing notes are devoid of any confirmation that these instructions were actually followed. 24. The Bravo team had day and night shift nursing supervisors. Milina Tellechea, an Advanced Registered Nurse Practitioner ("ARNP"), who had worked at Hollywood Hills for over ten years, was the daytime nursing supervisor. Sergo Colin, the night shift nursing supervisor, was employed at the facility for only a few weeks when Hurricane Irma hit. Although Mr. Colin had 17 prior years of experience as a licensed paramedic, and 11 years as an RN, as of September 11, 2017, he had little to no familiarity with the patients or the staff of Hollywood Hills.”
You have pointed out the tragic circumstances these people were needlessly in, and I agree with you on that. Do I think these are criminal....no. I think you had several healthcare professionals coming in and out of the facility and no one reported a thing until the EMS assessed the situation and finally identified it for the emergency it was. I think they were able to do that because they are EMS and trained to identify emergencies. I think that these people had just changed shift, the supervisor was new to the facility, they had been ordered to shelter in place, they knew that help had been called from the previous shift and their own efforts and all they thought of was they need to hunker down and wait it out...it is a hurricane after all. Not saying that was a good course of action, just saying that is what happens when people aren’t trained for crisis intervention and disaster preparedness. I think this is a tragedy that should be alerting the public that healthcare professionals are not a ‘catch all’ profession. You can’t expect them to be. And I certainly don’t see anything in here that makes me think these 4 people deserve manslaughter charges. I don’t really see something that makes me think they should loose their licenses really.
“Although multiple experts testified at the final hearing that "shelter in place until it is no longer safe to do so" is the standard of care in the nursing home industry during a hurricane, no testimony was presented to show that Hollywood Hills undertook an evaluation at any time after the loss of A/C whether it was more dangerous to relocate or evacuate patients versus continuing to stay in place indefinitely while waiting on restoration of power to the A/C.”
Because the nursing home didn’t have a protocol to do so. There was no protocol for A/C outages, just plans for other ‘emergencies’ such as complete power outage, flooding, high winds etc.
“ At 11:00 a.m. on Monday, Broward County issued the "all clear" alert. Hollywood Hills reopened its facility to families and visitors. Multiple health care providers, including physicians, nurses, other clinical staff, and EMS personnel, were in the facility on Monday. There were no complaints to AHCA or the Department of Children and Families ("DCF") regarding the climbing temperatures within Hollywood Hills. This is significant because licensed health care providers, including physicians, nurses, and paramedics, are required by Florida law 14 to report any dangerous conditions potentially affecting nursing home residents. 23. On Monday afternoon, the Alpha team began to be relieved by the Bravo team. Each Alpha team clinician had to be replaced with a Bravo team clinician. Instructions about monitoring patients closely, continuously offering hydration, and reporting any changes to the nursing supervisor were given to the Bravo team. However, the nursing notes are devoid of any confirmation that these instructions were actually followed. 24. The Bravo team had day and night shift nursing supervisors. Milina Tellechea, an Advanced Registered Nurse Practitioner ("ARNP"), who had worked at Hollywood Hills for over ten years, was the daytime nursing supervisor. Sergo Colin, the night shift nursing supervisor, was employed at the facility for only a few weeks when Hurricane Irma hit. Although Mr. Colin had 17 prior years of experience as a licensed paramedic, and 11 years as an RN, as of September 11, 2017, he had little to no familiarity with the patients or the staff of Hollywood Hills.”
You have pointed out the tragic circumstances these people were needlessly in, and I agree with you on that. Do I think these are criminal....no. I think you had several healthcare professionals coming in and out of the facility and no one reported a thing until the EMS assessed the situation and finally identified it for the emergency it was. I think they were able to do that because they are EMS and trained to identify emergencies. I think that these people had just changed shift, the supervisor was new to the facility, they had been ordered to shelter in place, they knew that help had been called from the previous shift and their own efforts and all they thought of was they need to hunker down and wait it out...it is a hurricane after all. Not saying that was a good course of action, just saying that is what happens when people aren’t trained for crisis intervention and disaster preparedness. I think this is a tragedy that should be alerting the public that healthcare professionals are not a ‘catch all’ profession. You can’t expect them to be. And I certainly don’t see anything in here that makes me think these 4 people deserve manslaughter charges. I don’t really see something that makes me think they should loose their licenses really.
I think it was you who said earlier that the expectations of nurses are sometimes too high. In many respects, I agree. It seems sometimes that nurses are expected to thrive and excel, despite innumerable obstacles. Yet we are the first to be blamed when things go wrong. We are often the first and last line of defense for our patients. I think the recognition of this fact is why nurses have been rated the most trusted profession for over 15 years.
However, we have struggled in the respect department. We tout nursing as a profession, distinct from other healthcare roles. If we truly believe this, we must be responsible for our actions and judgments. It is not legally defensible, nor do I think it's fair, to point out what others did or did not do. We cannot blame inaction on "just following orders." It does not matter that the doctors or other healthcare professionals didn't sound the alarm. The nurse, as the primary safeguard for the patient's well-being in the facility, had a responsibility to protect lives and he/she/they abdicated that to the judgment others. Any prudent and reasonable nurse knows that elderly patients cannot withstand elevated temperatures. They did not need any emergency/disaster training or EMS to know that. If there was no formal evacuation plan, they should have asked EMS/Florida government officials for help. Threaten to call the media if you have to. They may not have gotten evacuated earlier but they never even asked or discussed asking.
Most of the patients who died were NOT in hospice while at the nursing facility. Some were discharged to hospice after being evacuated and hospitalized. The case report also determined that a few of the patients, including at least one that was in hospice at the facility, could not conclusively be attributed to heat exposure, so they won't be charged with those deaths. It is not my intent to be confrontational, but I have to admit I find it a bit callous to even bring their hospice status up. Even if every single one was in hospice, they deserved to die comfortably, peacefully, and free of anxiety, not burning up in their beds.
What bothers me, even more, was the false charting, and the attempt to falsify records after the fact. Mr. Colon charted that he was routinely rounding and assessing patients. Video evidence contradicts this. After the facility was evacuated, several late entries were added to charts, some documenting care given after the patient was transferred or already dead. This is a black mark on the integrity of our profession. It doesn't matter how much your supervisor threatens you, this is just plain wrong.
I agree that manslaughter feels harsh. I'm not a lawyer, so I don't know what other lesser charges could be applied instead. The false documentation alone makes me comfortable with criminal charges. I'm not even sure that any jail time is in order. I would be satisfied with community service and/or probation. I do absolutely believe they should lose their licenses. I worked in a nursing home as a CNA while in college, and my sister has lived in one for almost 10 years. I understand the pressures they face. I also worked agency for a bit, lured by the high salary. I was assigned once to a very sub-standard emergency dept, where a patient with an active MI was taken, without my knowledge or approval, for a CXR while I was medicating another patient. I will only say that things went downhill from there, and I vowed to myself and my agency that I would never set foot in that place again, and I didn't. Nurses need to understand that protecting patients come first, always. And after that, always, always, protect your license. You worked too hard to get it to sacrifice it for an organization that almost inevitably will hang you out to dry at the earliest opportunity to save itself.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
3 hours ago, Devnation said:
I think it was you who said earlier that the expectations of nurses are sometimes too high. In many respects, I agree. It seems sometimes that nurses are expected to thrive and excel, despite innumerable obstacles. Yet we are the first to be blamed when things go wrong. We are often the first and last line of defense for our patients. I think the recognition of this fact is why nurses have been rated the most trusted profession for over 15 years.
However, we have struggled in the respect department. We tout nursing as a profession, distinct from other healthcare roles. If we truly believe this, we must be responsible for our actions and judgments. It is not legally defensible, nor do I think it's fair, to point out what others did or did not do. We cannot blame inaction on "just following orders." It does not matter that the doctors or other healthcare professionals didn't sound the alarm. The nurse, as the primary safeguard for the patient's well-being in the facility, had a responsibility to protect lives and he/she/they abdicated that to the judgment others. Any prudent and reasonable nurse knows that elderly patients cannot withstand elevated temperatures. They did not need any emergency/disaster training or EMS to know that. If there was no formal evacuation plan, they should have asked EMS/Florida government officials for help. Threaten to call the media if you have to. They may not have gotten evacuated earlier but they never even asked or discussed asking.
Most of the patients who died were NOT in hospice while at the nursing facility. Some were discharged to hospice after being evacuated and hospitalized. The case report also determined that a few of the patients, including at least one that was in hospice at the facility, could not conclusively be attributed to heat exposure, so they won't be charged with those deaths. It is not my intent to be confrontational, but I have to admit I find it a bit callous to even bring their hospice status up. Even if every single one was in hospice, they deserved to die comfortably, peacefully, and free of anxiety, not burning up in their beds.
What bothers me, even more, was the false charting, and the attempt to falsify records after the fact. Mr. Colon charted that he was routinely rounding and assessing patients. Video evidence contradicts this. After the facility was evacuated, several late entries were added to charts, some documenting care given after the patient was transferred or already dead. This is a black mark on the integrity of our profession. It doesn't matter how much your supervisor threatens you, this is just plain wrong.
I agree that manslaughter feels harsh. I'm not a lawyer, so I don't know what other lesser charges could be applied instead. The false documentation alone makes me comfortable with criminal charges. I'm not even sure that any jail time is in order. I would be satisfied with community service and/or probation. I do absolutely believe they should lose their licenses. I worked in a nursing home as a CNA while in college, and my sister has lived in one for almost 10 years. I understand the pressures they face. I also worked agency for a bit, lured by the high salary. I was assigned once to a very sub-standard emergency dept, where a patient with an active MI was taken, without my knowledge or approval, for a CXR while I was medicating another patient. I will only say that things went downhill from there, and I vowed to myself and my agency that I would never set foot in that place again, and I didn't. Nurses need to understand that protecting patients come first, always. And after that, always, always, protect your license. You worked too hard to get it to sacrifice it for an organization that almost inevitably will hang you out to dry at the earliest opportunity to save itself.
I don’t think the nursing field has any respect. The whole field is just a scape goat. Patients ‘trust us’ to wipe their buts and hand them sandwiches, they have very little clue what we do. I do agree with you that the falsified charting is a criminal act. But I have also completed charting well after a patient has died because I sure as heck wasn’t charting while I was saving their life. In this situation I would imagine the charting would have several late entries. There are 140 patients and what 3 nurses and they participated in evacuation of the residents. And that what makes me so curious, is it falsified charting or are they saying it is falsified because the entry was late? A late entry does not mean it is falsified.
May point in bringing up the other medical staff who came in the facility is that none of them noted the heat. So was it not as hot then? If not when did it get too hot that staff should have called 911? Weren’t these nurses also working in this heat? How did that affect their judgement? Just to many questions left for me to agree that they should even be charged. But thanks for your opinion.
Specializes in Clinical Leadership, Staff Development, Education.
8 minutes ago, KalipsoRed21 said:
And that what makes me so curious, is it falsified charting or are they saying it is falsified because the entry was late? A late entry does not mean it is falsified.
K9lover, ASN, RN
507 Posts
California ratios are in acute care. I don't know about SNF.