A nursing home patient called 911 to alert authorities to the heat problems in Baltimore’s Ravenwood Nursing and Rehabilitation Center. As a result, the state ordered evacuation of the facility’s 150 patients.

The patient may have saved many lives. This could have been a very deadly situation. Temperatures in the facility’s rooms were measured at 93 degrees. The Center had been using room air conditioners to attempt to deal with the heat, but patients reported that they weren’t effective. (Not too surprising, because room air conditioners can only serve a small area, and in larger buildings they’re usually inadequate.)

The state Department of Health and Mental Hygiene is currently looking at the failure to report conditions potentially harmful to patients as required by law. The obvious issues created by a patient making a report have called into question the efficacy of these reporting requirements.

The nursing angle in this story refers what appears to be an equally inadequate process. On learning of the situation, the Department contacted local nursing homes and the Health Facilities Association of Maryland. Staff from other facilities were tasked to go to Ravenswood and assess the situation.

The Department clearly did everything it could, as soon as it could, but this situation highlights a gaping procedural hole in the system.

Consider the logic:

1. Ravenswood has obviously been caught short by the heatwave. It does what it can, but it’s the wrong option.
2. The Department apparently lacks direct means of monitoring situations like this.
3. Third parties are required to drop everything and come to the rescue, which fortunately they did.
4. Dangerous heatwaves have been common for at least a decade. Public health warnings are common around the world.
5. There’s no major mystery about the possible health effects of heat stress on vulnerable patients. They’re a primary risk group.

The actual result, however, was caused by the fact that none of the obvious precautions were taken. There was apparently nobody on site at Ravenswood able or willing to make a report. The reporting system therefore had no hope of working.

What, exactly, is wrong with having some qualified nurses checking up on these well-flagged seasonal public health issues?

Not wishing to criticize the Department, because it did the best it could with what it had in the emergency, but wouldn’t things work a bit better if these problems didn’t happen? This procedure isn’t working, didn’t work, and can’t be trusted to work in future.

The net cost to the state of Maryland of a few nurses making sure public health regulations are being complied with is likely to be a lot less than the cost of large numbers of lawsuits for medical negligence. Nurses are trained to make these judgments, and having a few onsite to deal with dehydration, kidney damage and treating the related conditions of heat stress wouldn’t hurt, either.

The economic issues of health care can only go so far. Prevention is a primary medical process. That applies to health regulations, too.