|
|
|
|
||
|
||
|
|
||
| SEARCH | SUBSCRIBE | ||
|
 |
Legal
System Struggles With Dementia Patients
By Rob Stein
When police arrived at the Tiffany House living complex for seniors in Fort Lauderdale, Fla., they found 90-year-old Bess Kleinman on the floor, slumped against her bed with a plastic trash bag over her face. She had been suffocated. Detectives did not have to look far for Kleinman's killer. Her next-door neighbor, Felix Freed, 72, had told the night security guard that he had "killed Bess," according to police. The slaying shocked the residents and staff. Freed and Kleinman had become close friends. They would walk together and share meals. He would read to her and help unlock her door when her hands were trembling too much. He could not explain why he had killed her. Freed was charged with first-degree murder even though all those involved -- the nursing home staff, the police, the prosecutor, his family -- were well aware of something else: He had dementia. Freed would eventually spend nearly a year in the Broward County jail and almost two years in the Florida State Hospital for the criminally insane in Chattahoochee, Fla., before the charge was dropped. Finally, he was released to another assisted-living facility that could ensure his safety and that of those around him. The nearly three years in the criminal justice system were "very, very difficult for him," said George Reres, a public defender who represented Freed. "He was scared to death all the time and appeared to deteriorate more quickly than he would have. He would cry. He would be confused. He would walk in circles in his room. It's a sad situation." Freed's case is a dramatic illustration of a wrenching problem that is becoming more common as the number of seniors -- and those with dementia -- rises: People with Alzheimer's disease and other forms of mental deterioration are increasingly getting entangled with law enforcement. That has police, prosecutors, judges, psychiatric workers and caregivers struggling to balance the humane treatment of a vulnerable but volatile segment of the populace against the need to protect the public. "It's a problem, and a problem that's only going to grow," said Max B. Rothman, executive director of the Center on Aging at Florida International University in Miami. "As the baby boomers age, it's going to become an even bigger problem."
Advocates for the aging have begun to respond with campaigns to educate police, lobby prosecutors and judges and change state laws to improve the chances that aging, demented defendants will get treatment instead of jail. No one knows how often disoriented seniors wind up in jail, but Alzheimer's advocates, experts on aging and law enforcement officials coast to coast report a small but rising flow of cases. Most often, older people get taken into custody after they wander away from their homes or caretakers and are found acting erratically. "There was one case where the neighbor called police because the person with Alzheimer's was wandering into their home, another case where the person was wandering around and committing random acts of vandalism -- breaking street lights and porch lights," said Gregory Paveza of the University of South Florida in Tampa, who studies aging. In more alarming cases, police are summoned for a domestic disturbance, often in the homes of couples who had been happily married for decades. Sometimes police won't realize the belligerent husband -- it is almost always the husband -- has dementia. But even if they do, they frequently make an arrest anyway to comply with domestic violence laws. "There's been a real move towards arrest in this country when there's violence in the home," said Judith Riggs of the Alzheimer's Association. "It's a terrible situation, but there's got to be no place worse for an Alzheimer's patient than a jail. Arresting them is not the solution." The same thing can happen when a senior gets pulled over for driving erratically, appears to be intoxicated and starts acting threateningly. There are some reports of frail older people being taken into custody, sometimes forcibly subdued and handcuffed. "When they get into the legal system, the system often doesn't know how to handle it," said Donna Cohen, a professor in the Department of Aging and Mental Health at the University of South Florida. "Yes, older people with dementia may do something that's hurtful. But throwing them into a cell . . . is not the way to handle it. It's inhumane." Some are jailed for hours, or even days, before anyone realizes they have a brain disease. Most are finally released into someone's care when a judge is convinced they have dementia. "Usually the police and prosecutors simply want the family to show measures to avoid a recurrence of the incident and to pay restitution for whatever damage was done to a third party," said Turley, the law professor. "Prosecutors know that at the end of the day, the jury will be looking at someone who is quite sympathetic and is not motivated by criminal intent." In some cases, however, dementia patients such as Freed have perpetrated serious, violent acts. Caretakers -- relatives or nursing home workers -- are the most frequent victims. But aging people with dementia have been arrested nationwide for stabbings, shootings and other violent assaults. Aggressive behavior is common among dementia patients as disease ravages their brains. Violence is relatively rare, but it does occur, usually in the later stages of the illness, when paranoia and fear take over. "As prosecutors, we are charged with the responsibility of making the decision: What is the potential risk for the public? If no prosecution occurs, what are the risks of this person being able to kill somebody else?" said Paul Greenwood, head of the Elder Abuse Prosecution unit in the San Diego district attorney's office. "I think it has to be done on a case-by-case basis." Several years ago, Greenwood decided against prosecuting a man who killed his wife because he was clearly suffering from severe dementia. But "the danger lies in cases where you have someone in the early stages of Alzheimer's or middle stages. That's more of a dilemma," he said. "In the early or mild stages, it could be argued that the person still understood the nature of their actions and could understand the basic principles of our criminal justice system, and could cooperate with their attorney in preparing their defense." To try to deal with the problem, programs have sprung up nationwide in recent years, usually in response to an incident that shocks the public. In Wisconsin, the Alzheimer's Association has been meeting with police across the state to teach them how to recognize and approach dementia patients and to convince them that they don't always have to make an arrest in a domestic disturbance. The Wisconsin advocates have also been sending teams across the country, including to Fairfax County, to re-create the training. Similarly, in Buffalo, the Alzheimer's Association local chapter teaches recruits at the police academy how to recognize dementia patients and defuse conflicts. In Indiana, a state task force recommended that specialized facilities be established to care for potentially aggressive nursing home patients. The task force was formed after a dementia patient shoved a woman who lived in his nursing home in 1999. The woman died from her injuries. And in West Palm Beach, Fla., workers at the Elder Justice Center scour the list of overnight arrests every morning for anyone 60 and older. A case worker visits them to make sure they do not have dementia and obtains whatever help they need. "There are thousands and thousands of these situations going on every day," said Mary Barnes, executive director of Alzheimer's Community Care Association in West Palm Beach. "The only reason why we know about it is we happen to have someone in place keeping track of what's going on." Almost immediately after Bess Kleinman's May 10, 2001, death, investigators concluded it was unlikely that Freed would ever be competent to stand trial. He was thoroughly confused about what had happened, and bewildered and frightened by what was happening to him at the time. But "unless he was charged, there was no way for us to take any action to even find out if he's competent," said David Frankel, who prosecuted the case. While he was being evaluated, Freed was held in the Broward County jail for what turned out to be more than nine months, said Reres, Freed's lawyer. After several weeks in the general prison population, Freed was moved into protective custody, where he would have minimal contact with the other, often dangerous prisoners. "He was fearful of everything," Reres said. "The jail did the best they could, but he was extremely frail. He had very little touch with reality. I don't think the jail environment was the right kind of environment for a person in that condition." Freed was formally diagnosed with dementia, and psychiatrists said there was virtually no chance he would recover enough to be competent to stand trial. But it took months before he was moved to the state mental hospital. There, "he was in a forensic ward with other individuals charged with first-degree murder and other violent crimes," the lawyer said. "He was always fearful. People would yell and he would cower -- just a gentle old man in a place that he didn't need to be. "This was a man that had a wonderful life -- raised wonderful children, was a pillar of the community. He was never a violent person at any time in his life," Reres said. "It was really tragic that after that many years of living the good life that this would be the fate to befall him." Eventually, Reres persuaded a judge to transfer Freed to a small, assisted-living facility in Hallandale, Fla., where he could receive appropriate care. He died in June. Copyright
© 2002 Global Action on Aging
|
