A state investigation has found that a Denver assisted living facility took 13 minutes to locate a resident who collapsed and begin CPR — failures regulators say placed all residents in “immediate jeopardy.”

The Colorado Department of Public Health and Environment concluded that The Argyle assisted living facility violated multiple rules in connection with the January death of 73-year-old Robert Dutkevitch. The violations were classified at the CDPHE’s most serious level, indicating 125 Argyle residents were at immediate risk of harm, according to the agency.

The findings stem in part from the facility’s own surveillance video system, which captured the events leading up to Dutkevitch’s death. CBS Colorado obtained copies of the same videos reviewed by state investigators.

According to police reports, video footage, interviews and the state investigation, Dutkevitch — who used a wheelchair — went outside to a designated smoking patio at about 8:30 p.m. on Jan. 6. Roughly 2 minutes later, the video shows him slumping forward and falling from his wheelchair onto the ground. He remained there for about 8 minutes before another resident noticed him and alerted staff. Surveillance footage shows several staff members arriving at the patio and determining Dutkevitch had no pulse. However, investigators say staff did not begin CPR immediately, waiting approximately five additional minutes before attempting lifesaving measures.

In total, 13 minutes passed from the time Dutkevitch collapsed to the start of CPR.

State investigators cited the delay as a critical deficiency, noting that trained staff are required to provide CPR promptly. According to Denver police call logs obtained by CBS Colorado, one staff member told a 911 operator she did not want to perform chest compressions because she had the flu.

After CPR was finally initiated, Denver Fire personnel arrived and continued lifesaving efforts for approximately 30 minutes before Dutkevitch was pronounced dead.

The death was later classified as natural, with acute coronary syndrome and atherosclerosis listed as the immediate causes, according to the death certificate.

Colorado investigators finds monitoring problems 

The state investigation also found problems with how the facility monitored its outdoor smoking area.

A surveillance camera was positioned on the patio, but The Argyle said the video feed was not continuously monitored. State regulations require that designated smoking areas “shall be monitored whenever residents are present.”

According to the report, the facility administrator acknowledged there was “no official process” in place to monitor the area. The administrator told investigators he was unaware of the regulation and said the facility did not have enough staff to continuously monitor the patio.

The department concluded the facility failed to meet CPR requirements because it “failed to require all staff certified in CPR to provide CPR services promptly.”

Investigators found gaps in training and preparedness. One staff member was described in the CDPHE report as “unaware of how to respond,” while others said they had not been trained on what to do if a resident becomes unresponsive.

“I did not respond very well, I’m sorry,” one staff member told investigators.

CPR delay leaves widow devastated

Dutkevitch’s widow, Sharon Dutkevitch, said the delay in care has left her devastated.

“My heart aches. I cry every night,” she said. “Every second that went by, he didn’t have a chance that way. I wish I had been there to help him.”

After watching the surveillance video, she questioned why staff did not act immediately.

“I don’t understand why caregivers stand around and do not give him CPR,” she said. “Those people are standing around him doing nothing to help him. That’s what really hurts.”

 She believes her husband might have survived if CPR had been started sooner.

“You’re losing brain cells every second that goes by without CPR,” she said.

Dutkevitch had been a resident at The Argyle since 2022 and, according to his wife, generally liked living there. He had several health conditions, including high blood pressure and cognitive decline.

He also had written directives on file stating that he wanted life-saving measures, including CPR, performed in an emergency.

Anita Springsteen, an attorney representing Sharon Dutkevitch, said the response by staff fell far short of expectations.

“They took so long to respond and didn’t seem to be aware there was an emergency going on,” Springsteen said. “Once they were aware, they lingered around and didn’t do anything, didn’t immediately give CPR, didn’t do the things you would think a facility like that — with trained staff — would do on an immediate basis.”

Springsteen said a lawsuit is likely.

“It seems like there was a window in there where something could have been done — he could have been saved,” she said.

The state issued an immediate $2,500 fine and ordered The Argyle to correct multiple deficiencies related to the case.

A spokesperson for the facility said those issues were addressed by Feb. 12 and that the “immediate jeopardy” designation was lifted that day.

The Argyle challenges some of state report’s conclusions

Since Dutkevitch’s death, the facility says it is no longer accepting residents who smoke and now closes its outdoor smoking patio each night at 10 p.m.

The Argyle administrators declined an on-camera interview request from CBS Colorado. In a written statement, administrators said they take resident safety and regulatory compliance “extremely seriously” and have implemented additional training, communication protocols, and oversight measures.

The facility said some conclusions in the state report are being challenged.

Argyle officials maintained that staff members who were CPR-certified responded promptly once they became aware of Dutkevitch’s condition, contacted emergency services immediately, and followed instructions from 911 operators.

The Argyle also defended its training practices, saying it maintains comprehensive onboarding and ongoing instruction in CPR certification and emergency response procedures, and is reinforcing those processes.

Regarding the “immediate jeopardy” designation, the facility said it does not reflect the overall safety and care provided and noted it was lifted shortly after the state required the addition of an “Unresponsive Resident Policy.”

The facility also disputed findings related to monitoring the smoking area, stating that regulators agreed a camera system could be sufficient for monitoring during discussions about the rule.

A spokesperson for the Colorado Department of Public Health and Environment said the investigation is continuing.

“The investigation of Argyle Living Residence is still ongoing,” said spokesperson Alexandrea Kallin. “Until it’s complete, we cannot provide any additional information. Investigations vary in their complexity and can take some time to complete.”

Sharon Dutkevitch said she chose to speak publicly in hopes of preventing similar incidents.

She said she wants accountability and change — “so no one else goes through this.”