Source : http://www.rgj.com/article/20091112/NEWS01/91112064/1018/SPORTS/Reno-woman-facing-elder-abuse-and-concealed-weapon-charges-allegedly-found-with-drugs-in-jail-cell
By Jaclyn O'Malley • jomalley@rgj.com • November 12, 2009
A 35-year-old former Washoe County legal guardian jailed last week for bringing an unloaded gun into a Reno court was booked additionally for possessing prescription drugs after deputies found them during a search of her jail cell.
Angela Cheri Dottei was arrested Nov. 3 on suspicion of carrying a concealed weapon into Reno Justice Court. An unloaded firearm was allegedly found in her belongings as she went through the court’s metal detector. Authorities said she had gone to the court for a scheduled hearing. She was arrested on-site and later ordered jailed in lieu of $25,000 cash bail.
Dottei is also under investigation by Reno police for allegedly financially exploiting her elderly wards. A Washoe Family Court investigation revealed she was allegedly stealing money from her wards while in her role as a legal guardian through her company, Assurity Guardian Resources. A judge in September placed sanctions upon her, fined her hundreds of thousands of dollars and suspended her license to work as a guardian.
Wednesday, during a search of her jail cell, deputies found a plastic bag containing multiple types of prescription drugs hidden in hygiene products, said Deputy Brooke Keast. She was booked additionally on two counts of suspicion of possessing a controlled substance by an inmate, which is a felony.
Deputies were still investigating how she possessed the drugs. Keast said that under the law, inmates may not be strip searched unless there is a reasonable suspicion they may have hidden contraband. In this case, she said deputies had no reason to believe she hid anything.
Keast said it’s rare that inmates are found in possession of drugs.
“We always do systematic searches of cells,” she said. “The search is what lead us to finding the drugs. It’s why we do them.”
Reno police fraud detectives say they are investigating Dottei for allegedly exploiting at least three of her elderly wards. No charges have been filed.
Source : http://www.rgj.com/article/20091112/NEWS01/91112064/1018/SPORTS/Reno-woman-facing-elder-abuse-and-concealed-weapon-charges-allegedly-found-with-drugs-in-jail-cell
Friday, November 13, 2009
Tuesday, November 10, 2009
BOOMERS RICH TARGETS FOR ESTATE LOOTERS
January 11th, 2008
http://www.lawnewtrends.com/law/20080111/boomers-rich-targets-for-estate-looters.htm
"Gone to Texas" was a phrase used by Americans immigrating to Texas in the 19th century and is applicable again today as the Baby Boomers (Americans born 1946-1964) begin to retire and relocate, as in times past, to Texas. Georgetown, Texas, was just named a top retirement town by Where to Retire magazine and a recent report by the North Carolina Center for Creative Retirement lists Texas as the #2 state for retiree relocation surpassing Arizona and continuing to close the gap with Florida.
Whether in Texas or elsewhere, being a retirement "hot spot" energizes everyone from government officials and Chambers of Commerce to realtors and other business interests. The concentration of a retirement-age population, however, can bring another element into a community - predators seeking to operate within probate venues so as to divert estate assets from intended beneficiaries or heirs. In more simple terms, modern day looters and poachers intent on using the American legal system to steal property from the dead or disabled/incapacitated.
A new Horace Cooper column entitled A New Inheritance Tax for Baby Boomers discusses the upcoming transfer of wealth from Baby Boomers to their heirs and warns that "inheritance and estate planning scams are reportedly on the rise and perhaps even more pernicious is the rise in inheritance related litigation as the ever larger stockpiles of cash and real estate act as a magnet for trouble-makers." Involuntary Redistribution of Assets (IRA) acts that base Lawsuits on probate instruments such as trusts, wills and guardianships are insightfully characterized as a litigation tax on inheritance.
That lifelong productivity and an accumulation of assets could cause a person to become a target is the reality of today's world. The upcoming years will see a transfer of wealth prompting new IRA efforts. Legal speculation is fueling some of these cases as legitimate heirs are induced to "settle" opposed to expending resources to defend frivolous claims. People think proper estate planning will protect them or that they don't have enough assets to be a target, but there is no inoculation from the threat of IRA. Entrusting the execution of your wishes to an individual who is respectful of your wishes is key, but thwarting of this effort occurs as IRA practitioners are often shameless masters of deception.
Law enforcement and the courts provide minimal safeguard or justice. Local authorities often refrain from criminal prosecutions and instead defer IRA adjudications to civil courts. Court battles are the traditional "remedy" for such actions. But win or lose, massive financial expense as well as a stringent emotional toll can yield the only true "winners" in these cases to be the participating Lawyers. Many people cannot afford to take action as our courts are a pay-to-play venue. Others recognize that even with a meritorious case, many IRA actions involve a Lawyer as a primary or secondary perpetrator and judges (usually former Lawyers) are not known for taking substantive action against "their own kind." With increased understanding, the need for criminal prosecutions will hopefully become self evident and communities will take action to ultimately protect their residents - both the living and the dead. The prospect of a few years behind bars might one day make poaching Uncle Paul's nest egg less appealing, but we are not there yet.
In his column, Horace Cooper encourages people to review their estate plans. IRA cases happen quietly and those involved in estate looting actions want to keep it that way. Two other areas of vigilance, however, also exist. First, take a look at your own community. Your town is likely home to "trouble-makers" as described by Cooper - those who use the legal system to subject legitimate heirs to this litigation tax on inheritance. Work to know who these people are and avoid them. Hopefully others will do the same and your area will cease to be viewed as potentially target rich. Also, make this an election issue with local officials, especially your judges. When these cases come before a judge, does the judge support individuals' property rights or their legal industry peers' property poaching actions?
Involuntary Redistribution of Assets (IRA) actions occur through abuse of probate venues and/or probate documents such as wills, trusts or guardianships. When taken to court, these actions truly become a de facto inheritance litigation tax. They happen daily and if many in the legal industry continue prevailing in their quest to keep this an undocumentable, "overstated" non-issue, the lifelong asset accumulation of an entire generation is at risk. Areas with heavy retirement populations must be especially vigilant. The upcoming transfer of wealth will occur, but without prompt legal system reform, the property recipients may be far different from what many Baby Boomers anticipate.
Lou Ann Anderson is an advocate working to create awareness regarding the Texas probate system and its surrounding culture. She is the Online Producer at http://www.lawnewtrends.com/law/20080111/%22http://www.EstateofDenial.com%22 and may be contacted at http://www.lawnewtrends.com/law/20080111/%22mailto:info@EstateofDenial.com%22
Related posts:
Estate Planning Advice From Walters And Ward, A.p.c
Baby & Echo Boomers: - How Generational Trends Affect the Real Estate Market?
Living Trusts And Estate Planning
Protecting Women And Children Through Estate Planning
Revocable Living Trust Vs Will
Posted in Law Tags: guardianships, nerve endings, probate abuse, probate corruption, profession
http://www.lawnewtrends.com/law/20080111/boomers-rich-targets-for-estate-looters.htm
"Gone to Texas" was a phrase used by Americans immigrating to Texas in the 19th century and is applicable again today as the Baby Boomers (Americans born 1946-1964) begin to retire and relocate, as in times past, to Texas. Georgetown, Texas, was just named a top retirement town by Where to Retire magazine and a recent report by the North Carolina Center for Creative Retirement lists Texas as the #2 state for retiree relocation surpassing Arizona and continuing to close the gap with Florida.
Whether in Texas or elsewhere, being a retirement "hot spot" energizes everyone from government officials and Chambers of Commerce to realtors and other business interests. The concentration of a retirement-age population, however, can bring another element into a community - predators seeking to operate within probate venues so as to divert estate assets from intended beneficiaries or heirs. In more simple terms, modern day looters and poachers intent on using the American legal system to steal property from the dead or disabled/incapacitated.
A new Horace Cooper column entitled A New Inheritance Tax for Baby Boomers discusses the upcoming transfer of wealth from Baby Boomers to their heirs and warns that "inheritance and estate planning scams are reportedly on the rise and perhaps even more pernicious is the rise in inheritance related litigation as the ever larger stockpiles of cash and real estate act as a magnet for trouble-makers." Involuntary Redistribution of Assets (IRA) acts that base Lawsuits on probate instruments such as trusts, wills and guardianships are insightfully characterized as a litigation tax on inheritance.
That lifelong productivity and an accumulation of assets could cause a person to become a target is the reality of today's world. The upcoming years will see a transfer of wealth prompting new IRA efforts. Legal speculation is fueling some of these cases as legitimate heirs are induced to "settle" opposed to expending resources to defend frivolous claims. People think proper estate planning will protect them or that they don't have enough assets to be a target, but there is no inoculation from the threat of IRA. Entrusting the execution of your wishes to an individual who is respectful of your wishes is key, but thwarting of this effort occurs as IRA practitioners are often shameless masters of deception.
Law enforcement and the courts provide minimal safeguard or justice. Local authorities often refrain from criminal prosecutions and instead defer IRA adjudications to civil courts. Court battles are the traditional "remedy" for such actions. But win or lose, massive financial expense as well as a stringent emotional toll can yield the only true "winners" in these cases to be the participating Lawyers. Many people cannot afford to take action as our courts are a pay-to-play venue. Others recognize that even with a meritorious case, many IRA actions involve a Lawyer as a primary or secondary perpetrator and judges (usually former Lawyers) are not known for taking substantive action against "their own kind." With increased understanding, the need for criminal prosecutions will hopefully become self evident and communities will take action to ultimately protect their residents - both the living and the dead. The prospect of a few years behind bars might one day make poaching Uncle Paul's nest egg less appealing, but we are not there yet.
In his column, Horace Cooper encourages people to review their estate plans. IRA cases happen quietly and those involved in estate looting actions want to keep it that way. Two other areas of vigilance, however, also exist. First, take a look at your own community. Your town is likely home to "trouble-makers" as described by Cooper - those who use the legal system to subject legitimate heirs to this litigation tax on inheritance. Work to know who these people are and avoid them. Hopefully others will do the same and your area will cease to be viewed as potentially target rich. Also, make this an election issue with local officials, especially your judges. When these cases come before a judge, does the judge support individuals' property rights or their legal industry peers' property poaching actions?
Involuntary Redistribution of Assets (IRA) actions occur through abuse of probate venues and/or probate documents such as wills, trusts or guardianships. When taken to court, these actions truly become a de facto inheritance litigation tax. They happen daily and if many in the legal industry continue prevailing in their quest to keep this an undocumentable, "overstated" non-issue, the lifelong asset accumulation of an entire generation is at risk. Areas with heavy retirement populations must be especially vigilant. The upcoming transfer of wealth will occur, but without prompt legal system reform, the property recipients may be far different from what many Baby Boomers anticipate.
Lou Ann Anderson is an advocate working to create awareness regarding the Texas probate system and its surrounding culture. She is the Online Producer at http://www.lawnewtrends.com/law/20080111/%22http://www.EstateofDenial.com%22 and may be contacted at http://www.lawnewtrends.com/law/20080111/%22mailto:info@EstateofDenial.com%22
Related posts:
Estate Planning Advice From Walters And Ward, A.p.c
Baby & Echo Boomers: - How Generational Trends Affect the Real Estate Market?
Living Trusts And Estate Planning
Protecting Women And Children Through Estate Planning
Revocable Living Trust Vs Will
Posted in Law Tags: guardianships, nerve endings, probate abuse, probate corruption, profession
Financial exploitation: the best kept secret of elder abuse
Financial exploitation: the best kept secret of elder abuse
SOURCE: Aging, Spring, 1996 by Health Care Industry
href="http://findarticles.com/p/search/?qa=A.">A. Paul Blunt
The injuries suffered by an older person from physical abuse or neglect are tragic, but there's a much less sensational and publicized form of elder abuse - financial exploitation - that can be equally devastating. When a relative or "friend" exploits an older person and manages to drain away savings and assets that have taken years to accumulate, from that point on, the elder's life style is severely diminished. Despite its devastating impact, financial exploitation seems to be the least understood of all forms of elder abuse. A review of the literature on elder abuse and neglect reveals that most books and articles spend little or no time on financial exploitation. In addition, most protective service agencies, which are charged with investigating financial abuse cases, do not adequately train their caseworkers to handle the problem. Usually, adult protective services (APS) caseworkers either are trained as social workers or come from other public service agencies that emphasize the caregiving or social services aspect of elder care. While this kind of background equips APS workers to deal with abuse or neglect cases, it does not provide them with expertise in investigating financial cases involving the transfer of monies and properties from incapacitated or vulnerable adults.
More Articles of Interest
Making the perpetrator pay: collecting damages for elder abuse, neglect and...
Living with the Enemy
Warning signs: elder abuse and neglect
Challenges in prosecuting elder abuse
Prevention of financial abuse, focus of new institute at Brookdale Center on...
Finally, there is an overall reluctance to report financial exploitation. Elderly victims may fail to report either because of their own incapacity or because of the stigma they feel would be attached to their being identified as a victim. An older person may also be reluctant to inform on a relative or caregiver who is exploiting because of emotional or psychological attachment to the person. Professional service providers, such as bank personnel, attorneys and health care workers often fail to report such cases either because they don't know which agency to call or because they adhere to a policy of strict confidentiality with respect to their client's affairs.
How Do You Recognize Financial Exploitation?
While the definition of financial exploitation varies among the states, the one most commonly cited is illegal or improper use of an elder's or incapacitated adult's resources for profit or gain. (This definition comes from A Comprehensive Analysis State Policy Related to Elder Abuse, published by the American Public Welfare Association/National Association of State Units on Aging in July 1986.) Service professionals should check their local laws to determine the precise definition used in their county or state.
(continue reading)
http://findarticles.com/p/articles/mi_m1000/is_n367/ai_18200034/
SOURCE: Aging, Spring, 1996 by Health Care Industry
href="http://findarticles.com/p/search/?qa=A.">A. Paul Blunt
The injuries suffered by an older person from physical abuse or neglect are tragic, but there's a much less sensational and publicized form of elder abuse - financial exploitation - that can be equally devastating. When a relative or "friend" exploits an older person and manages to drain away savings and assets that have taken years to accumulate, from that point on, the elder's life style is severely diminished. Despite its devastating impact, financial exploitation seems to be the least understood of all forms of elder abuse. A review of the literature on elder abuse and neglect reveals that most books and articles spend little or no time on financial exploitation. In addition, most protective service agencies, which are charged with investigating financial abuse cases, do not adequately train their caseworkers to handle the problem. Usually, adult protective services (APS) caseworkers either are trained as social workers or come from other public service agencies that emphasize the caregiving or social services aspect of elder care. While this kind of background equips APS workers to deal with abuse or neglect cases, it does not provide them with expertise in investigating financial cases involving the transfer of monies and properties from incapacitated or vulnerable adults.
More Articles of Interest
Making the perpetrator pay: collecting damages for elder abuse, neglect and...
Living with the Enemy
Warning signs: elder abuse and neglect
Challenges in prosecuting elder abuse
Prevention of financial abuse, focus of new institute at Brookdale Center on...
Finally, there is an overall reluctance to report financial exploitation. Elderly victims may fail to report either because of their own incapacity or because of the stigma they feel would be attached to their being identified as a victim. An older person may also be reluctant to inform on a relative or caregiver who is exploiting because of emotional or psychological attachment to the person. Professional service providers, such as bank personnel, attorneys and health care workers often fail to report such cases either because they don't know which agency to call or because they adhere to a policy of strict confidentiality with respect to their client's affairs.
How Do You Recognize Financial Exploitation?
While the definition of financial exploitation varies among the states, the one most commonly cited is illegal or improper use of an elder's or incapacitated adult's resources for profit or gain. (This definition comes from A Comprehensive Analysis State Policy Related to Elder Abuse, published by the American Public Welfare Association/National Association of State Units on Aging in July 1986.) Service professionals should check their local laws to determine the precise definition used in their county or state.
(continue reading)
http://findarticles.com/p/articles/mi_m1000/is_n367/ai_18200034/
Monday, November 9, 2009
Nation's nursing homes are quietly killing thousands
Nation's nursing homes are quietly killing thousands
Articles Courtesy of the STL.TODAY.comBy Andrew Schneider and Phillip O'Connor Copyright 2002 A special report by the ST. LOUIS POST-DISPATCH Posted 10/12/2002
Thousands of America's elderly mothers, fathers and grandparents are being killed each year in the nation's nursing homes - frail victims of premature and preventable deaths.
This quiet pandemic is rarely detected by government inspectors, investigated by law enforcement, appraised by medical examiners or prosecuted by anyone.
These deaths are not at the hands of crazed "angels of death."
Most are caused by fatal neglect traced to caregivers upon whom residents depend for food and liquid and for turning them in their beds to prevent the formation of life-threatening sores, say investigators and leading researchers in elderly care.
"Unlawful abuse and neglect is widespread, underreported, infrequently prosecuted and the cause of untold suffering, injury, illness and death," Marie-Therese Connolly, who heads the U.S. Department of Justice Nursing Home Initiative, says in a study published last month in the Journal of Health Care Law and Policy.
These are examples of the types of deaths Connolly describes:
Pulaski County, Arkansas coroner Mark Malcolm (left) and deputy coroner Tim Irizarry remove the body of Willie B. Harris, an 83-year-old woman, for autopsy after she died in a North Little Rock nursing home. Malcolm decided to further investigate the death after talking to family members who detailed past treatment for broken ribs and recurring infections. Donald Mallory, lost 40 pounds in a 37-day stay in the former Claywest Nursing Home in St. Charles. Court records state that Mallory, 60, was dehydrated, malnourished and rife with infection from bedsores when he died. Doctors who reviewed Mallory's medical records for a lawsuit said neglect caused his death.
Ruby Faye Martin, 88, died in Mount Vernon Countryside Manor in Mount Vernon, Ill., of sepsis, an overwhelming bacterial infection that poisons the blood. An evaluation of her medical records by a doctor who specializes in medical problems of the elderly stated that the death was caused or exacerbated by malnutrition and multiple infected bedsores caused by poor care at the nursing home. A home official declined to comment.
Rex Riggs was in stable condition when transferred to Beverly Healthcare nursing home in Neosho, Mo., according to Veterans Administration doctors. Six weeks later, the disabled Vietnam War veteran, 57, was hospitalized with gangrenous infections that led to the surgical removal of his scrotum, penis and lower abdomen. He died three days later. Federal investigators said bad nursing care caused his death.
Prosecutors charged no one in the three cases.
Government documents and court records reviewed by the Post-Dispatch show hundreds of similar deaths caused by neglect in nursing homes across the nation.
The latest national compilation of more than 500,000 nursing home deaths - for 1999 - lists starvation, dehydration or bedsores as the cause on 4,138 death certificates. The data, collected by the National Center on Health Statistics, include 138 such deaths in Missouri and 186 in Illinois.
But death certificates alone don't begin to tell the story.
A handful of investigators and researchers, working in specific geographic areas, took the time to compare patient medical records with their death certificates. Plaintiffs' lawyers, representing aggrieved relatives across the country, have gone through the same exercise.
Their findings indicate that the number of preventable deaths attributable to malnutrition, dehydration and bedsores from bad care or no care is much higher.
Louisiana Sen. John Breaux, a Democrat and chairman of the Senate Special Committee on Aging, called deaths from nursing home neglect "a hidden problem."
"We know it's significant," said Breaux, noting that investigations by his staff and other research show that 500,000 to 5 million cases of elderly neglect and abuse take place in institutions and private homes each year, although about 80 percent go unreported.
"The number of avoidable deaths of our elderly could be in the tens of thousands," said Breaux, who along with Republican Sen. Orrin Hatch of Utah last month introduced the Elder Justice Act, which seeks to prevent such deaths.
Many medical and regulatory investigators who work in nursing homes every day characterize the number of wrongful deaths in terms such as "massive" and "pervasive," based on their daily experience. Most of the deaths can be traced to an inadequate number of nurses and aides to provide life-sustaining care. The U.S. Department of Health and Human Services reported to Congress this year that nine out of 10 nursing homes have staffing levels too low to provide adequate care.
There are a number of reasons for the shortages, which plague the entire health care industry, including hospitals. Many workers are unwilling to accept poverty-level wages for unpleasant, demanding work that often requires mandatory overtime or double shifts. Constant corporate focus on the bottom line frequently requires managers to operate homes with skeleton staffing because the industry says it lacks enough government money to provide proper care.
Yet, some nursing homes find ways to provide adequate service with existing staff. Many nurses and aides are dedicated to their profession and provide excellent, compassionate care.
The American Health Care Association, the lobbying group for most of the nation's nursing homes, says malnutrition, dehydration and bedsores "are common conditions associated with the frail elderly, especially at the end of life."
"AHCA states unequivocally that any incident of neglect or abuse is unacceptable, but drawing a link of patients passing away from these maladies as a result of alleged poor care is simply irresponsible," the trade group said in a statement.
Finding deaths by neglect
Government studies in two states and the work of plaintiffs' legal teams begin to document the magnitude of the problem.
In 1998, the General Accounting Office assigned three registered nurses (two with advanced degrees in gerontological nursing) and a physician to determine what had actually killed 62 people who had died in California nursing homes. They were randomly selected from nursing homes that had multiple deaths, the GAO said.
The GAO, which is Congress' investigative arm, subpoenaed medical records and nursing notes, some of them 600 pages long. Its investigation determined that 34 of the 62 had received "unacceptable care" and had died of dehydration, malnutrition or raging infections from uncontrolled bedsores.
For example, one man lost 59 pounds - one-third of his weight - over seven weeks. A woman who had weighed 100 pounds dropped to 54 pounds before her death, and another woman developed four pressure sores so severe that they ate through to her bones. She received pain medication only three times during five weeks of painful daily treatments for the infections, the GAO investigator reported.
A year later, in 1999, complaints from nursing home workers, family members and Arkansas long-term care inspectors who believed that poor nursing care was killing residents troubled Little Rock Coroner Mark Malcolm.
"I didn't know. Nobody knew," Malcolm said. "These poor souls were cremated or buried with no one but the nursing home or its doctor deciding why they died - whether it was natural causes or because they weren't properly cared for."
Malcolm and his deputies reviewed about 100 questionable nursing home deaths that occurred from 1993 to 1999. They interviewed families and nurses and examined whatever clinical information was available on the deceased, including medical records and nursing home charts. Seven bodies were exhumed.
Working with the medical examiner's office, Malcolm determined that more than 30 percent of the death certificates listed an incorrect cause of death.
"The families were being told by the nursing homes that their loved ones died of heart attacks, strokes and other natural causes, but what we actually found was that about a third were wrongful and preventable deaths, either caused by or exacerbated by dehydration, malnutrition, including choking, or from sepsis from bedsores," said Malcolm, who was just appointed to the U.S. Department of Justice's newly formed forensic working group.
Although the number of cases reviewed was not enormous, the finding was significant enough to get the Arkansas Legislature to immediately pass a law - the only one in the nation - that demands that nursing homes notify a coroner of every death.
Arkansas nursing home regulators say the new law already has had a strong deterrent effect. The number of citations for life-threatening care issued against the state's nursing homes dropped after the law took effect.
Lawyers examine deaths
In every state, there is a group of professionals who routinely compare the cause of death listed on death certificates with the medical records of deceased nursing home residents. They are lawyers representing families who believe their loved ones were killed by poor care or no care.
An examination by the Post-Dispatch of hundreds of these court cases across the nation found that the vast majority of death certificates attributed the deaths to natural causes such as pneumonia, heart attack and - in some cases - "cessation of breathing," "heart stopped," "old age" or "body just quit."
"Our staff examines hundreds of alleged wrongful nursing home deaths a year, and only a handful of the death certificates reflected what medical records showed actually killed the person," said Tim Dollar, whose law firm in Kansas City is Missouri's largest litigator of nursing home deaths. "Some physicians go to amazing lengths to avoid admitting that by omission or commission, the nursing home killed these people."
The Post-Dispatch examined the death certificates and the physicians' evaluations of 55 nursing home residents in Missouri and Illinois who died in the past two years and whose relatives decided to sue for neglect. In 42 of the cases, the newspaper found that the cause of death listed on the certificate differed from what physicians said the medical records actually showed. In 40 of these cases, the nursing homes involved agreed to a settlement with the family before trial or were found in civil proceedings to have committed neglect.
A deadly trio of neglect
The three causes of death that the Post-Dispatch examined in its yearlong investigation - malnutrition, dehydration and bedsores - were selected because government investigators and medical experts said an overwhelming majority of such cases are preventable with proper nursing care.
When left untreated, any of the trio spawns a domino effect of system failures that can kill.
"It's like a house of cards. One slips out and the whole thing comes crashing down, and death is often inevitable," said Dr. Margaret Wilson, a gerontologist and researcher at St. Louis University. Specifically:
Malnutrition can reduce immunity from infections to an almost AIDS-like state and can quickly cause loss of muscle strength, which can lead to increased frailty, pneumonia, kidney and liver failure, and death.
Dehydration can lead to dangerously low blood pressure, which can generate strokes and heart attacks. It also can cause infections, kidney failure, uremic poisoning and death.
Decubitus ulcers or bedsores can result in flesh being eaten away down to bone and organs, causing a life-threatening toxic poisoning called sepsis. The sores come from the weight of the person's body pressing on a bone while lying in bed, which compresses the blood vessels in the skin and underlying tissues. Within only two or three hours, red, burnlike wounds appear. If left untreated, this tissue then begins to decay from lack of blood circulation.
The industry trade group said that many pressure ulcers develop before a resident enters the nursing home - a statistic it says is not often reported.
Medical authorities estimate that 12 percent to 15 percent of the deaths from the three causes could not have been prevented. They cite residents who have decided not to eat or drink. Others have diseases that aggravate bedsores or that impede the consumption of nutrition. Still others have living wills or advance directives that preclude supplemental food, liquid or medical treatment. Even allowing for those exceptions, the number of preventable nursing home deaths is far greater than reported.
"It isn't rocket science to say that you need enough staff to help every resident with eating, drinking and infections. It's not like we need to discover the cure for the Nile virus," said Catherine Hawes, a professor and director of Texas A&M University's Southwest Rural Health Research Center and a national authority in evaluating nursing home quality. "We know how this is supposed to be done, but in all too many places it's not."
An earlier tragedy
This isn't the first time that government regulators, law enforcement and medical professionals failed to detect that vulnerable victims were being killed.
"These preventable deaths in nursing homes are almost parallel to the realization 30 years ago that child abuse was an undetected and lethal problem," said Paul Weidenfeld, an assistant U.S. attorney in New Orleans.
Children would be rushed into emergency rooms with concussions or broken necks. Doctors would call the deaths tragic and chalk it up to the fact that babies fall out of cribs and kids tumble from trees or down stairs.
"Finally, people started questioning: How did the child fall? Why did that happen? And it was realized that enormous numbers of children were being abused, were being killed, and crimes were being committed," said Weidenfeld, who is co-chair of the Louisiana Nursing Home Working Group, a team of federal and state agencies that investigates poor care.
In the 1970s, doctors diagnosed so many children with unexplained head injuries that medical journals of the period were writing about spontaneous subdural hematomas - bleeding under the lining of the brain.
"They called it spontaneous because they just happened without any clinical reason for it," said Dr. Patricia McFeeley, New Mexico's assistant chief medical investigator. "Everyone believed they developed naturally.
"It wasn't until medical, law enforcement and death-investigation professionals realized that these fatal bleeds were being caused by violence, that these children were not dying of natural causes, but were being killed, did we change the way we handle these deaths," McFeeley said. "This is what we must do with the elderly. We can't trust the old system to catch these deaths."
Deficiencies are rampant
About 3 million people a year pass through America's 17,000 nursing homes. Patients occupy about 1.8 million beds on any given day; most are white women who are at least 75 years old.
Many of the 1.3 million cooks, janitors, administrators, nurses - the majority working for near poverty-level wages - treat their jobs as a calling to ease the pain and safeguard the dignity of their charges.
But it is the homes and workers that don't perform up to standard that concern most of the 700 professionals interviewed by the Post-Dispatch for this series. They include nurses, researchers, physicians, patient advocates, death investigators, nursing home operators, prosecutors and federal, local and congressional investigators.
In their eyes, government regulators are losing the war - and in some cases, not even fighting the battle - of preventing negligent deaths of the elderly.
They tell of state investigators failing to ensure safe care in homes; of government-mandated ombudsmen being prevented from intervening; and of federal regulators unable to do much about it.
These experts attribute the negligent deaths, in most cases, to inadequate numbers of nurses and aides on hand to provide basic, life-sustaining care. The detection of these deaths, they say, is often thwarted by state nursing home inspectors who fail to see - or act upon - the warning signs. The experts complain that law enforcement authorities are rarely notified of deaths by neglect and that coroners and medical examiners are seldom called.
Collin Wong, a California deputy attorney general who heads his boss's aggressive program to halt wrongful nursing home deaths, said that killings by neglect often are overlooked because "too many people shrug it off by saying, 'Old people die. So what.'
"This is not to say that every death in a nursing home should be treated as a homicide and every injury as an assault," Wong continued. "But at the same time, these deaths shouldn't automatically be chalked up to old age and natural causes. This is a major faulty perception that is allowing this pervasive neglect, these homicides, to continue."
Many deaths are called criminal
"It's homicide. Don't sugarcoat it," says Dr. Vincent Di Maio, the medical examiner for San Antonio. He has extensively researched negligent deaths in nursing homes.
"Enormous numbers of patients are being killed in nursing homes throughout the country because the administrators or the corporate executives order the staffing reduced to the point where the staff cannot provide the promised care that's needed for their patients to survive," he said.
Some prosecutors agree.
Finding that regulatory fines and bureaucratic sanctions have had minimal impact on reducing dangerously poor care, a small but increasing number of prosecutors have brought homicide charges. They've targeted nurses and aides found to be responsible for the deadly care and nursing home operators and corporate officials who fail to employ enough nurses to prevent these deaths.
Prosecutors gained allies among some state regulators who also are calling for criminal charges when death by neglect is confirmed.
"If it can be proven that the failure to feed, hydrate or properly care for wounds led to deaths in nursing homes, they should be considered as potential homicides and turned over to law enforcement for criminal investigation," said Darrell Hendrickson, Missouri's new deputy director of the Division of Health Standards and Licensure.
In Hawaii, Indiana, California and Tennessee, district attorneys, county prosecutors and state attorneys general have brought some charges of homicide for nursing home deaths by neglect over the past three years. But they number fewer than a dozen.
In Pennsylvania, Louisiana, Virginia, Florida, Kentucky and Missouri, U.S. attorneys have used a Civil War-era law to bring federal civil charges in these types of deaths.
Each year, thousands of allegations of wrongful deaths in nursing homes are brought in courtrooms across the nation by aggrieved family members. Court records show that most of these cases result in judgments against the nursing homes or pretrial settlements. But many judgments are sealed, which prevents the public and state regulators from finding out about the offending nursing home.
Misleading death certificates
The widespread undercounting of deaths attributed to the three preventable conditions is due mainly to the lack of accuracy - or what some investigators contend is intentional deception - exercised by doctors in filling out death certificates. Many are signed by physicians who have never seen the body.
"I see a lot of death certificates signed with myocardial infarction, which means: 'I don't have a clue because I wasn't there when the person died,'" said Dr. John Morley, a St. Louis University gerontologist.
Jeanie Keyser-Jones, a professor in medical anthropology at the University of California at San Francisco School of Medicine and a nationally recognized expert in nursing care, said: "Far too many death certificates list the cause as cardiac arrest, but that's (usually) a wastebasket diagnosis because obviously, everybody's heart stops when they die."
In January, the Indiana health department processed a death certificate that attributed to natural causes the death of an 80-year-old woman from respiratory problems and cardiac failure. That surprised the Evansville coroner's office, which, after an extensive examination and an autopsy, had just ruled the woman's death a homicide. The coroner said death was caused by severe dehydration. Nursing home records gave no indication that the woman had been fed or given liquid for days, he said. No sign of heart damage was found.
No one in Missouri signed more death certificates in the past four years citing malnutrition as the cause than Dr. Constantino Carpio.
Of the 242 malnutrition deaths in nursing homes listed in Missouri records during that period, the health department's vital statistics database of death information shows that Carpio signed 46.
But he denies it.
"I never sign malnutrition. I always put down bronchial pneumonia as the cause of death," said Carpio, who said he cared for 500 patients in 11 nursing homes around Troy, Mo.
When asked why, he answered: "That's what the textbooks say old people die of. You can look it up."
When Charlotte Gregory, 78, died in September 2001 in the Meadowood Nursing Center in Clear Lake, Calif., court depositions show employees tried to persuade two different physicians to list her cause of death as heart disease. Both refused, saying there was no evidence that heart failure had killed Gregory. An autopsy demanded by her family showed she had died from infection from a ruptured colon aggravated by dehydration and a misplaced feeding tube.
"It's murder," Dr. Marvin Sando, Gregory's son-in-law and a retired physician, said when he saw the autopsy results. "Whether it was unintentional or through indifference, a preventable death occurred, and it's still homicide."
The district attorney's office in California's Lake County says it is examining the evidence in the case.
Without a public outcry for reform, the outcome is predictable, say advocates for the elderly.
"If you don't feed somebody, they will die. If people aren't given adequate liquids, they will die. If an elderly person's major infection isn't treated, they will die," said Candace Heisler, who retired after 25 years of handling abuse and neglect investigations as an assistant district attorney in San Francisco. She works as a consultant to law enforcement and lawyers.
"Bad care is often as deadly as having a knife in your hand and aiming it at their heart."
Articles Courtesy of the STL.TODAY.comBy Andrew Schneider and Phillip O'Connor Copyright 2002 A special report by the ST. LOUIS POST-DISPATCH Posted 10/12/2002
Thousands of America's elderly mothers, fathers and grandparents are being killed each year in the nation's nursing homes - frail victims of premature and preventable deaths.
This quiet pandemic is rarely detected by government inspectors, investigated by law enforcement, appraised by medical examiners or prosecuted by anyone.
These deaths are not at the hands of crazed "angels of death."
Most are caused by fatal neglect traced to caregivers upon whom residents depend for food and liquid and for turning them in their beds to prevent the formation of life-threatening sores, say investigators and leading researchers in elderly care.
"Unlawful abuse and neglect is widespread, underreported, infrequently prosecuted and the cause of untold suffering, injury, illness and death," Marie-Therese Connolly, who heads the U.S. Department of Justice Nursing Home Initiative, says in a study published last month in the Journal of Health Care Law and Policy.
These are examples of the types of deaths Connolly describes:
Pulaski County, Arkansas coroner Mark Malcolm (left) and deputy coroner Tim Irizarry remove the body of Willie B. Harris, an 83-year-old woman, for autopsy after she died in a North Little Rock nursing home. Malcolm decided to further investigate the death after talking to family members who detailed past treatment for broken ribs and recurring infections. Donald Mallory, lost 40 pounds in a 37-day stay in the former Claywest Nursing Home in St. Charles. Court records state that Mallory, 60, was dehydrated, malnourished and rife with infection from bedsores when he died. Doctors who reviewed Mallory's medical records for a lawsuit said neglect caused his death.
Ruby Faye Martin, 88, died in Mount Vernon Countryside Manor in Mount Vernon, Ill., of sepsis, an overwhelming bacterial infection that poisons the blood. An evaluation of her medical records by a doctor who specializes in medical problems of the elderly stated that the death was caused or exacerbated by malnutrition and multiple infected bedsores caused by poor care at the nursing home. A home official declined to comment.
Rex Riggs was in stable condition when transferred to Beverly Healthcare nursing home in Neosho, Mo., according to Veterans Administration doctors. Six weeks later, the disabled Vietnam War veteran, 57, was hospitalized with gangrenous infections that led to the surgical removal of his scrotum, penis and lower abdomen. He died three days later. Federal investigators said bad nursing care caused his death.
Prosecutors charged no one in the three cases.
Government documents and court records reviewed by the Post-Dispatch show hundreds of similar deaths caused by neglect in nursing homes across the nation.
The latest national compilation of more than 500,000 nursing home deaths - for 1999 - lists starvation, dehydration or bedsores as the cause on 4,138 death certificates. The data, collected by the National Center on Health Statistics, include 138 such deaths in Missouri and 186 in Illinois.
But death certificates alone don't begin to tell the story.
A handful of investigators and researchers, working in specific geographic areas, took the time to compare patient medical records with their death certificates. Plaintiffs' lawyers, representing aggrieved relatives across the country, have gone through the same exercise.
Their findings indicate that the number of preventable deaths attributable to malnutrition, dehydration and bedsores from bad care or no care is much higher.
Louisiana Sen. John Breaux, a Democrat and chairman of the Senate Special Committee on Aging, called deaths from nursing home neglect "a hidden problem."
"We know it's significant," said Breaux, noting that investigations by his staff and other research show that 500,000 to 5 million cases of elderly neglect and abuse take place in institutions and private homes each year, although about 80 percent go unreported.
"The number of avoidable deaths of our elderly could be in the tens of thousands," said Breaux, who along with Republican Sen. Orrin Hatch of Utah last month introduced the Elder Justice Act, which seeks to prevent such deaths.
Many medical and regulatory investigators who work in nursing homes every day characterize the number of wrongful deaths in terms such as "massive" and "pervasive," based on their daily experience. Most of the deaths can be traced to an inadequate number of nurses and aides to provide life-sustaining care. The U.S. Department of Health and Human Services reported to Congress this year that nine out of 10 nursing homes have staffing levels too low to provide adequate care.
There are a number of reasons for the shortages, which plague the entire health care industry, including hospitals. Many workers are unwilling to accept poverty-level wages for unpleasant, demanding work that often requires mandatory overtime or double shifts. Constant corporate focus on the bottom line frequently requires managers to operate homes with skeleton staffing because the industry says it lacks enough government money to provide proper care.
Yet, some nursing homes find ways to provide adequate service with existing staff. Many nurses and aides are dedicated to their profession and provide excellent, compassionate care.
The American Health Care Association, the lobbying group for most of the nation's nursing homes, says malnutrition, dehydration and bedsores "are common conditions associated with the frail elderly, especially at the end of life."
"AHCA states unequivocally that any incident of neglect or abuse is unacceptable, but drawing a link of patients passing away from these maladies as a result of alleged poor care is simply irresponsible," the trade group said in a statement.
Finding deaths by neglect
Government studies in two states and the work of plaintiffs' legal teams begin to document the magnitude of the problem.
In 1998, the General Accounting Office assigned three registered nurses (two with advanced degrees in gerontological nursing) and a physician to determine what had actually killed 62 people who had died in California nursing homes. They were randomly selected from nursing homes that had multiple deaths, the GAO said.
The GAO, which is Congress' investigative arm, subpoenaed medical records and nursing notes, some of them 600 pages long. Its investigation determined that 34 of the 62 had received "unacceptable care" and had died of dehydration, malnutrition or raging infections from uncontrolled bedsores.
For example, one man lost 59 pounds - one-third of his weight - over seven weeks. A woman who had weighed 100 pounds dropped to 54 pounds before her death, and another woman developed four pressure sores so severe that they ate through to her bones. She received pain medication only three times during five weeks of painful daily treatments for the infections, the GAO investigator reported.
A year later, in 1999, complaints from nursing home workers, family members and Arkansas long-term care inspectors who believed that poor nursing care was killing residents troubled Little Rock Coroner Mark Malcolm.
"I didn't know. Nobody knew," Malcolm said. "These poor souls were cremated or buried with no one but the nursing home or its doctor deciding why they died - whether it was natural causes or because they weren't properly cared for."
Malcolm and his deputies reviewed about 100 questionable nursing home deaths that occurred from 1993 to 1999. They interviewed families and nurses and examined whatever clinical information was available on the deceased, including medical records and nursing home charts. Seven bodies were exhumed.
Working with the medical examiner's office, Malcolm determined that more than 30 percent of the death certificates listed an incorrect cause of death.
"The families were being told by the nursing homes that their loved ones died of heart attacks, strokes and other natural causes, but what we actually found was that about a third were wrongful and preventable deaths, either caused by or exacerbated by dehydration, malnutrition, including choking, or from sepsis from bedsores," said Malcolm, who was just appointed to the U.S. Department of Justice's newly formed forensic working group.
Although the number of cases reviewed was not enormous, the finding was significant enough to get the Arkansas Legislature to immediately pass a law - the only one in the nation - that demands that nursing homes notify a coroner of every death.
Arkansas nursing home regulators say the new law already has had a strong deterrent effect. The number of citations for life-threatening care issued against the state's nursing homes dropped after the law took effect.
Lawyers examine deaths
In every state, there is a group of professionals who routinely compare the cause of death listed on death certificates with the medical records of deceased nursing home residents. They are lawyers representing families who believe their loved ones were killed by poor care or no care.
An examination by the Post-Dispatch of hundreds of these court cases across the nation found that the vast majority of death certificates attributed the deaths to natural causes such as pneumonia, heart attack and - in some cases - "cessation of breathing," "heart stopped," "old age" or "body just quit."
"Our staff examines hundreds of alleged wrongful nursing home deaths a year, and only a handful of the death certificates reflected what medical records showed actually killed the person," said Tim Dollar, whose law firm in Kansas City is Missouri's largest litigator of nursing home deaths. "Some physicians go to amazing lengths to avoid admitting that by omission or commission, the nursing home killed these people."
The Post-Dispatch examined the death certificates and the physicians' evaluations of 55 nursing home residents in Missouri and Illinois who died in the past two years and whose relatives decided to sue for neglect. In 42 of the cases, the newspaper found that the cause of death listed on the certificate differed from what physicians said the medical records actually showed. In 40 of these cases, the nursing homes involved agreed to a settlement with the family before trial or were found in civil proceedings to have committed neglect.
A deadly trio of neglect
The three causes of death that the Post-Dispatch examined in its yearlong investigation - malnutrition, dehydration and bedsores - were selected because government investigators and medical experts said an overwhelming majority of such cases are preventable with proper nursing care.
When left untreated, any of the trio spawns a domino effect of system failures that can kill.
"It's like a house of cards. One slips out and the whole thing comes crashing down, and death is often inevitable," said Dr. Margaret Wilson, a gerontologist and researcher at St. Louis University. Specifically:
Malnutrition can reduce immunity from infections to an almost AIDS-like state and can quickly cause loss of muscle strength, which can lead to increased frailty, pneumonia, kidney and liver failure, and death.
Dehydration can lead to dangerously low blood pressure, which can generate strokes and heart attacks. It also can cause infections, kidney failure, uremic poisoning and death.
Decubitus ulcers or bedsores can result in flesh being eaten away down to bone and organs, causing a life-threatening toxic poisoning called sepsis. The sores come from the weight of the person's body pressing on a bone while lying in bed, which compresses the blood vessels in the skin and underlying tissues. Within only two or three hours, red, burnlike wounds appear. If left untreated, this tissue then begins to decay from lack of blood circulation.
The industry trade group said that many pressure ulcers develop before a resident enters the nursing home - a statistic it says is not often reported.
Medical authorities estimate that 12 percent to 15 percent of the deaths from the three causes could not have been prevented. They cite residents who have decided not to eat or drink. Others have diseases that aggravate bedsores or that impede the consumption of nutrition. Still others have living wills or advance directives that preclude supplemental food, liquid or medical treatment. Even allowing for those exceptions, the number of preventable nursing home deaths is far greater than reported.
"It isn't rocket science to say that you need enough staff to help every resident with eating, drinking and infections. It's not like we need to discover the cure for the Nile virus," said Catherine Hawes, a professor and director of Texas A&M University's Southwest Rural Health Research Center and a national authority in evaluating nursing home quality. "We know how this is supposed to be done, but in all too many places it's not."
An earlier tragedy
This isn't the first time that government regulators, law enforcement and medical professionals failed to detect that vulnerable victims were being killed.
"These preventable deaths in nursing homes are almost parallel to the realization 30 years ago that child abuse was an undetected and lethal problem," said Paul Weidenfeld, an assistant U.S. attorney in New Orleans.
Children would be rushed into emergency rooms with concussions or broken necks. Doctors would call the deaths tragic and chalk it up to the fact that babies fall out of cribs and kids tumble from trees or down stairs.
"Finally, people started questioning: How did the child fall? Why did that happen? And it was realized that enormous numbers of children were being abused, were being killed, and crimes were being committed," said Weidenfeld, who is co-chair of the Louisiana Nursing Home Working Group, a team of federal and state agencies that investigates poor care.
In the 1970s, doctors diagnosed so many children with unexplained head injuries that medical journals of the period were writing about spontaneous subdural hematomas - bleeding under the lining of the brain.
"They called it spontaneous because they just happened without any clinical reason for it," said Dr. Patricia McFeeley, New Mexico's assistant chief medical investigator. "Everyone believed they developed naturally.
"It wasn't until medical, law enforcement and death-investigation professionals realized that these fatal bleeds were being caused by violence, that these children were not dying of natural causes, but were being killed, did we change the way we handle these deaths," McFeeley said. "This is what we must do with the elderly. We can't trust the old system to catch these deaths."
Deficiencies are rampant
About 3 million people a year pass through America's 17,000 nursing homes. Patients occupy about 1.8 million beds on any given day; most are white women who are at least 75 years old.
Many of the 1.3 million cooks, janitors, administrators, nurses - the majority working for near poverty-level wages - treat their jobs as a calling to ease the pain and safeguard the dignity of their charges.
But it is the homes and workers that don't perform up to standard that concern most of the 700 professionals interviewed by the Post-Dispatch for this series. They include nurses, researchers, physicians, patient advocates, death investigators, nursing home operators, prosecutors and federal, local and congressional investigators.
In their eyes, government regulators are losing the war - and in some cases, not even fighting the battle - of preventing negligent deaths of the elderly.
They tell of state investigators failing to ensure safe care in homes; of government-mandated ombudsmen being prevented from intervening; and of federal regulators unable to do much about it.
These experts attribute the negligent deaths, in most cases, to inadequate numbers of nurses and aides on hand to provide basic, life-sustaining care. The detection of these deaths, they say, is often thwarted by state nursing home inspectors who fail to see - or act upon - the warning signs. The experts complain that law enforcement authorities are rarely notified of deaths by neglect and that coroners and medical examiners are seldom called.
Collin Wong, a California deputy attorney general who heads his boss's aggressive program to halt wrongful nursing home deaths, said that killings by neglect often are overlooked because "too many people shrug it off by saying, 'Old people die. So what.'
"This is not to say that every death in a nursing home should be treated as a homicide and every injury as an assault," Wong continued. "But at the same time, these deaths shouldn't automatically be chalked up to old age and natural causes. This is a major faulty perception that is allowing this pervasive neglect, these homicides, to continue."
Many deaths are called criminal
"It's homicide. Don't sugarcoat it," says Dr. Vincent Di Maio, the medical examiner for San Antonio. He has extensively researched negligent deaths in nursing homes.
"Enormous numbers of patients are being killed in nursing homes throughout the country because the administrators or the corporate executives order the staffing reduced to the point where the staff cannot provide the promised care that's needed for their patients to survive," he said.
Some prosecutors agree.
Finding that regulatory fines and bureaucratic sanctions have had minimal impact on reducing dangerously poor care, a small but increasing number of prosecutors have brought homicide charges. They've targeted nurses and aides found to be responsible for the deadly care and nursing home operators and corporate officials who fail to employ enough nurses to prevent these deaths.
Prosecutors gained allies among some state regulators who also are calling for criminal charges when death by neglect is confirmed.
"If it can be proven that the failure to feed, hydrate or properly care for wounds led to deaths in nursing homes, they should be considered as potential homicides and turned over to law enforcement for criminal investigation," said Darrell Hendrickson, Missouri's new deputy director of the Division of Health Standards and Licensure.
In Hawaii, Indiana, California and Tennessee, district attorneys, county prosecutors and state attorneys general have brought some charges of homicide for nursing home deaths by neglect over the past three years. But they number fewer than a dozen.
In Pennsylvania, Louisiana, Virginia, Florida, Kentucky and Missouri, U.S. attorneys have used a Civil War-era law to bring federal civil charges in these types of deaths.
Each year, thousands of allegations of wrongful deaths in nursing homes are brought in courtrooms across the nation by aggrieved family members. Court records show that most of these cases result in judgments against the nursing homes or pretrial settlements. But many judgments are sealed, which prevents the public and state regulators from finding out about the offending nursing home.
Misleading death certificates
The widespread undercounting of deaths attributed to the three preventable conditions is due mainly to the lack of accuracy - or what some investigators contend is intentional deception - exercised by doctors in filling out death certificates. Many are signed by physicians who have never seen the body.
"I see a lot of death certificates signed with myocardial infarction, which means: 'I don't have a clue because I wasn't there when the person died,'" said Dr. John Morley, a St. Louis University gerontologist.
Jeanie Keyser-Jones, a professor in medical anthropology at the University of California at San Francisco School of Medicine and a nationally recognized expert in nursing care, said: "Far too many death certificates list the cause as cardiac arrest, but that's (usually) a wastebasket diagnosis because obviously, everybody's heart stops when they die."
In January, the Indiana health department processed a death certificate that attributed to natural causes the death of an 80-year-old woman from respiratory problems and cardiac failure. That surprised the Evansville coroner's office, which, after an extensive examination and an autopsy, had just ruled the woman's death a homicide. The coroner said death was caused by severe dehydration. Nursing home records gave no indication that the woman had been fed or given liquid for days, he said. No sign of heart damage was found.
No one in Missouri signed more death certificates in the past four years citing malnutrition as the cause than Dr. Constantino Carpio.
Of the 242 malnutrition deaths in nursing homes listed in Missouri records during that period, the health department's vital statistics database of death information shows that Carpio signed 46.
But he denies it.
"I never sign malnutrition. I always put down bronchial pneumonia as the cause of death," said Carpio, who said he cared for 500 patients in 11 nursing homes around Troy, Mo.
When asked why, he answered: "That's what the textbooks say old people die of. You can look it up."
When Charlotte Gregory, 78, died in September 2001 in the Meadowood Nursing Center in Clear Lake, Calif., court depositions show employees tried to persuade two different physicians to list her cause of death as heart disease. Both refused, saying there was no evidence that heart failure had killed Gregory. An autopsy demanded by her family showed she had died from infection from a ruptured colon aggravated by dehydration and a misplaced feeding tube.
"It's murder," Dr. Marvin Sando, Gregory's son-in-law and a retired physician, said when he saw the autopsy results. "Whether it was unintentional or through indifference, a preventable death occurred, and it's still homicide."
The district attorney's office in California's Lake County says it is examining the evidence in the case.
Without a public outcry for reform, the outcome is predictable, say advocates for the elderly.
"If you don't feed somebody, they will die. If people aren't given adequate liquids, they will die. If an elderly person's major infection isn't treated, they will die," said Candace Heisler, who retired after 25 years of handling abuse and neglect investigations as an assistant district attorney in San Francisco. She works as a consultant to law enforcement and lawyers.
"Bad care is often as deadly as having a knife in your hand and aiming it at their heart."
Friday, October 2, 2009
Guardianships - The latest Tool for Extracting funds from the Incapacitated and now their Family Members too
http://www.care2.com/c2c/share/detail/1161177
Elder Abuse and Financial Exploitation of our most vulnerable citizens is on the rise at alarming rates.
The very systems that should be protecting these victims are failing miserably.
What's worse is some of those systems meant to protect these vulnerable people who are already hurting and need help have become a mechanisms that can and is used to perpetrate abuse and financial exploitation against them. In fact Guardianship are now being used as a tool to exploit money from estates and from their family members as well who are vulnerable to the complex legal system that are assaulted in.
This Share is dedicated to providing education to other so that they can help us help those who are in need.
Once a person is put into guaridanship (a legal instrument) they most often lose all of their civil rights and constitutional rights. It doesn't seem right that a person can become essentially a non-person, a person who has lost their birthrights as citizens of this great nation founded on these very principles. It doesn't seem right that a person can lose their right to their own property. But in happens every single day in America, in courts all over this land in our State Courts.
To protect is the goal of the instruments that appoint another as the "decider" for another. There are two such instruments: one is guardianship of the person and the other is guardianship of the property or conservatorship.
There are other less instrusive means of providing surrogate decision making for an person who is unable to manage their own affairs. For centuries family and loved ones have stepped in to help a loved one.
Guardianships were meant to be used as a very last resort for those who had no one else there to help them. Today however this instrument is being abused by those who find it as a means to reward themselves financially from the assets of a person who has no say whatsoever over their own money and property.
Quite simply put these people are easy pickings and the law has created the incredibly easy to abuse instrument for others including greedy relatives, lawyers, professional fiduciarys and others to abuse. When you had a elderly widow with an estate worth millions there are those who will jump at the opportunity to be that persons gaurdian because the system is set up for them to be paid from the fund that they manage, the ward's estate.
This opportunity leads to numerous petitions for guardianship that are entirely unwarranted and the unnessesary and inappropriate declaration of incompetance of a person who is just old and perhaps forgettful or just basically in need of a helping hand.
Today the abuse of our Elderly is being worsened by the abuses occuring in guardianships and conservatorship.
We need to all work to stop this problem or we will be victims one day.
ELDER ABUSE VICTIMS ADVOCATES
Elder Abuse and Financial Exploitation of our most vulnerable citizens is on the rise at alarming rates.
The very systems that should be protecting these victims are failing miserably.
What's worse is some of those systems meant to protect these vulnerable people who are already hurting and need help have become a mechanisms that can and is used to perpetrate abuse and financial exploitation against them. In fact Guardianship are now being used as a tool to exploit money from estates and from their family members as well who are vulnerable to the complex legal system that are assaulted in.
This Share is dedicated to providing education to other so that they can help us help those who are in need.
Once a person is put into guaridanship (a legal instrument) they most often lose all of their civil rights and constitutional rights. It doesn't seem right that a person can become essentially a non-person, a person who has lost their birthrights as citizens of this great nation founded on these very principles. It doesn't seem right that a person can lose their right to their own property. But in happens every single day in America, in courts all over this land in our State Courts.
To protect is the goal of the instruments that appoint another as the "decider" for another. There are two such instruments: one is guardianship of the person and the other is guardianship of the property or conservatorship.
There are other less instrusive means of providing surrogate decision making for an person who is unable to manage their own affairs. For centuries family and loved ones have stepped in to help a loved one.
Guardianships were meant to be used as a very last resort for those who had no one else there to help them. Today however this instrument is being abused by those who find it as a means to reward themselves financially from the assets of a person who has no say whatsoever over their own money and property.
Quite simply put these people are easy pickings and the law has created the incredibly easy to abuse instrument for others including greedy relatives, lawyers, professional fiduciarys and others to abuse. When you had a elderly widow with an estate worth millions there are those who will jump at the opportunity to be that persons gaurdian because the system is set up for them to be paid from the fund that they manage, the ward's estate.
This opportunity leads to numerous petitions for guardianship that are entirely unwarranted and the unnessesary and inappropriate declaration of incompetance of a person who is just old and perhaps forgettful or just basically in need of a helping hand.
Today the abuse of our Elderly is being worsened by the abuses occuring in guardianships and conservatorship.
We need to all work to stop this problem or we will be victims one day.
ELDER ABUSE VICTIMS ADVOCATES
Friday, September 25, 2009
Judge Appoints Guardian for Plaintiff in Copyright Suit
Now they can use guardianships as a weapon in lawsuits???? How can we stop the abuse of Adult Guardianships.
May 28, 2009
Judge Appoints Guardian for Plaintiff in Copyright Suit
A federal district judge in Washington appointed a guardian ad litem yesterday to represent the interests of a Maryland architect who has battled her own lawyer for seven years in a copyright suit against a rival architectural firm and the United Arab Emirates.
Elena Sturdza’s suit, filed in 1998 in the U.S. District Court for the District of Columbia, has stalled since 2002 when her lawyer, Nathan Lewin, called into question his client’s competency to make rational decisions regarding her case. Lewin moved then for an appointment of a guardian, and U.S. District Judge Henry Kennedy Jr. granted the request.
But the U.S. Court of Appeals for the D.C. Circuit this year reversed Kennedy, saying Sturdza had not been given ample notice about the proceedings. The appeals court said Sturdza should be given a shot to be heard on Lewin’s motion. That hearing was held earlier this month, at which time there was little doubt that Kennedy would re-appoint a guardian for Sturdza.
“Having provided Sturdza notice and an opportunity to be heard, this court again concludes that the motion for appointment of a guardian ad litem should be granted,” Kennedy wrote in an order published May 28. Click here for a copy of the order. Kennedy earlier this month also ordered Sturdza to undergo a psychiatric evaluation.
When Kennedy first appointed a guardian, the judge noted Sturdza's behavior before him and her pro se filings as compelling reasons why a guardian should represent the plaintiff. Sturdza is "prone to paranoid outbursts and has expressed irrational hostility" toward Lewin, Kennedy wrote in an order.
Sturdza said she has no intention of undergoing an evaluation and she said there is no need for a guardian ad litem. A copy of Sturdza's motion arguing against the appointment of a guardian is here.
Lewin, meanwhile, told The National Law Journal earlier this month that he has no interest in remaining Sturdza’s attorney but he is unwilling to remove himself and let Sturdza proceed pro se. Lewin filed this response to Sturdza's claims earlier this month.
Sturdza would lose the case if she were allowed to go alone in the litigation, Lewin said. Lewin does, however, have a financial interest in the case—Sturdza hired Lewin on a contingent fee basis. If a guardian ad litem determines another lawyer should represent Sturdza, then Lewin said he would not challenge that decision. Kennedy's order did not name of the guardian who will represent Sturdza.
Sturdza’s suit claims the architectural firm Angelos Demetriou & Associates and the UAE ripped off her winning contest design for the UAE embassy in Washington, D.C. Sturdza is seeking millions in damages. A district judge ruled against Sturdza, but Lewin, hired for the appeal, won a favorable ruling in the D.C. Circuit that revived the case.
Posted by Mike Scarcella on May 28, 2009 at 11:39 AM in Current Affairs, D.C. Courts and Government, Legal Business, Personal Finance, Politics and Government Permalink
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May 28, 2009
Judge Appoints Guardian for Plaintiff in Copyright Suit
A federal district judge in Washington appointed a guardian ad litem yesterday to represent the interests of a Maryland architect who has battled her own lawyer for seven years in a copyright suit against a rival architectural firm and the United Arab Emirates.
Elena Sturdza’s suit, filed in 1998 in the U.S. District Court for the District of Columbia, has stalled since 2002 when her lawyer, Nathan Lewin, called into question his client’s competency to make rational decisions regarding her case. Lewin moved then for an appointment of a guardian, and U.S. District Judge Henry Kennedy Jr. granted the request.
But the U.S. Court of Appeals for the D.C. Circuit this year reversed Kennedy, saying Sturdza had not been given ample notice about the proceedings. The appeals court said Sturdza should be given a shot to be heard on Lewin’s motion. That hearing was held earlier this month, at which time there was little doubt that Kennedy would re-appoint a guardian for Sturdza.
“Having provided Sturdza notice and an opportunity to be heard, this court again concludes that the motion for appointment of a guardian ad litem should be granted,” Kennedy wrote in an order published May 28. Click here for a copy of the order. Kennedy earlier this month also ordered Sturdza to undergo a psychiatric evaluation.
When Kennedy first appointed a guardian, the judge noted Sturdza's behavior before him and her pro se filings as compelling reasons why a guardian should represent the plaintiff. Sturdza is "prone to paranoid outbursts and has expressed irrational hostility" toward Lewin, Kennedy wrote in an order.
Sturdza said she has no intention of undergoing an evaluation and she said there is no need for a guardian ad litem. A copy of Sturdza's motion arguing against the appointment of a guardian is here.
Lewin, meanwhile, told The National Law Journal earlier this month that he has no interest in remaining Sturdza’s attorney but he is unwilling to remove himself and let Sturdza proceed pro se. Lewin filed this response to Sturdza's claims earlier this month.
Sturdza would lose the case if she were allowed to go alone in the litigation, Lewin said. Lewin does, however, have a financial interest in the case—Sturdza hired Lewin on a contingent fee basis. If a guardian ad litem determines another lawyer should represent Sturdza, then Lewin said he would not challenge that decision. Kennedy's order did not name of the guardian who will represent Sturdza.
Sturdza’s suit claims the architectural firm Angelos Demetriou & Associates and the UAE ripped off her winning contest design for the UAE embassy in Washington, D.C. Sturdza is seeking millions in damages. A district judge ruled against Sturdza, but Lewin, hired for the appeal, won a favorable ruling in the D.C. Circuit that revived the case.
Posted by Mike Scarcella on May 28, 2009 at 11:39 AM in Current Affairs, D.C. Courts and Government, Legal Business, Personal Finance, Politics and Government Permalink
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Sunday, July 5, 2009
National Groups Address Guardianship Reform To Protect Older Americans
Posted: Thursday, November 11, 2004
COLORADO SPRINGS, CO (November 11, 2004) - Leading advocacy groups for seniors are meeting this week to continue the process of addressing guardianship reform and implementation. Hundreds of thousands of Americans are under the care of a guardianship system in desperate need of repair, according to a report from Washington?s General Accountability Office (GAO). The National Academy of Elder Law Attorneys (NAELA), along with other national groups, will address the surprising nationwide deficiencies in the guardianship system across the United States.
NAELA, The National College of Probate Judges (NCPJ) and the National Guardianship Association (NGA) are convening a Joint Conference with a Wingspan Guardianship Implementation Session at The Broadmoor in Colorado Springs. The three groups will to discuss guardianship issues during the Conference that brings together guardians, elder law attorneys, case managers, social workers, healthcare professionals and state judges from around the country.
We would all like to think that we will be protected by ethical professionals or loving family members if we are ever faced with the need for guardianship as we age, said NAELA elder law attorney A. Frank Johns, who testified at the GAO hearing and is Joint Conference chair. The truth is that in many states across the country little is being done to ensure the necessary funding, training, accountability and monitoring of guardians that could prevent the horrific abuse that continues to occur against our older Americans. This Conference and Session is another step towards a remedy.
The organizations note that, while most guardians do a difficult job very well, standards between federal and state authorities should be set to ensure the quality of all legal guardian care from coast to coast. Guardianship is a legal process utilized when a person can no longer make decisions in his or her own self interest.
United States Senator (ID) Larry Craig, Chairman of the Senate Special Committee on Aging, asked Johns to provide testimony during a U.S. Senate Special Committee on Aging Forum in July of this year. The testimony of Johns, NAELA and NGA member and Joint Conference Chair, coincided with the release of the GAO report underscoring the significance of the problems with the present guardianship system. While our members are dedicated to professional, ethical guardianship for our nation's seniors, said Francine Saccio, NGA President, we agree that significant changes are long overdue for improving the guardianship system in most states across the country. The GAO report found only a few courts working well beyond the state minimum requirements for training and monitoring of guardianship. Those courts are the exception rather than the norm.
In the face of these reports, including felony allegations of a Michigan-based company providing guardianship for over 600 individuals and discoveries earlier this year by Texas Governor Rick Perry of a severe elder neglect cases in his state, the groups will publish guardianship implementation recommendations for states to use for raising standards and helping to fight this nationwide problem.
About the National Academy of Elder Law Attorneys (NAELA)Established in 1987, the National Academy of Elder Law Attorneys (NAELA) is a non-profit association that assists lawyers, bar organizations and others who work with older clients and their families. Members of NAELA are attorneys who are experienced and trained in working with the legal problems of aging Americans and disabled individuals. The mission of the National Academy of Elder Law Attorneys is to establish NAELA members as the premier providers of legal advocacy, guidance and services to enhance the lives of people with special needs and people as they age. NAELA currently has more than 4,800 members across the United States, Canada, Australia and the United Kingdom. For more information on NAELA, the 2004 Wingspan Implementation Work Groups and the 2004 Joint Conference please contact NAELA at 520.881.4005 or visit http://www.naela.org/.
About the National Guardianship Association (NGA)Founded in 1988, NGA is comprised of more than 730 individuals in public and private, for-profit and not-for-profit agencies and organizations as well as individuals concerned with guardianship issues. NGA provides its members with education and training, networking opportunities, and the opportunity to set a national agenda to ensure standards of excellence. The National Guardianship Foundation (NGF) administers a guardianship certification examination, which is the only national credentialing process for guardians in the nation. For more information, please contact NGA at 520.881.6561 or visit http://www.guardianship.org/.
About the National College of Probate Judges (NCPJ)The National College of Probate Judges (NCPJ) was organized in 1968 to improve the administration of justice in courts with probate jurisdiction. The College was established in response to public concern with the time and costs involved in estate administration. NCPJ is the only national organization exclusively dedicated to improving probate law and courts. Probate courts are responsible for equitably handling many kinds of problems in our society. Although they deal primarily with the estates of deceased persons, probate courts also play an important role in protecting the rights of people with special needs - the mentally ill, alcoholics, orphaned children, the aged and persons with developmental disabilities. For further information on NCPJ's membership, programs and events, contact NCPJ at 757.259.1841, or visit http://www.ncpj.org/.
Associations Contact: Ann Krauss 520.323.5786Colorado/On Site Contact: Stan Samples 770.605.0039
source
COLORADO SPRINGS, CO (November 11, 2004) - Leading advocacy groups for seniors are meeting this week to continue the process of addressing guardianship reform and implementation. Hundreds of thousands of Americans are under the care of a guardianship system in desperate need of repair, according to a report from Washington?s General Accountability Office (GAO). The National Academy of Elder Law Attorneys (NAELA), along with other national groups, will address the surprising nationwide deficiencies in the guardianship system across the United States.
NAELA, The National College of Probate Judges (NCPJ) and the National Guardianship Association (NGA) are convening a Joint Conference with a Wingspan Guardianship Implementation Session at The Broadmoor in Colorado Springs. The three groups will to discuss guardianship issues during the Conference that brings together guardians, elder law attorneys, case managers, social workers, healthcare professionals and state judges from around the country.
We would all like to think that we will be protected by ethical professionals or loving family members if we are ever faced with the need for guardianship as we age, said NAELA elder law attorney A. Frank Johns, who testified at the GAO hearing and is Joint Conference chair. The truth is that in many states across the country little is being done to ensure the necessary funding, training, accountability and monitoring of guardians that could prevent the horrific abuse that continues to occur against our older Americans. This Conference and Session is another step towards a remedy.
The organizations note that, while most guardians do a difficult job very well, standards between federal and state authorities should be set to ensure the quality of all legal guardian care from coast to coast. Guardianship is a legal process utilized when a person can no longer make decisions in his or her own self interest.
United States Senator (ID) Larry Craig, Chairman of the Senate Special Committee on Aging, asked Johns to provide testimony during a U.S. Senate Special Committee on Aging Forum in July of this year. The testimony of Johns, NAELA and NGA member and Joint Conference Chair, coincided with the release of the GAO report underscoring the significance of the problems with the present guardianship system. While our members are dedicated to professional, ethical guardianship for our nation's seniors, said Francine Saccio, NGA President, we agree that significant changes are long overdue for improving the guardianship system in most states across the country. The GAO report found only a few courts working well beyond the state minimum requirements for training and monitoring of guardianship. Those courts are the exception rather than the norm.
In the face of these reports, including felony allegations of a Michigan-based company providing guardianship for over 600 individuals and discoveries earlier this year by Texas Governor Rick Perry of a severe elder neglect cases in his state, the groups will publish guardianship implementation recommendations for states to use for raising standards and helping to fight this nationwide problem.
About the National Academy of Elder Law Attorneys (NAELA)Established in 1987, the National Academy of Elder Law Attorneys (NAELA) is a non-profit association that assists lawyers, bar organizations and others who work with older clients and their families. Members of NAELA are attorneys who are experienced and trained in working with the legal problems of aging Americans and disabled individuals. The mission of the National Academy of Elder Law Attorneys is to establish NAELA members as the premier providers of legal advocacy, guidance and services to enhance the lives of people with special needs and people as they age. NAELA currently has more than 4,800 members across the United States, Canada, Australia and the United Kingdom. For more information on NAELA, the 2004 Wingspan Implementation Work Groups and the 2004 Joint Conference please contact NAELA at 520.881.4005 or visit http://www.naela.org/.
About the National Guardianship Association (NGA)Founded in 1988, NGA is comprised of more than 730 individuals in public and private, for-profit and not-for-profit agencies and organizations as well as individuals concerned with guardianship issues. NGA provides its members with education and training, networking opportunities, and the opportunity to set a national agenda to ensure standards of excellence. The National Guardianship Foundation (NGF) administers a guardianship certification examination, which is the only national credentialing process for guardians in the nation. For more information, please contact NGA at 520.881.6561 or visit http://www.guardianship.org/.
About the National College of Probate Judges (NCPJ)The National College of Probate Judges (NCPJ) was organized in 1968 to improve the administration of justice in courts with probate jurisdiction. The College was established in response to public concern with the time and costs involved in estate administration. NCPJ is the only national organization exclusively dedicated to improving probate law and courts. Probate courts are responsible for equitably handling many kinds of problems in our society. Although they deal primarily with the estates of deceased persons, probate courts also play an important role in protecting the rights of people with special needs - the mentally ill, alcoholics, orphaned children, the aged and persons with developmental disabilities. For further information on NCPJ's membership, programs and events, contact NCPJ at 757.259.1841, or visit http://www.ncpj.org/.
Associations Contact: Ann Krauss 520.323.5786Colorado/On Site Contact: Stan Samples 770.605.0039
source
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