Escalating a legal and regulatory fight, Gov. Rick Scott's administration Wednesday issued an emergency suspension of the license of a Broward County nursing home after the deaths of nine residents following Hurricane Irma.
The license suspension was another step after the state Agency for Health Care Administration last week placed a moratorium on admissions to The Rehabilitation Center at Hollywood Hills and suspended the facility from the Medicaid program. The nursing home late Tuesday filed a lawsuit challenging the admissions moratorium and the Medicaid cutoff.
Eight of the residents died Sept. 13, three days after Hurricane Irma shut down the nursing home's air-conditioning system. The license suspension alleged that four of the residents had body temperatures of at least 107 degrees when they arrived at a nearby hospital or when they died.
“Respondent (the nursing home) failed to maintain safe conditions in its facility; failed to timely evacuate its facility once conditions were no longer safe for residents; and failed to timely contact `911' during a medical emergency,” said the emergency suspension order, signed by Agency for Health Care Administration Secretary Justin Senior.
But Kirsten K. Ullman, co-counsel for the nursing home, released a statement Wednesday night that said caregivers "continuously monitored their residents, offered them hydration, and implemented efforts to keep the facility temperatures as comfortable as possible." The statement, in part, also took issue with the assertions that residents suffered from body temperatures of 107 degrees or more.
"During the evacuation, residents were placed outside," Ullman said. "It is not known specifically for how long, nor is it known when the AHCA cited temperatures were taken, where they were taken, by whom they were taken, or to which residents they are attributed to. However, before the evacuation, only two of the residents who passed away had elevated temperatures, neither of which were in the critical range."
The Scott administration and the nursing home have been locked in a debate for the past week about whether the facility acted properly after Hurricane Irma knocked out a transformer for the air-conditioning system. While eight residents died Sept. 13, the Hollywood Police Department said late Tuesday that a ninth resident, 93-year-old Carlos Canal, also had died. Other residents were evacuated from the 152-bed home Sept. 13.
While Wednesday's emergency license suspension would prevent the nursing home from operating, the facility argued in the lawsuit filed Tuesday in Leon County circuit court that the admissions moratorium and the suspension from the Medicaid program would have the same effect.
The lawsuit seeks injunctions against the admissions moratorium and Medicaid suspension. Attorneys for The Rehabilitation Center at Hollywood Hills argue, in part, that the facility followed emergency-preparedness plans in the way it handled the air-conditioning outage. Also, the lawsuit alleges that the Scott administration violated the facility's due-process rights by issuing the immediate admissions moratorium and Medicaid suspension.
The nursing home used fans and devices known as “spot coolers” while the air-conditioning system was out.
“With the stroke of a pen, AHCA (the Agency for Health Care Administration) has effectively shut down Hollywood Hills as a nursing home provider in Broward County,” the lawsuit said. “These illegal and improper administrative orders took effect immediately and without any opportunity for the facility to defend itself against unfounded allegations.”
In issuing the orders last week, AHCA alleged that the facility presented a threat to public health, safety or welfare, with one of the orders saying that “deficient practices exist presently and will more likely than not continue to exist if the agency does not act promptly.”
Senior said in a prepared statement Wednesday that the emergency license suspension was justified by the preliminary results of an investigation.
“As more information has come to light on this egregious situation, this facility absolutely cannot continue to have access to patients,” Senior said. “This facility failed its residents multiple times throughout this horrifying ordeal.”
The deaths of the nursing-home residents have drawn national attention and a criminal investigation. The Scott administration and the nursing home also have release timelines of the events leading up to the deaths, as the two sides try to bolster their arguments.
While the Scott administration and the nursing home reach different conclusions about whether the facility handled the situation properly, both timelines reflect a series of phone calls and messages between representatives of the nursing home and the state on Sept. 11 and Sept. 12.
In the license suspension Wednesday, the Agency for Health Care Administration contended that the nursing home “knew or should have known the danger presented to residents in its physical plant, yet failed to monitor, care for, and protect its residents.” It also pointed to the proximity of nearby Memorial Regional Hospital.
“Respondent's sole identified response was to belatedly call `911' on an individual basis as its residents suffered, one after another, cardiac or respiratory arrest,” the license suspension said. “In addition, respondent was and is located across the street from a large, air-conditioned public hospital. This hospital was fully functional during the relevant period, yet respondent failed to transfer its residents to that large, air-conditioned public hospital, or any other appropriate placement, in a timely fashion.”
But in the lawsuit filed Tuesday, the nursing home pushed back against arguments that it should have moved residents to the hospital.
“As to evacuation of residents to a nearby hospital in the event of the loss of AC power, there is no requirement in any rule, regulation or policy and in fact such evacuation of nursing home residents would be contrary to the approved Hollywood Hills hurricane preparedness plan, and contrary to the general requirement that hospitals be available in a reserve capacity in a natural disaster for those patients who have acute and critical care medical needs,” the lawsuit said.