While his caretakers watched him die, William Hughes shivered under the covers in a cramped and dirty bedroom.
They didnt give him food. They didnt give him water. Despite doctors orders, they never gave him the very medicine that would have saved his life.
Instead, they let him languish for days at the Tampa assisted-living facility where he lived in 2006 vomiting and defecating in his bed refusing to clean him because the stench was too strong.
Despite pleas from residents that he desperately needed help, caretakers never called paramedics to try to save the severely diabetic man.
They let this man just die, said resident Kevin Conway. It just boggles my mind to this day.
His body was sent to the Hillsborough County morgue and cremated at state expense his ashes sent to his mother in Ohio, the state investigation closed.
The 55-year-old musician was among dozens who died at the hands of their caretakers in assisted-living facilities across Florida.
One starved to death; another burned in a tub of scalding water. Two were fed lethal doses of drugs. Three died from the ravages of gangrene when their wounds were ignored for weeks.
The state Agency for Health Care Administration the entity entrusted with overseeing ALFs refuses to release the records of more than 300 questionable deaths during the past decade, citing state law.
But The Miami Herald obtained confidential records of 70 people who died in the past eight years from the actions of their caregivers.
The records from the Department of Children & Families, another agency tasked with investigating deaths, show people are routinely abused and neglected to death in assisted-living facilities but in the end, few are ever held accountable.
There comes a point when you need to say peoples lives are in danger and we need to do more, said Nick Cox, a former DCF regional administrator who is now Floridas statewide prosecutor.
Though Florida boasts one of the toughest elder-abuse laws in the country, The Miami Herald found few caretakers are ever charged in the deaths of the people they are supposed to protect.
In an analysis of each of the deaths, including a review of police and autopsy reports, medical records, and interviews with relatives, residents and employees, The Miami Herald found:
• An average of nearly once a month, law enforcement agents were called to investigate cases of residents who died from abuse or neglect with caretakers even admitting to breaking the law but almost never made arrests. In at least five cases, caregivers were fired from homes after people directly under their care died from neglect, but none were charged.
• In the two cases in which arrests were made, caregivers were granted plea agreements, never spending a day in prison. One owner was given probation in the death of a 74-year-old woman who was strapped so tightly to her bed that she suffered blood clots and died. The charges were later expunged from the caretakers record.
• Four caretakers were caught forging and shredding medical records during death investigations concealing key evidence. None was charged.
• Records of deaths at the homes are kept secret by the state hidden even from family members allowing facilities to conceal the critical mistakes that took the lives of their residents.
• In three cases, family members were told relatives died of natural causes, but records show their caretakers had abused and neglected them.
The wrong drugs
When the Marrones gathered to bury the 82-year-old matriarch of the family two years ago, they believed Magdalena Marrone had succumbed to old age.
What they didnt know: Caretakers at Emeritus at Crossing Pointe had violated a doctors orders and failed to give her critical heart medication for four days and then gave her the wrong drugs on the day she died.
The elderly grandmother was found blue and frothing at the mouth in the Orlando homes activities room. Home administrators later admitted they never read her chart.
What happened to my grandmother is just devastating, said Kevin Marrone. We assumed as a family that it was natural.
When Suzanne Hughes got the call from the Hillsborough County medical examiners office in 2006, she was told her younger brother William died at Escondido Palms from complications of diabetes.
What she wasnt told: He didnt get his insulin for 27 days, and caretakers refused to call an ambulance as he slipped into the throes of diabetic shock.
It would be five years before she would learn from a Miami Herald reporter the fate of William Hughes and the medical neglect that killed him.
The case is among dozens buried in the archives of state regulators the names blacked out and the details sparse revealing the blunders and mistakes that cost people their lives in ALFs.
As William Hughes shook in the darkness of his room in the aging facility, two caretakers refused to clean him while his body was shutting down one complaining the odor was too strong and the other saying she was pregnant.
No one is helping this man, recalled resident Larry Thrall, 41. Hes still laying there in his own feces.
In the end, Thrall was forced to call paramedics from a cellphone using an alias after the caretakers refused to dial 911, records state.
By the time rescue workers arrived, it was too late: Hughes was dead from a lack of diabetes medication. One shot of insulin would have revived him immediately, said Hillsborough County associate medical examiner Leszek Chrostowsk, who performed the autopsy.
Though a state attorney generals agent called for prosecutors to charge chief caretaker Charlotte Allen with neglect after she admitted to never reading his charts, the case took a familiar turn. Instead of pursuing charges, the Hillsborough County state attorneys office dropped the case, saying there wasnt enough evidence to prove culpable negligence.
Though a witness told police Hughes had gone four times to the office asking for his drugs, assistant state attorney Jay Pruner said he couldnt prove the requests were made to Allen.
We were looking to make a case against her, Pruner said. This was a horrific situation.
But under Florida law, prosecutors have charged entire facilities with criminal neglect and have won convictions.
I dont have a response to that, Pruner said.
Two years after Hughes death, Allen, 60, pleaded guilty to stealing $9,000 in disability checks from another resident at the home after being charged by the state attorneys office. The facility has since been sold.
The lack of prosecutions come as the number of assisted-living facilities rises in Florida 408 new ones in the past three years.
During the past decade, the DCF death cases reveal a stunning sequence of fatal mistakes made by caretakers who are supposed to protect their vulnerable wards.
In more than 40 percent of the death cases reviewed by The Miami Herald 29 in all the people who died of neglect or abuse were suffering from dementia.
At one West Melbourne home, caretakers were supposed to follow a simple rule when the homes exit alarm was triggered: do a head count and call 911.
But when 74-year-old Waymon Cross slipped out the door of Alterra Clare Bridge in the early hours in 2003, his caretaker shut off the alarm and went back to work.
It was hours before another employee spotted his cap floating in a pond near the home, his body drifting nearby.
Her job is to protect and take care of [Cross], and she didnt do that, recalled West Melbourne police Detective Barbara Smith, adding the caretaker twice changed her story before admitting to what happened.
The homes administrator did not return repeated phone calls.
For a month in 2008, workers at Living Legends Retirement Center were finding Frances Tremblay sprawled on the floor, her body covered in cuts and bruises.
Instead of taking steps to protect her, administrators at the Deerfield Beach home ignored warnings from a staff nurse that the woman was constantly falling.
The end came after the 11th fall.
When a Broward County sheriffs deputy showed up, the 98-year-old grandmother was lying in a puddle of blood in a locked room, screaming for help.
At the hospital, doctors found she had two black eyes, a gash over her nose and a fractured neck. She died months later without ever recovering from her injuries.
What they did to her was criminal, said William Dean, an attorney who represents Tremblays family.
Though charges were never filed in the case, the details of her death emerged for the first time this year, when a Broward County jury found sweeping negligence in Tremblays death, awarding her estate $2.39 million in one of the countys largest jury awards ever rendered against an ALF.
As people were dying in homes across the state 40 in the past five years another agency joined regulators in probing deaths: the state attorney generals office.
In the past eight years, the office reviewed more than half the death cases turned up by DCF including drownings, medical neglect and drug overdoses but made just one arrest.
The DCF files show that even when caretakers were caught destroying evidence in death cases shredding and in some cases falsifying key medical records the attorney generals office didnt act.
When Dorothy Archer arrived at a Pasco County hospital two years ago, rescue workers discovered a blackened hole the size of a baseball festering on her back.
Egregious neglect was how the wound was described by DCF agents investigating her treatment at Edwinola ALF.
But when agents tried to find out how the 90-year-old developed the septic sore, they hit a barrier: Key records describing her final two months at Edwinola had disappeared. Worse, nurses notes detailing the wound appeared fabricated.
For such a serious wound to develop undetected in the ALF was inexplicable, DCF agents wrote after she died.
The homes only punishment: a $1,000 fine levied by the Agency for Healthcare Administration for failing to seek medical care or keep proper records.
Archers husband of 37 years, Theodore Robert Archer, said hes still angry over the homes treatment of his wife. They never told me a thing about her condition, he said. Oh God, she was suffering. Janice Merrill, an attorney representing the home, declined to comment.
Beyond problems at the homes, the DCF records reveal another troubling breakdown in the death cases: dozens of bodies found at the homes were sent to the grave without any forensic scrutiny.
The Miami Herald found 33 cases in which bodies were already embalmed or cremated by the time state agents found sweeping evidence of neglect.
Take the case of Muriel Christine Staab, a blind woman in a wheelchair, whose body was cremated before state agents found she had been a victim of neglect.
Clay County sheriffs deputies responded three years ago to a call to the states abuse hotline: The 101-year-old woman developed a severe infection that went untreated and weeks later was found sprawled on the bathroom floor at Park of the Palms.
Under state law, sheriffs deputies could have asked for an autopsy, but instead allowed a doctor to sign the death certificate saying the death was due to natural causes.
Dr. Daniel B. Cox told police he would simply declare she died from natural causes, even though he was told she had fallen and injured herself. Dr. Cox said that he would not list the bump on the back of the victims head as a contributing factor to death because she probably had a heart attack and then fell to the floor, a Clay County sheriffs report states.
Two days later, her body was cremated at Watts Funeral Home in Keystone Heights with no autopsy.
In the end, DCF agents concluded Cox had signed the death certificate with limited information.
Agents later found the home had failed to call a doctor when Staab came down with a serious stomach virus, and then waited 15 minutes to call 911 after finding her on the bathroom floor the night she died.
There is a strong possibility had medical attention been sought earlier in the day or evening, or 911 called immediately, [the victim] may have survived, investigators wrote.
No red flags
Cox said the call from sheriffs deputies the night she died didnt raise any red flags, and he decided to declare her cause of death without examining her. Home administrator Larry Henderson declined to comment, citing privacy restrictions.
Bentley Lipscomb, a former secretary of Elder Affairs, said the DCF files show for the first time the extent of neglect in homes, and the lack of criminal prosecutions that follow. They just dont value old peoples lives, he said.
He and others spearheaded the changes 15 years ago that toughened state law to allow prosecutors to charge caretakers with neglect when people die under their care. I was tired of seeing people die unnecessarily and no one doing anything about it, he said.
George Sheldon, the former DCF secretary, said prosecutors are still failing to look for ways to hold caretakers accountable. He said his former agency which investigates abuse of the elderly and children has been frustrated by the number of cases turned over to law enforcement that dont get prosecuted.
A lot of attention is paid to children, he said. Somehow, we dont have the same kind of outrage when a person is 70 or 80. Theres clearly a lack of justice.
One of two cases that prosecutors took to court began on Mothers Day in 2004 when Gladys Hortas family got a call from caretakers: the 74-year-old had fallen in the shower, but she wasnt hurt.
When one of her relatives arrived at The Gardens of Kendall that night to take Horta to dinner, however, she found the elderly woman in bed, curled up in pain.
By the time Horta arrived at the hospital, she was soaked in urine and unconscious, with blackened feet and deep bruises inexplicably circling her legs.
Though doctors performed emergency surgery, Horta died two days later.
In the ensuing weeks, investigators found there was more to the story than what the family was told on Mothers Day.
Instead of a fall in the shower, Hortas injuries were caused by a caretaker who had gone to extremes to keep the elderly woman from wandering: Horta was strapped down for at least six hours so tightly she lost circulation in her legs, forming the blood clot that killed her, DCF reports state.
After an investigation by the attorney generals office, facility owner Mayra Del Olmo was charged with aggravated neglect and later sentenced to one year of house arrest and five years probation in 2006, a state attorney general report said.
But to this day, there is no record of her conviction. The reason: Her case was later expunged.
Miami Herald staff writer Jared Goyette contributed to this report.