Sometimes, the cases were never reported to Florida's abuse registry, as required by law.

And of the more than 900 HRS reports of adult abuse reviewed by Dade state attorneys that didn't involve death over the past five years, only six resulted in criminal charges being filed. Those dealt with financial exploitation, rather than medical abuse or neglect.

"Is our track record the greatest? No." said Katherine Fernandez Rundle, Dade's chief assistant state attorney. "It sounds like we don't care. But we do care. These are difficult, time-consuming cases. I can't tell you how many hours we've spent going back and forth analyzing a case because they're so disturbing and what you see is the end product: shameful abuse or shameful neglect or both."

Dade chief investigator George Havens said his office reviews every file it gets from HRS, but often can't prove "willful, wanton neglect" by one particular suspect.

Adult abuse and neglect is not limited to nursing and boarding homes, where the perpetrators are easier to find. Many cases involved retarded and elderly people who died in the care of their own families, private nurses and doctors, or in hospitals and state institutions.

"And we have to find someone who's criminally culpable, someone who knew what was happening, or who should have known," Rundle said. "You've got to have investigators and prosecutors with this expertise. And, really, like the rest of the country, we're in the dark ages with that."

The failings are complex -- and many.

The Herald found shoddy police investigations of suspicious adult deaths, health care workers who tampered with medical documents to hide neglect or poor medical care, and doctors who failed to properly report suspicions of abuse.

Death investigations for the elderly and disabled are often mishandled -- in part because of poor law enforcement training, lack of coordination among investigating agencies and a systemic ignorance of Florida adult abuse laws.

"I don't mean to sound callous, but the fact is, sometimes, the mistakes just get buried," said Broward prosecutor Jeffrey Driscoll.

Hospitals and health facilities, for example, often break the law by not sending the bodies of people who die under suspicious circumstances to the county medical examiner where a proper cause of death can be found -- and then, if necessary, a criminal investigation could follow.

Instead, doctors just sign a death certificate and send the body to a funeral home with a general cause of death like "heart failure" or "heart disease."

Those deaths go unnoticed forever.

In fact, Florida authorities have no idea how many deaths among disabled or elderly adults involved abuse, neglect or substandard medical care. No state or national agency even attempts to find out.

"The question is whether people are getting away with negligent deaths? The answer is, yes." said Broward Medical Examiner Ronald Wright. "When we have a neglectful-looking death, I report it to all the agencies, the police, HRS. But I have very little faith that anything happens.

"What I worry about are the ones I don't even see."

At least twice in the past year, Wright has fired off letters chastising county agencies for not sending suspicious deaths to the medical examiner for autopsies.

"I am finding out about these deaths days or weeks after the fact," he wrote the North Broward Hospital District. "I shudder to imagine how many I won't find out about until they are in litigation."

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