Irma nursing home tragedy: How could this happen?




Several days after Hurricane Irma wreaked havoc across Florida, nine residents from one of its nursing homes died.

The deaths were not caused by flooding, high winds or a building collapse, but by room temperatures that went from hot to oppressive and finally to fatal after a transformer powering their cooling system failed. The first question that came to my mind was, “How could this have happened?”

The tragic events at the nursing home

The tragedy came to light following multiple calls to fire rescue crews from The Rehabilitation Center at Hollywood Hills during the early morning hours of Sept. 13. The first, at about 3 a.m., involved a patient in cardiac arrest. The second emergency call an hour later prompted fire officials to call the State Department of Children and Families to report their concern.

At about 5 a.m., a third call came in. At that point, the hospital staff at Memorial Regional Hospital across the street had decided to check the facility themselves, and as one report described it, “What they found was an oven.”

The facility was evacuated immediately. Rescue units moved residents out while hospital workers established a command center and triaged patients. They checked the facility room by room, discovering three patients already deceased and nearly 40 others with breathing issues. Most were treated for dehydration, respiratory distress and heat-related problems. Some patients had temperatures of almost 106 degrees, and four expired soon after arriving at a hospital.

Authorities learned later that another patient had died at the center that morning and was moved directly to a funeral home and not counted initially.

To date, nine patients ranging in age from 71 to 99, have died, including 93-year-old Carlos Canal, who passed away Sept. 19. The medical examiner is investigating their deaths; a criminal homicide investigation is under way; new admission processing has been halted; and the nursing home is temporarily closed.

Nursing home situation leaves many questions, few answers

Calling the situation “unfathomable,” Gov. Rick Scott vowed to “aggressively demand answers,” and hold accountable anyone not acting in patients’ best interests. Sen. Bill Nelson called it, “an emerging scandal of gargantuan proportions,” saying it was “inexcusable” that no one called 911 as residents sweltered in their rooms.

The Florida Department of Health said that “at no time” did the nursing home “report that conditions had become dangerous or that the health and safety of their patients was at risk,” according to reports.

These tragic deaths raise many disturbing questions for family members, healthcare consumers, concerned citizens and nurses. As cries for answers from bereaved families and the public began, Florida state officials, utility company executives and nursing home administrators started pointing fingers and playing the blame game.

The center’s administration said they prepared “diligently” for the hurricane, and after the storm staff worked to get needed government help, but to little avail. They reported calling the utility company when warm air began coming through vents, but the promised equipment was never received. Portable fans were purchased for each patient room; patients were dressed in as little clothing as possible and moved to hallways near cooling units. Staff used ice to cool them; provided cold drinks; and checked temperatures every shift. But was it was enough?

As nurses, we want to know what policies were in place regarding patient checks. Were extra emergency steps taken to ensure safety during and after the hurricane? How were staffing numbers and mix; were they increased based on changing patient conditions? How aggressively was outside assistance sought? Were follow-up calls to officials timely? Were extra physicians, supervisors and administrators called in? When room temperatures began to become unbearable, were rescue plans made? and why wasn’t 911 called to evacuate patients?

With a hospital so close by could patients have been moved there sooner? Was the facility generator in good working condition pre-storm, and did the portable generators used post-storm emit noxious fumes causing the medical examiner to delay determining final causes of death?

After asking these valid questions, how can nurses take action?

1. Nurse leaders can meet with their teams to review disaster plans, looking at what happened in this tragedy to determine how they might better prepare themselves to safeguard their patients. Meetings could include open discussion and assessment of the completeness of disaster preparedness plans; consideration of possible scenarios not included; and creation of back-up plans.

2. Staff nurses can educate themselves on the quality of oversight and review of nursing homes by state and federal agencies, and what needed changes they may see.

3. Nurses also should expect questions from patients’ families and be prepared to share information regarding their disaster plans and any corrective actions they’ve put in place so a situation like this one never arises in their facility.

There have been no official accusations of any deliberate act causing the tragedy. Whether conditions that resulted in the deaths were unwittingly allowed to continue is a separate question that investigators, lawyers and judges will be answering. But nurses can use this tragic event to look at any possible ethical issues that could have contributed to things ending the way they did, looking honestly at their own and their colleagues’ ability to report any unethical behaviors or practices they’re aware of without fear of reprisal, retribution or even ostracism.

Let’s ensure it never happens again

The governor announced new rules requiring nursing facilities to have generators and fuel that can “maintain comfortable temperatures” for at least four days after a power failure. Facilities have 60 days to comply. He also instructed the state’s Agency for Health Care Administration and the Florida Department of Children and Families to work with law enforcement officials to determine whether staff did enough.

Safety check systems have been stepped up. Firefighters have helped relocate many elderly residents from centers without power. Facilities statewide have devised new patient cooling methods, and are working with utility companies to restore power much faster.

Heartbreaking tragedies, particularly ones involving the frail elderly, whose children worry about their vulnerability and helplessness in emergency situations, can spur us to action — take stock of our readiness and make needed changes. And in the wake of these storms, there’s a lot to learn.
 


Courses Related to ‘Care of Seniors’

60081: Protecting Seniors in Disasters
 (1 contact hr)

Major disasters affect everyone, but the senior population is particularly vulnerable to their devastating effects. Of the about 1,200 people who died in Hurricane Katrina in 2005, 74% were older than age 60, and 50% of those were older than age 75. Those who survived experienced stressful and sometimes inappropriate displacement and often a significant decline in health and functioning. Similar disproportionate deaths among seniors have been documented in other natural disasters. This module will inform nurses about how they can help protect the health and lives of older Americans when they are faced with disaster.

60050: Stopping Abuse and Neglect in Nursing Homes
 (1 contact hr)

By 2060, 98 million Americans will be age 65 or older. The future increase in the aging population suggests that more elderly and disabled people will stay in a nursing home at some point in their lives, making it all the more important for nursing homes to be safe places for residents. Congressional investigators found that one in three U.S. nursing homes was cited for an abuse violation, and abuse in 256 nursing homes across the country was so serious that it put elderly lives in jeopardy or actually resulted in death. Factors contributing to abuse and ways to identify, respond to and prevent abuse are discussed.

60080: Clearing Up the Confusion About Delirium
 (1 contact hr)

Delirium is a medical condition manifested as a disturbance in consciousness and cognition that occurs for a short time. Delirium occurs in around 50% of hospitalized patients 65 years or older and costs more than $164 billion per year in hospital and medical costs. An estimated 30% to 40% of delirium cases among hospitalized patients are preventable. Among community-dwelling elderly and those in long-term care, cases of delirium may accompany a number of medical conditions. The risk rises with age and accompanying dementia. Primary care providers should be aware of a relatively high risk of delirium among patients in long-term care, those over the age of 85 and those with dementia. Among older hospitalized patients, delirium is a common complication adding to length of stay and increasing cost of care. As in many other healthcare situations, nurses are frontline observers who can recognize beginning signs of delirium and initiate care.


About the author
Eileen Williamson, MSN, RN

Eileen Williamson, MSN, RN 

Eileen Williamson, MSN, RN, is a former senior vice president and CNE at OnCourse Learning, where she led nursing programs and initiatives. She continues to write and act as a consultant for Nurse.com. Before joining the company in 1998, Eileen was employed by North Shore-Long Island Jewish Health System in New York, where she held a number of leadership positions in nursing and hospital administration, including chief nurse at two of the system’s member hospitals. She holds a BSN and an MSN in administration, and is a graduate fellow of the Johnson & Johnson University of Pennsylvania Wharton School Nurse Executives program. She also is a board member and past president of the New Jersey League for Nursing, a constituent league of the National League for Nursing.

11 responses to “Irma nursing home tragedy: How could this happen?”

  1. Nursing homes are essentially society’s polite dog pounds to dispose of our elders where you check in and don’t check out.

  2. It may not be proper to comment on this matter, since it is still under investigation. But one thing is certain, there will be enough blame to go round everybody.

  3. There isn’t any excuse for this tragedy! Anyone even an aide could have and should have advocated for these residents ! I can’t believe anyone with a brain and a heart think it was ok to leave these residents in hot temperatures ! There is no excuse and they should all be held accountable !

  4. A tragedy. Unfathomable that facility supporting generators were not already in place. The new law/ guidelines with a 60 day compliance window will be helpful. Compliance or closure should be a positive outcome. You cannot provide what you do not have. Having a hospital across the street is equally disconcerting. However they did take unsolicited action after the 3rd incident. We must all remember the conditions, staffing or lack there of, supervision, education level of staff present. Very very sad. The elderly are so vulnerable to changes of any kind. Every state, regardless of location should review current policies and make changes and upgrades to prevent such terrible outcomes. There should be a universal mandate /standard of care for facilities, regarding temperature control and apparently some common sense training. Get help! Let’s hope this doesn’t end up being about money. . M

  5. I’ve found that in my 17 years of working primarily in long-term care and subacute care,
    longterm care facilities don’t keep up or require a lot from the nursing staff in regards to clinical competence. When it comes to the clinical education competence,
    it is not a high priority. It’s about surviving the shift while always working with a
    Short staff. As a nurse, you easily get burned out and become number and dull to emergent clinical situations. It would be unfair to blame tragedies on the staff, but how about investigating these facilities when there’s no disasters.

    Look deeper into the owners, administrators,management and staff. Look at the hearts of the owners. Look deeper. Look at the unrealistic daily expectations of the nursing staff. Look at the educational in servicing of the nursing staff versus a hospital
    in servicing.

  6. I am a healthcare facility risk manager and we face much politics on taking initiatives to ensure safety and compliance. My last employer (in Florida btw) indicated to me on one issue “he” would be the one to determine what risks to take and which ones to act on. This happens frequently and many times the instances go unnoticed but lives are put at risk nonetheless.

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