The Louisiana Department of Health removed nearly 850 nursing home residents from this warehouse (pictured above) after nursing home owner Bob Dean transferred people there during Hurricane Ida. (Photo by Wes Muller/Louisiana Illuminator)
Louisiana state government does little to screen the nursing home natural disaster evacuation plans required by law or to ensure that nursing homes carry out those plans as written, according to several state government officials and records released by the Louisiana Department of Health this month.
The health department reviews the nursing home evacuation plans, but the agency isn’t in charge of “approving” the plans or testing their feasibility, officials said, and they have been reluctant to explain what the health department’s review of the plans entails.
A lack of nursing home oversight may have contributed to the horrific scene of a nursing home evacuation to a warehouse in Independence after Hurricane Ida. Nursing home owner Bob Dean moved nearly 850 residents from seven of his facilities into a former pesticide warehouse he owns ahead of the storm in late August.
Those residents ended up in squalid conditions — without regular bathing, clothes and adequate food. Hundreds eventually had to be rescued. Fifteen have died since the evacuation first took place a month ago. In response, Louisiana health officials have revoked Dean’s seven nursing home licenses — an action Dean is expected to fight.
But when asked repeatedly by legislators to explain the health department’s role in vetting nursing home evacuation plans last week, the agency’s executive counsel Stephen Russo cited a law or regulation — instead of answering the question directly.
“[The Louisiana health department] does not approve emergency preparedness plans,” Russo told lawmakers Friday.
“So what do you do?” asked Rep. Rick Edmonds, R-Baton Rouge.
“I believe the [state] statute 40:2009.25 spells out exactly what the department is supposed to do,” Russo responded.
The indirect response frustrated lawmakers who attended a regularly-scheduled committee meeting about Medicaid spending and policies last week. Edmonds, the committee’s chairman, had added a discussion about nursing home evacuation plans to the agenda, in light of the scandal surrounding Dean’s warehouse.
Russo told lawmakers that local governments are responsible for keeping full nursing home evacuation plans on file, even if the state health department and federal government oversee every other aspect of nursing home operations. It’s the state health department that issues nursing home licenses and regularly inspects the facilities — not local parish officials.
Five law enforcement agencies are investigating what happened at Dean’s warehouse: Louisiana’s Office of the Attorney General, Office of Inspector General, State Police, Baton Rouge City Police and the East Baton Rouge Sheriff’s Office.
Nursing home residents and their families have also filed nine lawsuits against Dean — and at least one against the health department. That pending litigation is the reason health officials can’t be more forthcoming about the state’s role in vetting nursing home plans, Russo said.
“Any time you have loss of life or alleged poor treatment, your heart just breaks for those folks,” he said. “However…we have a job here to do as lawyers and that’s to protect the integrity of the legal process — to not discuss it and let this play out in the courts.”
Several questions remain about why hundreds of nursing home residents ended up in a warehouse in the first place.
“[Nursing homes] have to have evacuation plans but no one has to approve them,” said Rep. Tony Bacala, R-Gonzales. “What is the purpose of a mandated plan that can say anything, apparently, if nobody has to approve it?”
Should a nursing home evacuation site have enough bathrooms and a kitchen?
Days before Hurricane Ida made landfall Aug. 29, the health department didn’t push back on Dean’s plan to move hundreds of vulnerable people to a warehouse, according to a copy of a state inspection report released earlier this month. That decision raised the eyebrows of lawmakers.
“[A warehouse] just doesn’t seem like an appropriate place for people who are medically fragile to be housed,” said Rep. Thomas Pressly, R-Shreveport.
“I’m asking, generally, of the plans that are reviewed by the department, is it normal for those plans to include housing in a warehouse?” Pressly asked at last week’s hearing.
“The answer to that is you can go to an unlicensed facility,” Russo said.
“An unlicensed facility? Are there any minimum standards for what that means?” Pressly replied.
Russo paused, consulted with another attorney sitting next to him, and then responded: “No. I cannot answer that.”
A state surveyor visited Dean’s warehouse on Aug. 27, two days before Hurricane Ida made landfall. The surveyor noted that Dean planned to move at least 700 nursing home residents to the site, that Dean planned to put them on air mattresses on the warehouse floor and that Dean planned to use 30 portable toilets to service the residents and staff during the evacuation, according to an inspection report.
The health inspector was also told that there wasn’t going to be laundry or linen service for at least five days at the warehouse and that the nursing homes would primarily rely on a nearby church to provide food for the residents during the evacuation. The warehouse didn’t have kitchen equipment, according to an inspection report.
With all of that information, the inspector still gave Dean’s homes the go-ahead to move to the warehouse. Then, much of that plan went sideways.
It’s not clear what happened to the church that was supposed to feed the residents — health inspectors don’t mention them in post-storm reports — but the nursing homes eventually started cooking food outside with propane tanks. In the days following the storm, the health inspectors said that residents’ meals were meager and many were sleeping on dirty bedding.
Lawmakers were aghast that the initial inspection of Dean’s warehouse hadn’t raised alarms.
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“The idea that we allow standards where portalets inside a building are an acceptable standard? There’s no kitchen in there. We had men and women laying side by side on the floor that are people held dear by their families,” said Senate Pro Tempore Beth Mizell, R-Franklinton.
“This is something we should hold our heads in shame about as a body because we should have addressed the lack of standards a long time ago,” Mizell said. “Whatever it takes to address the standards is going to be done.”
Inspections of evacuation warehouse contradicted each other
Nursing homes in hurricane-prone regions are required to file evacuation plans with the state. Those plans are reviewed every nine to 15 months as part of a federal inspection process, Russo said. The nursing homes are also required to conduct two evacuation drills annually in years where a real-life evacuation doesn’t take place.
Still, much of Dean’s warehouse evacuation plans appear to have been up in the air before Hurricane Ida.
The state inspectors who examined his warehouse either couldn’t agree — or weren’t clear on — on basic information like the occupancy of the facility, according to health department reports.
On Aug. 27, two days before Hurricane Ida, a state inspector noted that Dean’s warehouse had an “allowed capacity” of 600 people. After the storm on Aug. 30, when Dean had moved 839 nursing home residents into the warehouse, the building’s “allowed capacity” started being listed as unknown on inspection reports. By Sept. 1, the “allowed capacity” had changed again on an inspection report — to 1,600 people.
Even as the warehouse capacity numbers shifted, inspectors documented severe overcrowding in the building.
“The beds were placed side by side with mere inches between them, approximately 40 by 60 foot area with no isles (sic) or space other than 3-6 inches. These twin-size air mattresses were on the floor and the sheets had visible dirt from being treaded upon. Most residents lay on their beds in a morass of bedding and people,” one inspector wrote on Aug. 31.
A handful of inspectors filed reports on the warehouse. The inconsistency surrounding the listed warehouse capacity is part of an ongoing internal review of the event, said Aly Neel, spokeswoman for the health department.
Health department doesn’t have full evacuation plans on file
The Louisiana Department of Health would have had a difficult time reviewing the evacuation plans for Dean’s nursing home ahead of Hurricane Ida because full copies of those plans aren’t kept at the agency.
The health department only has summaries of nursing home evacuation plans on file. The full plans — which run hundreds of pages — are housed at the local parish emergency operations centers where the nursing homes are located.
The evacuation plan summaries — that the health department receives annually — are simply extended checklists in which nursing home operators answer “yes” or “no” to questions about their facilities and evacuation sites, according a review of documents.
The health department has declined to say whether any of the information in those plan summaries is checked for accuracy.
“Do you guys have a responsibility to ensure that the answers [nursing home owners] provide to you are accurate? Or do you take it at face value that if they said it, it must be true?” Bacala asked the health department last week.
“I’m going to have to, on advice of counsel, respectfully decline to answer that,” responded Russo, representing the health department.
“Will you do an assessment on whether the answers that [the nursing home owners] gave are accurate on the documents which they provided to you guys?” Bacala asked.
Russo also declined to answer that question.
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Dean’s most recent nursing home evacuation plan summaries — which were filed in March — list details that don’t appear to be workable during a hurricane evacuation, according to a review of health department records.
For example, Dean is required — according to the forms — to list primary and secondary evacuation sites for his nursing homes. On his evacuation plan for his River Palms Nursing and Rehab facility in New Orleans, he lists a “WAREHOUSE CONVERTED INTO EVAC SHELTER” as his primary evacuation site.
As his alternate or secondary evacuation sites for River Palms, Dean then listed the six other nursing homes he owns. But these nursing homes could not have been used as evacuation sites during Hurricane Ida because those homes also needed to be evacuated to the warehouse.
Given the proximity of the other nursing homes to River Palms, it’s not clear how any of them could ever be used as an evacuation site ahead of a hurricane. Four of the six nursing homes are located within 15 miles of the River Palms, according to the home’s evacuation plan summary.
Dean also incorrectly answered “yes” to a question in the River Palms evacuation plan summary form asking whether these secondary evacuation sites are located outside of “parishes identified as hurricane risk areas.” The nursing homes listed are located in Lafourche, Orleans and Jefferson — all parishes prone to hurricanes. After Ida, those three parishes all lost electricity or water service for several days and had severe property damage.
It’s not clear who would be responsible for catching such inconsistencies in the evacuation plan. The state health department oversees most of the state and federal inspections of nursing homes, but hasn’t taken responsibility.
“[The health department] does not approve the [nursing home] plan,” said Russo again during last week’s hearing.
“Who does?” responded Sen. Kirk Talbot, R-River Ridge. “I mean we can’t even get that? That’s public record is it not?”
“I would refer to the [health department] rule. They are supposed to submit their full plan–” Russo said.
“Sir, I don’t think these families [of the nursing home residents] want to be referred to the rule,” responded Talbot, cutting off Russo. “They want to know who is at the end of the line that said it was a good idea to send [nursing home residents to a warehouse].”
Nursing home rules mostly silent on evacuation site requirements
Louisiana has regulations that must be followed when a nursing home evacuates, but those rules mostly don’t address what should be provided at a nursing home evacuation site. This could explain why Dean was shown such flexibility at his warehouse.
The regulations currently focus on three areas: what needs to happen for a nursing home to “shelter in place” during a disaster, what needs to be provided in the vehicles that transport nursing residents to an evacuation site, and what needs to happen in order for the residents to return to the nursing home site following the evacuation. The state code is largely silent on what type of accommodations nursing homes have to provide at the evacuation site.
But regardless of whether there are specific regulations outlining evacuation site requirements, lawmakers said it should have been obvious from the health department’s first inspection of Dean’s warehouse that the facility wasn’t adequate for medically fragile people.
“It looks like a place Hitler sent people to,” Mizell told the health department last week. “This should not have passed muster for anything. … And yet it passed the sanitarium walk-through.”
Legislators said they plan to look at more nursing home rules and laws as a result of what happened at the Dean warehouse.
“I think requiring permanent restrooms at an evacuation site that are handicap accessible seems to be pretty common sense,” said Sen. Patrick McMath, R-Covington.
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