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?
That is the mission of every.single.board. If you have not read the Nurse Practice Act of your state I would highly recommend it. There is a reason why we have to take a test and petition the state (the public's proxy) to serve them as nurses.
The fact that our boards, and the profession at large, have maintained this view is largely one of the reasons why nursing is the most trusted and ethical professions in the world. When governing bodies start protecting the profession they were created to govern you get things like the police (not to pick on them) who instinctively claim no wrongdoing regardless of the evidence. We are better than the police, when we investigate ourselves you can be assured the outcome is not predetermined.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
2 hours ago, It'sYaGirlK said:
That is a scary thought
That is the plight of all BONs. They aren’t established for nurses, they are for the public. HOWEVER, if they really wanted to protect the public they would all be pushing for legislation that requires better staffing ratios.
That is the plight of all BONs. They aren’t established for nurses, they are for the public. HOWEVER, if they really wanted to protect the public they would all be pushing for legislation that requires better staffing ratios.
What makes you think they generally do not?
Now to be fair they are generally gubernatorial appointees so they do have to support their administration's policies and generally not cause too many waves but I am not aware of any board that openly opposed reasonable legislation.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
On 9/3/2019 at 11:36 AM, Asystole RN said:
What makes you think they generally do not?
Now to be fair they are generally gubernatorial appointees so they do have to support their administration's policies and generally not cause too many waves but I am not aware of any board that openly opposed reasonable legislation.
Because if their mission is to make sure the public is safe, and their is like a TON of evidence based articles demonstrating the poor out comes for patients when nurses ratios get to high, AND there is a recommendation from the ANA on what the ratios should be, then all of their judgments on nurses should first be based on if the ratios are appropriate. If there are articles upon articles demonstrating how nurses fail when ratios are high, then any nurse complaint brought to the board should be nulled if the nurse to patient ratio was not at the recommended level. We have scientific proof that increased misses and death occur in patients when the ratios are to high, how can they possibly make an accurate judgement as to if that nurse was practicing poorly or if s/he was overwhelmed and it was a slip through if the ratios are not at the recommended levels to keep the patients safe?
Nursing boards do consider all factors related to a specific complaint - including staffing, orientation, etc. but they are not going to "null" complaints about the unsafe practice of a particular nurse. They will consider all circumstances but it is not their role to dismiss cases based upon ANA recommendations or studies.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
1 hour ago, EdieBrous said:
Nursing boards do consider all factors related to a specific complaint - including staffing, orientation, etc. but they are not going to "null" complaints about the unsafe practice of a particular nurse. They will consider all circumstances but it is not their role to dismiss cases based upon ANA recommendations or studies.
That’s just a lot of excuses not to act if you ask me. Very basic things will get missed and I highly doubt as retarded as judgments that I have read by several BONs are that they would rule in the nurses favor if she had to many patients and missed something ‘simple’. Which, to me, defeats the purpose of protecting the public from a ‘bad nurse”. It reminds me of a Facebook page post I recently read stating something like, “Nurses aren’t running around like crazy because they are competing against each other for the Daisy award. They are doing it in hopes of not being “the one” who missed something important.” I feel this is a pretty common feeling, especially in facility and hospital nursing. There is nothing professional about playing hit potato with people’s lives then having a BON judge those who dropped it as incompetent. That is just stupid.
So respectfully, I don’t feel that any BON is doing their job to protect the public appropriately. I get that they aren’t here to boost nurses, or be political, or protect nurses, but they aren’t protecting the public either.
Again, common misunderstanding about the mission and role of the nursing board. Just go to any nursing board website and see what they do and don't do.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
28 minutes ago, EdieBrous said:
Again, common misunderstanding about the mission and role of the nursing board. Just go to any nursing board website and see what they do and don't do.
I don’t miss understand their mission. Their mission is not accomplishing anything worthy of having them exist in their current state.
You are too cynical to have an actual conversation with about this. I was responding to the original post suggesting that the nursing board was supposed to intervene on behalf of the nurses and trying to correct that misunderstanding. You might feel differently about BON missions when you have a loved one harmed by a nurse who is unsafe, impaired, incompetent, or unethical. Not all adverse events are related to staffing.
Asystole RN
2,352 Posts
That is the mission of every.single.board. If you have not read the Nurse Practice Act of your state I would highly recommend it. There is a reason why we have to take a test and petition the state (the public's proxy) to serve them as nurses.
The fact that our boards, and the profession at large, have maintained this view is largely one of the reasons why nursing is the most trusted and ethical professions in the world. When governing bodies start protecting the profession they were created to govern you get things like the police (not to pick on them) who instinctively claim no wrongdoing regardless of the evidence. We are better than the police, when we investigate ourselves you can be assured the outcome is not predetermined.