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Report: Chaos, Rising Temps At Nursing Home Where 12 Died

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A Florida nursing home descended into chaos as its temperatures rose after Hurricane Irma knocked out its air conditioning in 2017, leading to the deaths of 12 people and the arrest this week of an administrator and three nurses on manslaughter charges, according to a report cited by police. 

Hollywood Police Chief Chris O'Brien told news reporters Tuesday he expects further arrests from the investigation that included 500 interviews, the collection of more than 1,000 pieces of evidence and the seizure of 55 computers.

"The families sitting here today should not have lost their loved ones this way. They placed their faith and trust in the facility ... and that trust was betrayed. They have been living an absolute nightmare," O'Brien said as several family members watched nearby. They declined to speak to the media.

Police did not immediately release documents outlining their evidence against the home's administrator, Jorge Carballo, lead nurse Sergo Colin and nurses Althia Meggie and Tamika Miller. Instead, police pointed to a 111-page state report , saying much of the evidence it describes came from their investigation.

Carballo and Colin face 12 counts of aggravated manslaughter, Miller faces six counts and Meggie two. Meggie and Miler are also charged with evidence tampering. Colin remained jailed late Tuesday pending bail, while Carballo and Meggie had been released, according to jail records. Miller was being held in Miami-Dade County pending her transfer to Broward County.

The report says in the days before Irma, Carballo and his staff made appropriate preparations. They purchased extra food and water for the two-story, 150-patient facility, rented portable air conditioners and acquired seven days' fuel for the generator.

Administrators also participated in statewide conference calls with regulators, including one where then-Gov. Rick Scott said nursing homes should call his cellphone for help.

When Irma hit Broward County on Sept. 10, 2017, it knocked out the transformer powering the home's central air conditioning. Otherwise, the building never lost power .

The air conditioner wasn't attached to the generator, however. Carballo and his building manager immediately contacted Florida Power & Light, reporting they had an emergency but the repair was simple.

When that didn't work, Carballo and other administrators called Scott and state and county officials. They set up spot coolers and fans and called FPL repeatedly. They even tried to stop an FPL truck that passed, the report says.

"Nobody came," said attorney David Frankel, who represents Colin. "For three days, these people did everything possible they could to keep everyone stable. And they were stable."

By Sept. 12, serious problems arose. The first floor's temporary air conditioners vented into the ceiling, meaning its heat went to the second floor. That's where 11 of the 12 victims lived.

In an internet chatroom managers used to communicate, the director of housekeeping wrote, "the patients don't look good." The report says Carballo never responded, but did order the installation of large fans

At 1 p.m., Hollywood paramedics made the first of several visits over the next 16 hours: a 93-year-old man had breathing problems. A paramedic asked about the high temperatures — staff said they were getting the air conditioner repaired. Paramedics took the man to Memorial Regional Hospital across the street, where doctors measured his temperature at 106 degrees (41.1 Celsius). He died five days later.

Carballo told investigators that when he left at 11 p.m. the temperature inside the home was safe. The report found that "not credible."

At 3 a.m. Sept. 13, paramedics returned to treat an elderly woman in cardiac arrest, with one telling investigators the home's temperature was "ungodly hot." The woman's temperature was 107 (41.7 Celsius) and so was another person's. The paramedics were called into a room where Colin, the lead nurse, was performing CPR on a dead man.

Paramedics told investigators the man had rigor mortis, meaning he had been dead for hours, undercutting the staff's contention they monitored patients closely. The report says security video shows no one visited the man for seven hours.

Paramedics said Colin tried to stop them from checking other patients, saying everything was OK. Lt. Amy Parrinello said she replied, "you told me that before and now we have multiple deceased patients so with all due respect, I don't trust your judgment."

At 6 a.m., fire Capt. Andrew Holtfreter arrived and was summoned to another dead body. A paramedic began treating a patient whose temperature was so high it couldn't be measured -- the department's thermometers max out at 108 degrees (42.2 Celsius).

Alarmed by the patients arriving at its emergency room, Memorial Hospital staff went across the street. One nurse said the home felt like "the blast of heat" inside a car that's been sitting in the sun all day.

The fire department ordered the home evacuated.

Soon, Hollywood homicide detectives arrived -- about the time FPL came to fix the air conditioner.