The night before Hurricane Irma began roaring over Florida, staffers at the Rehabilitation Center at Hollywood Hills locked the doors, shuttered the windows and turned the temperature down to about 67 degrees - a buffer, administrators thought, to keep the building cool in case the power went out.
It wouldn’t last long. About 3 p.m. on Sunday, the lights flickered, nursing-home executives say. The power stayed on, but a janitor soon noticed a problem: The massive chiller used to serve the 152-bed facility was spewing warm, muggy air.
The following evening, Natasha Anderson, one of the executives, called a private phone number for Gov. Rick Scott, R, seeking urgent help, Anderson said. It was the first of three such calls, she said.
“Repeatedly, I was told that our case was being escalated to the highest level,” Anderson said.
Yet, she said, no one came — and nursing-home officials did not consider the crisis urgent enough to bring patients to the hospital across the road.
The governor’s communications director, John Tupps, did not respond to questions about whether Hollywood Hills had called Scott but said all calls from nursing homes were “referred to the Agency for Health Care Administration and the Florida Department of Health and quickly returned.”
By noon Wednesday, eight residents were dead. Their deaths are being investigated as criminal homicides, and the nursing home has been closed.
SLIDESHOWS: IRMA'S AFTERMATH
The account the nursing-home executives provided to The Washington Post offers new details of the deteriorating conditions inside the facility. But it also is contradicted by law enforcement and state officials on key points, including how aggressively the nursing home had sought assistance and precisely when staffers called 911 as a patient went into cardiac arrest.
Attempts to assign blame abound.
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.”
“It’s shocking that these trained medical professionals put patients’ lives in needless jeopardy. The fact is that this facility never called 911,” said Mara Gambineri, a spokeswoman for the department. “The Rehabilitation Center at Hollywood Hills is responsible for the health and safety of their patients.”
The tragedy at Hollywood Hills showed that for billions of dollars and countless hours spent preparing for Florida’s next inevitable hurricane, the lifeline for one of the nation’s largest concentrations of the elderly and disabled remained tenuous in the aftermath of Irma.
The survival of residents at the home rested not just on the state’s vaunted $3 billion “smart grid,” intended to limit power outages and target repair efforts, or on lists of critical infrastructure where restoring power is a top priority. Survival also depended on phone tag between nursing-home administrators, state officials and utility providers.
Several executives of a limited liability corporation that controls the nursing home declined to comment, including the principal owner, Florida resident Jack Michel.
But the nursing home made Anderson available for an hour-long interview, as well as a company official who spoke on the condition of anonymity under ground rules set by Hollywood Hills. The officials provided an internal timeline of attempts to reach state officials and its utility provider.
“Nurses, doctors, administrators, staff — everyone was doing everything that they could,” Anderson said. “We were waiting and waiting for help that never came.”
The nursing home and an adjoining psychiatric facility are connected to the power grid by two lines, the officials said. One provides electricity to most of the facility, including lights, oxygen machines, ventilators and the kitchen. The other supplies a central air-conditioning system.
When the warm air began pouring out of vents Sunday, executives contacted Florida Power and Light within 45 minutes, saying the line approaching the facility from the north appeared to have been down, according to their timeline. Anderson said the nursing home heard from the utility Monday that it would be coming that day.
It never did, she said.
The nursing home provided ticket numbers for service requests that it had placed with FP&L beginning Sunday. The Post was able to confirm two of the requests using state records and the utility’s website.
The power company Friday expressed “our deepest sympathies” but said in a statement that “we are limited in what we can say” due to the ongoing investigations. The company did not answer questions regarding the calls the nursing home said were made.
Hollywood Hills had in the days before the storm obtained eight “spot chillers” that could be run using a generator. Each had two “armlike” funnels that direct cool air. An exhaust vent from each machine releasing warmer air was routed upward, to the drop ceiling on each floor.
With the power otherwise still on at the nursing home, they were plugged into wall outlets. Staffers on Monday also went searching for portable fans and spent $900 to put one in each resident’s room.
After 5:30 p.m., more than 24 hours after the air conditioning stopped working and with forecasts for higher temperatures in the days ahead, Anderson said she first called the governor’s cellphone and left a message: “162 patients, elderly, some on oxygen. We need the air conditioning restored.”
Between then and 10 p.m. on Monday, Anderson said she received two return calls from state officials saying they were working on the request.
On Tuesday, there was still no sign of an electric crew. Anderson said she continued making calls at about 10 a.m., as did staffers and family members of patients who by that time were beginning to worry.
Ellie Pina, daughter of Mirelle Pina, a 96-year-old resident at the facility, said she and others repeatedly called FP&L and were ignored. Pina said that by Tuesday at noon it was extremely hot.
“It was like 110 degrees in there, it was unbearable. Not even the fans were helping them,” she said. “The heat was amazing.”
“I told Florida Power and Light the generators were going to give up soon. And it happened. I told my husband people were going to die in there. And it happened,” she said, reciting her ticket number for service.
Pina said the staff had put patients, clothed in as little as possible, in the hallways close to the cooling units.
The company official who spoke on the condition of anonymity said that each of the chillers had a thermometer and that the readings upstairs showed temperatures in the low 80s - “82 or 83, it was holding steady,” the official said.
Patients’ temperatures were checked on each eight-hour shift, and for the last time Tuesday evening by a physician’s assistant who made rounds. None of the people who gave accounts of the situation were present after 11 p.m. Tuesday night.
According to the timeline provided by the nursing home, the first 911 call was placed at about 1:30 a.m. to report a patient in cardiac distress.
In an email Friday, officials with the city of Hollywood and its police department said the first 911 call came later, at 3:01 a.m.
By 4:45 a.m., according to the timeline provided by the nursing home, five patients had been in cardiac arrest or respiratory distress and were treated by paramedics.
Randy Katz, chairman of the department of medicine at Memorial Regional Hospital, across the street, said that around 6 a.m. one of the senior nurses walked over to Hollywood Hills. She made a call: These patients needed to be evacuated, immediately, he said.
Patients looked to be in distress. The second floor was extremely hot.
“There’s no reason patients that age with chronic medical issues should be in a facility without air conditioning,” Katz said.
The hospital activated what is called a mass-casualty event. Hospital staffers rushed to Hollywood Hills, looking for patients and getting them out as soon as possible.
“Our staff literally went room to room and evacuated the building,” he said.
The sickest patients were rolled to the emergency room across the street on stretchers, with some being treated for dehydration, respiratory issues including respiratory failure, heat exhaustion or infection and high fevers.
“The temperatures during the day outside are in the mid-90s. I’m going to guess you can probably add another 10 degrees to that,” Katz said of the temperature inside.
In a news conference later in the day, Scott called the situation “unfathomable” and vowed that the state would hold accountable anyone not acting in the best interests of their patients.
As nursing-home executives began arriving at the building later Wednesday morning, they were instructed to stay behind a police line, saying the facility was a crime scene.
By 2 p.m., Anderson said, with detectives the only ones remaining, the air conditioning was turned back on.