NEW ORLEANS - When photos and firsthand accounts showed that more than 800 frail nursing home residents were languishing in an ill-equipped warehouse after Hurricane Ida in August, Louisiana’s regulators acted swiftly.

Bob Dean

In this file photo from 1997, Baton Rouge businessman, developer and nursing home owner Bob Dean discussed an urn/vase that he acquired. More than two decades later, Dean would be at the center of a scandal involving how his seven nursing homes evacuated for Hurricane Ida to a warehouse that he owned in Independence. More than 800 people were at the warehouse; seven have died and more than 50 have been hospitalized. (Photo by Bill Feig, The Advocate)

The state Department of Health yanked the licenses for all seven nursing homes owned by Baton Rouge businessman Bob Dean. They cited him for leaving nursing home residents in inhumane conditions, failing to ask for help and booting state inspectors out of the warehouse, which he owns. They shut down Dean’s nursing homes and canceled his Medicaid provider agreements.

But if history is any guide, it could only be a matter of time until Dean is back in the nursing home business.

This is not the first time that the state has tried to shut down nursing homes over disastrous hurricane evacuations that left vulnerable residents dead and that prompted public outrage. But in the last 15 years, the state has never succeeded at shutting a nursing home permanently: Every time the LDH has tried, the agency has been overruled by courts or has chosen to enter a settlement, according to records reviewed by The Advocate | The Times-Picayune.

It’s yet another example of how Louisiana’s nursing homes have stayed a step ahead of the state’s regulators despite collectively ranking among the worst in the nation.

The state revoked two nursing homes’ licenses in 2005 and 2006 over botched Hurricane Katrina evacuations after residents died on buses. One was strapped into a bus seat with a bedsheet and fell out of it, while another endured the bus ride in heat that exceeded 100 degrees.

But the nursing homes responsible won back their licenses, one through an administrative appeal and another through a settlement agreement with the state. One of those homes was later sold to Dean.

The LDH also attempted to revoke a nursing home’s license and Medicaid agreements in 2012 after an accumulation of bad inspections, including a failure to respond to reports of abuse. A federal judge overruled them, and the state entered another settlement instead.

Those three attempts are the only times the state has tried to revoke a nursing home’s license within the past 15 years, according to records reviewed by this newspaper. None resulted in permanent closures of the homes.

The LDH says it does not keep records for longer than 15 years, so it’s hard to tell whether earlier revocation attempts might have succeeded. A 2005 Times-Picayune investigation found only one example of the state revoking a nursing home license since 1999, and said “state regulators closed none of the facilities they blamed for the death of one or more residents.”

While it’s rare for LDH to revoke licenses, i’s not because Louisiana’s nursing homes are providing stellar care. Compared to their counterparts in other states, residents in Louisiana nursing homes are far more likely to be hospitalized, have pressure sores and experience poor end-of-life care, according to AARP’s annual nursing home score cards.

Former LDH officials say their traditional approach has been to correct problems at nursing homes, rather than shutting them down. Their win-loss record on trying to revoke licenses also figured into the calculus.

Asked why the LDH rarely seeks to yank a license, spokesperson Aly Neel pointed to the outcomes of the previous attempts.

“We refer you to the decisions in those cases,” she said.

But even if the state is not revoking licenses, it could be doing more to protect nursing home residents, according to Denise Bottcher, the state director of AARP.

“The question becomes, at what point does the state come in with more oversight, more surveying — and at what point do they say, ‘We need to help these nursing homes get up to standard,’” she said. “Revoking a license is the last straw. It typically results when there’s a death, as you saw with the Bob Dean nursing homes.”

Dozens of Dean’s nursing home residents have died in the months since the Ida evacuation, but coroners have only classified five of the deaths as “storm-related.” Dean filed an appeal last month seeking the return of his nursing home licenses and Medicaid provider agreements. His attorneys expect it to take at least a year before his case will go to a trial.

Botched Katrina evacuations

Nursing home residents started dying hours before Hurricane Katrina made landfall in 2005.

At Ferncrest Manor Living Center in New Orleans East, 120 residents were herded onto three buses headed to Baton Rouge the day before the hurricane hit. Three of them did not live to see the storm, according to LDH records.

After a five-hour bus ride, the drivers pulled up at a Baton Rouge church and found that two residents died en route. A third was unresponsive and brought to the hospital, where he also died.

Paramedics noted that one of the buses was not air-conditioned, and the temperature was over 100 degrees. They transported the 22 residents who rode on the un-air-conditioned bus to the hospital, where doctors treated them for dehydration and heat exhaustion.

The LDH revoked Ferncrest’s license on Dec. 28, 2005, citing the home for failing to provide air-conditioned buses, failing to provide water and ice and failing to have nurses on board.

But a panel of administrative law judges overruled LDH in October 2006, finding that Ferncrest’s decision to evacuate was reasonable, and that no cause of death was determined for any of the three who died. The panel reinstated Ferncrest’s license, and it remains open with a one-star rating — the lowest possible — from the federal Centers for Medicare and Medicaid Services.

Ferncrest officials did not return a message for this story.

The outcome of the Ferncrest case affected others. Six months after revoking Ferncrest’s license, the LDH notified a second nursing home that it would also be losing its license.

Administrators of that nursing home, Crescent City Healthcare Center, waited until after the storm to evacuate. Witnesses later told inspectors that when they evacuated on Sept. 1, 2005, residents were tied to bus seats using strips made from sheets. They did not have food, water, medication or identification, and they sat in their own waste for hours.

“People were crying for water,” said one resident’s father, who traveled on the bus. “The bus driver had stopped to get food and drinks for himself but nothing was offered to residents. There were no medical personnel to assist them.”

During the drive, a resident fell out of a seat. The driver pulled over to check on what happened, and discovered the resident was dead. When the coroner arrived, he took note of “the poor condition” of the remaining residents and ordered them transferred to a hospital to be hydrated and cleaned up.

The LDH notified Crescent City Healthcare Center it was revoking the home’s license on June 27, 2006, and administrators filed an appeal. But after the LDH lost the Ferncrest case, regulators opted against another trial. Instead, they entered a settlement in June 2007: the nursing home would pay a $15,000 fine, hire a new administrator and bring in an independent consultant.

In 2013, Crescent City Healthcare Center changed hands. The seller was Jeremy Goux, the nursing home’s president, who often provides legal representation to nursing homes in lawsuits. The Goux family is known for its vast network of nursing homes, along with its influence in the nursing home industry; Goux’s father, Ronald, was the longtime president of the Louisiana Nursing Home Association.

Jeremy Goux did not return a message for this story.

The buyer was Dean, according to paperwork filed with the state. He renamed it Uptown Healthcare Center, and then changed the name again in 2017 to Maison Orleans.

It was a name that Dean had recycled from two decades prior, when he owned homes named Maison Orleans I and II. He renamed Maison Orleans I after a brain-damaged man drowned alone in a whirlpool there in 1999. And at Maison Orleans II, he faced complaints and lawsuits after multiple residents wandered off and were struck by cars on a busy highway. A jury awarded $840,000 to the family of one victim in 2000. State regulators, on the other hand, only fined the home $1,500 for the infraction — far below the $10,000 cap set by law, The Times-Picayune previously reported.

LDH prefers reform to revocation

Some say that nursing homes are capable of reform, which is why LDH has found it so challenging to revoke licenses.

“It’s obviously the death penalty for an institution, so it’s rare,” said attorney Jim Cobb, who defended the owners of St. Rita’s Nursing Home in St. Bernard after Hurricane Katrina. They were charged with negligent homicide after 35 residents drowned there.

A jury acquitted the St. Rita’s owners in 2007, but they did not seek to reopen the nursing home. LDH records show that their license simply expired in 2011.

“They’re largely unsuccessful because a lot of the things they complain about are correctable and corrected,” Cobb said about LDH.

Kathy Kliebert, a former secretary of LDH, said closing down nursing homes can also cause logistical difficulties, such as finding new places for residents to live.

“LDH’s perspective has always been to work with an entity to get them to meet the standards versus closing them down and having individuals have to search for new places,” she said.

But critics say LDH has a long history of coddling nursing homes. They point to Dean as Exhibit A: He’s had few regulatory problems before Ida despite a history of poor inspections and botched evacuations. And the state also approved his plans to evacuate 700 people — a limit Dean toppled by more than 100 — to the warehouse in Tangipahoa Parish, only stepping in after things got dire.

“LDH dances to the nursing home tune; they are utterly subordinate,” said Bruce Blaney, a former state health official and nursing home critic.

LDH’s most recent attempt to revoke a nursing home’s license came in 2012. The state had spent decades running the New Orleans-based John J. Hainkel Home and Rehabilitation Center, also known as the New Orleans Home for the Incurables, before handing off operations to a nonprofit.

The next year, LDH revoked the home’s license, citing a litany of complaints. Among the most serious: an office manager started telling residents that they needed to give her all of the money in their bank accounts, or else they’d be kicked out onto the street. The office manager took at least $2,154 from at least three residents, and inspectors found that the home’s operators had failed to run any reference checks before hiring her.

But Hainkel Home hit back, represented by Cobb. Its management filed a federal lawsuit arguing that they were denied due process and that ending their Medicaid provider agreements before their appeals were exhausted would run them out of business. U.S. District Judge Nannette Jolivette Brown sided with Hainkel Home, and granted a preliminary injunction against the state.

The next year, LDH and Hainkel Home signed a settlement agreement that allowed them to stay open. The state required the home to hire an independent consultant and to submit to additional inspections. Hainkel Home remains open; officials there did not return a message for this story. The home now has a five-star rating from CMS.

Cobb has helped dozens of nursing homes avoid penalties, but he predicts that Dean, whom he does not represent, could be in for some turbulence. The Attorney General’s Office has opened a criminal probe into the nursing home owner, and Dean also faces more than a dozen lawsuits from nursing home residents and their families.

Cobb said Dean should be worried about facing charges under the state’s “cruelty to the infirm” statute, which can carry up to 10 years in prison.

“I know that Dean is in big trouble, not so much with the decision to evacuate or not evacuate, but with the cruelty that he exposed these elderly to,” Cobb said. “Given the conditions that the residents were in, they’ve got a very good case for cruelty for the elderly and the infirm.”

Dean’s lawyer, John McLindon, said no aspect of the Ida evacuation rises to the level of criminal activity.