A Bronx nursing home with one of the highest reported coronavirus death tolls in New York is at the center of a class-action lawsuit that accuses the facility of poor treatment and low staffing.

Forty-five residents as of Tuesday have died due to the coronavirus at Kings Harbor Multicare Center, one of a handful of nursing homes statewide that have reported more than 40 coronavirus deaths, state data shows.

The lawsuit in Bronx Supreme Court sparks questions about what steps were taken to protect residents and whether the 720-bed facility was prepared to handle the virus.

As the U.S. continues to reel from the pandemic, nursing home death totals are painting a clearer picture of the virus' devastation on the most vulnerable in society. It's also drawing national attention to long-running issues in the nursing home industry, such as low staffing that health experts say can accelerate the spread of an infectious disease.

New York state's data is still an incomplete counting of how many coronavirus deaths are tied to which nursing homes. Some of the totals include presumed COVID-19 deaths, along with confirmed COVID-19 deaths, according to the state.

Years before the pandemic crashed onto U.S. shores, the class-action lawsuit in 2015 accused Kings Harbor of being understaffed and leaving its residents in their own feces for extended periods of time. There would be no nurses on the floor for hours at a time and families would often find "no staff" at the facility, the state-level litigation alleged.

Those low nurse staffing levels left residents confined to their beds for long periods and led to long response times—or no responses—to call lights, according to the lawsuit.

Jeremiah Frei-Pearson, an attorney for the plaintiffs, said Kings Harbor engaged in slow and "scorched-earth" litigation tactics over the class-action suit.

"Because we were trapped in litigation and had not yet achieved a court order fixing the home, the home remained vulnerable," he said, reporting that Kings Harbor repeatedly refused to provide discovery information.

Frei-Pearson said he believes the nursing home's death toll would have been dramatically lower if a class had been certified and a court order came through.

"Even without coronavirus, horrible things are going to happen if you don't have enough staff to take care of the people in the home," he said. "And that was happening on a regular basis at Kings Harbor before this latest tragedy."

Kings Harbor issued a statement saying the number of deaths should be taken in context and the nursing home is many times larger than most long-term care facilities.

"We have opened up two dedicated Covid Units to relieve the surge, and help our referring hospitals with Covid patients that do not require ventilator support. These numbers are included in our totals," according to the statement.

The statement said the facility is following all recommendations from the Centers for Disease Control and Prevention.

In a letter dated Monday, Dr. Roy Goldberg, medical director at the nursing home, wrote the facility has "stringent cleaning protocols" and has had enough personal protective equipment. 

"We are heartsick over those who lost their battle with COVID-19," he wrote in the letter.

Mary Gibbs, a plaintiff in the class-action lawsuit against the facility, said in a sworn court filing that she or a family member visited her father nearly everyday due to the unsafe conditions at the nursing home.

Gibbs, a nurse aide and nurse technician for nearly 30 years at a hospital, said she was shocked at Kings Harbor's staffing levels and often smelled urine and feces because staff didn't clean up the waste, according to the affidavit.

She said her father was routinely left to sit in a chair for up to eight hours. Some days, according to the affidavit, he was simply left in bed all day because there were not enough staff members to move him from the bed to a chair.

The firm Mauro Lilling Naparty, the appellate counsel for the nursing home, issued a statement saying Kings Harbor is disappointed the case has continued for years. The firm said the coronavirus crisis is affecting all nursing homes and there is not a connection between the class-action suit and the pandemic.

Overall, health experts told the New York Law Journal that low staffing levels in nursing homes can quicken the spread of an infectious disease. When staff are overburdened with resident care, there can be lapses in prevention efforts aimed at stopping the spread of a virus, they said.

New York state reports that more than 3,500 residents from nursing homes or adult care facilities have died from the virus as of Tuesday. The death total includes deaths at facilities and at hospitals.

"There is sort of the perfect breeding ground for an infection like this," said Dr. Morgan Katz, an assistant professor at Johns Hopkins University, commenting on nursing homes.

Gov. Andrew Cuomo on Thursday announced there will be a joint investigation on nursing homes by the state Department of Health and the state Attorney General's Office. He said the investigation will be into whether New York nursing homes are following rules.

Cuomo, a Democrat, indicated that part of the investigation will look into why certain nursing homes have high death figures.

Nursing homes can face fines or lose their license if policies are not being followed, he said. Among those rules, an executive order measure requiring nursing homes to notify a family member or a next of kin if any resident tests positive for the virus or suffers a death related to COVID-19.

Those notifications must occur within a 24-hour period, according to the order.