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On April 2, Malene Lawrence sent a text message to her cousin.
“3:50pm I watched my father take his final breath with Fred Hammond, Mahalia Jackson & Shirley Caesar playing in the background… I’m home now getting ready to have some mint tea and go to sleep. ??”
It was a temporary recess after a series of stunning events that began just five days prior.
Lawrence, a former school teacher and non-profit administrator, celebrated her younger son’s birthday on March 27 with a social distancing party. Noticeably absent was a phone call from her father, 89-year-old George Hawkins, a retired Korean War veteran who resided at Unique Rehabilitation and Health Center for the last two years. He entered the facility after enduring a rough bout with pneumonia that led to the need for long term care. Although he was blind, Lawrence says her father had a memory “like an elephant” and could identify people well just by the sound of their voice.
“On my son’s birthday he didn’t call. I didn’t think anything of it at first,” Lawrence says. “The very next day I received a call from Medstar Washington Hospital Center’s ICU saying that they were trying to reach Malene Lawrence. They said ‘Your dad was just rushed to the emergency room. You need to get here immediately.’” Before she got off the phone, she granted the hospital permission to intubate her father and discussed a do-not-resuscitate order.
By the time she arrived at the hospital, her father was in the ICU on a ventilator, breathing at 50 percent. Lawrence says the doctors weren’t sure if the diagnosis would be pneumonia or COVID-19 but to her, they seemed focused on the endgame. “On Saturday the doctors were talking to me about end of life procedures. Have I discussed that? Have I thought about it? On Sunday the doctors were talking to me about end of life procedures. Have I discussed that? Have I thought about it? But they didn’t give any preliminary test results. And then on Monday when the tests came back positive it was like full force. That was all they wanted to talk about.”
With her brother in New York and her husband out of state on business, Lawerence didn’t want to make decisions under duress. She asked the hospital to wait before taking her father off the ventilator. The calls from MedStar came daily anyway. “I felt like I was being harassed by the social worker and doctors telling me that they needed the bed in the ICU and if someone else comes into the hospital with more dire conditions we don’t want to make that decision for you but we’re going to have to do that. I’m going through all of these emotions. Now I have the hospital saying ‘Well, your dad is 89. It’s not like he’s going to get any better. You need to make these end of life decisions right now.’”
Medstar Washington Hospital Center responded to City Paper’s inquiry about their practice in the following statement. “We have protocols in place to ensure comfort of patients in their last days and hours. During this time, the patient and family members are brought together to discuss the changing goals of care, which can then shift toward maintaining physical comfort, and addressing emotional, spiritual, and social needs. These procedures are all in place to ensure patient comfort and dignity. At the same time, our caregivers involve family members in every step of this process.”
Lawrence also wants to know why the nursing home never contacted her about her father’s rapidly declining health condition or his transfer to the emergency room.“The nursing home finally called me on April 14 to see how my dad was doing,” she says. “I couldn’t say anything. I just hung up the phone.”
City Paper contacted Unique Rehabilitation to inquire about the events surrounding Hawkins’ admission into the emergency room. Chris Johnson, chief operating officer of Rytes Company, a corporate compliance firm that represents Unique Rehabilitation, answered in an email. “Federal law prevents Unique from commenting about the condition of specific residents, but we notify the family member identified as the responsible party whenever anyone is believed to be Covid positive and anytime a resident is transferred to the hospital.”
Unique Rehabilitation and Health Center in Northwest has had trouble sticking with the guidelines that regulate nursing homes in the past. A federal inspection report from 2017 cited the facility for not preventing spread of infection. Two sharps containers were filled beyond the full line on the 3 South Unit, and the facility failed to ensure that one of nine newly hired employees was screened for communicable disease before interacting with physicians and residents. They were also written up that year for failure to “accurately and consistently assess and/or monitor the skin integrity (surgical site)” of a patient. In 2019, the facility failed to meet the transfer and discharge requirements for residents. A review of medical records found six violations where patients were transferred to outside medical institutions without proper documentation.
Nursing homes have been receiving guidance on how to protect residents and staff from the spread of COVID-19 through the Centers for Medicare and Medicaid Services (CMS). D.C. nursing homes have been working to follow the rules while encouraging family members to stay in touch in other ways. D.C. law requires providers to report cases of certain diagnoses to the health department to help prevent and control the spread of communicable diseases. When COVID-19 hit the scene, specific guidelines were released on screening and monitoring healthcare personnel for the virus. (The guidelines were last updated on March 21.)
At Mayor Muriel Bowser’s April 22 press briefing, DC Health Director Dr. LaQuandra Nesbitt confirmed that the long term care facilities in the District are required by law to notify the residents and their families any time there is a change in health status. She also stated that CMS now suggests and DC Health requires that long term care facilities notify residents and their representatives of any positive COVID-19 cases found at least 12 hours after diagnosis.
Lawrence’s woes have yet to subside. She is now challenged to find a funeral home that will claim her father’s body and cremate it affordably. “He did receive Social Security and VA benefits, but in order to get the burial benefits from those organizations I have to have a death certificate. Well I can’t get a death certificate until a funeral home takes possession of my dad’s body.” Her search continues for now as she hopes to find some place to cremate her father. “I don’t want him just thrown out in potter’s field somewhere,” she says.
If you need legal assistance or have concerns about a long-term care facility in the District, call the Legal Counsel for the Elderly’s Office of the D.C. Long-Term Care Ombudsman at (202) 434-2190.