TALLAHASSEE, Fla. _ Twelve hours after Irma blasted through South Florida, conditions at Larkin Community Hospital in Hollywood were miserable.
The Broward County psychiatric hospital was at full capacity with adults and adolescents who were mentally ill; the air conditioning wasn't working and they couldn't open windows. So what did the director of nursing at Larkin do to seek help? He wrote an email _ to a Broward County commissioner, whose office was closed.
"We need to know if there is an emergency team who can come and help us to fix the problem that is getting worse by hours with no proper ventilation," wrote Joaquin Machado at 6:11 p.m. Monday, Sept. 11, to Broward County Commissioner Tim Ryan.
Ryan didn't get the message until days later, but Gov. Rick Scott included the misdirected call for help in a cache of documents released late Tuesday as part of his office's defense of the state's handling of the crisis at the Rehabilitation Center at Hollywood Hills.
Larkin Community Hospital Behavioral Health Services is the sister operation to the adjacent Hollywood Hills rehab center, where eight residents died Sept. 13 when power was lost to an air conditioning system and a set of portable air coolers malfunctioned. A ninth resident died Tuesday.
Ryan had forwarded the email to Justin Senior, secretary of the Agency for Health Care Administration, and its release Tuesday night was intended to underscore the inadequacy of the nursing home's calls for help. But beyond highlighting the nursing home's feckless response, the email also raises doubts about the state's strategy for helping elder-care operators brace for a looming catastrophe.
During a conference call with nursing home and assisted living facility representatives in the run-up to the storm, Gov. Scott did something that might seem unusual for the leader of the nation's third-largest state.
Scott, who wedged in the conference call amid a flurry of interviews with cable news anchors, gave out a private cell phone number to the caregivers. He said give us a call if you have a problem.
Many did just that, including the Hollywood Hills nursing home. The rehab center made multiple calls to the cell phone and to a separate state information hotline set up to deal with storm-related emergencies. In the calls, the Hollywood nursing home reported the electrical breakdown and indicated the situation was becoming increasingly urgent.
Not only did those calls fail to yield any substantive help, but they have resulted in sharp criticism from the governor's office, which said the nursing home never reported that lives were in jeopardy. It also questioned why the staff didn't take the sick and dying residents to Memorial Regional Hospital, which is next door.
Late Wednesday, the state added to the barrage of condemnations, saying the nursing home had fudged its medical records after residents had been evacuated. One resident was reported to be breathing without difficulty _ after already having died.
The deaths at Hollywood Hills have raised questions about the strategy of routing emergency pleas through the governor's office as well as the thought process behind phoning Tallahassee or emailing a county commissioner rather than calling 911 when conditions are careening from uncomfortable to stifling to deadly.
The Rehabilitation Center of Hollywood Hills wasn't the only facility to heed the governor's advice and call him either before or after the storm. Results were mixed.
As the storm warnings reached a crescendo, anxious operators of senior homes phoned either the private cell or the toll-free hotline, which dispensed information, but offered little assistance for those reporting a mass emergency at a nursing home.
Hours passed before some got a response, and some said they heard nothing back.
According to the governor's office, as the calls cascaded in to Scott's phone, the governor's travel aide, Elliott Stewart, would convert them to emails. Those emails would then be sent to a small group of some of the governor's closest aides _ Senior, the AHCA secretary; Emergency Operations Chief Bryan Koon; two of Scott's former campaign aides now working as aides to Koon and him, Wes Maul and Brad Piepenbrink; and the deputy chief of staff at the Florida Department of Health, Alexis Lambert, who is the daughter of Rick Scott confidant Pete Antonacci.
"There wasn't much they could do," said Melissa Bongart, who operates the eight-bed Ranch Assisted Living Facility in east Manatee County. She called seeking help obtaining plywood to replace some of her storm shutters that had rotted, and to find out where she could get a generator in case her power went out for an extended period.
"They said they didn't have a supply of generators or plywood," she said. "We hoped that if they say 'call us,' they had a way to solve the problem. It wasn't effective."
The documents released by the governor's office late Tuesday show that Senior, the head of the agency that licenses nursing homes and assisted living facilities, had been dealing with desperate pleas from the facilities for a full week.
In 12 pages of carefully handwritten notes, he recorded some of them: "Demaska Hills ALF 5 residents; all caregivers quit and/or evacuated." At Addington Place, he reported "staffing challenges." Beach House, an assisted living facility with 46 residents and a memory care unit, was on the border of a surge zone and had "no shutters, plywood."
Each of these centers _ no matter the location, the size, the crisis _ had one thing in common: As required, they had prepared an emergency response plan, filed it with county emergency managers _ and Senior's agency had approved it.
Based on the requests to Senior, some of those plans appear to have been either incomplete or inadequate. So, in some cases, the homes called the private cell phone.
Some said they did get help. An assisted living facility operated by David and Carrie Damaska, Grace House of Tampa, reported during the conference call being without a full staff because an evacuation order had been issued. The Damaskas wanted to evacuate their five residents, too, but needed help and a safe place to go.
"We were basically looking for some assistance with staff and a possible relocation place just to be able to help us, and sandbags and things like that," David Damaska said.
About 10 minutes after the conference concluded, a state official called back to say staff had found another assisted living facility _ about two miles away _ that was willing to take in Grace House's residents.
"As far as I'm concerned it worked for us," David Damaska said. "It was a blessing."
Senior's notes show that Damaska's home was one he personally focused on as he recorded the needs for generators, plywood, sandbags and diesel fuel before the storm.
After the storm, the calls to the governor were more dire: "flooding/power," "oxygen/power" "evacuating." Not all got personalized attention.
"We never heard back," said Luann Foos, executive director of the 245-acre Good Samaritan Society Kissimmee Village, a retirement community that operates a nursing home, assisted living facilities and apartments.
She called the governor on Tuesday, Sept. 12, after the storm, "to get our electricity turned back on when flooding was a small issue," she said. "But the flooding became a big issue and we ended up evacuating."
The records released by the governor's office shed some light on how the requests for help from the Rehabilitation Center at Hollywood Hills were handled.
The home's CEO, Natasha Anderson, called the Emergency Information Line at 5:37 p.m. on Monday, Sept. 11, after the storm had passed. "Our AC is down and we do have chillers, but they're not cooling the building enough," she said, according to a transcript of the call.
The information line referred Anderson to a "private sector coordinator" _ actually advisers working out of the state Emergency Operations Center in Tallahassee. They included administrators from power companies, nursing home associations, first responders and others.
It appears emergency officials confirmed that the nursing home had a "ticket" with Florida Power & Light to restore its power _ but there is no indication that anything else was done.
Much of the information released Tuesday consists of documentation of emails received and forwarded about phone conversations. One document was a statement written by Susan Glass, an AHCA administrator who fielded some of the calls to the governor. The statement recounts a conversation she had with Anderson, the CEO, on Tuesday, Sept. 12, the day before eight residents died.
"My understanding from the conversation is that both the EOC (Emergency Operations Center) and power company had been informed of the A/C issue/need," Glass wrote.
In a complaint filed Tuesday in Leon County Circuit Court, the Rehabilitation Center of Hollywood gave its own timeline, detailing how administrators made numerous calls to the governor and his staff, as well as multiple calls to FPL. The complaint suggests that the center followed the emergency preparedness plan that was "reviewed and approved by AHCA, the Department of Health, County Emergency Management Officials."
On Tuesday, the Rehabilitation Center asked a judge in Tallahassee to block state health regulators from going forward with a halt to all new admissions, and a suspension of the rehab center's reimbursement under Medicare and Medicaid, federal insurance programs for elderly and poor people.
Health regulators responded Wednesday with an emergency order suspending the home's license.
State Sen. Gary Farmer, D-Hollywood, whose district includes the nursing home where the nine residents died, said the documents raise doubts about the efficiency of the state's system of protecting elder-care centers in an emergency.
"It's a very accommodating thing to do to give your personal cell phone number to people in an emergency, but this is the head of the executive department of our state," he said. "It seems to me to be undermining the system you have in place when you give out this number."
Farmer filed legislation on Wednesday revising many of the provisions in the state's nursing home law, including strengthening the state enforcement of federal standards meant to keep seniors safe, comfortable and cool in an emergency.
He said the conflicting timelines, and continued finger-pointing, show "there are gaping holes in the system." Bongart, the east Manatee assisted living facility operator whose call to the governor didn't get her help, is upset that the governor has issued an emergency rule requiring all assisted living facilities and nursing homes, no matter their size, be equipped with generators by Nov. 15 or face $1,000-a-day fines. She said she supports the mandate but the timeline is "out of alignment and not fair."
"I don't think you'll find many of us calling the governor's hotline again," she said.
