One by one, the calls for help poured in from nurses at the Rehabilitation Center at Hollywood Hills.
Mostly the voices were calm, but the situation was dire. Throughout the two-story rehab center, lives were flickering out. The nursing home became a hellish steambath when the air conditioning went out after Hurricane Irma struck, cutting the power to much of South Florida.
"I have another person who is in respiratory distress," one nurse told a 911 operator.
Another nurse betrayed some emotion as she fumbled with a computer while trying to access a resident's vital information. "Oh my God, this is crazy!" she said, adding: "I only come here every month!"
On Monday, the city of Hollywood handed over eight 911 phone calls from the Hollywood nursing home where 14 residents died after Irma struck South Florida. Released in response to a public records lawsuit by the Miami Herald and the Sun Sentinel, the calls offer some insight into how so many people could die in a nursing home that was steps away from one of Florida's biggest hospitals, Memorial Regional.
In the course of the eight calls, totaling more than 30 minutes, only one nurse mentioned that there was no air conditioning in the nursing home, which served more than 140 residents, including people as old as 99.
Not one caller suggested that an evacuation was urgently needed. No one beseeched the paramedics to hurry.
By the time the nursing home was evacuated, eight residents would be dead or dying.
Six other deaths in the coming days would be attributed to the sweltering conditions after the storm.
"So I saw her slouch over," one nurse said of a stricken resident. "I realize that she's not breathing."
Asked for additional description, the nurse says: "Her fingers started to change color, slightly blue."
The records released Monday as a result of the lawsuit offered no listing of when the calls were made. However, that information can be gleaned from a previously released public record, which indicates the first call came in at 6:15 a.m. Sept. 11 and the eighth was received at 6:33 a.m. Sept. 13. A ninth plea for help was relayed by the Broward Emergency Operations Center shortly after.
The emergency seemed to climax starting at 3 a.m on the 13th and ending around the time the center was evacuated shortly after dawn. Seven 911 calls, including the one from the EOC, came in over a four-hour period.
In the Sept. 11 call, a nurse matter-of-factly reports that an 81-year-old woman is having respiratory issues. Use the front door, she says, because the side door isn't working.
In the second call on Sept. 12 at 12:49 p.m., a 93-year-old man is having difficulty breathing. He's not completely alert, the nurse says as the 911 operator goes through a checklist of questions.
The clearest indication of the severity of the health crisis came in the last call, the one from the EOC. A staff member says the center received a call about multiple residents being ill, and possible deaths.
"We're not 100 percent positive of the situation [at the home], but that's what we've been informed," he says. "The call that came in was a little daunting."
The Broward medical examiner has yet to state an official cause of death for any of the 14 victims. In the end, more than 140 residents were evacuated to Memorial Regional and other nearby hospitals.
Dr. Irwin E. Redlener, director of the National Center for Disaster Preparedness at Columbia University, said that in an emergency it is important for both sides — 911 callers and operators — to convey and understand a sense of urgency.
Redlener, provided a synopsis of the calls, noted that a lot of time was spent going over scripted questions.
"You have both parties in this situation that are complacent with not getting these frail patients, these sick patients, to the hospital," he said.
Redlener also wondered if there was a doctor present at the nursing home.
The nursing home and rehabilitation center at 1200 N. 35th Ave. is now a homicide investigation crime scene after the state revoked its license on Sept. 20. The home laid off all 245 workers the same day. Federal regulators said last Thursday that they are cutting off Medicare funding to the nursing home.
The Centers for Medicare and Medicaid Services also imposed a penalty of $20,965 a day for the three days that the home lost power to its air conditioning unit.
EXCERPTS FROM THE 911 AUDIO
Some of the 911 calls from the Rehabilitation Center at Hollywood Hills follow a Q&A format. Others are fragmentary. Some snippets:
Operator: "Is he awake?"
Nurse: "His eyes are open."
Operator: "Is he completely alert?"
Operator: "Is he breathing normally?"
While talking to a 911 operator, a nurse pauses and shouts at a colleague, asking her to help an 84-year old in severe distress: 'Can somebody ice her? Please somebody!'
"So I saw her slouch over. I realize that she's not breathing. ... Her fingers started to change color, slightly blue."
"She's not breathing."
"They're doing CPR now."