With the novel coronavirus sweeping through the West Oaks Nursing and Rehabilitation Center in Austin, Maurice Dotson posted a stark message on his Facebook. "Off to work again. Healthcare never closes . . . pray 4 me," he wrote.
That same day, a state inspector showed up at the sprawling facility to check on a complaint that managers failed to order the staff to wear masks and gloves, despite strict federal guidelines.
During the visit on March 26, the inspector found the facility had violated critical infection control practices, including failing to isolate a sick patient, not sanitizing their hands, and not properly disposing of protective gear. It was the second time in two years the state had found such problems.
Two weeks later, Dotson, a certified nursing assistant who had worked at the facility for 25 years and was now caring for patients with COVID-19, feared he was coming down with something. "I’m hurting so bad,” he said in a Facebook post. “I don't know what's going on with me.”
Ten days later, on the morning of April 17, at the age of 51, he died from the virus.
Inspection records reveal that, like many nursing homes, West Oaks has a history of safety and infection control problems and now must confront an unprecedented crisis.
The state said one Austin facility has at least 35 patients who have tested positive, and employees at West Oaks say it's their facility. West Oaks will not say how many have died among its residents and workers.
With thousands of nursing home residents and employees dying across the country, unions are demanding N95 respirators and even more basic equipment — masks and gloves — from government agencies, hospitals, and long-term care facilities where the virus has flourished.
Dr. Karl Steinberg, a geriatrician and chief medical officer for a California nursing home chain, said the facilities’ failure to move quickly at the onset of the virus put their residents and workers at risk.
"A two-week delay in instituting basic and mandated precautions is highly likely to have contributed to the number and severity of cases," said Steinberg, who also is president-elect of the Society for Post-Acute and Long-Term Care Medicine.
It's not clear what precautions were taken by the West Oaks staff after the state inspection in March, but two days after Dotson died, inspectors turned up at the facility and found multiple violations for immediate jeopardy, a charge that can cost a home its license unless corrected.
That kind of citation can include anything from a failure to keep critical medical records to hazards that cause injuries and deaths.
State officials did not provide records of the findings, and the nursing home said it could not comment until it sees a final report.
Brooke Ladner, an official for Regency Integrated Health Services, which runs the center, said the nursing home implemented federal and state guidelines after the Center for Disease Control released its protocols on March 13 and the company has "worked diligently to continually improve the standard of care at the facility." Any alleged violation is immediately investigated, she said.
Ladner said all inspection violations prior to last year took place under a different manager, and that the deficiencies from late March have since been corrected. As far as the most recent inspection by the state, Ladner said she could not comment pending the final report.
“The loss of Maurice Dotson was deeply felt by his friends and co-workers at West Oaks Nursing and Rehabilitation Center,” she said, “and we grieve with his family."
Dotson's sister, Felicia, said her brother faced enormous hazards when he went to work each day.
“You see people dying around the world, the main place they're dying is in nursing homes,” she said. “Why would they not use more precautions?"
Her brother would never have considered quitting his job or not showing up for work, she said. With relatives barred from visiting, "he would say, ‘I am their family. They don't have their family.’"
The facility’s documented problems date back well before the pandemic. In 2018, inspectors found that caretakers were not showering patients for a week at a time and discovered some residents with gaping, infected wounds. In other cases, caretakers were not properly cleaning catheter tubing or washing their hands, risking the spread of infection, records show.
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At the end of 2018, the facility’s operator, Senior Care Centers LLC, filed for bankruptcy, citing cuts in government reimbursements, and the home was taken over by Regency Integrated Health Services, a parent company that runs 57 facilities in Texas.
As recently as last month, a source familiar with the state’s inquiry said, nursing home managers were not ordering all employees and patients to engage in social distancing.
On March 24, staff members learned that a nursing assistant, a woman, had been infected. In the following weeks, at least five other staff members tested positive, according to three former employees.
For days, Dotson, described as a hard-working nursing assistant with a passion for movies and cooking, shared what it was like caring for people while the virus spread rapidly through the 125-bed facility.
On March 26, with a host of patients infected at the time, he noted on Facebook: "Back to work again in this crazy world, Protect me lord."
Florence Dodson, his 71-year-old mother, said her son would work long hours even when he knew it was risky. He would throw birthday parties for his residents and celebrate holidays. "He loved his patients,'' said Dodson. "It was all about them."
In early April, health officials showed up and delivered a trove of personal protection equipment to the home. State records show that by April 3, the facility was in compliance with its infection control program.
But another problem emerged as the cases mounted inside.
Because some health care workers were calling in sick, employees who worked with COVID-19 patients now had to sometimes care for patients who were not infected, risking the spread of the virus, according to a current employee and another who recently worked at the center.
Dotson, whose hallway initially did not have COVID-19 patients, was now getting them. As the days progressed, he told family members, he was increasingly tired from the pace. For years, he took a bus to work or he walked, his sister said. (Both she and their mother spell their last name differently than Maurice Dotson did.)
When a Facebook friend suggested he stay home on April 7, he became upset. "I can't!” he wrote. “Who the hell is gonna pay my bills? I can't depend on a mf! (Excuse my French). The only way that's gonna happen if I'm in a wheelchair and then that's not to happen if I can still work period." Then, he added: "I love what I do is taking care peoples who can't take of themselves. Apparently it's my calling!"
On April 8, he posted a message that was frequently on his Facebook page: "Thank God for letting me see another day can I get an amen." But that same day, he called for an ambulance from his home, his sister said.
Admitted into St. David's South Austin Medical Center, Dotson was diagnosed with the virus. He posted several messages in the ensuing days, including one on April 13: "The journey of a thousand miles begins with a single step."
Five days later, while his condition deteriorated, he put up another post: "Some people think that to be strong is to never feel pain. In reality the strongest people are the ones who feels it, understand it, and accept it."
His mother said she spoke to him by phone two days later, April 15, before he was placed on a ventilator. "He said, 'Mama, I'm going to be all right. I got the virus at my job.'''
Two days later he died.
In the ensuing days, his sister said, scores of messages of condolences poured into her email inbox and Facebook account, many from the relatives of patients. "I didn't know how many people’s lives he touched," she said.
Dotson's remains were flown back to Arkansas, his birthplace, where his funeral will take place on Saturday in a graveside service.
Dina Mata, a former receptionist at the facility, said she created a special plaque with photos of her coworker to be hung in the same hallway where he had worked for years. He was remembered at the facility on Friday with a release of purple balloons, his favorite color.
"Many times I would get calls from family members who couldn't be at the facility to feed the resident, and they would ask for him," she said. "He was known for working 10 days straight. He spent many, many days holding their hands. I still remember when a CNA called in sick, and Maurice had just finished his shift. At the last minute, he looked down the hallway, and said, ‘I got this.'"