Saturday, August 18, 2018
Tampa Bay Weather

From care center to purgatory to 'hellhole': How 11 frail elders died after Irma

As she got ready to say goodbye to her mother at the Hollywood Hills nursing home, Rose Wyda's heart was sick. Hurricane Irma had been gone for nearly 48 hours, but the trail of shattered trees and broken, hissing power lines the storm left behind was still dangerously apparent. And the nursing home was part of the storm's collateral damage.

Its air conditioning system hadn't worked in more than two days, and the interior of the two-story building was sweltering. Staffers were running to and fro, ministering to the elderly residents, but there seemed to be too little of everything: ice, water, fans. Some residents were breathing only in labored rasps; others lay motionless and silent, seemingly comatose.

Wyda, confident of her mother's strength, was certain she would be OK. But as a regular visitor at the home, she knew all too well just how precariously many of the frail, elderly residents clung to life. "I knew people were going to die," Wyda recalled later.

She quickly walked the two blocks home, and started to say prayers that would last all night — to no avail. By morning, eight of the nursing home's residents would be dead, and three more would follow within days. Another casualty: the nursing home itself, closed by the state and sunk in a miasma of lawsuits, criminal investigations and political finger-pointing from which it is unlikely ever to emerge.

What happened at The Rehabilitation Center at Hollywood Hills from the moment Irma struck Broward County as a tropical storm at 8 a.m. on Sunday, Sept. 10, until the nursing home finished clearing away its dead almost exactly 72 hours later makes for a harrowing tale of miscalculation and miscommunication, of plans that looked much better on paper than amid the exacting standards of real life. And it's a tale that did not end with the stifling, sweaty deaths of the victims, because human rage is immortal.

"How mad would you be if somebody didn't take care of your mom and they said they would?" demanded Vendetta Craig of Miramar, whose mother survived only after a hospital packed her in ice following the nursing home's evacuation.

"You'd be stuttering mad. You want to punch somebody. You want some answers. You want justice. You want all of that."

***

There's nothing about The Rehabilitation Center at Hollywood Hills to suggest it would become the site of a tragic mass death. It's a mundane gray, two-story building located a few blocks west of Interstate 95 in Hollywood. It's no more than 20 or so steps from Memorial Regional Hospital, one of the largest hospitals in the state.

Licensed as a skilled nursing facility with the state, the rehab center cares for three types of residents: those who are recovering from surgery or an injury and only intend to be there for a short time; those who are in long-term care, meaning they live there and have a medical condition or disability — often Alzheimer's disease or dementia — that requires around-the-clock care from a nurse or other medical professional; and those in hospice, who are terminally ill.

As nursing homes go, Hollywood Hills is on the large side, with 152 beds scattered among rooms ranging from private suites to quadruple bedrooms. Most of the nursing home residents live on the building's first floor, which has a dining room and recreational area as well as a kitchen. A few live on the second floor, which is mostly the home to Larkin Community Hospital Behavioral Health Services, a 50-bed psychiatric hospital. Both share ownership with South Miami's Larkin Community Hospital.

Hollywood Hills is by no means a cheap place to stay. The nursing home's average rate was about $315 a day in 2015, according to state records, about 30 percent higher than the Florida average of $240.

There's no shortage of culprits in the deaths in a hellhole of a nursing home

There's no shortage of culprits in the deaths in a hellhole of a nursing home

Some families, however, regarded the care at Hollywood Hills as substandard at any price. In Boulder, Colorado, Denise Crease Byers felt a chill of recognition as she watched CNN reports about the Hollywood Hills deaths: This was the same nursing home where her 89-year-old father, longtime Hollywood mail carrier Christopher Crease, last year first broke a leg, then suffered through a stifling Memorial Day without air conditioning when the power failed.

Crease's family got him out of Hollywood Hills a week later and eventually filed suit against the nursing home. Still pending, it won't be resolved in time to help Crease, who died about six weeks after the scorching Memorial Day weekend.

Courtesy of the family

The family of Christopher Crease sued the Rehabilitation Center at Hollywood Hills over the care he received in the nursing home.

His daughter still recalls how the residents suffered in the searing heat. "When the heat gets up to a certain level, the patients are not breathing right because they are boiling up inside," she said, calling the place a "hellhole" and "torture chamber."

Prolonged exposure to heat can be deadly to frail elders, said Dr. Robert Schwartz, chair of family medicine and community health with the University of Miami Health System. Those with underlying medical conditions and who take prescription drugs, especially diuretics that increase the amount of water expelled from the body, are more likely to develop heat stroke or heat exhaustion.

"Once they develop heat stroke, their risk of death goes up dramatically," Schwartz said.

The Crease lawsuit was by no means the only black mark on Hollywood Hills' record. It got a "below average" rating from Medicare's nursing home online comparison tool. And several reports from state and federal regulators over the past year documented examples of deplorable conditions at Hollywood Hills.

And though state regulators cleared the nursing home to keep operating after administrators fixed the problems in March, the allegations — ranging from some elders being left sitting in soiled diapers to others getting showers only every 10 days or so — are disturbing.

Still, Hollywood Hills had its supporters, including Rose Wyda, the woman who would later foresee storm-related deaths. When Wyda's 85-year-old mother, Rita Toteda, arrived at the nursing home in 2015 she was recovering from a bout of pneumonia and too frail to walk or even talk.

But under Hollywood Hills' care, Toteda rebounded to the point where she could leave to spend Sunday afternoons at home with her daughter. And with Wyda's house just two blocks away, the daughter could visit her mother nearly every day.

"I know it doesn't look like the best place, but I was involved every day. I would put her to bed every night, so I knew what was going on, and I was so close by," Wyda said. "A lot of people there were never visited by anyone, and some of them leaned on me and they liked having me around."

Rita Toted, mother of Rose Wyda, made it through the storm. Her daughter photographed her at Memorial Regional Hospital South.

As Hurricane Irma stalked South Florida, though, even Hollywood Hills' staunchest supporters were nervous about its ability to stand up to what some public officials had warned would be a "nuclear hurricane."

Many wanted to bring their family members home, but the prospect of caring for erratic elders with dementia who might also need specialized medical care like oxygen tanks, all of it in a dwelling that could be seriously damaged or without electricity, was a daunting one.

"The whole week I was going through this emotional battle," said Vendetta Craig, a frequent visitor to Hollywood Hills to see her Alzheimer's-afflicted mother. "What do I do with my mom? Do I take her? Do I leave her? If I take her, I need to get an ambulance, you know? I need a staff with me."

In the end, the Hollywood Hills staff convinced Craig to let her mother stay there. "They had generators, blankets, food, everything they could possibly need," Craig said, recalling the conversation later. "They told me, 'This is the place where other hospitals come in situations like this.' So I had confidence, this is a hurricane shelter, my mom is in the best place."

The family of R.B. Greggs was worried, too. Family members, having read a host of negative online reviews of Hollywood Hills for its resident care, had only reluctantly brought the 80-year-old Greggs, a longtime city of Miami power-equipment operator, for therapy for a spinal injury caused by cancer.

And after a only a week, their doubts were increasing. He had bedsores — the product, they were certain, of staff inattention. Greggs' wife, Verlia, began spending the night on a recliner bed in his room so she could get up and rotate him every few hours in an attempt to control the bedsores.

Just three days before Irma landed, they met with several of the nursing home's top officials, including administrator Jorge Carballo to voice their complaints about patient care — and ask about hurricane precautions. "We're well prepared for this," Carballo assured them. Another staffer reminded the family members that Memorial Regional Hospital was right next door, a backup if things went wrong at Hollywood Hills.

The family members decided to keep Greggs at the nursing home. But their concerns began anew when Verlia had to leave her nighttime vigil at his bedside on Friday. She couldn't stay there during the storm, the staff told her.

The nursing home wouldn't let Adriana Giraldo stay during the hurricane, either. Giraldo's parents, Libia and Gabriel, both 89, had moved into Hollywood Hills in April as dementia and Alzheimer's, respectively, began to get the best of them.

Libia Giraldo was evacuated from the Hollywood Hills nursing home Sept. 13.

In August, Giraldo had come from her home in Augusta, Georgia, to visit. What she saw of her mother's care — bedsores and soiled diapers — appalled her. She was planning to move them to Augusta to be closer to her, but the hurricane interrupted. "It scared the hell out of me," Adriana said, especially when she heard TV weather forecasters say Irma might be bigger and faster than Hurricane Andrew, a storm Giraldo had lived through in South Florida.

She was somewhat reassured when the Hollywood Hills staffers told her they had plenty of medical supplies, food and backup generators in case of a power outage. Still: "I wanted to stay with my parents," Giraldo said. "But they wouldn't allow it." Reluctantly, Giraldo went to spend the weekend at a friend's house in Cooper City.

The families of residents weren't the only ones concerned about Hurricane Irma. Earlier in the week, Florida's Agency for Health Care Administration (AHCA), which regulates nursing homes, ordered them all to start checking in twice a day with a status report, and to call immediately if anything major went wrong.

Sunday, Sept. 10

Libia Giraldo was evacuated from the Hollywood Hills nursing home Sept. 13.

Irma's tropical-storm force winds arrived in the dark skies over Broward County around 8 a.m. For much of the day, it seemed Hollywood Hills would make it through the storm without damage. But at 3 p.m. the lights flickered for a moment, a small but significant indication that something had gone wrong.

The Hollywood Hills building gets its power through two Florida Power & Light transformers. One — with a backup generator — powers most of the building's electrical appliances, including the lights and all the medical-safety systems like oxygen. The other is hooked only to the air conditioning's chilling unit, and has no backup.

After that flicker, the transformer powering the lights and medical systems went back to work immediately. The one connected to the air conditioning didn't. At 3:49 p.m., Hollywood Hills called FPL to report the outage.

But the nursing home didn't say anything to AHCA, as it was supposed to do. And in its 6:46 p.m. status report, according to records released by Gov. Rick Scott, Hollywood Hills claimed that everything in the building was operational, including the air conditioning.

A few minutes after that report was filed, the wind dropped below tropical-storm levels. Irma would continue making noise for a few more hours, but mostly it was over for Broward.

But the nightmare inside Hollywood Hills was just beginning.

Monday

In a timeline released later, Hollywood Hills administrators would say that on Monday morning, though the air conditioning had been out for over 18 hours in the sullen tropical heat of South Florida, "the building was still cool and spot coolers were placed on both sides to maintain the temperature. At no point were patients at risk."

That's not the way anyone else remembers it. Verlia Greggs, who returned to the nursing home at 8 a.m. for the first time since she was sent away on Friday, noticed as she walked in the door that "everybody was sweating."

She found her husband, R.B., lying in a room with no fan, no water and closed windows. Running outside for help, she discovered there wasn't any.

"We have 150 patients here and we only have 20 to 30 fans," a nurse's aide told her. There were some so-called spot coolers — small, portable air-conditioners that cool only the immediate area around them — scattered through the building, but Verlia counted only six, just half of them actually working.

And though the Hollywood Hills staff was working hard to assist the residents, it seemed to Verlia that their numbers were low, as if some had stayed home because of the storm, the opposite of what the family had been promised.

Frantically, she sent her son Randy out to buy a fan for her husband. By the time Randy returned, the staff had scrounged one, but Verlia was still distraught about R.B., who was soaked in sweat and obviously dehydrated. "I was afraid he was going to die," she said.

In the afternoon, Adriana Giraldo reached the nursing home to see how her parents were doing. As she pulled up outside, she was encouraged to see that the lights were on. But inside, her parents, too, had been left in a room without a fan, where the window was barely cracked open.

Dinner was served on schedule at 6 p.m., but there was little water for her parents to drink. She went looking for Carballo, the administrator, she said, to ask him about the air conditioning, but he was already gone.

Carballo and other Hollywood Hills administrators had spent much of the day on the telephone, trying to get help with the air conditioner. Their primary target was FPL; the nursing home claims it made at least 13 calls to the company on Monday, and were promised first that repairmen would arrive in the morning (they didn't) and then in the afternoon (they didn't). Why FPL never showed up remains unknown; the company refused to answer specific questions about its role.

Meanwhile, the nursing home looked for other sources of help. Four times, staffers called a cell phone number belonging to Gov. Rick Scott. The governor gave out the number to nursing home operators during a conference call as the hurricane approached and urged them to call if they had a problem.

Sometimes the calls to Scott were answered by a member of his staff; sometimes the nursing home left a message and got a call back later. Either way, they weren't fruitful. The governor doesn't have a tactical squad of carpenters and electricians to jump in a helicopter and fly out to do repairs. Instead, the information the nursing home provided was forwarded to another state agency — at least in part because Scott's office didn't sense any urgency in the calls.

Typical was the final exchange of the day, just before 10 p.m., between Scott's office and an administrator at the Larkin psychiatric hospital. The hospital said it and the nursing center had air-conditioning problems 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," according to a statement and timeline released by the governor's office.

The stream of back-and-forth phone calls between the nursing home and state agencies continued all day long, picking up steam as it continued; there were at least 10 exchanges between 5 and 10 p.m. And if nothing else, they seem to have given Hollywood Hills administrators assurance that help was on the way.

When Rose Wyda arrived at the nursing home in the late afternoon to see her mother, she noticed the heat. But Jorge Carballo told her that "FPL is coming, they are going to come," and he sounded so certain that she put it out of her mind.

Tuesday

Tuesday morning dawned hot and clear. As Hollywood Hills neared its 48th hour without air conditioning, the nursing home was a purgatory morphing into a genuine hell. Wyda arrived with a fan for her mother and was immediately stunned at how useless it would be.

The building reeked of body odor and echoed with groans of residents who said they could not breath. The hum and hiss of oxygen machines and fans — and the incongruous, other-worldly chatter of a TV set somebody had turned on — only added to the clamor.

"It was as hot as an oven," said Wyda. "I was frantic because it was early in the day and I knew they would all be sitting there in the heat. Some of the rooms didn't have fans. The staff just kept saying 'everything will be OK — FPL is coming.' " The horrified Wyda decided to take her mother away from the nursing home for the rest of the day.

Even more shocked was Jean Johnson, who came to see her old friend, 84-year-old BeBetty Hibbard, who spent a career working in real estate but was now in the tightening grip of dementia.

No one died more cruelly than Betty Hibbard, who was seen folded in two in the hallway of the second floor of the nursing home.

She visited the home at 4:30 p.m. Tuesday, and immediately noticed that the place was sweltering.

"I went upstairs, and I saw Betty wasn't in her room," she recalled. She found her sitting on a bed rolled into the hallway.

Johnson asked a nurse for ice and the nurse said she didn't have any.

"I walked down the hall and it was pitiful," she said. "I had no idea they had been without electricity for three days. They didn't have ice."

Hibbard looked forlorn. "So I sat down and I gave her a cold Coke; she was so glad to have that cold Coke to drink."

Johnson stayed to comfort her friend for a while. But when a nursing home staffer brightly assured her that "FPL is coming," she went home.

The entire building was hot as blazes, but the second floor, where Hibbard stayed, was much the worst of the two, like a blast furnace. Adriana Giraldo, taking the elevator to her parents' upstairs room, felt the heat like a slap in the face when the door opened. Her parents, their room airless and suffocating, begged her for water and ice.

Meanwhile, Rose Wyda picked up her telephone. She didn't put it down for hours.

"I called FPL continuously, couldn't get through," she said. "I called the county number 311 and got nothing." But even when Wyda finally reached a human being instead of an endlessly ringing phone, the results were no less frustrating.

"It's an emergency. There's no air conditioning. I'm afraid people might die," she says she told someone at the county board of health.

"There's nothing we can do," came the reply. "You have to call DCF, the state Department of Children & Families."

Wyda called DCF. "People are sick and they will die in there," she said.

IT WAS AS HOT AS AN OVEN. I WAS FRANTIC BECAUSE IT WAS EARLY IN THE DAY AND I KNEW THEY WOULD ALL BE SITTING THERE IN THE HEAT.

Rose Wyda, whose mother was at the nursing home

"There's nothing we can do," replied the voice on the phone.

"Don't you represent the elderly?" she asked bitterly.

As Wyda made her plaintive phone calls, the first grim foreboding of what was ahead for the nursing home appeared. Lily Schwartz, who works for a non-profit organization in Austin, Texas, got a phone call from the nursing home.

Her father, 93-year-old Cuban emigre Carlos Canal, wasn't feeling well, the nurse told Schwartz. They were sending him across the street to the emergency room at Memorial Regional. A few hours later, one of the ER doctors phoned to say her father had pneumonia and a 105-degree temperature. They were giving him antibiotics, oxygen and morphine.

In none of these conversations did anybody say anything to Schwartz about air conditioning. She just assumed her father had fallen ill, the way 93-year-old men do. "I really just thought he was going to be in the hospital and he was going to get out," Schwartz said.

Nor did the nursing home mention Canal's illness to anyone else. Though a gravely ill resident had just been evacuated from the nursing home to the hospital, a clear suggestion that the blistering heat inside Hollywood Hills was posing a health threat, no one said that during the endless ping-ponging calls between the nursing home and state agencies, according to the chronology released by the governor's office.

Carballo, the nursing home administrator, "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," an AHCA official who talked to Carballo that afternoon said. The official added that he had told Carballo "to call 911 if there was any reason to believe that the health or safety of patients was at risk."

And the nursing home really didn't seem to think anybody was in danger. Throughout the day, Carballo and three doctors made rounds of the residents — including the room of the administrator's father-in-law, who was living there — checking to see if they were in any medical trouble. "None of these healthcare professionals reported any patients or residents being in distress or having any significant problems," Hollywood Hills would say later.

"It is only based on hindsight of outcome that the reasonable actions taken at the time are being criticized," the rehabilitation center's lawyers, Kirsten K. Ullman and Julie Allison, said in a statement.

Tuesday night/Wednesday morning

Wyda reluctantly brought her mother back to the nursing home on Tuesday about 7:30 p.m. Nothing had changed.

"Everyone was hot and uncomfortable, but they were moving and the staff had jugs of water and kept giving people water," Wyda said. "They had wet cloths, and you could see that that the nurses were sweating.

"The staff was frantic. They were running all over the place trying to cool the people. They were doing the best they could, but I worried all night that something was going to happen," she said.

"What's happening?" Wyda asked one senior staffer.

"What do you mean? We got the fans and we are waiting for FPL," the staffer replied buoyantly.

Wyda walked through the nursing home, accompanying her mother to her second-floor room. It was like a stroll through a gallery of portraits by Hieronymus Bosch.

"I saw people who were paralyzed, people who had breathing problems," she said. Many of the residents had been rolled out into the hallway on their beds, hoping to catch a whiff of a breeze from the fans and spot chillers. Others lay inert in their rooms without fans.

The most disturbing sight of all was Betty Hibbard, the former real estate worker, who was stripped down to a diaper and was sitting on a bed in the hallway, folded over like a magazine stuck in a back pocket. "She was crying and saying she couldn't breathe," said Wyda. "It was horrible."

Adriana Giraldo found Hibbard an even more terrible and striking sight, because she had seen Hibbard in exactly the same position the day before — but with her hospital gown on. To Giraldo, that was evidence that the hospital staff, despite the constant repetition of "FPL is coming," knew better.

"They knew how bad the situation was getting because they put that lady out in the hallway on Monday and she still had a gown on," Giraldo said. "The next day, someone had taken her gown off and she was naked because the heat was so unbearable."

Giraldo was scheduled to return home to Georgia, while her sister, who had evacuated from Hollywood to New York as the storm approached, would return to look after their mom. So that her sister wouldn't be blindsided by how bad the situation at the nursing home was, Giraldo shot a video with her cell phone. It included a few seconds of the naked, nearly insensate, Hibbard.

That image would stay with Giraldo, and not just in her camera. Days later, she would sob as she talked about it with a reporter. "When I left," she said, "I knew that the lady was still breathing."

It was around 1:30 in the morning when all those aging hearts and lungs began to give out in one long, exhausted spasm. The nursing home called one ambulance for a resident felled by tachycardia, an irregular heartbeat, and an hour later a second for a resident who couldn't breathe.

When a third ambulance was called at 4:30 a.m., for a resident who suffered a heart attack, he was dead before it arrived. Before the crew could leave the building, another one dropped dead and then another.

As Hollywood Hills residents began arriving at the Memorial Regional emergency room next door, it set off alarm bells there.

"The emergency room staff alerted our command center that three patients had arrived from Hollywood Hills with extraordinarily high temperatures," said Memorial Regional's chief nursing officer, Judy Frum, who was working the command center. "It kind of set off a red flag that something might be going on in the building."

Frum and a colleague hustled over to the nursing home, where they saw dehydrated residents sprawled everywhere. The scorching heat inside the building was the obvious culprit. "I wanted to sound the alarm," Frum said. She did, and with the aid of emergency rescue squads, the evacuation of Hollywood Hills finally began — so quickly that it was well underway before any senior nursing home officials could even arrive.

And, for that matter, before relatives of the nursing home residents could be alerted. Wyda, tipped off by a nurse, arrived to find the building taped off like a crime scene, with no sign of where her mother had gone. (They would reunite at a different hospital a few hours later.)

Others learned in more frightening ways. Verlia Greggs showed up at the nursing home at 7 a.m. to take her husband to a chemotherapy session, but the building was surrounded by police. The approximately 140 surviving residents had been dispersed to a handful of hospitals. As she tried to figure out what to do next, her son Randy called. "You can't go in there," he warned his mother. "Come back home."

He'd already seen TV news stories about the deaths and the evacuation, but none of the victims had been identified yet.

For hours the family huddled together in muted terror as the reported number of dead kept rising — from three to five to eight — without any names being released. When Verlia's daughter Felicia finally found R.B. in the emergency room of Memorial Regional, the rest of the family wouldn't believe it until she sent a photo snapped with her cell phone.

Vendetta Craig also had an agonizing wait to learn the fate of her mother. She was awakened by a phone call from a friend in Tampa who said, hesitantly, "I don't want to alarm you, but I think you need to turn on CNN."

It took what seemed a lifetime to Craig to track her mother to a hospital that had packed her in ice to bring down her 102-degree fever.

"I said her name, Edna Jefferson," recalled Craig. "She opened her eyes, she looked at my eyes, oh my gosh that was the best thing. That was the best thing that ever came into my soul! She gave me life."

For so many others, though, there was no happy ending. Betty Hibbard, whose dignity suffered so grievously in her final moments, was dead. So was Albertina Vega, a retired New York seamstress just a month shy of her 100th birthday. And Carlos Canal, who lingered on a week before his death without ever recovering sufficiently to speak with his daughter.

Autopsies have been ordered on all 11 victims, but because of the criminal investigation, few details have emerged about the deaths. What little has been made public, though, offers a cruel picture of their final hours.

Emily Michot

The Rehabilitation Center at Hollywood Hills was cordoned off like a crime scene after the surviving residents were evacuated.

Gail Nova, a former Miami X-ray technician, died seven minutes after arriving at the emergency room; her temperature at death was a stunning 109.9 degrees. Estella Hendricks, of whom little is know except that she once lived in the U.S. Virgin Islands, wasnot far behind at 108.5 degrees.

To those figures, perhaps one more stark number should be added. Within a few minutes after the end of Hollywood Hills' evacuation, an FPL crew arrived to fix the transformer. It took 15 minutes.

This story was reported by Miami Herald staff writers Julie K. Brown, Daniel Chang, David J. Neal, Carli Teproff and Jay Weaver, and Herald writer Caitlin Ostroff. It was written by staff writer Glenn Garvin.

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