Lazaro Aleman
ECB Publishing, Inc.
On Friday, April 17, the Florida Department of Health (FDOH) issued an emergency order suspending the licenses of two administrators at the Cross Landings Health and Rehabilitation Center in Monticello.
The summary suspension of the licenses of Mark Daniels, 63, and Sebrina Cameron, 53, by State Surgeon General Scott Rivkees resulted from a stated systematic failure of Cross Landings to follow the proper protocols and implement the required safety measures to slow the spread of the novel coronavirus, per the 22-page FDOH suspension order issued separately to Daniels and Cameron.
The order notes that COVID-19 is a highly contagious illness that spreads through respiratory transmission and that has significant morbidity and mortality rates, particularly to individuals 65 and older and/or with chronic medical conditions.
The order further notes that as part of the state's emergency response to the pandemic, the FDOH facilitated visitation to the various nursing homes across the state with COVID-19 positive cases in order to assist in evaluating the infection control procedures, test additional residents and provide education to the staff on how to control the spread of the disease.
The many objectives, per the FDOH, included assessing the general patient care procedures, infection control practices and cleaning processes at the different facilities; assessing the process used in the screening of the healthcare workers; providing the healthcare workers with guidance on hygiene, the proper use of personal protective equipment and the practices to follow with patients who had tested positive for COVID-19; and identifying and recommending actions that should be taken to improve the sanitation practices and control the spread of the infections.
The order identifies Cross Landings as a skilled nursing facility that operates under the parent company Golden Senior Care. It identifies Daniels as the nursing home administrator and Cameron as the regional nursing home administrator.
According to a Miami Herald story, Cross Landings Golden LLC “is a company owned wholly by Broward County resident Joyce Plourde,” a Florida-licensed nursing home administrator since 1986.
On April 5, per the FDOH order, a 76-year-old patient at Cross Landings tested positive for COVID-19, making for the first case at the facility. Two days later, on April 7, a second patient, age 67, tested positive for the illness.
In response, the FDOH sent a team of four registered nurses to the facility to evaluate the situation. Which team, according to the FDOH, made eight visits to Cross Landings between April 9 and April 13.
“The team spent between eight and 12 hours each day at Cross Landings and worked closely with the staff and residents,” the order states, underscoring that both Daniels and Cameron were present and acting in their administrative roles during the FDOH team's visits.
“During their time at Cross Landings, the team members observed that there was a systematic failure in the planning and implementation of safety measures designed to prevent further spread of COVID-19 to the other residents of Cross Landings,” the order reads.
“Moreover,” the order continues, “Mr. Daniels and Ms. Cameron willfully resisted the team's recommendations and obstructed their attempts to ensure the safety of the residents at Cross Landings.”
Per the order, Daniels and Cameron often refused to participate in the team's daily briefings, or “were otherwise dismissive of the team's recommendations.”
On its several visits, per the order, the team observed that the proper screening of staff wasn't being done to ensure the residents' safety. Such procedures include taking a person's temperature and inquiring if an individual has experienced symptoms or has been in contact with a COVID-19 positive person before allowing entrance into the facility.
The team noted repetitive failures on the part of the staff to appropriately screen individuals before the latter's entrance into the facility. Or the individuals were screened after they had already entered the facility and “the results were inconsistently logged and reviewed.”
“This resulted in individuals with symptoms of a respiratory illness being permitted to enter the facility,” the order states.
Additionally, according to the order, the staff failed to sanitize the thermometer between individuals seeking entry into the facility and often used the thermometers incorrectly, “resulting in invalid temperature readings.”
Moreover, the team's attempts to educate the staff on the proper screening procedures were met with resistance from Daniels, Cameron and staff, the order states.
The team during its visits documented a slew of failures and omissions on the part of the Cross Landings staff that are too numerous to cite here. Suffice to say these omissions and failures included the staff not wearing personal protective equipment; staff not washing or sanitizing hands; individuals not wearing masks or wearing them incorrectly; the administration failing to distribute available N95 respirators; a poorly monitored and policed isolation area that allowed the intermingling of infected and non-infected residents and staff; and calling back to work a suspected COVID-19 infected worker because of staff shortage.
At one point, the director of nursing allegedly informed the team that if the members weren't there to help, they should leave the premises. The same person later supposedly approached the team and said that henceforth all conversations would be recorded “and the owner of Cross Landings would be involving his attorney.”
On April 11, two more patients at the facility tested positive for COVID-19, one a 95-year-old and the other an 89-year-old. The FDOH team noted that despite the two new cases, “there were no meaningful differences in how staff were operating to isolate the positive patients and employ the proper measures...”
The team noted that as time went on, Daniels and Cameron grew “increasingly obstructive, instructing staff to not comply with the team's instructions and telling staff not to speak to them because they were 'trouble'.”
Among the many cited instances of obstruction or resistance, the order notes that the owner of Cross Landings called the team members at one point and told them that they weren't allowed to review patient charts or direct staff at the facility. The director of nurses then threatened to file a grievance against the team, after which the administration banned the team from the facility.
On April 15, an additional eight residents at the facility tested positive for COVID-19, requiring their transportation to another facility for proper care.
In conclusion, the order found Daniels and Cameron to be in violation of various state statues as well as administrative rules. It deemed the twos' failure to ensure for the safety of the facility's residents unacceptable. And it further found the two administrators' “antagonistic relationship” with the team members that had been sent to assist them, and the twos “repeated failures to enact or enforce reasonable safety measures were more than mere mistakes, but rose to the level of negligence and incompetence.”
“Cross Landings resistance to training and support from the department, interference with the team's efforts to assess the situation, and continued spread of COVID-19 throughout the facility, indicate that this severe danger is likely to continue,” the order states.
The suspension of the licenses of Daniels and Cameron followed on the heels of the FDOH on Saturday, April 18, identifying Cross Landings as one of 303 nursing facilities across the state whose staff or residents had tested positive for COVID-19.
The FDOH identified the 303 facilities at the direction of Gov. Ron DeSantis, as it has become increasingly evident that elder care facilities are the “hot spot” of incubation for the novel coronavirus. The governor's order reversed a longstanding FDOH policy of not identifying such facilities.
The governor reportedly had come under increasing pressure from the AARP, the families of nursing home residents and other advocates to release the names of the facilities, a move opposed by the Florida Health Care Association, which represents 300 nursing homes.
The state also faced a potential lawsuit from a coalition of news organizations that wanted the information released, including the Miami Herald, Sun Sentinel, Tampa Bay Times, New York Times and First Amendment Foundation.
According to a Miami Herald story, the FDOH has documented 1,627 cases of infected residents or staff at long-term-care facilities across the state. The data also, according to the Herald, “shows that about eight percent of the 3,800 nursing homes and assisted living facilities have active positive cases.”
The FDOH's newly released list, however, does not reveal the number of cases per long-term facility nor the severity of the problem or number of deaths at each facility, leading critics to say that while the release was a step in the right direction, it doesn't go far enough.
In Florida, according to a Washington Post report, the data shows that one of every four coronavirus deaths are associated with long-term-care facilities.