This is part two in a three-part series. Read part three here. When Alva Trout’s earthly remains arrived on March 4, 2007, at the Barbara Falowski funeral home in Fort Lauderdale, the death certificate had already been signed.

Cause of death: Failure to thrive.

Natural causes.

But to the funeral home, the death was anything but natural, said relatives: Trout’s neck was broken in one place and dislocated in another. Gaping pressure sores ravaged her back and ankle. Instead of preparing her body for a service, the home sent her remains to the Broward County Medical Examiner.

There, an autopsy reached a far different diagnosis: Trout, 93, died of pneumonia brought on by a traumatic injury: “Accident,” the new death certificate said, “with neck fracture.”

The case of Trout, who had been living at Williamsburg Landing in Wilton Manors, was among at least three found by The Miami Herald in which death certificates signed by doctors working with ALFs were directly contradicted during state neglect investigations.

In four other cases at other ALFs, the Department of Children & Families found evidence that caretakers falsified records during death cases, but no one was charged.

Unreliable information

For investigators and family members, the lack of reliable records creates gaps in understanding what happened to residents in their final days and ultimately, how they died.

To DCF agents looking into the death of Edith Carpenter Layton, the falsification of key drug records concealed just how many powerful narcotics were fed to the 84-year-old during her decline at Crystal Gem ALF.

When Layton checked into the home in Citrus County in April 2007 — recovering from broken ribs — she was supposed to stay only a few days while her family left town to celebrate her grandson’s birthday.

“She did not want to ruin the party for the rest of the family, so she agreed to go to the home for a long weekend,” said granddaughter Anne Layton Rice of Key West.

Shortly after being dropped off at the home, Layton fell and broke her hip. Caretakers gave her heavy doses of tranquilizers instead of taking her to the hospital.

When Layton’s daughter returned to pick up her mother, she found the woman clinging to consciousness, and rushed her to Citrus Memorial Hospital. There, doctors found the elderly woman was “extremely sedated and severely dehydrated,” records show.

Her condition was so bad that surgeons had to hold off for three days before trying to repair her broken hip. After lingering for several weeks, Layton died from complications arising from the injury.

In the ensuing days, DCF agents reached a startling conclusion: The home had falsified records of medications given to the woman.

Medical logs that were supposed to show the quantity of narcotics given to Layton didn’t match the number of pills missing from the facility’s inventory. In addition, signatures on logs were forged.

Even a home administrator suggested the medication log had been “made up” after Layton left the facility, reports stated.

But in the end, no one was charged. Rich Buxman, an assistant state attorney in Citrus County, said his office found discrepancies in the records and signatures that appeared forged, but “those are civil matters,” he said. “That would be great for a civil case.”