Each year, dozens of Florida's frail and feeble die under suspicious circumstances in state nursingand boarding homes -- forgotten fatalities afflicted with bruised bodies and broken hips, headwounds, rib fractures or infections.
A Miami Herald review of hundreds of adult deaths over the past five years shows that thesedeaths, even in state- sanctioned facilities, are often a result of abuse and neglect.
The fatal injuries go undocumented in medical records, unnoticed by welfare workers,unchallenged by police and prosecutors.
Frequently, family members don't even know what happened to their relatives in the veryshelters licensed by the state to protect them.
"I was shocked when I looked at the death certificate and saw 'blunt head trauma,' " saidTony Rosco of his 88-year-old mother. She died while a patient at the Meridian Nursing Home inPlantation earlier this year, emaciated at 74 pounds. "More shocking than that is that I still don'thave any idea what happened to her. Can you imagine what that's like?"
When Harriet Roberts Martin last saw her grandmother Idora Smith in a Dade County fosterhome, she was horrified by the 83- year-old woman's condition. "Her face was caved-in fromdehydration, her eyes were back in her head, she looked like something in a horror show," Martinsaid.
Four weeks later, her grandmother was dead, a victim of neglect and infection. The stories of these forgotten fatalities have been chronicled from hundreds of pages of Floridaautopsy and abuse reports, investigative files and state welfare documents. They tell a troublingtale of death among the elderly and disabled in licensed facilities.
* Maude Weiss, 87, who died of gangrene and infection of the leftleg after living in two Broward County nursing homes. Abuse investigators determined that she wasmistreated at both Aviva Manor in Fort Lauderdale and later at Beverly Manor in Pompano Beach. Shedied bruised, with bedsores that cut to the bone. Administrators at both facilities said she was notabused.
"What happened to my mother was terrible," said Constance Konen, her daughter. "I'm still notable to cope with her unnecessary death."
* Vera Frazier, 65, a cancer patient at the Ashley Manor Nursing Home in Miami, who diedafter suffering second- and third-degree burns. She was left unattended with a cigarette thatdropped in her lap and set her on fire. Her undergarments smoldered unnoticed for several minutes,and healthcare workers waited almost 10 hours to send her for emergency medical help.
Kenneth Hawkins, administrator at Ashley Manor, said he could not comment on the case becausehe wasn't in charge at the time of her 1990 death. Since then, he said, the home has undergone acomplete management change and "turnaround."
* Maria DeBertran, 92, a resident of El Ponce de Leon Convalescent Center in Miami, whodeveloped a stomach infection and slowly starved because her abdominal feeding tube malfunctionedand wasn't repaired. She arrived at the hospital emaciated, covered with sores. She had beenchronically underfed, abuse reports show. Nursing home officials declined to comment on her case,but Michael Segal, an attorney for the nursing home, said: "Obviously, there was no proof of anyserious abuse, or something would have happened."
* Della Heltz, 99, who died of heart disease. She lived in an unlicensed Miami boarding homeowned by David Winfrey. There, she lay dead for hours -- maybe days -- before care-givers calledsomeone to pick up her body. She was found clutching a pillow, her body badly decomposed. An HRSabuse report found: "It is difficult to believe that a prudent person could live in a house for anyreasonable length of time with a decomposed body that is not only stinking but the body has beendead for so long that the insects had eaten parts of the body away."
Winfrey's state license had already been revoked for previous abuse and neglect. He did notreturn numerous phone calls to his home. In a letter to the Dade County medical examiner, he saidHRS had exaggerated the charges against him.
* Nicholas Gutierrez, who died at 75 after developing nine severe bedsores. He lived in theSnapper Creek Nursing Home. Investigators from the Long-Term Care Ombudsman Council concluded he wasneglected and that the home waited to send him for treatment until one day before his Medicarebenefits lapsed. By then, he was already near death.
Andrew McKillop, administrator at Snapper Creek, said doctors at the home did everything theycould for him, treating him on several occasions for the sores. "From what I can see, he got thetreatment he needed," McKillop said.
"Is this kind of care adequate? I'm not a medical professional, but I have my doubts," saidAl Ackerman, head of South Florida's regional Medicaid Fraud Unit, which investigates abuse innursing homes. "And I'm concerned that most of the population has no idea how the elderly are livingor dying."
More than 100,000 elderly and disabled people live in Florida's nursing homes andfoster-care and boarding facilities. Many of them are alone, without family to supervise their careclosely. Even when family members are involved, they often don't detect the warning signs that leadto neglect, abuse and, too many times, death.
Other disabled and elderly end up inappropriately placed, living in state-licensed homes thataren't required to provide the kind of critical care they need. Only nursing homes are required bylaw to provide skilled care, and far more elderly need it than get it.
The Herald found several cases in which boarding homes and foster homes became a dumpingground for impoverished, desperate and difficult-to-place elderly, whose delicate conditions quicklydeteriorated.
When Idora Smith, a church-going, Georgia-born widow, went to live at Edith Bryant's fosterhome in Miami, she couldn't walk, eat or bathe by herself. What she needed was more specializedcare.
Instead, she got sicker and died after four months. A confidential Department of Health andRehabilitative Services abuse report concluded after her death four years ago:
"Investigation evidenced that client was accepted into the foster home in nonambulatorycondition, unable to take her own medicines, which were in turn administered by Edith Bryant. Clientprogressively deteriorated to the point that her admission diagnosis at Palm Springs Hospitalincluded anemia, gram negative sepsis (overwhelming infection) . . . malnutrition, dehydration,urinary tract infection, mild diabetes . . . and arteriosclerotic heart disease."
Martin, Smith's granddaughter, said HRS referred her to Edith Bryant's in the first placebecause the family could no longer care for her.
Martin said she visited her grandmother as often as she could, but usually Smith wascovered with sheets. She didn't notice her grandmother was failing until the day of her last visitto the foster home, four weeks before her grandmother's death.
When Martin pulled away the sheet that covered Smith, she found her 105-pound body wasriddled with bedsores so deep and infected that bones and raw tissue were exposed. She was starvedand sick, doped up on Haldol, a psychotropic medication that leaves patients lethargic and lifeless.
She immediately called an ambulance.
"All I know is that she had to besuffering," Martin said. "I mean, when you have sores where you can see someone's skeleton, it hasto be painful. This was a human being. She didn't deserve to die this way."
By the time HRS investigators were called to document Smith's injuries, she was alreadydying. They found her covered in bed sores. They were on her back, her legs, her feet, her anklesand her groin.
Bryant told investigators she noticed only a sore the size of a teacup on Smith that"eventually caved in." She cleaned the sore with an antiseptic, she said, and telephoned Smith'sdoctors. She said they never called her back. Before that, she sent Smith to a local clinic, wherethey treated her at least twice, Bryant said.
"I'm not an abusive woman," Bryant says today. "She came to me with all this stuff. Those arejust lies about me."
She said she never wanted to accept Smith in the first place, but Smith's family pleaded withher because they couldn't take care of her any longer. Bryant says the family was well- aware ofSmith's declining health.
HRS later discovered that Bryant's foster care license had expired, but the state Officeof Aging and Adult Services, charged with monitoring foster homes, had never noticed.
An autopsy showed Smith died of overwhelming infection. Maria Conte, Dade associate medicalexaminer, said Smith should have received skilled nursing care and didn't belong in a foster home.Conte's investigation also found that Smith did not have the bedsores before she was admitted to thefoster home.
HRS ruled it a clear case of medical neglect that led to death.
The Dade stateattorney's office called it one of the most disturbing cases of medical neglect ever investigated inthe past five years.
But there wasn't enough evidence to prosecute anyone. Instead, Smith became a casualty of thestate's seldom-used, poorly defined neglect and abuse laws.
"We got into it, and we thought, 'This is a good one,' " said Katherine Fernandez Rundle, achief assistant prosecutor in Dade. "We were outraged. I'll never forget it. But there was no way tohold Edith Bryant fully responsible criminally. She clearly didn't do a good enough job, but she atleast was doing something."
The Florida Long-Term Care Ombudsman Council this year chastised the state for its laxregulation of foster homes, saying in its 1991 annual report: "There is the potential forexploitation of the system by opportunistic facility owners and desperate case managers" who don'tdo enough, or care enough, to protect the sick and vulnerable.
Even in skilled nursing homes, where the elderly are supposed to get advanced care, TheHerald found life-threatening medical problems going unreported or unattended.
Tony Rosco says no one at the Meridian Nursing Home in Plantation ever told him that hismother had injured herself, and he had no idea what was wrong with her the last day he saw her atthe home. Sue Rosco was dying. Normally alert, she didn't speak. She didn't recognize her son.
"I just thought she was peaceful for once," he said.
The Meridian Nursing Homehas since been sold to Global Health Management, another corporation. Gary Sudhalter, a GlobalHealth spokesman, said he knows nothing about Rosco's death and couldn't comment on it.
"I keep thinking I should have seen something, that if my wife was alive, she would havenoticed there was a problem," Tony Rosco said. "And I feel guilty."
Rosco's wife was killed in an auto collision just months before his mother died. His wife hadvisited his mother regularly.
"You wonder, who else does this happen to?" Tony Rosco asked.
Sue Rosco'scondition astounded her doctor and the pathologist who performed her autopsy. Raul Vila, Browardassociate medical examiner, said Rosco's skull was severely fractured and the injury had goneuntreated, probably undetected.
"She had fallen or something, and they just left it at that," said Vila, who noted that theinternal brain injury covered half of her head. Vila estimated that the injury was at least a weekold and had been slowly bleeding.
But when Tony Rosco talked to his mother's doctor, the doctor told him that he had never seensomeone fail so fast, with so little warning and that her death was suspect. Doctors at the hospitaltold Tony Rosco that it looked as if his mother hadn't eaten in seven to 10 days. There was old,decaying food in her mouth.
HRS abuse investigators turned the case over to the Broward state attorney's office. Theinvestigators said there were indications that Sue Rosco wasn't properly cared for: She wasdehydrated and covered with dried feces and food when she arrived at the hospital.
State law only requires doctors to see their nursing home patients once a month, leaving theburden of responsibility for daily health care with overworked, sometimes inexperienced nurses andaides.
Although numerous state agencies are responsible for making sure the frail are properly caredfor in licensed facilities, that protective net often fails to detect neglect and abuse problems.Overlapping jurisdictions, poor investigative coordination and ignorance about abuse and neglecthave made a growing problem worse.
"Among the care-givers, it is pretty well-known that it's rare that anybody is prosecuted forcrimes against the elderly," said Robert Lee, a prosecutor in Fort Myers. "It's rarely a crimethat's witnessed by anyone, and usually, even if it is, there's pressure not to do anything about itor to document it."
Lee spent months attempting to bring criminal neglect charges against the Cross Key ManorNursing Home on behalf of Mildred Buie, an 80-year-old Fort Myers woman who died while a patientthere in 1990. Lee claimed workers at the home didn't notice that Buie was critically sick eventhough the woman hadn't had a bowel movement in 18 days. Her medical records failed to explain why.
By the time the home sent her to a hospital, she was filthy, dehydrated and had rectalbleeding. Feces was so severely impacted that her colon ruptured, infecting her with bacteria thatprobably killed her. But no autopsy was performed. HRS's abuse registry wasn't called until daysafter her death. By the time criminal investigators were involved, Buie's body had been sent toMinnesota and buried. In the first attempt in Florida to prosecute a corporation on charges ofabuse, Lee brought criminal charges against Crossgates Medical Inc., a Pennsylvania firm that ranthe home.
The corporation pleaded not guilty, but agreed to settle the case by paying the state a$10,000 fine.
"You had neglect that led to her death, no doubt," Lee said. "But we couldn't identify oneindividual who was responsible. We just know that someone somehow failed to detect that she was introuble.
"And because of that, she died."