Fullerton resident Bridgett Fontanez remembers being told April 9 there weren’t any novel coronavirus cases in her father’s west Anaheim nursing home, and that he was “doing great,” after she grew concerned over local news headlines about the pandemic.

Little over two weeks later, she and her brothers were burying him at a Los Angeles County cemetery, after the virus took his life on April 17. Social distancing restrictions didn’t even permit them to watch his casket lower into the ground.

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The Fontanez family is one of hundreds impacted as novel coronavirus cases break out and climb in at least 20 nursing homes and long term care facilities throughout Orange County, which counts more than 75 such facilities in total. More than 35,000 people are admitted to them each year, according to this county webpage.

OC Health Care Agency officials say much of the latest increases in the county’s overall positive cases are due to the nursing homes.

“Nursing home outbreaks affect the highest risk patient populations. They are a significant contributor to hospitalizations in the county,” said Dr. Matt Zahn, medical director of the agency’s Communicable Disease Control Division, on May 15.

In May 14 remarks to reporters, county CEO Frank Kim said the county was “fortunate” that the infection rate within congregate living environments like nursing homes came “in a delayed manner compared to some of our large urban peers.” But, he added, “it is here now within Orange County.”

Asked by Voice of OC how much of the county’s coronavirus hospitalizations have so far consisted of nursing home cases, OC Health Care Agency officials said their research manager, Dr. Curtis Condon, had requested an advance download of state patient discharge numbers for the county, but the state denied his request.

A total of 902 long term care facility patients and staff have gotten the virus so far in the county — up from 334 cases at the start of the month. That’s according to the latest, May 20 emergency services data, which is compiled under the Medical Health Operational Area Coordination (MHOAC).

Among those cases, at least 29 people have died, according to an earlier MHOAC report from May 18.  The datasets in those reports are gathered from long term care facilities — including assisted living and care home facilities, not just skilled nursing ones — that are self-reporting cases and deaths. But the real infection numbers are likely larger than that.

Click here for the county’s archive of daily MHOAC reports.

Despite county officials’ repeated mentions of “enhanced testing” at the facilities, not everybody is being tested — just the patients and staff showing symptoms.

“We are not mandating testing at this point, but testing of residents and staff in Skilled Nursing Facilities (SNF) is a very high priority and our Communicable Control Disease Division is actively working to increase testing volume in all SNFs,” said Marc Meulman, Chief of Operations for Public Health Services, in an email on May 13. 

When cases are identified in facilities, an “expert team assesses the situation and directs testing based on the particular situation. Our first priority is testing where there are known cases and then expanding testing in facilities where no case is identified.”

Should Families Pull Their Loved Ones Out?

The county Health Care Agency’s director, Dr. Clayton Chau, said much of the more than 200 new cases reported by the county on May 14 factored nursing home cases, as well as cases in the Orange County jails.

For residents thinking about pulling their loved ones out of their facilities out of caution, Chau said the decisions need to be made off a number of different factors as to why residents are in those homes and how removing a loved one from their facility would affect them. 

“Sometimes it’s safer for a loved one to stay in a facility versus taking them home,” he said, especially if a family at home didn’t have the required special resources to care for them. “I would advise the family, you really need to talk with the (insurance) provider to weigh out the pro’s and con’s.”

Chau said it’s personal for him. 

“I understand the anxiety that loved ones are experiencing right now, as I personally have a family member in a similar setting and am feeling the same things,” he said in a later written statement. “The best thing for us to do is to carefully consider all the different factors involved before making the personal decision about the best place for these residents to receive the care they need and deserve.”

Dr. Clayton Chau, the new director of the Orange County Health Care Agency, at the OC Board of Supervisors meeting on Tuesday, May 5, 2020. Credit: Screenshot of County of Orange video

There are now more than 40 coronavirus cases at the Anaheim Healthcare Center on Beach Blvd, where Bridgett Fontanez’ father George passed away, according to data from the state.

A culmination of work injuries, heart issues and the death of his wife, Martha, landed the 68-year-old, Puerto Rican-born drywall expert and construction worker in long term care there, about three years ago. 

Bridgett’s brother, Brian, said his last conversation with his father was over the phone, a few days before his father died in the early morning hours of April 17.

Representatives for the Anaheim Healthcare Center didn’t return phone and repeated email messages seeking comment. Their website lists a number of measures the facility says it’s taken to ensure the safety of patients and staff inside its walls, like restricting visitors and conducting “hygiene observations.”

Anaheim city spokesman Mike Lyster said that while the situation is still challenging with “four deaths at the facility” so far as of May 11, it’s “stabilizing with patients being treated in an advanced isolation wing.”

The Anaheim Healthcare Center on Beach Blvd. Credit: Google

Brian Fontanez said his family is currently looking into options for legal action against the facility, describing a lack of communication from staff about his father’s condition — and the overall situation of cases in the facility in general — in the final days of his life. He also criticized the facility for treating his father on site rather than taking him to a hospital.

“It kind of felt like they were giving us the runaround. We didn’t have a complete timeline of what was going on,” Brian Fontanez said. “The quality of care wasn’t up to the standard of what we thought it would be.”

Legal Immunity, or Accountability?

But the Fontanez family’s possible legal action could be hindered by nursing home groups across the state who want lawsuit immunity for facilities affected by the coronavirus crisis.

In a coalition letter signed by various California nursing home associations — including the California Association of Health Facilities (CAHF), which represents the Anaheim Healthcare Center — the groups call for a legal “immunity” order from the governor, and argue that the unprecedented COVID-19 pandemic “is projected to affect so many people that health care providers will be forced to allocate scarce medical resources among too many patients who need them.”

“In this time of crisis, care providers must be able to observe, evaluate, and respond to rapidly-changing conditions and events; the prospect of being subjected to future lawsuits would burden and slow these decisions, threatening greater loss of life throughout California,” the letter, signed April 20, reads.

It’s a request that Governor Gavin Newsom has said in news conferences he’s talking over with state officials. A decision has yet to be made. 

The request has troubled those on the opposite side of the issue: nursing home reform advocates.

“Across California, nursing home residents and their families are suffering from terrible lack of transparency about the true scope of the pandemic’s impact on them,” said Michael Dark, a staff attorney for California Advocates for Nursing Home Reform (CANHR), in a phone interview.

The statewide nursing home groups’ request for legal immunity “is extremely broad,” he added. “They’re asking for immunity from civil, administrative, and criminal claims.” 

He wondered aloud why “any nursing home anywhere in California needs or deserves immunity from criminal complaints,” and said due to public health restrictions on visitors and inadequate oversight by state investigators, “residents in nursing homes have almost no safety nets left.” 

“Really the only protection they have left is the prospect that the dangerous owner or operator could be sued if someone gets sick or dies,” Dark said. 

Deborah Pacyna, director of public affairs for CAHF, said the liability protection her group is asking for is “not absolute” – “facilities would still be exposed to liability regarding willful conduct that takes place.”

“We’re asking for the same kind of liability given to hospitals and physicians during declared emergencies,” she said, adding her group is “not seeking immunity from criminal claims – only baseline protection because we expect there’s going to be a surge of litigation … there are caregivers trying to do their absolute best under the most difficult of circumstances.”

But the letter Pacyna’s group signed specifically requests any order from the governor include text that specifically says “physicians, professionals, and employees shall be immune from any administrative sanction or criminal or civil liability or claim for any injury, death, or loss alleged to have resulted from any act, omission, or decision made …”

The immunity that nursing home groups are requesting would cover reckless conduct, Dark said. “Dangerous conduct — not accidental acts.”

“Obviously we mourn the losses of any death taken by the predatory virus,” Pacyna said. “Everybody is trying to do the best they can under different circumstances. Certainly a lot of what’s happening is changing everyday so families might feel confused about directions they’re given, may feel they’re not getting the handholding and support that they need.”

Bridgett Fontanez said her father was at the nursing home “to be taken care of,” and that her family’s “very frustrated” with her father’s facility.

As her family reels from her father’s death, family members say they’re currently planning for a proper memorial service some time in the Summer. 

“My dad was like a big kid — always trying to make a joke,” Brian Fontanez said. “Didn’t take life too seriously, in a good way. Didn’t let life get to him. He was very loving – always joking around.”

During the funeral on April 23, the cemetery only permitted one of George Fontanez’ children — the oldest, Albert, who helped carry the casket — to witness the actual burial due to public health guidelines restricting groups and gatherings of people.

Brian Fontanez said only after his father was buried, and the casket-carriers were gone, was his family allowed to come in and look at the grave.

But even for that, he added, they were only allowed 10 minutes. 

Brandon Pho is a Voice of OC staff writer and Report for America corps member. Contact him at bpho@voiceofoc.org or on Twitter @photherecord.

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