The emergency room workers at Memorial Regional Hospital rushed the first patient to Room 9, which was devoted to the hope and practice of arresting death. They threaded fluid lines into her veins and readied a breathing tube. Even through gloves, they could feel the heat corseting the 84-year-old woman’s body.
As they prepared to insert a catheter, they saw what looked like steam rising from her legs.
The numbers on the catheter’s temperature gauge would not stop climbing. The nurses, respiratory technicians and other medical staff watched it halt at last at 41.9 degrees Celsius — 107 degrees Fahrenheit.
It was only the fourth-highest body temperature Memorial would record that morning among elderly patients being evacuated from the nursing home nearby, the Rehabilitation Center at Hollywood Hills, where air-conditioning had failed after Hurricane Irma chewed up power lines across the state.
Eight residents of the nursing home were dead by the end of that day, Sept. 13, and three who were among the 140 evacuated have died since. The Hollywood police have opened a criminal investigation, while the state has all but shut down the residence.
That same day, about 160 other nursing homes across Florida had no electricity, and most of those, like Hollywood Hills, had no generator capable of powering air-conditioning. But of all those places, the only one where a power loss is known to have caused multiple deaths was the home that advertised being “directly across the street from Hollywood’s Memorial Regional Hospital — so patients receive the finest health care day and night.”
Interviews with nursing home representatives, hospital personnel, residents’ families and government officials, as well as a review of emergency response records, show a preventable descent into the suffocating chaos of that early morning.
The nursing home’s state-approved emergency plan was confounded by a foreseeable electrical failure. The home said its repeated requests for help from state and county officials, and to the power company, yielded no results.
Gov. Rick Scott and other state and local officials say they never had any indication from Hollywood Hills that residents were in distress, though records show that a facility that shared the building reported that the conditions were “adversely affecting patients.” In any event, the officials and the power company said, it was the nursing home’s responsibility to ensure its residents’ safety. The local medical examiner’s office is still investigating the cause and manner of the deaths.
As Irma threatened and then passed, nursing home workers reassured families that their loved ones would be safe. But fans and portable coolers were not enough for some residents, with one so overcome by the heat that she lay nearly naked on a bed in the second-floor hallway. When firefighters were finally summoned to rush people out, they said the conditions reminded them of battling a fire.
Somewhere in between, the misery of a nursing home teetering toward tragedy was reported to every official channel, but no attempt was made to transfer the residents to a safer place, or even to the air-conditioned hospital practically next door.
“I’d had the deepest fear all along of my mother being in a situation, a helpless situation,” said Vendetta Craig, whose 87-year-old mother was evacuated from the home and survived. “This is the nightmare that has come to fruition.”
Plans Set, Hotlines Ready
It was never supposed to come to that.
Before the hurricane bellowed ashore, Mr. Scott, the governor, held news conference after news conference imploring Floridians to flee while they still could. To elder-care facilities after the storm, he was even more solicitous: He gave them what he said was his personal cellphone number to call for help. There were also state and county emergency hotlines to turn to.
Hollywood Hills was not in an area that the Broward County had ordered evacuated. Its emergency management plan called for moving residents to a nearby cluster of senior residences, the Marrinson Group, if the need arose.
As it happened, Marrinson residences ended up without power, too.
More than 164 assisted living facilities and 29 nursing homes did evacuate after the storm, according to the Florida health department.
Very few nursing homes had generators powerful enough to keep the air-conditioning running. In 2006, Florida lawmakers considered requiring nursing homes to maintain generators to ensure comfortable temperatures during disasters. But the industry raised concerns about the cost, according to The Miami Herald, and the bill died. Last week, after the Hollywood Hills deaths, Mr. Scott announced new rules requiring those generators.
Among the nursing homes of South Florida, Hollywood Hills was not highly regarded. The 152-bed residence had a “below average” rating from Medicare, with two out of five stars. Its most recent health inspection, from March, described residents who were not bathed or groomed properly, food that went uncovered in a soiled kitchen, and flaws in the in-room patient call system.
Its owners, who acquired Hollywood Hills in 2015, were among defendants who paid $15.4 million in 2006 to settle federal and state civil claims that they had paid kickbacks to doctors in exchange for patient admissions.
But the home was right next to the hospital and offered round-the-clock nursing care, two important factors for families choosing a home.
Among those who died were Miguel Franco, 92, who visited his wife every day at the home until he joined her there; Gail Nova, 71, who worked as an X-ray technician until her own health failed; and Betty Hibbard, 84, who, after decades working in real estate, would die in the Memorial emergency room with a 107-degree fever, and with no family to mourn her.
Several family members said in interviews that until Irma, they had seen no major problems with their relatives’ care, praising the staff as dedicated and hardworking.
When Ms. Craig dropped by three days before the hurricane made landfall to visit her mother, Edna Jefferson, employees at the home told Ms. Craig that the home had a generator and plenty of extra food, diapers and other supplies. (After the storm, Hollywood Hills said, it stationed eight spot coolers and more than 20 fans around the home.)
One worker told Ms. Craig, “You don’t have anything to worry about, we’re all set.”
But the preparations were taking a toll.
Ms. Craig said she passed about 30 nursing assistants who had gathered to hear when they were expected to come in over the following days. As the meeting broke up, Ms. Craig said, she overheard some of them grumbling about the schedule, saying: “How can do they do this to us?” and “We have families, too.”
A few minutes later, Ms. Craig heard the woman who had been conducting the meeting tell another nursing assistant, “You have to come in.”
If she refused, the woman said, she would make sure the assistant never worked in the field again.
Irma’s winds and rain collided with South Florida on Sunday morning. At 3 p.m., according to the nursing home, the main power supply at Hollywood Hills flickered, but only for a moment. The transformer that powered the air-conditioning system, however, was dead.
The risk to older and debilitated adults in the aftermath of hurricanes, especially in summer weather, should have been obvious.
As people grow older, bodily systems that fight heat break down. People with common conditions such as heart trouble and diabetes are more susceptible to heat stroke, and those with dementia may not have the wherewithal to remove sweaters or blankets or to drink more to avoid dehydration. Drugs often used in nursing homes can also inhibit sweating, the body’s main defense. Officials said Hollywood Hills had been advised to call 911 if anyone was in trouble. The home said it did call 911. But doing so when someone is in extremis may already be too late.
“You prevent heat stroke by preventing people from getting so hot that they suffer from it,” said Dr. Paul Auerbach, a professor of emergency medicine at Stanford University. “The prevention is essential.”
Dr. George Kuchel, a geriatric medicine specialist and the director of the UConn Center on Aging, said bodily temperatures can spike rapidly. “We see it often,” he said. “They’re able to compensate until a certain point but then are overwhelmed.”
Many Calls but Little Action
The Monday after the hurricane, the power company said it would repair the transformer that morning, according to a timeline provided by the nursing home. Then it promised to send someone in the afternoon.
More phone calls went out to state health and emergency management officials, and even to the governor’s cellphone. A psychiatric hospital in the same building, Larkin Community Hospital Behavioral Health Services, which shared an owner with Hollywood Hills, also called to ask for help.
“Our A.C. is down and we do have chillers, but they’re not cooling the building enough,” an executive of that facility, Natasha Anderson, said in a call to the state’s emergency information hotline at 5:37 p.m. on Monday, according to a transcript of the call released by the governor’s office. “It’s like 80 degrees in the building right now with elderly and psychiatric patients.”
When Eva Moulder, 64, checked on her 93-year-old mother, Bertha Aguiar, who lived at the home and has Alzheimer’s, she noticed portable air-conditioners in the hallway. Her mother’s small room on the first floor was a little warm. She opened a window to let in a breeze.
But the temperature seemed normal, she said.
All around South Florida, however, concern about seniors was rising. On Tuesday morning, caller after caller reported that nursing homes and retirement communities where thousands of seniors lived had no power. Century Village had none. Neither did Wynmoor Village.
Sometime that day, according to records released by the governor’s office, a note was added to Broward County’s emergency management system: The building that housed Larkin and Hollywood Hills “is running on generator power w/o air conditioning.”
The conditions were “adversely affecting patients,” the note said.
The power company had been alerted, the note said, and a representative from the state agency that oversees elder-care facilities was “aware.”
Voice mail messages left on Mr. Scott’s cellphone were transcribed by staff members into emails that were forwarded to other state officials. But the problems remained unsolved.
In Broward County, the mayor, Barbara Sharief, said in an interview that Hollywood Hills never told the county there was an emergency. Accordingly, she said, when she met with power company executives that afternoon, she did not single out the residence when she urged them to move all nursing homes and senior communities to the “critical” category for restoring power.
The power company told her that prioritizing all such buildings was impossible, she said. There were just too many.
In a statement, Florida Power & Light officials said they could not say much because of the investigation, but they echoed comments made by state and county officials that customers should call 911 in a life-threatening situation.
Inside the building, the heat was closing in.
Adriana Giraldo came to visit her 89-year-old parents, Libia and Gabriel Giraldo, at 8 that evening. Upstairs, where residents with dementia and others who could not take care of themselves lived, nothing was normal.
Rolled out of their usual rooms into the hallway, some people lay in their beds in front of a large, ineffectual fan. They normally wore pajama-like clothing; now they had only light hospital gowns on. A video Ms. Giraldo shot on her cellphone showed Ms. Hibbard crumpled in motionless misery. She was naked except for a diaper.
Ms. Giraldo found her parents, who ultimately survived the ordeal, in bed in their small beige room, wearing socks and blankets, which she hurried to relieve them of. The window was cracked open, with the floral drapes pulled up to keep the slit clear. (The nursing home did not explain why the windows were not more open, but some homes restrict openings for residents’ safety.) A small fan was running. Someone brought water when she asked, but there was no ice.
One resident, a 93-year-old man, was taken to the hospital with a fever sometime that day. But no alarms went off.
That evening, the home’s administrator, Jorge Carballo, checked on every resident, one of whom is his father-in-law, according to Hollywood Hills. Doctors and a physician assistant had made the rounds earlier that day. No one seemed to be in distress, the home said.
“Hollywood Hills was staffed well above state requirements, and residents were monitored by both caregivers and nonclinical individuals,” the home’s lawyers, Kirsten Ullman and Julie Allison, said in a statement. “There was no indication at this time that a global emergency existed based on overall conditions at Hollywood Hills.”
One Death After Another
The calls for rescue, when they finally came, kept coming in gasps all that long and airless night.
Ms. Hibbard, the first person to make it to the emergency room that Wednesday morning, with a diagnosis of heat stroke, was removed from life support and died.
Just minutes after hospital workers had cleaned Room 9 and restocked it with supplies, another patient arrived: Carolyn Eatherly, 78, who, like Ms. Hibbard, had no family.
Her heart had stopped. Her forehead was purple. At 4:33 a.m., about half an hour before she was pronounced dead, she had a temperature of 108.3.
By then, other residents were going into cardiac arrest. At 6 a.m., Hollywood Hills’s director of nursing told the staff to move everyone from the hotter second floor to the cooler first floor, according to a court filing by the nursing home contesting the state’s move to shut it down.
The emergency responders who had seen the residents and felt the heat for themselves decided that everyone had to get out.
“We had no idea the extent of what was going on until we literally sent people room to room to check on people,” said Dr. Randy Katz, the hospital’s chairman of emergency medicine.
Many of the families heard something was wrong for the first time that morning when they turned on their televisions.
A friend called Ms. Craig. I don’t want to scare you, she told Ms. Craig, but turn on CNN.
Ms. Craig was thinking, “What did I do?” she said in an interview, breaking off to sob. She blamed herself for putting her mother in the home. She prayed: “Oh God, please don’t let my mother be dead.”
“I just imagined her wanting me there with her,” she said, “looking at the door, wondering when I was going to get her out of the heat.”
When she found her mother in the hospital just before noon, she had a fever of 102 degrees, an IV in each arm and a catheter. Her hair was matted; a whitish crust, like dried milk, glazed her hairline, her neck and the skin around her ears. She whimpered, and jumped at Ms. Craig’s touch.
“She was not the lady that I left on Thursday,” Ms. Craig said. “I trusted them. I trusted them, and they failed my mother.”
That morning — three days after Irma, a few hours after Ms. Hibbard died and soon after everyone else was evacuated — someone from the power company arrived at Hollywood Hills to fix the transformer. It took 15 minutes to get the air conditioning back on.
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