The urgency of a 911 call ratcheted up about two minutes after it was placed Feb. 15, 2021, from the Parmer Woods assisted living facility in North Austin, on the day that many throughout Texas lost power.
At first, the caller responded “no” to the dispatcher’s question, “Is she in respiratory distress?” But moments later, the caller acknowledged that 88-year-old Bertha “Cookie” James, a patient at the facility, was “having a hard time breathing.”
Then, as the dispatcher continued to gather information while EMS medics were en route, someone farther away from the phone shouted, “She can’t breathe!”
By the time the medics arrived, James had died.
The Texas Health and Human Services Commission opened an investigation into James’ death after receiving inquiries from the American-Statesman about 911 records that indicated someone had died there after experiencing issues with oxygen equipment that required either electricity or batteries.
As a result of the Statesman’s reporting, the commission has now determined that two people died in assisted living facilities as a result of the 2021 Texas freeze — both of them in Austin — across all of Texas.
James’ death highlights the reality that, nearly a year later, some victims of the freeze have gone uncounted — and it’s still unclear how many people lost their lives because of the catastrophic failure of the state’s power grid.
“Relying on self-reports didn’t detect one death,” said Patty Ducayet, ombudsman for the Texas Health and Human Services Commission. “I wonder if there are others.”
Parmer Woods declined to comment on James’ case.
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Nursing home deaths in the freeze
The commission previously said that only one person in a Texas nursing or assisted living facility died as a result of the freeze and power loss. Cynthia Pierce, 73, a resident of the Renaissance Austin assisted living facility in Northwest Austin, died from hypothermia after a staff member left a window open in her room while temperatures dropped below freezing.
Pierce was autopsied by the Travis County medical examiner’s office, but James was not. James’ death certificate says she died of chronic obstructive pulmonary disease, according to her family.
In James’ case, “there was no history of any recent injuries or medical events, and no evidence of abuse of alcohol or drugs,” said Hector Nieto, spokesman for the medical examiner’s office. “There was no information relayed that the decedent was without oxygen prior to death. There was no evidence of foul play.”
The medical examiner’s limited records of James’ death do mention that her facility had lost power in the middle of the night and that she required “supplemental oxygen and had to switch to portable oxygen.”
After the Statesman reached out to the Texas Health and Human Services Commission about the case, the commission determined that the facility had failed to ensure there was adequate oxygen on hand at all times.
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“These failures resulted in (James’) death,” the investigative report states.
The state fined Parmer Woods $7,000.
“Life just doesn’t mean too much anymore these days,” said James’ daughter, Ginger Hill.
In total, 24 nursing or assisted facility residents died throughout Travis County from Feb. 15 to Feb. 19, 2021, most of them after they had been without power for at least 48 hours.
Like James, none of those people was autopsied by the medical examiner’s office because they were in the care of a licensed physician at the facility who signed their death certificates.
In an ideal world, Parmer Woods would have reported to the Health and Human Services Commission that a resident died after she had issues with her oxygen equipment.
“Requiring a facility to self-report deaths isn’t enough,” Ducayet said. “We may need new strategies and to increase fines when a facility fails to report.”
State officials “are not going in and investigating, facility by facility, without a complaint filed or an incident reported by the facility,” she said.
The incident also highlights the need for nursing and assisted living facilities in Texas to have more generators on hand, she said.
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Generator bill didn’t get far
While assisted living facilities are required by state law to have an evacuation plan, they are not required to have or maintain generators on site. Nursing homes are required to have a generator on hand, but it does not need to heat the building.
After the 2021 freeze, state Rep. Ed Thompson, R-Pearland, introduced a bill that would have required assisted living facilities to have backup electric generators. However, the measure died in committee, even after Thompson testified that nearly half of the state’s nursing homes lost power or had water issues during the disaster.
“We ran into a lot of opposition from the operators of these facilities. … We tried to work with them, … but we never really reached a point where I could get them to commit to much of anything,” Thompson told the Statesman.
The state of Florida, though, did pass a similar bill in 2018, and the South Florida Sun-Sentinel reported in 2021 that the vast majority of Florida facilities were in compliance with the rules.
George Linial — president of LeadingAge Texas, a nonprofit nursing home industry group — testified against Thompson’s bill.
“The costs associated with installing and maintaining these power systems, particularly those able to heat and cool entire buildings, are prohibitively high,” Linial said. “Even if existing facilities are able to accommodate the equipment necessary, many would not be able to pay for it. The requirements of this bill are not practical or financially feasible for long-term care facilities.”
“The emergency plans work as designed to protect the health and safety of residents,” Linial told the Human Services Committee while the Legislature was in session.
Leah Gage, with the Independent Coalition of Nursing Home Providers, also spoke against the bill.
“This would most definitely result in the closure of some and would be a huge financial hardship to all facilities,” Gage said.
Thompson told the committee that the purpose of his bill was to save lives.
“What price do we put on the lives of some of our senior citizens here in the state of Texas?” Thompson said.