Case for review

Case for Review
Note: This case is fictitious but includes components of several actual fatalities.
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?