With Baltimore sweating through a second straight day of triple-digit temperatures, state officials ordered the Ravenwood Nursing and Rehabilitation Center to relocate all 150 patients because of problems with its air- conditioning system and began a comprehensive investigation of the facility.
Throughout the day, residents in wheelchairs and on stretchers were loaded into vans and ambulances, as the West Franklin Street nursing home — where temperatures had climbed as high as 93 amid this week's heat wave — was gradually emptied.
State health authorities plan to meet with Ravenwood officials Thursday to discuss inspectors' findings and to determine "whether they were deficient in any of their practices and whether they should be cited. There could be fines," said Nancy B. Grimm, director of the state Office of Health Care Quality.
Officials were alerted to the air-conditioning problem after a resident called 911 early Tuesday morning. Nursing homes and other long-term care facilities are not specifically required by state regulations to report air-conditioning failures, said Grimm, whose office is part of the Department of Health and Mental Hygiene. But they are required to report conditions that have "the potential for harm to a patient."
"We would expect a nursing home to advise us and let us know what is happening so we can … help the facility in assessing the situation and, if necessary, help them in the relocation of residents," she said. "It is very troublesome for us in the sense that it was a delayed notification."
There was no indication of any heat-related injuries or illness as a result of the air-conditioning problems, Grimm said. The death of a 92-year-old woman at Ravenwood in recent days was investigated and found not to be heat-related, she said. The patient was on "palliative care … and apparently passed away due to a natural death."
Ravenwood's parent company, Foundation Health Services Inc., was unavailable for comment. But a spokesman for Foundation has said it was not aware of the air-conditioning problem until Tuesday.
Faced with the need to move dozens of Ravenwood residents to other facilities on short notice, state health officials called on other area nursing homes and the Health Facilities Association of Maryland, a trade group representing 120 nursing and long-term care facilities.
Among those who sent staff to Ravenwood to assess the medical condition of the patients and determine which ones they could take in was the Frankford Nursing and Rehabilitation Center, on Frankford Avenue in the city.
"We sent two registered nurses over to Ravenwood and began assisting them," said Daren Cortese, president of Frankford's parent company, Brinton Senior Living. The process went well, he said. "Every nursing home has to have an evacuation plan in place for situations like these."
After consultations with Ravenwood's pharmacy provider and medical director, which Frankford shares, Frankford increased its staffing and 16 patients were transferred.
"Clinically, they were stable, but obviously they were hot and hungry," he said.
It was not clear how long the air conditioning had been off by the time a resident called 911 to report the failure. Grimm said information received by the department on Saturday indicated it was cool then.
Although previous reports have pointed to Friday as the beginning of Ravenwood's heat problem, some patients and employees indicated that the air conditioning had not been fully functional for one to two weeks.
The prolonged heat had driven temperatures inside Ravenwood as high as 93 degrees when state inspectors arrived Tuesday morning, Grimm said.
The facility had acquired 10 to 12 portable air conditioners and placed them in the hallways in an attempt to cool it down. Fifteen more portable units were moved in early Wednesday, but it remained "fairly warm," Grimm said.
All but about 10 of the facility's residents had been moved to an air-conditioned multipurpose room, where most had spent the night on beds, cots and mattresses on the floor, she said. They were being provided with ice water.
One resident of four months, who declined to give his name to reporters as he left Ravenwood on Wednesday, described the heat inside as "intolerable."
Meanwhile, Linda Pannel drove to the nursing home to pick up her sister, Tanya Johnson, a nurse. "She was concerned about the safety and health of the residents," Pannel said.
The air conditioners "were functioning, but they weren't really cooling down the areas," Grimm said, and repairs to the main air-conditioning system were not expected to be complete for another week. After assessing the situation, she said, health authorities made the decision to move all residents to other care facilities, beginning with the most vulnerable.