A nursing home’s deadly secret

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By Megan Cassidy | San Francisco Chronicle | May 4, 2020

Senait Kifle first learned about a coronavirus infection at Gateway Care & Rehabilitation Center on April 4, when her father’s doctor called with a troubling report. Kifle’s 81-year-old father, a temporary resident recovering from hip surgery, had tested positive about a week earlier.

Kifle had little reason to worry, the doctor said. While her father would need to be quarantined for two weeks, he was asymptomatic and in good shape.

But the doctor hadn’t told her everything. Two weeks earlier a resident at the Hayward nursing home and rehabilitation center had tested positive for the virus, and at least four patients had since died of COVID-19. And the virus was spreading quickly.

The news broke on April 8, in a statement from Alameda County health officials: six Gateway residents were dead and 53 others were infected. At the time, it was the biggest coronavirus outbreak in a nursing home in California — and it remains perhaps the deadliest. Kifle and her family were stunned. “All of the sudden, we see the facility on TV,” she said.

The death toll climbed over the next several days. An inconsistent and sparse flow of information dried up completely. Family members said their calls to Gateway management and Alameda County officials went unanswered.

Meanwhile, Kifle’s father, Ghebremichael Ghebreselasie, remained at Gateway.

“I feel like it’s the Twilight Zone,” she said. “Nobody can go and rescue a patient. I feel like my dad is in jail, (and) the system put him in that.”

The story of Gateway — like many deadly coronavirus hot spots in nursing homes across the country — is one of missed early warnings, lack of preparedness, testing shortages, difficult working conditions for staff members, and tragic endings for patients and families who had little warning about what was coming.

The Chronicle reported this story through public records, emails and interviews with family and Gateway staff. A co-owner of the facility did not respond to interview requests, but said what happened at Gateway has been misrepresented in media reports.

The coronavirus officially began its tear through the 99-bed rehab and skilled nursing center on March 23, when the first resident tested positive. In the span of a month it killed at least 13 people and infected more than 100 residents and staff members.

No one will say where the death toll now stands.

Alameda County health officials stopped releasing information on Gateway two weeks ago, and while the California Department of Public Health releases a daily count of total coronavirus-related deaths at skilled nursing facilities, the agency has declined to provide specifics on individual locations because of privacy laws.

As of Friday, 663 residents of California nursing homes had died from COVID-19, accounting for nearly a third of the 2,000-plus total deaths in the state.

Senait Kifle (right) and her daughter, Fiori Bourdon, stand outside Gateway Care & Rehabilitation Center as they speak with a staff member during an attempt to see Kifle’s father .
 | Yalonda M. James / The Chronicle

Throughout the country, skilled nursing homes and assisted-living facilities have emerged as epicenters for a virus that has infected more than 1 million people in the U.S. and killed more than 67,000. Many of the centers were chronically understaffed even before the pandemic, making them ripe breeding grounds for COVID-19, as medically vulnerable patients often share bedrooms, bathrooms and nurses — some of whom are caring for dozens of people each day.

The Alameda County district attorney’s office is conducting a criminal investigation into Gateway, and families of many patients who died at the facility have retained attorneys.

The dearth of information has left some families scrambling for answers — peeking into Gateway windows and cornering nursing staff for information as their mothers, fathers and grandparents remain isolated. Others, like Teri Wright, are wondering if there’s something that could have been done sooner.

Wright said her 64-year-old husband, David Wright, first reported a mild sore throat on March 25, the same day a letter was sent telling her that another patient had tested positive. The next day David Wright had a 102-degree fever.

When the fever didn’t break by March 28, Teri Wright said she begged nurses to send her husband to the hospital. A nurse told her that they would see how he was after midnight, and ultimately transferred him to Kaiser San Leandro at 5 a.m. on March 29.

That day, when the couple spoke over the phone at the hospital, David couldn’t keep his eyes open. “I gotta go, I gotta go,” he told his wife. “I can’t stay awake.”

It was the last time Teri Wright spoke to her husband of 28 years. After a week on oxygen, David Wright died on April 6.

“He had all the symptoms and they kept him,” Teri Wright said. “My husband came there for a broken leg and he died.”

Senait Kifle’s 81-year-old father is a resident at Gateway Care and Rehabiliation Center recovering from hip surgery. While at the facility, he has tested positive for Covid-19. Media: Yalonda M James

While accounts vary on when Gateway residents’ families were told about the first coronavirus case, some families received a letter dated March 25. It said the facility had one confirmed case but all other residents were “found to be in stable condition with no distress.”

Kaiser, the health care provider that sends Gateway many of its patients, also “took steps to test” nursing home residents, said Kerri Leedy, a Kaiser spokesperson. Hospital officials declined to say how many of its patients were at Gateway.

On March 27, an Alameda County health official drafted a list of recommendations to control the spread of the virus and spoke with Gateway’s infection preventionist and the director of nursing at the facility, said Neetu Balram, a county health department spokeswoman.

The recommendations included nurses wearing face masks, monitoring and reporting fevers and other symptoms, thoroughly cleaning “high-touch” surfaces, and banning new admissions.

County health officials declined to release the names and dates of residents who have died from COVID-19 at Gateway, but the county coroner’s office confirmed what may have been the center’s first coronavirus fatality.

Gateway resident Linda Maynard, 74, died from COVID-19 on March 28, officials said. More deaths came in short order. Those confirmed by The Chronicle include:

Sympathy cards remembering Emma Patiño, who died after contracting the virus at Gateway, sit on a shelf at her grandson Jaime Patiño’s home.
 | Yalonda M. James / The Chronicle

• 89-year-old singer and Jewish leader Alby Kass, who died March 31.

• 98-year-old Bernice Spikes, who died April 3.

• 87-year-old Costell Akrie, who died April 4.

• 64-year-old David Wright, who died April 6.

• 82-year-old Sarah Washington, who died April 7.

• 84-year-old Emma Patiño, who died April 13.

• 73-year-old Hayward community leader Marshall Mitzman, who died April 14.

While these and other Gateway patients were falling ill and dying, the nursing home’s staffing situation was also deteriorating.

Crouched along a busy thoroughfare in residential Hayward, Gateway’s pea green stucco building has a neat lawn and a no-frills outdoor patio. Residents of the skilled nursing facility are a mix of short-term patients recovering from a surgery and mostly older patients who need constant care.

Emergency medical technicians with Royal Ambulance unload a patient at Gateway Care & Rehabilitation Center in Hayward, which has seen a deadly outbreak of the coronavirus.
 | Yalonda M. James / The Chronicle

Gateway received average to below-average ratings on Medicare.gov, and it has a record of violations, including 25 federal violations last year, according to the California Department of Public Health. The facility was fined $1,000 last year for failing to supervise a resident who broke her hand by falling in the bathroom.

On April 2, more than a week after Gateway reported its first positive test to local health officials, the city of Hayward dispatched a mobile team there to provide free coronavirus tests to residents and staff members.

Like other nursing homes, little testing occurred at Gateway before the outbreak. In Alameda County, testing for the coronavirus isn’t required unless an outbreak is suspected. San Francisco health officials are preparing to issue a health order this week that will mandate regular, universal coronavirus testing for residents and staff in the city’s skilled nursing facilities.

In other facilities, officials have found that asymptomatic staffers were unknowingly spreading coronavirus.

The Chronicle interviewed two current Gateway employees who spoke about the chaotic and high-pressure environment on the condition of anonymity, because they feared retribution from management. The Chronicle is withholding their names in accordance with its policy on anonymous sources.

One Gateway employee said dozens of staffers got tested in early April. Some who were off work made a special trip to the office. By April 18, 33 staff members had tested positive, according to a state report.

It was only because of this testing that many employees realized they had been infected, a nursing staff member told The Chronicle. Two employees said those who were infected but not showing symptoms were pressured to mask up and still come to work. At least one employee’s job allegedly was threatened if they refused.

Gateway has roughly 50 employees, and about 70% of them stopped reporting to work by mid-April, either because they tested positive or feared infection, a staff member said. The director of nursing resigned the week of April 13, and two housekeepers started filling in for certified nursing assistant duties, employees told The Chronicle.

On March 24, Gateway had 68 residents, according to data provided by county health officials. By April 12, after 11 people had died, there were just 42 patients. It’s unclear what happened to the other patients who left the facility.

On April 13, Alameda County officials issued a list of safety orders to all licensed nursing and facilities. Unlike past recommendations, these orders carried a fine of up to $10,000 for violations.

Arena Burke, whose mother, Linda Maynard, was the first known coronavirus fatality at Gateway, said the Hayward center was an upgrade when she moved there from a previous nursing home in February 2019. The Gateway building smelled like urine but was fairly clean, Burke said.

But soon she began to fear that the home was severely short-staffed. Her mother suffered several falls while waiting for help, she said, and complaints of being cold went unnoticed. A thermometer in Maynard’s room in mid-March read 54 degrees overnight.

“My mom suffocated to death, and she lived her last two weeks freezing,” Burke said.

An overwhelming majority of nursing homes in California are privately owned and not required to report coronavirus cases or deaths at their facilities, said Michael Dark, a staff attorney with California Advocates for Nursing Home Reform, based in San Francisco.

Union City councilman Jaime Patiño’s 84-year-old grandmother, Emma Patiño, was the 10th victim to die from COVID-19 at Gateway Care and Rehabilitation Center in Hayward. Media: Yalonda M James

“They don’t really have much of an incentive to disclose when residents or health care workers are ill, because it’s bad for business,” Dark said.

Gateway management did not respond to multiple requests for comment, and refused to speak to The Chronicle when a reporter visited the facility. Calls to the owners’ listed phone numbers went unanswered or were out of service.

Co-owner Antony Thekkek did not respond to multiple messages requesting comment to specific questions, but he provided a statement that said there have been “significant mischaracterizations and misrepresentations in the media regarding Gateway and its handling of this crisis.”

Thekkek said the facility is continuing to follow health guidelines and recommendations from federal, state and local officials. Specifics on those protocols, however, continue to elude Gateway patients’ families.

Relatives of Emma Patiño were stunned by the April 8 news that six Gateway patients were dead and dozens had fallen ill. Prior to that, the only call her family received was on March 29, when an employee said a person had tested positive and the facility was locking down as a precaution, said Emma’s grandson, Jaime Patiño.

Left: Jaime Patiño and his paternal grandmother, Emma Patiño, pose for a photo in 2018 at Gateway Care and Rehabilitation Center in Hayward. Right: Ghebremichael Ghebreselasie is now at the center and has tested positive for the coronavirus.
 | Courtesy Patiño And Kifle Familes

The Union City councilman rushed to Hayward after the news alert and was relieved to see his grandmother in her window, seemingly healthy and in high spirits. But when he returned hours later for a visit with his daughter, Emma Patiño had a slight cough.

That evening Jaime Patiño’s father received a call that Emma Patiño had tested positive. Her condition spiraled quickly.

On April 10, Emma Patiño was taken to the hospital with low oxygen levels. A battery of tests would later confirm she also had pneumonia, her kidneys were beginning to fail and she had septic shock.

Emma Patiño died on April 13, just after family called for their final goodbyes.

Now, more than three weeks after her death, Jaime Patiño said Gateway still hasn’t released his grandmother’s medical records. She was relatively healthy, he said, and the family thinks her ailments should have been detected sooner at Gateway.

“Had we known about the seriousness of what was going on there, we could have got her on some proactive measures, even bring her home,” Jaime Patiño said. “There was no way for us to know.”