Death by caregiver: The shame of Florida

By Max J. Castro
majcastro@gmail.com

Florida seems to specialize in neglecting its most vulnerable citizens. Earlier this year, all the talk was about Nubia Barahona, the little girl who allegedly died as a result of horrible abuse by her own parents. Nubia and the many other young children that have met a similar fate over the last 20 years died as a result of the catastrophic failures of the state’s child protection system.

On the wake of the shock waves still reverberating around the death of Nubia Barahona comes the news that Florida’s system for protecting another vulnerable group – the elderly and the mentally ill living in assisted-living facilities (ALFs) – may be in even worse shape.

That disturbing conclusion emerges from a lengthy three-part investigative series (“Neglected to Death”) published last week by The Miami Herald. Improbably, a bureaucrat, former secretary of the Florida Department of Children and Families (DCF) George Sheldon, gave the newspaper unprecedented access to 10 years of confidential records documenting abuse and neglect complaints in the state’s assisted living facilities.

The information uncovered by Herald reporters is more morally repugnant than anything that has come out of WikiLeaks. In all, DCF found evidence of maltreatment in nearly 3,500 cases statewide. In 70 of those cases, the neglect and/or abuse was serious enough to result in the death of the client.

Some of the deaths show signs of extreme cruelty. Others involve a cavalier disregard for the life and well being of frail, sick, and helpless people. In many instances, there is evidence of serious law violations, and in many others there was a clear attempt to cover up misdeeds by lying or falsifying or destroying records. Perhaps the greatest outrage of all is that, time and again, the persons or institutions found responsible were almost never punished, even in fatal cases.

An exception where the culprit was not allowed to walk away scot-free involves the heartrending story of Gladys Horta, a Cuban-born 74-year-old Miami grandmother, who died about two weeks after being placed in the Gardens of Kendall assisted-living facility. After being discouraged by Mayra del Olmo, the owner of the facility, from visiting Horta the first week, supposedly to allow time for adjustment, the family planned to visit their loved one the following week on Mother’s Day and take her out to dinner.

But, on that morning, del Olmo called the family to advise them to cancel the visit because Horta had fallen in the shower, had a little bruise, and wasn’t feeling well. Horta’s relatives disregarded del Olmo’s suggestion and dropped by anyway. They got the shock of their lives. Rather than suffering from a minor bruise, Horta was curled up in bed, smelling of urine, dribbling food from her mouth, and had severe swelling and bruising on her legs, which were turning black.

Horta’s family rushed her to South Miami Hospital, where doctors discovered the real cause of her deplorable condition. There, vascular surgeon Steven Kang, determined that the woman’s legs had been restrained “for a prolonged period of time,” causing a blood clot that was blocking her femoral artery, a life threatening condition.

Doctors therefore wanted to operate immediately but were unable to do so, among other things because the patient’s condition had been allowed to deteriorate badly while at the Gardens of Kendall and because at the ALF Horta had been given high doses of the tranquilizer Xanax in order to keep her subdued.

By the time doctors were able to perform surgery, it was too late and Horta died two days after the operation. Although investigators were unable to determine who was directly responsible for causing Horta’s injuries, in a rare event the state did charge the owner of the facility. Still, del Olmo was only accused of aggravated neglect, and her sentence consisted of a year of house arrest and five years of probation.

The cases go on and on, each more horrific than the next. Aurora Navas was an 85-year-old Alzheimer’s patient at Isabel Adult Care III. One day she wondered outside and was later found drowned in a nearby lake. In a tragedy (and not comedy) of errors, it turned out that the door alarm and video cameras were not operating, the back gate was unlocked, and the attendant had fallen asleep.

What has happened to a system that was supposed to be a model for the nation when it was instituted more than 30 years ago? There are multiple factors at work, probably including an attitude among some in the system that the lives of the old and the mentally ill somehow are not as worthy as that of other people. Institutionally, a major cause found by the Herald’s investigation is that “the Agency for Health Care Administration, which oversees the state’s 2,850 assisted-living facilities, has failed to monitor shoddy operators, investigate dangerous practices or shut down the worst offenders.”

The recent revelations in the Miami Herald series have sparked public outrage and promises of reform by politicians. Despite this, the outlook is not good. The prevailing political winds in Tallahassee favor cutting government, both resources and personnel, to the bone – and beyond. How can we hope that a system that is failing so miserably with current (inadequate) levels of staffing and funding will improve as the number of dollars and workers are slashed? The situation of too many elderly or mentally ill people living in Florida’s assisted-living facilities is shameful so one might expect a vigorous government response. Unfortunately, the politicians running this state today have no shame, only ideological zeal.