Wednesday, June 20, 2018
Opinion

Column: Nursing home deaths after Irma were avoidable

When a major hurricane strikes, the terrible human cost is limited by two things; luck and preparedness. The better prepared we are, the luckier we get.

When Florida was savaged by eight major hurricanes in 2004 and 2005 while Jeb Bush was governor, we learned many things about our health care safety net that protects the most vulnerable. The lessons learned translated into processes designed to rely upon competent leadership at local facilities executing thoughtful disaster plans, combined with a local and state infrastructure leaning in to help when such plans fail. Such plans always rely, first and foremost, on using local emergency resources, such as 911 and available first responders.

The processes we developed in 2004 and 2005 were used to evacuate facilities when the elderly were in danger, rush fuel for generator use when facilities feared fuel could run out, and deploy Disaster Medical Assistance Teams. The state wants to help where local authorities cannot.

As effective as this process is, it was never designed to substitute incompetence with state action.

The tragedy at the Rehabilitation Center at Hollywood Hills was avoidable and outrageous. It begs for the tough stand Gov. Rick Scott and the secretary of the Florida Agency for Health Care Administration, Justin Senior, are taking. Scott sees a failure in the system, and he's acted to correct it.

As for the nursing home industry, let's be clear: They are good people who have a difficult task serving the needs of Florida's most vulnerable. Most step up and perform well when the responsibility demands it.

But seeing what unfolded at Hollywood Hills, I recall another incident involving its ownership in 2004, the same year as that tough hurricane season. The Justice Department and the Florida attorney general accused the owners of Larkin Community Hospital and the current owner of the Rehabilitation Center at Hollywood Hills of fraud and theft from our federal and state health care program for seniors. That case resulted in a settlement which, unfortunately, permitted the owner of the Rehabilitation Center at Hollywood Hills to continue owning health care facilities.

Now the leadership of Hollywood Hills bears the responsibility for the lives of Floridians who were counting on sound judgment and reasonable steps to protect their lives. The 11 deaths were preventable if the people who swore to be responsible for them would have done what any reasonable person would do. Simply walking across the street to the fully functioning hospital for help would have been a good start.

Let's be clear. No successful disaster plan I've ever seen includes calling a governor's cell phone as a solution to a problem which involves medical care, particularly when there are local resources within reach. The shameful manner in which the facility has tried to cast blame on others has made matters worse. They failed, went outside the processes established to provide assistance, and then patients died. It is that simple. More than 100 other nursing homes were affected by Hurricane Irma, and so far there have been no stories of multiple deaths at any of these facilities.

What could possibly have been the motive for not evacuating vulnerable patients? What kind of culture exists in a facility where patient safety is not the highest priority? The criminal investigation could reveal this, but it appears the culture had little to do with the well-being of the people the leadership of Hollywood Hills was entrusted to serve.

Now that Irma is past, it's time to assess what worked well and what didn't. Other than where obvious negligence occurs, no one is to blame when the system falls short. Laying blame only causes people to withhold honest observations about what needs to improve. The governor will no doubt ask his Emergency Management Team to do a full assessment, and this information will be used to help future governors prepare and execute when disasters occur.

In the meantime, I applaud the steadfast approach to preparing for, and responding to, Irma by local, state and federal officials. Nowhere was the urgency more on display than in the manner by which Scott led. The sense of urgency he imposed serves to prompt all state agencies to be more prepared and competent. This is the ultimate lesson for future governors.

Alan Levine served as secretary of Florida's Agency for Health Care Administration from 2004-2006, and as secretary of Louisiana's Department of Health and Hospitals from 2008-2010. He currently serves as a member of the Florida Board of Governors.

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