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She had COVID-19 when she died and it was overlooked. Is Florida undercounting the dead?

An investigation into the death of Patricia “Pat” Schafer raises a question: How many other nursing home COVID-19 deaths are hiding in plain sight, never reviewed by a medical examiner?

Patricia “Pat” Schafer’s roommate was one of the coronavirus’ first victims at the Braden River Rehabilitation Center.

But when Schafer developed the same symptoms days later, and then suffered the same fate, the Bradenton nursing home’s attending physician ruled her death resulted from something strangely different: Old age. And pneumonia.

Schafer’s death would have escaped the notice of health department epidemiologists — and record-keepers — had a contact-tracer assigned to Schafer’s roommate’s case not detected the odd coincidence. Contact-tracers are tasked with identifying anyone with whom an infected person had interacted. The Department of Health flagged Schafer’s death, and Schafer’s remains were tested for the presence of COVID-19, the illness caused by exposure to the virus.

Three weeks after she died, Schafer became one of the 18 deaths — 17 residents and one staff member — linked to Braden River, which has become one of the deadliest elder-care facilities in Florida. Only one other nursing home in the state has reported more COVID-related fatalities: Seminole Pavilion Rehabilitation and Nursing Services, in nearby Pinellas County, with 22 resident deaths, along with one staffer.

Braden River Rehabilitation Center Is one of eight long-term care facilities in Manatee County that has had confirmed cases of COVID-19. [Tiffany Tompkins | Bradenton Herald]

“I kind of thought OK, she was older. She passed,” Schafer’s daughter, Patti Varrato, said Friday. “But when they were trying to hide it and lie about it, that’s when I needed to let people know that, ‘Hey, they are not being honest with the patients there and their families’.”

Florida law allows treating doctors to certify causes of death independent of medical examiners.

Schafer’s death likely would not have been counted among Braden River’s COVID fatalities had a health department epidemiologist not taken notice.

Is contract tracing reliable?

The investigation into Schafer’s death — or lack thereof, initially — raises important questions about Florida’s ability to track and study virus-related fatalities, especially in elder-care homes, which currently account for more than 40 percent of COVID-19 deaths in the state. How many other nursing home COVID-19 deaths are hiding in plain sight, never reviewed by a medical examiner?

It is unclear when Schafer’s roommate became infected with the coronavirus, or when she died.

Varrato said she got a call from Braden River on March 30, telling her that her mother’s roommate was running a fever. Schafer was moved into a different wing for observation.

“Two days later, I get a call in the evening that she’s gone into a coma, running a fever and her kidneys were shutting down,” Varrato said. “Then, two hours later, at 10:35 p.m., they called to let me know she passed.”

Varratto was confused by the turn of events: The very next day, Varrato received a letter dated March 31, notifying her that Braden River had only one confirmed case of COVID-19, but that the resident had been transferred to a local hospital and all precautions were being taken to protect other residents.

“She wasn’t even allowed to get last rites,” Varrato said. “There are times it hits me and I have to stop and remember, she is free from dementia now.”

Added Schafer’s son-in-law, Jim Varrato: “That’s not the way we wanted her to go. We wanted to be there with her.”

Varrato never got a chance to say goodbye to her mother.

Three days after Schafer’s April 1 death, Manatee County’s Chief Medical Examiner, Russell Vega, was dispatched to the funeral home preparing Schafer for cremation. The Department of Health contact-tracer had wondered why the roommate of someone who died from an extraordinarily contagious illness was never tested for the illness herself.

Schafer’s COVID test came back positive on April 8, and her death was reclassified. Schafer’s death certificate now says she died of complications of the coronavirus — not from old age.

Years in long-term care

Schafer, a retired Bradenton Herald accountant, lived in assisted living facilities or nursing homes for the last 11 years of her life. As her dementia worsened, she was transferred from home-to-home to keep up with the escalating demands of caregiving.

Varrato said Braden River, Schafer’s final stop, was the best among bad choices: Her mother’s care was being subsidized by Medicaid, Florida’s poorly funded insurance program for impoverished and disabled people. Braden River had a bed. Schafer needed one.

Her son-in-law said he stopped visiting, because the facility never looked very clean.

Patti and Jim Narrator, son-in-law and daughter of Patricia Schafer, who died of COVID-19 in the Braden River Rehabilitation Center. [Tiffany Tompkins | Bradenton Herald]

“I [couldn’t] see her this way in that nursing home,” he said. “Up front it looks like a AAA hotel.” But, he added, the home looked rundown and shabby once you got inside. “And, the smell….. I [couldn’t] go in there no more.”

He also noticed a high turnover among staff, saying he seldom saw the same person twice.

“It needs to be known in the community that they just weren’t doing things the right way,” Patti Varrato said.

“Towards the end, she didn’t know me,” she added.

Nursing home offers little explanation

After Schafer’s death certificate was rescinded, Varrato said Braden River was not very forthcoming with information, even claiming they didn’t have confirmed cases of COVID-19 in the home at all.

Vega, who oversees the medical examiner’s office, said the nursing home wasn’t terribly helpful with him, either. His office needed Schafer’s medical records in order to determine her cause of death.

“It did take a while to get the medical records to help us feel confident that we were making the right determination,” Vega said.

Susan Kaar, vice president of compliance & quality management for Southern Healthcare Management, the nursing home’s owner, said the company would not discuss details of the care and treatment of any specific resident or former resident.

Southern Healthcare Management also would not comment on the erroneous cause of death ruling by the nursing home’s doctor. The physician, she said, “is not an employee of the center.”

“Any resident who may be or has been showing signs or symptoms of COVID-19 — for example, fever, would be placed on appropriate infection-control protocols and isolation,” Kaar said.

“Typically, similar protocols would also be followed for that resident’s roommate. In some cases, unfortunately, the illness progresses rapidly and a resident may pass away a very short time after showing the first signs.”

According to Kaar, only then would the medical examiner’s office get involved.

But Braden River didn’t contact the medical examiner’s office. Part of the problem may have been that nursing homes aren’t as accustomed to reporting deaths or knowing when to, according to Vega.

“Even though it should have been made clear to all of these facilities,” Vega said.

Remembered for love of art and rocks

In addition to her daughter and son-in-law, Schafer is survived by a grandson, Jason Varrato, of Davenport, Fla.; sister Carolyn Roeske of Oregon; and many nieces and nephews.

Besides spending time with her family, she had a love for art and rocks.

“She was so creative when it came to ceramics,” Patti Varrato said.

Hanging in her home is her favorite of her mother’s artwork, a winterscape. For one of the Varratos’ anniversaries, her mother gave them a set of pasta bowls that she made, fired and hand-painted herself.

Besides painting and ceramics, she also liked to draw and loved photography.

“When we lived in the north before moving down here, we actually used to have a dark room in the basement and we used to work in there together,” Varrato said. “I used to love doing that because she used to love to develop all her own film and then she would do the printing.”

Schafer retired after 18 years working at the Bradenton Herald.

“She enjoyed working there, she really did,” Varrato said. “She had some great friendships with the people who worked with her.”

One of those friendships was with Fran Furner, who also retired after working 30 years for the Herald. After Furner’s husband died, the two took a cruise together, followed by other trips to Yellowstone National Park, Arizona and Las Vegas.

Schafer’s other great love was collecting rocks and fossils, and she belonged to the Tampa Bay Fossil Club.

“She had picked up so many rocks that she had to ship them back because she couldn’t carry them” all, Furner recalled of the two women’s trip to Phoenix.

Furner had planned to visit her friend in Oregon, where Schafer was living for a time with her sister, but the trip was canceled after Schafer was diagnosed with dementia. Schafer moved back to Bradenton, where her daughter was able to supervise her care.

“I lost her then, Furner said. “I went to see her, and of course she knew who I was. But five minutes later I would have to repeat the story I told her.”

It became increasingly difficult for Furner to visit her friend, because of the dementia. Schafer kept wanting to know how Furner’s daughter was, unable to remember the young woman had died.

“She was a dear friend and a traveling buddy. There were some interesting stories,” Furner added. “I really, really miss her.”

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