2003 — Sep 25, Fire, National Healthcare Center Nursing Home, Nashville, TN — 16
— 16 Associated Press. “Some of the deadliest nursing home fires in the US.” CNS.10-3-2014.
— 16 Finley (WSMV News 4). “New Documents Released in 2003 NHC Fire.” 2-9-2010.
— 16 Smith, David Randolph & Associates. NHC HealthCare Nursing Home Fire Litigation.[1]
— 16 USA Today. “Antiquated Codes: Rules Often Updated Only After Tragedy,” 10-6-2005.
— 15 Eisler. “Many Nursing Homes Run Risk of Catastrophic Fires.” USA Today. Oct 6, 2005.
— 15 Duval, Robert. Nursing Home Hartford, CT, February 26, 2003. NFPA, July 15, 2005, 29.
— 15 Smith, David Randolph & Associates. “NHC Fire Litigation,” slide 13, 2004.
— 15 US GAO. Nursing Home Fire Safety: Recent Fires Highlight Weaknesses…, July 2004, 1.[2]
— 14 AP. “Daughter of nursing home fire victim files suit claiming center understaffed.” 11-29-2003.[3]
— 14 National Fire Protection Association. Key Dates in Fire History. 1996.
Narrative Information
Eisler: “Since Congress first set minimum fire safety standards for nursing homes 35 years ago, at least 500 people have died in nursing home fires. Hundreds more have been injured. The number of casualties is based on federal studies and data gathered by the newspaper; no government agency or watchdog group keeps track.
“The 18 worst fires during that period — blazes that killed an average of more than 10 patients — occurred in nursing homes without sprinklers. There never has been a case in which fire killed more than two people in a nursing home fully equipped with sprinklers.
“Yet about 3,500 nursing homes lack sprinkler systems. Federal law mandates that all new nursing homes be built with sprinklers, smoke alarm systems and other fire protections. But older facilities, often the least resistant to fire, are excused from many of those requirements.
“The reason: money. Congress has repeatedly failed to act on bills that would require sprinklers in all nursing homes, mainly because owners say they can’t afford to retrofit older facilities. That job can cost more than $200,000 — about what a typical nursing home receives annually to care for three residents. Some nursing homes would have to close if they were forced to spend that kind of money, says Hal Daub, former president of the American Health Care Association, the largest nursing home industry group. “We all know what the right thing is to do here, and that’s to get all these buildings sprinkled,” says Daub, who left the association last month. “But Congress has to help us get there”….
“During the past 25 years, the government has routinely let fire safety regulations for nursing homes fall years out of date — sometimes by a decade or more — even as it has given the industry new rules on everything from the food facilities serve to the cleanliness of their bedding. Fire inspections, left primarily to states, are haphazard and often incomplete. “Everyone seems to be backing away from making the necessary changes,” says Janet Wells, public policy director at the National Citizens’ Coalition for Nursing Home Reform. She says she’d hoped for change after the nursing home fires of 2003, but “as soon as the debris is cleaned up, (lawmakers) start moving on.”
“Officials at the federal agency that regulates nursing homes, the Centers for Medicare and Medicaid Services (CMS), say they have taken steps to improve fire safety. Last month, CMS launched a new requirement: Nursing homes without sprinklers must have at least a battery-operated smoke detector in all patients’ rooms. “We’ve increased the standards, we’ve increased the monitoring, and we’ve increased the enforcement to make sure that identified problems are remedied correctly and promptly,” says Thomas Hamilton, who heads the nursing home oversight program at CMS, a division of the Department of Health and Human Services.
“But unless all nursing homes are required to install sprinklers, smoke alarms and other modern protections, fire safety experts say the potential for disaster remains great. Many see the mandate for battery-operated smoke detectors, which aren’t wired to alert the fire department in emergencies, as an inadequate solution. And they fear that the impetus for change is fading as the tragic fires of 2003 grow more distant. James Shannon, president of the National Fire Protection Association, says the risks of another major fire are too great to wait any longer to equip all nursing homes with sprinklers. “It seems intolerable to me that in the 21st century we still have a situation where we can have these multiple-death fires in nursing homes,” Shannon says. “The problem now is to keep people focused on the problem. … It’s past time”.” (Eisler. “Many Nursing Homes Run Risk of Catastrophic Fires.” USA Today. Oct 6, 2005.)
Finley, Dec 2006: “On Wednesday [Dec 20], court documents relating to the 2003 NHC nursing home fire, which had been sealed, were released to the public. Among the thousands of pages released to the public include documents from 32 lawsuits along with testimony and depositions jurors would have heard if all the suits had not been settled out of court. The Channel 4 I-Team[4] poured over the boxes and discovered why NHC may have wanted to prevent a trial. Along with depositions of seeing a patient on fire, there are also damning accusations from NHC workers. Many said NHC knew there was something wrong with the bed where the fire is believed to have started.
“NHC’s maintenance director, Scott Hansen, was interviewed and said the motor was bad and wouldn’t raise up and down, and he had planned to replace it but the fire happened first. Hansen went on to testify that in 1993, Ramco Electric made a bid to NHC to put smoke detectors in all the patients’ rooms for $11,000. But the sprinklers were never installed, and Hansen could not recall why.
“The frustration of the employees is evident in the testimonies, saying there was inadequate staffing, and they didn’t have regular fire drills. This claim was backed up by an independent audit that said NHC falsified fire drills.
“As for NHC, their attorneys denied all of the accusations in the court records and said they and their workers did everything they could to prepare for a fire. Channel 4 spoke on Wednesday to David King, one of NHC’s attorneys. He said experts testified that installing smoke detectors in each of the rooms would have only alerted workers to the fire by a few seconds. He also said, as for the claims about falsifying fire drill records, the only problem was a lack of documentation. The drills, he said, did happen. None of these accusations are proven facts. Independent tests of the bed ruled out mechanical problems. The cause of the fire has never been officially determined, and investigators closed their investigation in June 2004. As for the other accusations, they would have all been fought over in court. But now that the cases are settled, they are simply statements made by workers.
“History of the NHC Fire:
“A total of 16 people died as a result of the blaze. Firefighters were able to pull 120 survivors from the nursing home. The nursing home did not have a sprinkler system, and none was required at the time. After that fire and another fatal blaze at a Maryville retirement home, Tennessee passed laws ordering sprinklers in all nursing homes and assisted-living facilities. The NHC building on Patterson Street has since been torn down. HCA bought the property and said it would eventually be used to expand the services of Centennial Medical Center. (Finley, Jeremy. WSMV News Channel 4, Nashville, TV. “New Documents Released in 2003 NHC Fire.” 12-20-2006.)
GAO: “Why GAO Did This Study. In 2003, 31 residents died in nursing home fires in Hartford, Connecticut, and Nashville, Tennessee. Federal fire safety standards enforced by the Centers for Medicare & Medicaid Services (CMS) did not require either home to have automatic sprinklers even though they have proven very effective in reducing the number of multiple deaths from fires. GAO was asked to report on (1) the rationale for not requiring all homes to be sprinklered, (2) the adequacy of federal fire safety standards for nursing homes that lack automatic sprinklers, and (3) the effectiveness of state and federal oversight of nursing home fire safety.
“What FAO Found. Cost has been a barrier to CMS requiring sprinklers for all older nursing homes even though sprinklers are considered to be the single most effective fire protection feature. There has never been a multiple-death fire in a fully sprinklered nursing home and sprinklers are now required in all new facilities. The decision to allow older, existing facilities to operate without sprinklers is now being reevaluated in light of the 2003 nursing home fires. Although the amount is uncertain, sprinkler retrofit costs remain a concern, and the nursing home industry endorses a transition period for homes to come into compliance with any new requirement. If retrofitting is eventually required, it is likely to be several years before implementation begins.
“The nursing home fires in Hartford and Nashville revealed weaknesses in federal nursing home fire safety standards for unsprinklered facilities. For example, federal standards did not require either home to have smoke detectors in resident rooms where the fires originated, and the fire department investigations suggested that their absence may have delayed the notification of staff and activation of the buildings’ fire alarms. In light of inadequate staff response to the Hartford fire, the degree to which the standards rely on staff to protect and evacuate residents may be unrealistic. Moreover, many unsprinklered homes are not required to meet all federal fire safety standards if they obtain a waiver or are able to demonstrate that compensating features offer an equivalent level of fire safety. However, some of these exemptions raise a concern about whether resident safety was adequately considered. For example, a large number of unsprinklered homes in at least two states have waivers of standards designed to prevent the spread of smoke during a fire.
“State and federal oversight of nursing home fire safety is inadequate. Post-fire investigations by Connecticut and Tennessee revealed deficiencies that existed, but were not cited, during prior surveys. For example, a survey conducted of the Hartford home 1 month prior to the fire did not uncover the lack of fire drills on the night shift and, on the night the fire occurred, the staff failed to implement the home’s fire plan. The survey was conducted during the daytime and relied on inaccurate documentation that all shifts were conducting fire drills. On the other hand, Tennessee’s post-fire investigation failed to explore staff response, a deficiency cited on the home’s four prior surveys. The limited number of federal fire safety assessments, though inconsistent with the statutory requirement for federal oversight surveys, nonetheless demonstrate that state surveyors either miss or fail to cite all fire safety deficiencies. CMS provides limited oversight of state survey activities to address these fire safety survey concerns. In general, CMS (1) lacks basic data to assess the appropriateness of uncorrected deficiencies, (2) infrequently reviews state trends in citing fire safety deficiencies, and (3) provides insufficient oversight of deficiencies that are waived or that homes do not correct because of asserted compensating fire safety features.
“What GAO Recommends. GAO is making several recommendations to the Administrator of CMS to (1) improve oversight of nursing home fire safety, such as reviewing the appropriateness of exemptions to federal standards granted to unsprinklered facilities and (2) strengthen the fire safety standards and ensure thorough investigations of any future multiple-death nursing home fires in order to reevaluate the adequacy of fire safety standards. CMS concurred with GAO’s recommendations.” (US GAO. Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in Federal Standards and Oversight (Report to Congressional Requesters). July 2004, frontpage.)
NYT, July 16, 2004: “Washington, July 15 – Fatal fires at nursing homes in Connecticut an Tennessee showed severe weaknesses in federal fire safety standards, which go unenforced at many nursing homes across the country, Congressional investigators said on Thursday. At least 59 percent of the nation’s nursing homes were cited for deficiencies in fire safety in their most recent inspections, the investigators said, but many have refused to install sprinklers and smoke detectors because of the cost, and patients are exposed to huge risks as a result.
“The Government Accountability Office, an investigative arm of Congress…examined federal fire regulations for nursing homes after 16 people died in a fire at a Hartford home in February 2003, and 15 [16] died at a Nashville home seven months later. ‘The substantial loss of life in the Hartford and Nashville fires could have been reduced or eliminated by the presence of properly functioning automatic sprinkler systems,’ the report said, but the federal government has not required sprinklers at some older homes, ‘in part because of the cost of retrofitting such structures.”
“Federal officials assessed the safety at only 40 of the 871 nursing homes they inspected last year, the report said. Under federal law, they are supposed to evaluate fire safety at all the homes they inspect. But, the report said, ‘no federal assessments of fire safety were conducted in 27 states.’
“Enforcement of fire safety standards is critically important, the report said, because many nursing home residents have mental and physical disabilities. Some are bed-bound, some use wheelchairs and many have Alzheimer’s or other conditions that limit their ability to run or walk or even to follow instructions in an emergency.
“Federal employees visit about 5 percent of the nation’s 17,000 nursing homes each year to validate the findings of state inspectors. Nursing homes receive more than $64 billion a year from Medicaid and Medicare, and more than 70 percent of that is federal money. About two-thirds of the nation’s 1.6 million nursing home residents are on Medicaid.”
“Bush administration officials, stunned by the findings, moved quickly to respond. Dr. Mark B. McClellan, the new administrator of the federal Centers for Medicare and Medicaid Services, who took office in March, said he accepted all the finds and recommendations. To comply with the law, Dr. McClellan said he plans a five-fold increase in federal inspections. In addition, he said, his agency will propose a rule requiring smoke detectors, and he will ‘explore the feasibility’ of requiring sprinklers in all nursing homes….
“Alan E. DeFend, vice president of the American Health Care Association, which represents nursing homes, said, ‘We have not seen the report.’ The industry supports a requirement that all homes be equipped with fire sprinklers, Mr. DeFend said, but the federal government must help pay the cost, estimated at $1 billion , and homes should have three to five years to comply.
“Representative John B. Larson, Democrat of Connecticut, has drafted a bill that would require every nursing home in Medicaid or Medicare to be equipped with sprinklers. Under his proposal, to be introduced next week, the federal government would reimburse nursing homes for all the costs of sprinklers installed since September 2003.
“In its report, the G.A.O. concluded ‘State and federal oversight of nursing home compliance with fire safety standards is inadequate,’ and it made these points:
“Some nursing homes lack fire alarms. Many fail to conduct routine fire drills. Many lack safeguards to prevent the spread of fire and spoke from room to room.
“The federal government has exempted many nursing homes from selected safety standards, thus allowing deficiencies to go uncorrected for many years.
“In many cases ‘state surveyors missed obvious fire safety deficiencies.’ In one state, inspectors falsified information by ‘whiting-out deficiencies on the survey forms.’
“The nursing homes in Connecticut and Tennessee did not have smoke detectors in residents’ rooms, and they were not required.
“The federal government maintains a Web site providing comparative data on the quality of care at nursing homes. The site initially included data on fire safety violations, but federal officials removed the information because they were unsure ‘how to portray deficiencies that remain uncorrected’ under waivers granted by the federal government.
“Senator Charles E. Grassley, Republican of Iowa, who requested the study with Senator Bill Frist of Tennessee, said it showed that the inspection process ‘is broken.’ Moreover, Mr. Grassley said, the enforcement process, ‘in all likelihood has been seriously corrupted. Mr. Grassley said state inspectors had told his staff that they often felt political pressure from superiors to minimize or cover up violations.” (New York Times (Robert Pear). “Fire Safety at Nursing Homes is Criticized.” 7-16-2004.)
USA Today, 2005: “When a nursing home fire in Hartford, Conn., killed 16 people in 2003, federal rules required only that facilities meet an 18-year-old edition of the Life Safety Code, which had been strengthened repeatedly in the interim. Only after that fire did the government’s Centers for Medicare and Medicaid Services (CMS) begin making nursing homes meet a 2000 version of the code. That version required more stringent fire safety measures in facilities without sprinklers. In September, the fire protection association issued a new code. For the first time, it requires full sprinkler systems in all nursing homes. CMS says it will study the new code but won’t commit to adopting it. “We fully promote full sprinklering. That is an ultimate goal,” says Thomas Hamilton, head of nursing home oversight at CMS. “The real question is how quickly are we going to be able to get there.”
“More than a dozen states have passed their own laws requiring sprinklers in all nursing homes. But most are waiting for the federal government to take action. CMS wants to make sure that the costs of requiring sprinklers won’t force smaller facilities in underserved areas to close.
“Congress could force the agency to mandate sprinklers in all nursing homes, but lawmakers have refused amid industry complaints that facilities would need federal assistance to comply. Since 1999, nursing home operators and associations have donated almost $11 million to congressional campaigns, according to the non-partisan Center for Responsive Politics. About 60% of that went to Republicans.
“To help ensure that nursing homes without sprinklers are safe, CMS began requiring last month that those facilities install smoke detectors in all patients’ rooms. But few outside the agency are keen on the rule, in large part because it allows nursing homes to use battery-operated detectors. Those detectors can carry more risks than benefits, they say, because they require constant maintenance to see that their batteries are strong — a concern in facilities that often struggle to provide adequate staffing. And the detectors aren’t connected to a central alarm system. That means fire departments or even nursing stations within a facility are not alerted when the detectors sound. “It seems like an incentive for not putting in sprinklers,” says Robert Polk, who retired recently as South Carolina’s state fire marshal. “Everyone’s always looking for an alternative to doing the right thing”.” (USA Today, “Antiquated Codes: Rules Often Updated Only After Tragedy,” October 6, 2005.)
Narrative Information — Newspapers
Sep 26, NYT: “An overnight fire in a four-story nursing home killed 8 residents today and critically injured about 20, the authorities said. The residential area of the building had no sprinkler system. Among the victims was the 96-year-old mother of the district fire chief, Bobby Connelly, who responded to the fire, said Deputy Chief Kim Lawson. Most of the 116 residents had to be carried out by firefighters or rolled to safety in wheelchairs because few patients could walk and the elevators were knocked out of service. Some residents on upper floors were placed on backboards and carried down ladders. Others had oxygen tanks, and one was on a ventilator. The assistant fire chief, Lee Bergeron, said at least 25 residents were treated at hospitals for burns and smoke inhalation. ‘This is like the worst-case scenario for any firefighter in the country, a nursing home fire,’ Deputy Chief Lawson said. The victims, all women, ranged in age from 76 to 96.
“The fire started late Thursday in a room on the second floor of the NHC Healthcare Center, an older building in a medical area on the edge of downtown, the authorities said. The lone sprinkler in the building was over the kitchen grill, as required by law, said Gerald Coggin, a spokesman for National Healthcare, owner of the nursing home. National building codes adopted in 1991 require sprinkler systems in the residential areas of nursing homes. But enforcement was up to the states, and Tennessee did not adopt the stricter standards until 1994. Because the nursing home in Nashville was built with brick and steel in the mid-1960’s, it was required to add sprinklers only if the company extensively renovated the building, said Diane Denton, spokeswoman for the State Health Department…. Asked whether sprinklers would have helped, Assistant Chief Bergeron said, ”It definitely would have made a difference” in saving lives….
“National Healthcare, which operates 87 long-term health care centers, mostly in Tennessee and elsewhere in the South, bought the building in 1976.” (New York Times. “8 Elderly Women are Killed in Nashville Nursing Home Fire.” 9-27-2003.)
Nov 29: “….Since the fire, the company has said it will spend about $10 million to install sprinklers in 16 of its nursing homes….” (Associated Press. “Daughter of nursing home fire victim files suit claiming center understaffed.” Lubbock Avalanche-Journal, TX, 11-29-2003.)
Sources
Associated Press. “Daughter of nursing home fire victim files suit claiming center understaffed.” Lubbock Avalanche-Journal, TX, 11-29-2003. Accessed 10-11-2015 at: http://lubbockonline.com/stories/110903/nat_110903073.shtml#.Vhq0Pis9Z14
Associated Press. “Some of the deadliest nursing home fires in the US.” CNSnews. 10-3-2014. Accessed 10-11-2015 at: http://cnsnews.com/news/article/some-deadliest-nursing-home-fires-us
CNN (Wolf Blitzer). “Investigation underway in deadly Nashville nursing home fire.” 9-26-2003. Accessed 10-10-2015: http://www.cnn.com/2003/ALLPOLITICS/09/26/wbr.nursing.home/
Duval, Robert. Nursing Home Hartford, CT, February 26, 2003. Quincy, MA: National Fire Protection Association, Fire Investigations, July 15, 2005. Accessed 10-11-2015 at: http://webcache.googleusercontent.com/search?q=cache:pfz2GMwIJtoJ:www.nfpa.org/~/media/files/research/fire-investigations/fihartford.pdf%3Fla%3Den+&cd=5&hl=en&ct=clnk&gl=us
Eisler, Peter. “Many Nursing Homes Run Risk of Catastrophic Fires.” USA Today. Oct 6, 2005. Accessed 5-25-2016 at: http://www.usatoday.com/news/nation/2005-10-06-nursing-homes-cover_x.htm
Finley, Jeremy. WSMV News Channel 4, Nashville, TV. “New Documents Released in 2003 NHC Fire.” 12-20-2006. Accessed 10-10-2015 at: http://www.durhamanddread.com/blogs/2010/02/09/new-documents-released-2003-nhc-fire
National Fire Protection Association. Key Dates in Fire History. 1996, 2010. Accessed 5-25-2016 at: http://www.nfpa.org/research/reports-and-statistics/key-dates-in-fire-history
New York Times. “8 Elderly Women are Killed in Nashville Nursing Home Fire.” 9-27-2003. Accessed 10-11-2015: http://www.nytimes.com/2003/09/27/us/8-elderly-women-are-killed-in-nashville-nursing-home-fire.html
New York Times (Robert Pear). “Fire Safety at Nursing Homes is Criticized.” 7-16-2004.
Smith, David Randolph & Associates. NHC Fire Litigation, slide 10, 10-15-2004. Accessed 5-25-2016 at: https://www.drslawfirm.com/nhcfire.ppt
United States Government Accountability Office. Nursing Home Fire Safety: Recent Fires Highlight Weaknesses in Federal Standards and Oversight (Report to Congressional Requesters). Washington, DC: GAO, July 2004. Accessed 10-11-2015: http://www.gao.gov/assets/250/243404.pdf
USA Today. “Antiquated Codes: Rules Often Updated Only After Tragedy.” 10-6-2005. Accessed 5-25-2016 at: http://www.usatoday.com/news/nation/2005-10-06-nursing-homes-codes_x.htm
[1] Under “News” at the bottom of this webpage, is a link (no longer active) with the title “16th victim of fire dies.” At the top of the page, after noting “Sixteen persons died in the fire.” It is written that “Thirty-two lawsuits were filed and consolidated for discovery in the Third Circuit Court for Davidson County….David Randolph Smith & Associates and Bart Durham & Associates jointly prosecuted suits with other plaintiff’s counsel. Mr. Smith was appointed as lead liaison counsel for the plaintiffs….” We make this note to make the point that Mr. Smith appears to be a credible source for sixteen rather than fifteen deaths.
[2] “10 residents died on 2nd floor where fire originated. Five residents died on 3rd and 4th floors.”
[3] Victim was Anna Tolston. Notes “…investigators believe it [the fire] began in Tolston’s room. A key piece of evidence is her electrically operated bed.”
[4] WSNV-TV, Nashville, TN.