1. Health

Florida hides details in nursing home reports. Federal agencies don't.

In the foreground is a document detailing the findings of a Feb. 2016 inspection at the Rehabilitation Center at Hollywood Hills obtained from a federal agency, the Center for Medicare and Medicaid Services. Behind it is the state?€™s version of the same document, from the Agency for Health Care Administration, showing how it has been redacted before being released to the public. [Miami Herald]
In the foreground is a document detailing the findings of a Feb. 2016 inspection at the Rehabilitation Center at Hollywood Hills obtained from a federal agency, the Center for Medicare and Medicaid Services. Behind it is the state?€™s version of the same document, from the Agency for Health Care Administration, showing how it has been redacted before being released to the public. [Miami Herald]
Published Sep. 22, 2017

TALLAHASSEE — Gov. Rick Scott widened his offensive Thursday against the Broward nursing home he blames for the deaths of 10 residents by setting up a tip line for information, but when it comes to access to the inspection reports of all nursing homes, the governor's administration has heavily censored what the public can see.

HURRICANE IRMA: Read the latest coverage from the Tampa Bay Times.

In the past year, the Agency for Health Care Administration has purchased and employed new redaction software that removes key words, dates and descriptions from the inspection reports posted online and used by the public to monitor conditions at the 683 nursing homes and more than 3,100 assisted-living facilities in the state.

For example, a three-sentence section of a Feb. 18, 2016 inspection report at the Rehabilitation Center at Hollywood Hills blacked out words such as "room," "fingernails," "hands," "substance," "bruises," "skin," "arms" and "accidentally."

The agency says it is simply following the federal HIPAA rules, which shield from public disclosure sensitive health information. But the very same inspection report, submitted by AHCA to the federal Centers for Medicare and Medicaid Services is also available to the public — without the words redacted.

The federal Nursing Home Compare web site, for example, includes the following sentence but the AHCA web site redacts the words in italics.

"Resident #46 was observed in his room in bed," the report read. "His fingernails on both of his hands were observed to be long with the right hand worse, with long jagged sharp edges and a black unknown substance observed under the nails of his right hand and a thick yellowish spongy substance under the left hand fingernails. Additionally, the resident looked like he had not been shaven for a few days. The skin on his arms was noted to be very fragile with multiple bruises and scratches on both arms. An inquiry was made if he had accidentally scratched himself with his long fingernails ..."

The section is one of dozens of examples provided as evidence of 17 deficiencies that the state said must be addressed at the Hollywood Hills home in February 2016. Scott ordered the home closed this week, after eight residents died Sept. 13 when power was lost to an air-conditioning system during Hurricane Irma. A ninth resident died Tuesday and a 10th victim died Thursday.

AHCA, which regulates nursing homes and assisted living facilities, revoked the home's license Wednesday, alleging in a statement that at least eight of the residents died after not receiving proper medical attention. The tragedy is being investigated by the Hollywood Police Department and the Florida Department of Law Enforcement, which on Thursday set up a tip line for family members and others with information about the deaths or the nursing home from Sept. 9 to Sept. 13, encouraging informants to call (866) 452-3461.

PREVIOUS COVERAGE: Was it a crime? 10 patients at nursing home died after Irma

For family members that may have wanted to get information about what state regulators knew about the Hollywood Hills home, state officials have increasingly made access to that information harder to get, said Brian Lee, the head of a national watchdog group called Families for Better Care.

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In the last year, the state spent $22,000 for redaction software that automatically blacks out words the agency says must be shielded from the public to protect patient privacy. But for Lee and other senior advocates, the censored detail does more to protect the homes than patients.

"There's no rhyme or reason to it," Lee said. "They are so indiscernible now, they're almost useless. If the feds can put this same information on its web site, why can't the state? It's a favor to the industry by the Scott administration."

Nathan Carter, an Orlando attorney who represents families of residents in nursing homes and ALFs, said the lack of access to information under Scott "is the worst it's been in 25 years."

"It's a part of the bigger pattern," he said. "The regulations have gotten weaker and weaker and the disclosure worse and worse. I don't think it's a mistake you can't find anything."

Mallory McManus, spokesperson for AHCA, said the inspection reports are posted on the agency's website as a courtesy to the public.

"We're not required to post it online," she said. "We use an automated redaction tool, that we have refined over time, for online postings, but we do understand that it sometimes over redacts."

If people want the reports without the automatic redactions, they can make a public records request and a lawyer will hand-screen the document and more carefully redact the information, she said. The agency will charge a fee for those records.

However, state law does not give the agency a choice on much of the information but requires that AHCA "shall" post reports on nursing home deficiencies and other inspection details on its website "including all federal and state recertification, licensure, revisit, and complaint survey information, for each facility for the past 30 months."

As to why the state seems to know how to interpret the federal HIPAA laws better than the federal government, McManus didn't have an explanation.

"You'll have to ask them that question," she said.

Families seeking details on the Hollywood Hills nursing home or any other regulated senior centers in the state will see more detail on the federal Nursing Home Compare web site than on Florida's. There, the federal government ranks nursing homes and gave the Rehabilitation Center of Hollywood Hills a "much worse than average" health rating.

The 17 deficiencies state inspectors cited in its lengthy report of Feb. 18, 2016, were more than twice the state average for nursing homes and required the nursing home to provide a plan of correction, according to

And the unredacted federal documents also offer some insights into the operation of the home:

It had a medication error rate of 25.9 percent and a medication administration error rate of 8 percent on Feb. 18, 2016.

It failed to provide adequate hearing, vision and dental services to residents, the report said. Nursing staff failed to ensure proper wound care and catheter use.

Meals were prepared in kitchens where insects swarmed, were not sufficiently "palatable" and were often delivered late or to overcrowded dining rooms, the document said.

Medication and resident feeding tubes were not safely stored and secured; the laundry area "failed to maintain an infection-control program" and medical equipment was not properly sanitized.

And housekeeping and maintenance was blasted as not "sanitary, orderly and comfortable."

Four subsequent reports had numerous deficiencies that AHCA later listed as corrected. In July 2017, AHCA renewed the Rehabilitation Center's license.

Contact Mary Ellen Klas at Follow @MaryEllenKlas


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