Case for Review Note: This case is fictitious but includes components of several actual fatalities. Summary: The death is of an elderly woman, 75 years old, Carol Brown, who died in the hospital of a stroke on November 10, 2011. She had been under the care of her son, James, for the past two years, living in her own home, in unsanitary and poorly kept conditions. EMS: We received a call from 911 dispatch at 7 pm saying there was an elderly person not able to be awakened. Our local fire department took this run sending our fire captain and two paramedics. We arrived in the scene within 12 minutes. The victim was alive but not responsive. Paramedics attempted CPR and other medical procedures. We transported her to Sunrise Hospital and time of arrival there was8:55 pm. We get numerous calls similar to this from dispatch. But never have we had one in which the victim was in such terrible physical condition. When we arrived we found the 74-year-old woman in bad health and living in filthy conditions. Paramedics rushed Brown to the hospital in critical condition. Our captain described walking into the home and finding “a rotting corpse that was still breathing.” We had to pry Brown from her recliner because her legs were fused to the chair. She was sitting in her own bodily fluids and waste and had maggots inside an ankle wound. The house was really filthy. It’s in a nice older, neighborhood. Our responders are still pretty traumatized over this run. We completed our reports and sent them in electronically to the EMS data system. We are wondering if we will be called for any questions by the pathologists or law enforcement. We left the house while the police were interviewing the man who appeared to be her son. Hospital Emergency Department: The victim arrived unresponsive and seeming to be suffering a Cerebrovascular accident-what we know as a stroke. She arrived in a coma like condition but we were able to get her to a state of wakefulness for a short period. We were unable to maintain her and she died at 1:22 am on November 10th. We have a pretty long medical record here if anyone is interested but the bottom line is she appeared to have died of a stroke. She was frail, appeared undernourished, and had two decubitus ulcers the size of small plates on her bottom. She had what appeared to be multiple bruises on her arms. She also had several sores on her legs and feet, including one that was filled with maggots. Her legs were very swollen as well. We called the case in to the medical examiner instead of our own hospital pathologist because of these injuries. We also call adult protective services and spoke with the police officer, John Ridell, who arrived at the hospital about 30 minutes after the patient. Medical Examiner: We got the call early on the morning of the 10th. I dispatched one of our field investigators to the hospital. He worked with the ED nurses to conduct a physical examination of the body and we then had her transported to the morgue.. We conducted as full autopsy, including toxicology screens, full xrays and dissection. The immediate cause of death is rupture of an artery to the brain or a stroke. We also found that she was severely dehydrated and underweight. There was hardly any food content in her digestive system. She did have a lot of bruises on her arms that were deep into the skin and ligature marks on her wrists that had become infected. The EMS report was right-she has two very infected bed sores on her backside-she must have been sitting in the chair for a long while without much attention. The question everyone is asking I’m sure is did all of this kill her and is this a homicide? I haven’t decided yet on manner but I am leaning towards calling this a natural death. She was very much neglected but I am not sure if I can state that she was killed by the neglect. Certainly the dehydration and malnutrition was a factor but she did not have sepsis. I am also reluctant to call it a homicide because James was not her official guardian and therefore was not under a legal obligation to care for her. The tox by the way was negative which probably means she wasn’t taking any medication Law Enforcement: We got the 911 dispatch and sent an officer over to the scene arriving about 10 minutes after EMS. It is standard for us to always arrive as well for backup. While EMS was working on reviving the patient we spoke with James Brown, the patient’s 45 year old son. He stated that he went in to bring his mother her dinner and she wouldn’t wake up. He did not have much affect but was cooperative with us. The house in in total disarray-trash, old food, clothing and debris everywhere. It was filthy. This is a two bedroom house and we moved freely throughout after obtaining permission from James. The victim’s bedroom was upstairs and did not appear to have been in use-the bed did not have sheets on it and there was heavy dust everywhere. This was the only room in the house though that was neat. The victim had been sleeping in her lounge chair and we noticed after her departure that there were multiple stains and urine, feces, and other types of gel-like fluids on the seat of the chair and insects/maggots as well around its base. The son told us he had moved back into his mother’s house two years ago to take care of her after she had a minor stroke. He said he had three other siblings, all daughters, one who lives a few miles away. But he said he has been her only caretaker. He gave us the name of her primary doctor. At the scene, several neighbors approached us. They said she had lived in the neighborhood for many years, and was well-liked. They also said that since her son had moved in, they had not seen her and that he had refused to give them access, saying she didn’t feel well, each time they had tried to visit. James told us he is unemployed and that his benefits expired a few months ago. He has been living on the social security check his mother reviews-that he cashes for her at her local bank and uses it for their groceries and to pay utilities. He said his mother has lived in this house for the past 40 years and owns it outright. His father died of a heart attack about 15 years ago. We told James we may need to bring in him for more questioning. James has not been charged with any crime. We are waiting final autopsy results. Adult Protective Services: We got two calls on this case, one from the ED and one from police. We did not have a worker on call that evening die to an illness in her family-sorry but we were short staffed. We sent out a worker to the morgue the next morning and then she went to the house to interview the son. She also interviewed the daughter, Mary Jones. Mary jones was very angry- saying that she said her mother was a mother of four, a grandmother and often called the glue that held her family together. “I know he neglected her,” Jones reported. “He had not fed her in a week. He left her in her own waste. How can you do that to your mother? The doctors told me Thursday night her ankles were swollen. There were sores on her back the size of a man’s fist.” “Knowing that she died and it may have been prevented? I’m so far passed crying. I am just real mad! I’m beyond mad!” Jones reported that she had been to see her mother in several months, trusting that her brother was taking good care of her. During the interview with the son, he said his mother had no appetite and lived mostly on a diet of chicken noodle soup and tomato soup, two of her favorites. He said he had trouble moving her to the bathroom because of her weight and she was stubborn. He did not call her primary doctor when her legs became infected because she had told him she wanted to die at home like her husband and did not want anyone to come in to her messy house. He said he was honoring her wishes to die in her home. We did a background check and got the report from police. James had a long history of domestic violence reports while living with his now ex-wife. There were numerous police visits to the home but he was never arrested. There were also 10 CPS reports, none substantiated, from about 21 years ago on neglect for his own children. Both he and his ex-wife were reported but the situation must have gotten better because they were never placed on the central registry. We can’t get any more information on this since they were only reports. James did not have legal guardianship over his mother. He stated he was taking her signed social security check to the bank and using it for living expenses for the two of them. I’ll let the banker her explain that one. We feel this case if one of gross negligence and hope that charges will be filed. Community First Bank: I represent our fraud division. Mr. and Mrs. Brown have been banking with us for many years. Mrs. Brown assumed her husband’s assets after his death. At that time there was a significant amount of money in their checking account (about $75,000) and they had a nice savings of about 180,000that was paying out a monthly dividend of about $1,200. Our records show that Mrs. Brown has been receiving this for about ten years now. Two years ago, she authorized us to let her son make withdrawals from her checking account and deposit her other checks because she was not ambulatory. I assessed her account and have found that the checking account has been pretty much drained-withdrawals were being made very time a social security check was being cashed. In Home Service Program: We were providing services to Mrs. Brown in 20082009 but once her son moved in we were told he was able to take care of her himself. We get calls every week from children or grandchildren who are taking care of an aging family member. Caring for that person because of their increased physical demands and emotional difficulties, it becomes overwhelming at times and they do need help. This case is heart breaking because there are many community resources that can step in and help relieve the burden on the family caregiver. It’s the loving kind thing for the family member to try and want to grant the wish to remain in their own home but it can be an overwhelming situation. I feel bad for everybody in this situation-there are no winners. Prosecutor: We are waiting on the final designation of manner from the medical examiner. What do you folks think we should do with this case? We can charge easily on the neglect-did it cause her death?