Update (4/28/2020): NYC Health + Hospitals started testing patients at Coler for COVID-19. LeVar Lawrence tested positive for COVID-19 the day before this article was published. He had a fever but he’s doing okay. Seventy-three patients at Coler have tested positive for COVID-19 as of April 26.
Fifteen years ago, when LeVar Lawrence was 28 years old, he was shot and paralyzed from the neck down. Suddenly unable to bathe or eat or get out of bed without help, there were many days when he asked why God didn’t just let him die. In 2013, after the first hospital he was in closed down, he was moved to Coler Rehabilitation and Nursing Care Center on the northern tip of Roosevelt Island, a skinny strip of land floating between Queens and Manhattan in New York. Established in the 1950s, Coler is a city-run, long-term care facility for people like Lawrence who require full-time medical care and rely on Medicaid or Medicare to pay for it.
At Coler, Lawrence rediscovered his childhood interest in art through the OPEN DOORS project, joining an artist collective called the Reality Poets. Using a stylus that he drives with his mouth, Lawrence creates digital art. Known within the group as “the Vartist,” Lawrence illustrated the “Wheeling and Healing” poetry anthology and takes commissions. Every weekend he goes to visit his family in Brooklyn, where he was born and raised.
But for the past month, Lawrence has been isolated in his room at Coler with two other residents. Both of his roommates started showing symptoms of COVID-19 in early April. Lawrence was stuck in his bed for five days straight, growing restless and uncomfortable. “This is like being back in jail,” he told me.
Unlike Lawrence, most of the approximately 480 patients at Coler are elderly, but like him, the majority are in wheelchairs. All of them are considered to be medically high-risk, with severe conditions like quadriplegia or dementia. Residents typically live four to a room and require physical help to accomplish everyday tasks, like getting into their wheelchairs or eating, which makes social distancing impossible. Lawrence cannot wear a face mask because he uses his mouth to drive his wheelchair and type with a stylus on his phone. During our conversation, incessant, hacking coughs in the background interrupted the flow. “You’re hearing everything you need to know,” Lawrence said. “It’s just been hell. Very stressful.”
Nursing homes across the United States got a glimpse of the onslaught to come when COVID-19 swept through the Life Care Center in Kirkland, Washington, in late February and early March, killing at least 37 people and infecting many more. This upscale nursing home in the suburbs of Seattle had some of the earliest reported cases of the illness in the United States, but since then, nursing homes have become particularly precarious places, where a single infection can lead to dozens of deaths among elderly residents and their caregivers. Within a week of the reports coming out of Kirkland, boxes of personal protective equipment (PPE) started arriving. Photos of Servpro disaster recovery teams show nurses in head-to-toe protective suits brandishing high-tech respirators.
This is not what happened at Coler. I spoke with heath workers and residents, many of whom were concerned about speaking with me, to try to understand what it was like to be inside one of these facilities as this crisis unfolded. What I found was that Coler during the pandemic shows what happens when an institution with neglected residents is caught in a public health catastrophe.
The arrival of the coronavirus at Coler was swift and brutal. The first case was detected in mid-March, when two long-terms residents in a women’s unit tested positive for COVID-19 and one passed away. Since then, some staff estimate that over 20 residents have died. “They’re just not testing anymore,” said Cynthia, a staff nurse who is using a pseudonym for fear she might lose her job. “They said treat them all as infectious. Residents are dying every day.” There have been five deaths in Cynthia’s unit, all of whom were showing COVID-19 symptoms; she insists that none had been tested. The NYC Health + Hospitals (NYC H+H), the city agency that runs Coler, declined to comment on the number of resident deaths, citing confidentiality for patient privacy.
“They’ve been completely non-transparent with the residents and with the families of the residents,” said Patria Frias-Colon, whose cousin is paraplegic and has lived at Coler for more than 15 years. “Part of the perception among the residents is that because they are predominantly people of color—many of them young, mostly Latino and African American men who ended up there as the result of gun violence—the administration really doesn’t care about them.”
On Monday, March 16, the day after deciding to close New York City’s public schools, Mayor Bill de Blasio held a press conference to explain how the city was going to respond to the rapidly escalating spread of the coronavirus across its five boroughs. At that time there were 464 cases, but over the next month the number of cases skyrocketed to 112,141, and confirmed deaths rose to 7,890, which turned New York into the epicenter of the outbreak, first in the US and then in the world. De Blasio listed the groups of people most at risk. “Over 50, preexisting serious conditions—diabetes, lung disease, heart disease, cancer, compromised immune system. Those individuals are in the greatest danger by far,” said the mayor, who could have been describing the demographics of Coler. “Those are the people we have to go—all of us—out of our way to protect, not let anyone sick near them, make sure they are staying in, to the maximum extent possible.”
Then de Blasio outlined the city’s plan to deal with shortages in hospitals, which included moving patients into what he characterized as unused hospital facilities like Coler. “The Coler facility on Roosevelt Island, an H + H facility that was empty, it is being immediately brought back online—350 beds.” said de Blasio. “It will be ready in approximately a week’s time.”
But Coler was not empty—almost 500 people lived there. De Blasio’s administration issued a correction after being contacted by the local cable news station Spectrum News NY1. Officials then noted that Coler would only receive overflow patients from other hospitals, not patients with COVID-19 who could potentially endanger those who lived and worked there. On March 29, NYC H+H put out a statement: “The facility can hold a total of 350 non-COVID patients.” Since Coler was not supposed to receive patients who had the disease, the staff wasn’t prioritized to receive PPE.
Roosevelt Island has a long history of dealing with epidemics, quarantines, and forced isolation. It’s the home of America’s first smallpox hospital, as well as a psychiatric asylum and a prison—all of which are now destroyed or abandoned. Coler is a sprawling brick building opened in the 1940s as a hospital and long-term care facility for low-income patients. Three wings branch off the main entrance; residents live in the A and C wings, which dart off to the right and left. The entire institution is made of about 30 units with 14 people in a unit; generally one staff member is assigned to every six or seven patients. Beset by staffing shortages for years, $4.32 million was cut from Coler’s $120 million operating budget in 2019. Now, hospitals citywide are facing $400 million in cuts in the midst of a pandemic.
Those shortages have proved deadly. Cynthia’s unit is normally staffed with five health care workers. In April, she said that number dropped to three as her colleagues started calling out of work, either because they were sick or afraid of getting infected. “They are so short on staffing,” Cynthia said, “one day I came in and I was the only nurse on my floor, caring for two units.” The shortages only exacerbate the discomfort and poor health of residents. Another nurse who asked not to be named notes, “We try our best to turn them every two or three hours so they won’t break down, but you need two people for the transfer into the chair, and two people to get them back. Right now they cannot take them out. There are too few staff.”
Even before patients from other hospitals were moved there, residents were aware of the two women who had become ill in mid-March and wondered how they could possibly have gotten infected. Cynthia said that’s when she began asking for N95 respirators and PPE, but the hospital administration told her they didn’t have any. Staff continued caring for both sick and healthy patients, lifting them out of their beds, bathing them, and turning them over—all without wearing PPE.
Two days after the residents in the A wing became sick, two residents in the C wing also tested positive for COVID-19. The Coler administration started quarantining entire units, leaving patients who were showing symptoms in the same room as those who were healthy, like LeVar Lawrence. A resident who wished to remain anonymous said that on April 10, four units in the A wing and six units in the C wing were quarantined. “It’s a lot of craziness. It doesn’t have any common sense,” the resident said of the administration’s response. “Why would you hold someone who tests positive in a unit with 50 other people? It’s going to be nothing but death.”
The administration did provide thin, paperlike surgical masks and gowns to staff if patients started showing symptoms. When residents started dying, some health workers received face shields. “I asked what happened to N95,” said Cynthia. “They said we don’t have N95. Only for nurses and doctors, not nurse’s aids.” One day, one of her patients was still healthy when she left. Four hours later, she learned that the patient had been sent to Mt. Sinai hospital and died. “A healthy patient is a dead patient in four hours. We realized we don’t know what we’re up against,” she said. “We started ripping fabric to cover our hair, making our own PPE.”
At around the same time that the first COVID-19 cases started popping up at Coler, Roosevelt Islanders were on high alert that NYC H+H might start moving overflow COVID-19 patients there. Jennilie Brewster is a Roosevelt Island resident and one of the people in charge of the Open Doors project. She’s spent a lot of time at Coler over the past four years, working closely with a handful of residents, including Lawrence, and the recreational therapy department.
Following the March 16 press conference, she immediately wrote an open letter to Mayor de Blasio in which she urged the city not to move COVID-19 patients into Coler. In response, NYC H+H issued a statement on April 8 saying it had established a new Roosevelt Island Medical Center that was separate from Coler, “with no overlap or shared space,” and “no COVID-19 patients were moved into the nursing facility.” In fact, the city had outfitted unused floors of Coler with 350 beds for these patients and named it the new “Roosevelt Island Medical Center” (RIMC).
Cynthia said RIMC is set up at least partially on the fifth floor of the C wing at Coler, and it is “not separate,” because there are shared elevators and hallways. The new staff hired to work at RIMC “come through the same doors with us, they go to the same cafeteria with us on the second floor,” she said. The space separating RIMC from Coler is so minimal that one of the new nurses got lost and wandered into Cynthia’s unit one day. The nurse asked her, “Do you have COVID here?” and Cynthia responded, “Yes.” The new nurse told Cynthia that her staffing agency had said that they don’t have COVID in the building. To which Cynthia said she responded, “That is a fat lie.”
On April 3, in an attempt to call attention to the situation, a Coler staff member posted a video to Facebook. In it, five staff nurses and nurse’s aids begged for better PPE. One of the staff members who appeared in the video confirms that they were reported to HR. If they were fired, they’d lose their pension and become ineligible for future city jobs. “Someone from management asked me, why did you do this video?” the health worker said. “I said my facility is not protecting their workers. It is wrong. We need help. They informed me that we are not allowed to speak to media or anyone outside.”
Roosevelt Island is a small town within a big city. Local residents saw the video and created a “Friends of Coler” advocacy group, collecting PPE and contacting their elected officials. “I know how under resourced, how short staffed they already were,” Brewster said. On April 16, Brewster joined Assemblymember Rebecca Seawright in Coler’s parking lot to publicly deliver hundreds of gloves and surgical masks and about 100 N95 respirators. Coler CEO Dr. Robert Hughes came out to collect the supplies but denied they were necessary, telling a New York Post reporter, “We are very fortunate, we’ve always had what we needed. This adds to our ample supply but, you know, again, we are very thankful.”
NYC H+H denies that there has been a problem with PPE at Coler. “Every clinician and staff member system-wide who needs PPE during patient care/interaction has access to it,” they said in response to a request for comment. When I asked about the staffing shortage, they replied, “Coler maintains appropriate staffing levels to provide the care required to all resident[s].” Based on what Brewster was hearing from residents and staff at Coler, she was baffled by NYC H+H’s public statements. “It seemed like they should shout from the rooftops–things are bad here,” she said, “we need masks, we need staff, bring in the marines!”
Brewster noted that Friends of Coler are still actively collecting supplies, and more orders of N95s are on the way. As of last week, nurses and doctors were receiving N95 respirators, but the nurse’s aids weren’t. “This is ridiculous,” said Cynthia. “They’re the ones on the frontlines, they do the complete care, they do the cleaning, they give the baths. They’re the ones who are the most at risk.”
NYC H+H had contracted with Krucial Staffing, a Kansas-based medical personnel staffing service, to bring in nurses from around the country to work at RIMC. Some of the nurses are now suing Krucial Staffing alleging the agency had put them in unsafe conditions without proper PPE. According to court documents, a nurse from Alabama who uses the pseudonym Wyatt Logan first visited Coler on Tuesday, March 24. According to the court filing, he realized that any nurse working at Coler “would have vastly increased chances of contracting COVID,” because they have “inadequate PPE” and they were putting patients with COVID symptoms in crowded rooms, up to four beds per room. The close quarters and lack of protective gear, Logan alleges, made it clear to him that the infection would spread among roommates and the staff taking care of them.
Brewster said that there is more transparency from the city now; NYC H+H has confirmed that they are moving COVID-19 patients into unused floors at Coler, now the “Roosevelt Island Medical Center.” But the Mayor’s initial comment that Coler is “empty” has had damaging effects. “When you say Coler is empty, and actually 500 people live there, and you don’t correct that publicly, it is denying their experiences,” Brewster said. “Coler is not empty. It feeds this mythology that Roosevelt Island is this abandoned place.”
On April 17, more than a month after de Blasio’s press conference, Roosevelt Island’s three local elected officials, Gale Brewer, Rebecca Seawright, and José Serrano, wrote a letter to Dr. Mitchell Katz, president and CEO of NYC H+H. “There have been numerous—and sometimes conflicting—accounts regarding PPE, staffing, safety of patients, and nursing home residents as the new 350-bed facility comes online,” they wrote. They requested that NYC H+H confirm the numbers of COVID and non-COVID patients that have been admitted to Coler and outline the steps they’re taking when someone shows COVID symptoms. They also requested that all residents at Coler get “tested once a week for COVID.”
Seawright’s office said there has not been a response yet from NYC H+H. But according to one long-term resident who wishes to remain anonymous, during the week of April 20 they started isolating patients showing COVID-19 symptoms and fitting nurse’s aids for N95 respirators. They also started bringing in more staff from an outside agency.
Frias-Colon acknowledged that hospitals in New York City are under intense strain and need overflow beds. But she wants to know if there were any plans for keeping Coler’s original patients safe. “The message is not that we don’t want these people there,” she said referring to the COVID-19 patients who were being moved to the facility. “If there’s space they should do it, but only if it won’t compromise the patients, only if administration or staff show that they are equipped to follow the protocols they should be following. And they’re not doing it.”
So far Lawrence hasn’t had any symptoms of the coronavirus. But mentally, he is finding it hard to keep his spirits up, stuck in his room, and sometimes in his bed, as residents around him get sick. One of his fellow Reality Poets at Coler, Roy Watson, died on April 7, at the age of 65, after testing positive for COVID-19. As someone who has grown accustomed to living largely indoors, Lawrence can offer some guidance about how to cope with the pandemic. He shared one of his poems with me:
Doctor comes in shaking his head
Telling me that I will never walk and will be stuck in the bed
Told me that I needed a trache in my neck to help me breathe
Visiting hours over
Don’t want my baby mother to leave
Then looking up in the sky asking God why
Did he save me and just didn’t let me die
At that moment he spoke and said, “You’re special to me.
I have more in store for you
Just wait you’ll see.”
I told him that I didn’t want to hear that shit
Unless he’s giving me the ability to walk
He said, “My child, I just gave you back the ability to talk!”
Now, I just gave y’all part of my life to see
I know nothing about you but now you know a little bit about me