Did this nursing home fail in its duties? Or did authorities do too much to hinder it – and too little to help?

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In February of last year, a long term care facility near Seattle became America’s first COVID-19 hotspot. Flu tests were coming back negative at the 121-bed Life Care Center in Kirkland, but an increasing number of residents were running fevers, and a steady stream were being transferred to a nearby hospital.

Until February 27th, however, doctors at the hospital couldn’t test these patients for the coronavirus because the federal Centers for Disease Control (CDC) restricted tests to individuals who had traveled to China.

What transpired next is the subject of an impressive piece of journalism by Katie Engelhart, titled What Happened in Room 10? At nearly 16,000 words, it takes about an hour to read, and is eye-opening in several respects. Engelhart concludes that, from a big picture perspective, there is a legitimate debate: Did Life Care fail in its duties? Or was this facility let down by multiple government agencies?

In early March, more than 100 individuals associated with Kirkland Life Care would test positive for COVID-19. Twenty-six residents would perish, and dozens of employees would be unable to work because they themselves were infected. The remaining caregivers were so stretched they had little time to answer phone calls from alarmed relatives of the remaining residents. Those relatives understandably became even more alarmed.

During these weeks, Life Care was unsuccessful at acquiring temps from local staffing agencies. It sought permission from state authorities to import nurses from nearby states, but was told there was no way to expedite the lengthy application process. When Life Care turned to the county, it was advised no COVID tests were available. Engelhart quotes one official: “Their backs were up against the wall. They were pleading for help.”

Chelsey Earnest, one of the people we meet in this essay, is a 47-year-old nurse from another Life Care location who volunteered to temporarily relocate to Kirkland in order to lend a hand. When she arrived on March 1st, she found a facility in crisis.

That same day, an 18-person team from the CDC appeared on the scene. Although a county health official declared at a press conference that this team would “assess each and every one” of the residents, that didn’t happen. Rather than pitching in, these personnel conducted an academic exercise. Engelhart reports:

Most of the CDC people never set foot inside the nursing home; they asked questions over the phone. The ones who did come inside “were there with clipboards, sort of watching and observing”

On March 2nd, the facility’s doctor began to feel unwell, and retreated to self-quarantine at his own residence. Engelhart explains the significance of this development:

Between March 3 and March 5, at the height of the Life Care outbreak, there were no doctors in the nursing home to evaluate and treat the dozens of residents who needed to be assessed – and officials at the county, state, and federal level knew it. [bold added]

It wasn’t until March 7th that a ‘strike team’ of 28 military medical personnel finally arrived. They brought enough COVID test kits to test all the facility’s residents, but many of these reinforcements had little experience treating older patients. The doctor in charge, for example, was a pediatrician rather than a geriatrician.

A week later, that team was replaced by personnel from AMI Expeditionary Healthcare, a private company under contract with the US State Department that had battled Ebola in Africa. AMI, which brought along its own supply of Personal Protective Equipment (PPE), was stunned by what it found. Englehart quotes Ryan Azcueta, one of its doctors: “It was quite shocking. It took a while to stabilize things.” In his words, the assignment amounted to a “humanitarian emergency mission.”

It was precisely during those days of turmoil and struggle, that Medicare and Medicaid decided to conduct an inspection (which ended on March 16th). Writes Engelhart:

Over several days, “surveyors” reviewed documents and pulled nurses aside for interviews. Life Care later said that its staff spent approximately 400 working hours answering questions. To Chelsey, the inspection was “the height of ridiculousness.” Patients were still getting sick, and she was busy. “They’re walking around with their fingers pointing. ‘Oh, you didn’t cross this t or dot this i.’ I don’t care about the t’s and i’s. Get out of my way.”

The inspection’s findings, released on March 23rd, were harsh. The facility was criticized for, among other things, failing to properly identify infected residents – even though testing had first been prohibited, and test kits had then been unavailable.

On April 2nd, Life Care was fined more than $600,000. Families were soon deluged by messages from attorneys offering to file wrongful-death lawsuits against the nursing home. Englehart reports that one lawsuit is underway, and that the prospect of more has “divided Life Care residents and their families.”

This is a poignant, well-researched essay. It does a splendid job of describing a complex situation, full of nuance and shades of grey.

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