A woman is transported from the Rehabilitation Center at Hollywood Hills as patients are moved Wednesday after a loss of air conditioning caused by Hurricane Irma, in Hollywood, Fla. Several patients at the sweltering nursing home died, authorities said Wednesday. (Amy Beth Bennett/South Florida Sun-Sentinel via Associated Press)

HOLLYWOOD, Fla. — Dozens of nursing homes across Florida remained without power Thursday, a potentially perilous situation for elderly Floridians nearly a week after Hurricane Irma began knocking out electricity for millions statewide.

The most dangerous outcome of the lingering outages was seen here, in Hollywood, where eight people died at a nursing home and more than 100 others were evacuated to hospitals on Wednesday after generators failed and the air conditioning went out.

In dozens of counties spanning the state, 45 nursing homes continued to wait for the power to return as of Thursday night, according to the Florida Department of Health. While it was not clear how many of the thousands of people residing in those homes remained there during the outages, the smothering heat in Florida this week created an additional source of danger for an already vulnerable population.

In Hollywood, where humidity made it feel hotter than 100 degrees outside on Thursday, the Rehabilitation Center at Hollywood Hills was closed to residents and opened to detectives, who scoured a building that had become a crime scene.

Just down the street, Memorial Regional Hospital, a sprawling, palm tree-lined facility, continued treating patients brought in with dehydration, heat exhaustion and severe respiratory conditions. Many had been discharged or brought to other facilities, while 39 remained at Memorial, hospital officials said.

Vendetta Craig, said Thursday that she is “spitting mad” about what happened at the facility, where her 87-year-old mother, Edna Jefferson, is a resident. She says she believes her mother could have died had the sweltering conditions not been discovered when they were.

“No words can describe what I’m feeling, it was so unnecessary,” Craig said at a news briefing with hospital officials. “How would you be if someone was taking care of your mom and then they don’t? You want answers. You want justice.”

Reached Thursday, Jack Michel and Jorge Carballo declined to comment citing the ongoing investigation, while Natasha Anderson, chief executive of Larkin Behavioral Health Services, said she repeatedly requested help on behalf of the nursing home from the power company and state officials before the deaths early Wednesday.

When the first few nursing home victims were brought into Memorial’s emergency room early Wednesday morning, Judy Frum, the hospital’s chief nursing officer, was informed and “it immediately sent up some red flags.”

Frum walked over to the nursing home and said what she encountered was “not like anything I have ever seen.” She implemented the hospital’s mass casualty protocol.

“There were many people in distress,” Frum said. “They had extremely high temperatures. … Many of their staff were trying to assist patients. It was very warm. I saw a lot of patients who had been compromised. … It will stay with me for a very long time.”

The building was stifling, said Ellie Pina, whose 96-year-old mother Mirelle is a resident there.

“It was like 110 degrees in there, it was unbearable,” she said Thursday. “Not even the fans were helping them.”

Questions continued to swirl around the nursing home and how conditions there deteriorated so rapidly. Authorities and officials have provided little clarity, nor have they said yet how any of the eight patients died.

Craig said she first learned something might be wrong when one of her mother’s regular nurses called her on Wednesday morning to say she couldn’t get into the building. Not long after, another friend called and told her to turn on her television because there were news reports from outside the facility where her mother had been staying since January. Craig headed for Hollywood and, once she arrived, was able to reunite with her mother.

“It seemed like a lifetime, but it took only 20 to 25 minutes to see my mother,” Craig said. “She had an IV in her arm and ice packs and her temperature was down to 102 degrees. Then she opened her eyes, saw me and it just gave me life.”

Hollywood officials have released a timeline describing their response to the facility. The city’s Fire Rescue was first called to the facility at 3 a.m. Wednesday for a report of a patient in cardiac arrest, they said. A second call followed an hour later, and then a third, and then more Fire Rescue crews headed inside, along with Memorial hospital staff.

Authorities found three people dead inside. Eight people died in total, including a patient who died early Wednesday and was taken directly to a funeral home. Officials had said that person had a do-not-resuscitate order. Since the criminal investigation was launched, the medical examiner claimed that body and made it part of the inquiry, authorities said.

City officials had said Thursday that the patient taken to the funeral home had died Tuesday — well before authorities say they were first alerted to the crisis — but they later corrected that and said the person died early Wednesday morning. A city spokeswoman said the death occurred before the first call to Fire Rescue.

What happened before the firefighters first showed up, though, still remained uncertain.

The nursing home was aware on Sunday that its air conditioning “ceased to operate effectively” and placed portable air coolers and fans throughout the facility, according Justin Senior, secretary of the Florida Agency for Health Care Administration.

The office of Florida Gov. Rick Scott (R) said the facility had told the state health-care administration it had electricity and access to fans and coolers as of Tuesday afternoon. The Florida Department of Health said that as of 7:30 a.m. Wednesday, the facility reported that it had partial power and a generator was operating. The facility also told the state that its heating and cooling systems were not working, but “at no time” did the nursing home report that conditions had become dangerous or critical.

Broward County, where the facility is located, had said that nursing home staff contacted local officials Tuesday morning to say that they had lost power. In a statement, the county also said the nursing home reported that a tree was on a transformer, information that was relayed to Florida Power and Light, the utility giant.

The county also said the nursing home was not deemed “critical” infrastructure based on guidance from a Florida Power and Light document. The power company declined to release the document Thursday, and a spokesman said only that the company works “closely with county emergency management officials to review and make determinations regarding the top critical infrastructure facilities.”

The horror at the nursing home was the realization of a nightmare many feared when the power went out across Florida, a state where 1 in 5 residents are age 65 or older — an age range in which their bodies are typically more susceptible to heat-related illnesses.

The longer the power stayed out, the greater the potential risk for older Floridians. And in some places, there is no sign of when the lights will come back on. On Thursday, more than 2.6 million customer accounts in Florida — about a quarter of all accounts statewide, representing millions of residents — still lacked power.

Utilities have restored power to millions, but they also have warned that it could be days or weeks until electricity is restored in places that suffered the harshest blows from Hurricane Irma, which lashed essentially the entire state with rain and wind.

Kristen Knapp, a spokeswoman for the Florida Health Care Association, which represents most of the nearly 700 nursing homes across the state but not the Hollywood facility, said officials had counted 64 nursing homes without power as of Thursday, and the organization was working to determine if others still might be having trouble. More than 100 facilities had not reported their status to a state system, she said.

In addition to nursing homes without power, the Florida Department of Health reported that 164 assisted living facilities had evacuated after the storm, many because of power outages; 245 others were still on generator power five days after the hurricane made landfall.

The overall number of nursing homes without power could still be higher, since that association represents most — but not all — nursing homes statewide. Dozens of assisted living facilities, hospitals and other health-care locations have evacuated or closed, according to the governor’s office.

At the Miami Jewish Health System — which includes a 422-bed nursing home, a 32-bed hospital and 210 apartments — the power went out on Sunday, said Jeffrey Freimark, the chief executive. Generators operated as planned, as did portable cooling units, and it never got above 80 degrees in the facility, he said. Power was back in every building by Wednesday.

Freimark said he was on daily calls with the Florida Health Care Association and Gov. Scott. He said the storm appeared to catch many nursing homes off guard.

“It was also clear in listening to some facilities that they just really were not ready for this storm,” he said, noting that some were asking basic questions about safety at a time when they should have been evacuating or hunkering down. “We heard questions regarding, ‘Where can people get generators? Where can we get fuel?’”

Later, he said, the calls shifted to concerns about a lack of power, with some reporting that their buildings were hot.

Eric Cote, project director at the nonprofit Powered for Patients, said there is a requirement that nursing homes that have electric operated fire suppression systems or life support have emergency power for those systems, as well as for elevators.

“There isn’t a rule that says a generator must be the source of that emergency power, but I can tell you in 90 percent or more of the emergency cases generators are used,” he said. “As of today in the state of Florida, or in the United States, there is not a requirement that nursing homes have air conditioning systems attached to emergency power.”

That will change in November. A federal rule will take effect requiring hospitals, nursing homes and long-term care facilities to make sure that they can maintain certain temperatures when the power goes out.

But buildings with partial power could still expose residents to danger. Police and city officials in Hollywood say the nursing home there still had some power, though the initial investigation found that “the building’s air conditioning system was not fully functional.” Elderly residents who have been evacuated to other facilities with air-conditioning also face another danger, because research has found that hasty, stressful evacuations can lead to deaths among the elderly.

Berman, Zezima and Davis reported from Washington. Sandhya Somashekhar and Wesley Lowery in Washington contributed to this report, which has been updated since it was first published.

Further reading:

Millions are without A/C in Florida. Heat illness is their next big threat.