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Report on Elder Abuse Deaths
- Reviewers Find Few Unknown Suspicious Cases in the County -
By Nancy Weaver Teichert, Bee Staff Writer
November 23, 2004
The team's first report to the Board of Supervisors today will conclude that the review of more than 100 deaths "thankfully disclosed very few previously unrecognized cases of patient abuse or neglect." No cases were referred for prosecution, but several cases are still being investigated.
But founding member Deidre Kolodney cautioned that it's still difficult to know for sure if abuse occurred. Even with the team's groundbreaking work, she fears suspicious deaths are dismissed as natural.
She said doctors sign off on deaths as natural too quickly. By the time the case gets to the team, the crime scene and evidence needed for a prosecution is gone.
"You're 90, you're expected to die," is often the conclusion, Kolodney said. "Doctors do sign off pro forma on many elder deaths."
Unlike the deaths that come before the long-standing Child Death Review team, older people have more chronic and life-threatening health problems that cloud the cause of death.
The report found "that classifying elder deaths as abusive or negligent is greatly hampered by the lack of forensic medical markers ... ."
Dr. Diana Koin, director of elder and dependent abuse education at UC Davis Medical Center and the California Medical Training Center, said the team had to develop its own protocol for reviewing deaths.
For example, she explained that using bruising to date abuse can be problematic in older people because of medications such as blood thinners. On the other hand, blood tests can be used to uncover dehydration or malnutrition.
Assistant District Attorney Jeff Rose, team chairman, said autopsies are not routinely performed. Doctors can attribute death to natural causes in long-term care facilities without questioning if a patient was abused or neglected, he said.
"We need more education for doctors that deal with geriatric issues, and more training for the first responders so if there are suspicious issues, we catch them," Rose said.
The team was created by District Attorney Jan Scully and County Health and Human Services Director Jim Hunt after a 1999 campaign to encourage the reporting of elder abuse. The team is the first of its kind in the state, and possibly in the United States.
"It's really been a pioneer," Koin said.
The team conducted an in-depth analysis of deaths from the team's inception in December 2001 through December 2003.
Because of confidentiality restrictions, county officials had to get the state Legislature to pass a law to allow team members to share information.
The team includes law enforcement, prosecutors, the coroner, adult protective services, hospitals, state licensing officials and the state's Long-Term Care Ombudsman.
The team will review the death of anyone 65 and older that involved a prior call for suspected abuse to county officials; open cases of alleged abuse; any blunt trauma; referrals by health-care providers or protective agencies and where there is disagreement among investigators over the cause of death.
Koin said the team has a special role to play in protecting seniors with limited financial, physical, mental or social resources.
She referred to boardinghouse landlady Dorothea Puente, who was convicted in 1993 on five counts of first-degree murder and sentenced to life in prison without parole.
Puente had already been jailed once for drugging elderly tenants and stealing from them. Later, it was a social worker's concern for a client that led to the discovery of the bodies dating back to 1982 buried at her midtown Victorian.
The report also looked at how breakdowns in senior services, inadequate geriatric education and the lack of watchful eyes in the community can contribute to elder deaths.
Rose said hospital officials have to look beyond the discharge of an 80-year-old patient to who will help provide care at home.
Elderly spouses may not have the knowledge or ability to care for a seriously ill spouse once home, he said.
"Our first goal really is to identify issues, problems and correct them to make sure they don't happen again," Rose said.
Among the report's recommendations to the supervisors were:
* More scrutiny is needed to evaluate the deaths of those too disabled to communicate their medical condition or living situation.
* Law enforcement and social workers should have the ability to immediately consult with geriatric physicians.
* An educational campaign is needed to warn about the risks associated with common medications as people grow older.
* Trained retirees could be enlisted to educate seniors about financial scams.
* A volunteer telephone contact program is needed to check on seniors within Adult Protective Services.
* APS should create an ongoing case management unit to increase the monitoring of people 85 and older who can be at high risk due to frailty.
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