A Hollywood nursing home with a troubled history became a sweltering death trap Wednesday when a portable air cooler malfunctioned. Before the day was over, eight residents lay dead.
Memorial Regional Hospital’s emergency room was directly across the street.
Hollywood police have begun a criminal investigation into the deaths at Rehabilitation Center of Hollywood Hills. The Agency for Health Care Administration and the Department of Children & Families have begun their own investigations.
Hollywood Police Chief Tom Sanchez said officers would evaluate all of Hollywood’s 42 other nursing homes. Local governments had begun evacuating elders from other long-term care facilities across South Florida that had lost power in the wake of Hurricane Irma.
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On Wednesday night, the healthcare administration halted new admissions to the rehab center, which had a history of poor inspections by state regulators.
All the current residents already had been moved.
In its complaint, the healthcare agency said that on Sept. 10 the rehab center “became aware that its air conditioning equipment had ceased to operate effectively.” The nursing home contacted Florida Power & Light to report the problem, then set up eight portable air coolers throughout the facility, and placed fans in the hallways.
But between 1:30 a.m. and 5 a.m. Wednesday, “several residents suffered respiratory arrest or cardiac distress,” the complaint said.
First responders, “as a result of the heat in the building,” essentially ordered the home to evacuate its second floor. Administrators evacuated the entire building.
Healthcare regulators called conditions in the home “a threat to the health, safety or welfare of residents” and “an immediate serious danger to the public health.”
Gov. Rick Scott, who sought the moratorium, said he would “aggressively demand answers on how this tragic event took place.”
He called himself “absolutely heartbroken.”
“Protecting the lives of Floridians is my top priority and that’s why we have worked all week to help Floridians prepare and respond to Hurricane Irma,” Scott said.
The Broward Medical Examiner’s office released the names of the dead Wednesday afternoon, but declined to state the cause of any of the deaths. They were: Carolyn Eatherly, 78; Miguel Antonio Franco, 92; Estella Hendricks, 71; Betty Hibbard, 84; Manuel Mario Mendieta, 96; Gail Nova, 71; Bobby Owens, 84; and Albertina Vega, 99.
The rehab center’s administrator, Jorge Carballo, said the home “is cooperating fully with relevant authorities to investigate the circumstances that led to this unfortunate and tragic outcome.”
He said the rehab center staff “diligently prepared for the impact of Hurricane Irma. We took part in emergency management preparedness calls with local and state emergency officials, other nursing homes and health regulators.”
Responding to questions from the Miami Herald Wednesday night, the state Department of Health said regulators never were told that residents at the nursing home were in peril.
“At no time did the facility report that conditions had become dangerous or that the health and safety of their patients was at risk,” said Mara K. Gambineri, a health department spokeswoman.
In fact, Gambineri said, the nursing home had made 17 reports to the state through an online database beginning on Sept. 7. “Throughout the course of these reports, the facility never requested any assistance or reported the need for evacuations.”
As late as 7:30 a.m. Wednesday, Gambineri said, the nursing home “reported that they had partial power, the generator was operational and they had adequate fuel supply.” The home did report that its cooling system was not operational.
The home’s final three updates, which Gambineri provided to the Herald, show the home reported: “Have spot coolers and fans. Chiller is not operational pulling outside air.” In the updates, Carballo said repairs to the system were under FPL “ticket #4301.”
Carballo never sounded the alarm to the state that residents were in danger, the updates show.
The Hollywood Hills nursing home has been faulted in the past for its care of elderly patients, and is affiliated with a South Miami hospital with a questionable past of its own.
The rehab center, at 1200 N. 35th Ave., has a health inspection rating of “much below average” by the Florida Agency for Healthcare Administration. AHCA evaluates all long-term care facilities in the state for the U.S. government, which administers the Medicare and Medicaid insurance programs for older and impoverished Americans.
The home’s “overall rating,” which includes staffing, fire safety and health inspections, was “below average.”
An inspection of the nursing home by state health regulators last February revealed a host of violations, ranging from an ill-kept building to poor care. Nursing homes should not have an error rate of more than 5 percent when administering medication — meaning residents don’t get the wrong drug or the wrong dose of the right drug. The rehab center’s error rate was close to 26 percent.
Nursing home staff, the inspection said, “failed to ensure meals were provided timely.” On Feb. 15, one woman was seen “screaming she wanted lunch as she strolled back and forth with her wheelchair dressed in a patient gown,” the report said. “She was yelling that she was hungry.”
That same day, an inspector overheard the relative of a resident complaining that lunch was late. It was 1 p.m., and lunch trays were supposed to arrive by noon. “When are the lunch trays arriving?” the family member asked. “My mother is hungry.”
Three days later, inspectors wrote, a resident “was observed calling out for food, come, come. I want food, food, food.”
The resident was waiting outside the dining hall for her turn to eat breakfast, and a staff member later acknowledged “it is not fair to her to see others eat,” but that “this is normally how it is done.”
“Numerous flying insects” swarmed the kitchen, according to the report.
One resident had been kept in her room for hours with the drapes drawn shut, staring at a dark television set. Other residents were wheeled outside for a sing-along, and creative art and exercise were scheduled that day. But the woman was never taken out of her dark room.
A man was observed to have knife-like fingernails with a “blackish substance” in them. Another complained that he had been waiting months for glasses, hearing aids and new dentures — after he began to lose weight and his old pair of dentures no longer fit.
The nursing home had failed to maintain a program for controlling the spread of infection, the report said, adding that inspectors found “soiled brooms” in a clean wash room area, filthy clean-linen carts, and commercial dryers that were filled with lint and trash.
A trash can in the area where staff folded clean linen was overflowing, and “coming into direct contact [with] stored clean linen.” The ceiling ventilator in the linen room “had a build-up of black mold-like substance.”
The building itself was in disrepair, with missing and cracked tiles, holes in the floor, peeling paint, overflowing trash cans, loose door knobs and soiled bathtubs, the inspection said. Refrigerator and freezer gaskets were “full of dirt and debris.” A toilet seat was loose.
The fine for those violations: $5,500.
The rehabilitation center also had been sued twice in late 2016 by the relatives or representatives of two patients who died there, one allegedly from infection and dehydration — and the other from pressure sores.
The nursing home’s licensee is Rehabilitation Center at Hollywood Hills, LLC, which is owned by Dr. Jack Michel. State healthcare records list Michel as an officer and board member of the nursing home, with a controlling interest.
The home also has a relationship with Larkin Community Hospital, which has a long history of running afoul of healthcare regulators. Michel is listed in state corporate records as Larkin’s president, as well. In 2006, the U.S. Justice Department fined Larkin and its owners $15.4 million in a settlement of a civil fraud complaint.
The center is located across the street from Memorial Regional Hospital, which never reported losing power during Hurricane Irma.
In July 2015, Larkin Community Hospital issued a news release announcing it had won a bankruptcy auction and was taking over operations of the 152-bed Rehabilitation Center at Hollywood Hills, as well as other properties. The reason for the auction: The previous owner was in prison for Medicare fraud.
Both the nursing home and adjacent psychiatric hospital, Hollywood Pavilion, were owned by the family of former CEO Karen Kallen-Zury.
In 2013, a federal jury convicted Kallen-Zury of Lighthouse Point and three other Pavilion employees of conspiracy, saying they had bilked Medicare of $67 million by filing phony claims for mental health services form 2003 to 2012. Medicare was duped into paying about $40 million to Kallen-Zury’s company. Of those defendants, Kallen-Zury received the longest sentence, 25 years.
Larkin and Michel bid $24.6 million for the properties, the news release said. “This acquisition represents another step in the evolution of our hospital into an integrated delivery system,” Michel said in the news release.
Larkin Community Hospital, which is based in South Miami, and its president, Michel, have had a long relationship with a now-indicted healthcare businessman, Philip Esformes.
In 2006, Esformes, his father, Morris Esformes, Larkin’s Michel and the hospital’s previous owner, James Desnick, settled a civil dispute with the U.S. government for $15.4 million over allegations that they paid kickbacks to physicians in exchange for referring patients to Larkin.
Back then, Esformes owned a chain of Miami-Dade assisted-living facilities and supplied patients to Larkin. The patients then were returned to his facilities and recycled again, according to the settlement.
In a similar scheme, Esformes was indicted last year in a $1 billion Medicare fraud case that prosecutors called the largest in the nation.
Esformes, a wealthy Miami Beach executive who has been held without bond since his arrest, is accused of exploiting a network of about 20 Miami-Dade skilled-nursing and assisted-living facilities to fleece the taxpayer-funded Medicare program. His network filed false claims for services that were not necessary, or, in some instances, not provided, to about 14,000 patients, the indictment says.
Larkin, though not identified in the Esformes indictment, referred many of those Medicare patients to his network through kickbacks to doctors and other medical professionals, prosecutors say. Esformes, in turn, recycled the same patients back through the hospital after they stayed in his network.
Michel is not identified in the Esformes indictment.
Esformes’ attorney, Michael Pasano, said his client “has no interest or involvement” in Michel’s ownership of the Hollywood Hills nursing home.
The Florida Health Care Association, a long-term care industry group, released a statement Wednesday morning framing Wednesday’s deaths within the context of Irma’s brutal blow to the state.
“Our centers’ first priority is always the safety and well-being of every resident in their care and they are doing everything in their power to meet their immediate and ongoing needs,” wrote the association’s executive director, Kristen Knapp.
“The loss of these individuals is a profound tragedy within the larger tragedy of Hurricane Irma, and we extend our deepest sympathies to the families of these residents,” Knapp said.
Miami Herald staff writers Daniel Chang Jay Weaver, Carli Teproff, Alex Harris and Mary Ellen Klas contributed to this report, as did researcher Monika Leal.