D.C. Trying to Keep Up With Packed Caseload
By Henri E. Cauvin
Washington Post Staff Writer
Sunday, May 21, 2006
There wasn't much to take from Josephine Watson. Like many people who end up in nursing homes, she didn't arrive at the Northwest Health Care Center in Cleveland Park with a wealth of possessions.
But the woman, now 76, coveted what she did have. So one morning about a year and a half ago when she discovered her perfume missing, she spoke up. A search of the floor and everyone on it turned up Watson's bottle of White Diamonds -- in the purse of a nursing home employee.
In the not-so-distant past, the staff's swift action might have been the most notable element of the whole episode. But the case didn't end there. The D.C. inspector general's office stepped in, and after an investigation, the employee, Sylvia Eugenia Jones, was arrested and charged with theft.
A few years ago, such a charge would have been far less likely, authorities say, and so would the conviction that prosecutors eventually won against Jones when she pleaded guilty last year.
A push by the D.C. inspector general and the U.S. attorney's office has led to a surge in similar charges against caregivers and other offenders in the past two years, many under a law -- passed in 2001 but little-used until last year -- that made abuse of a vulnerable adult a specific crime.
Although reports of abuse have climbed, the frequency of abuse hasn't necessarily. More people have stepped forward to report suspected abuse and exploitation as word of interest in such investigations has spread. The number of reports coming into the inspector general's office for possible investigation climbed to just over 2,500 last fiscal year, up from just under 1,000 two years earlier.
Investigators in the inspector general's office have been "really aggressive," said Jerry Kasunic, who as the District's long-term-care ombudsman is a key advocate for the rights of people in nursing homes and other long-term-care facilities. "They've been taking more cases."
The inspector general's Medicaid fraud control unit, which investigates such incidents, is poised to add several people to its staff of 16 in an effort to keep up with the rising caseload. "It's about time," Kasunic said. "They've been overwhelmed."
Not that long ago, that would have been hard to imagine. Instances of exploitation and abuse in nursing homes and other assisted living facilities in the District often went unprosecuted or even uninvestigated, advocates and authorities say. The cases are hard to prove: With their infirmities, victims often struggled to convey, or even remember, what happened to them. And convoluted protocols for investigating such allegations didn't help, slowing down investigations and leaving fast-fading memories to dim even more.
Compared with the kinds of crime that are common in the District, slapping someone across the face or swiping something off of a person's dresser could seem almost inconsequential. But these crimes are anything but, said Assistant U.S. Attorney Benjamin Friedman, who oversees such cases for the U.S. attorney's office.
"This is a big deal for the victims, for the vulnerable adults," he said, "because they depend on their caregivers totally. They have to. When their caregivers abuse them, they can't trust anybody."
A former nursing assistant at a Northwest Washington nursing facility was sentenced this month in D.C. Superior Court to a year behind bars for assaulting two residents and trying to sexually abuse the two women, who were 49 and 51. And last month, a woman who worked at an adult day-care facility in Northwest was arrested and charged with punching a 54-year-old mentally retarded man in the face after the man tried to drink from a cup of coffee he had pulled out of the garbage.
Like many people abused or exploited in such facilities, the man could not, because of his mental limitations, describe how he was assaulted, which is what authorities say makes the crime all the more challenging and all the more important. "It's almost like a homicide, because your victim can't testify," Friedman said.
About two dozen cases have been filed in the past two years, and many of them are still working their way through D.C. Superior Court, but prosecutors from the inspector general's office and the U.S. attorney's office have secured convictions in several cases. Most cases are prosecuted as misdemeanors and might result in no jail time if not for the special investigative effort. But judges have shown increasing willingness to lock up the offenders.
"Whenever these abuse cases come about, I believe it's absolutely imperative that there be some jail time involved," Judge Zinora Mitchell-Rankin said in November in sentencing a man to 90 days in jail for abusing a patient.
"I believe it's important to send a message to those who are similarly situated that for far too long, this kind of conduct has been cloaked in the dark, that even if it's a dollar late, nevertheless, people are looking," Mitchell-Rankin said. "The government is involved, law enforcement is involved, and it's not going to be tolerated."
A few of the recent cases have ended in acquittals. But most important, authorities say, is that the cases are treated as the crimes they are and are getting attention and follow-ups. In the past, when health officials acted against a facility, they typically came at a case from a regulatory angle. And the police, with so many other demands, gravitated toward the most egregious acts of abuse.
The recent efforts rely on the inspector general's office, which as the designated Medicaid fraud investigator for the District already had the authority to investigate nursing homes and other facilities where federal money pays the bills for many of the patients.
Under long-standing practice, the inspector general's investigators did not bring cases directly to the U.S. attorney's office. Instead they first went to the D.C. police -- a step that authorities now say is not always necessary. More and more, the inspector general is going straight to prosecutors.
Susan Bieber Kennedy, the nurse-lawyer who heads the Medicaid fraud unit, said streamlining the process has transformed the way her unit works. "It's just been a sort of sea change," she said.
"We know there's a lot of abuse and neglect out there," Kennedy said, "and the fact that we can process these cases more expeditiously enables us to act on the offense much quicker."
And that, she said, sends a message that people who are abused and caregivers who witness abuse have a place to turn.
As often as caregivers are involved in abuse, other caregivers just as often bring the trouble to light, as happened in the case of Josephine Watson and her pilfered bottle of perfume.
When the perfume was stolen, in November 2004, Watson was at the Northwest Health Care Center temporarily for rehabilitation. Eventually she went home. But Watson has since had to return to the facility as her health has deteriorated. An administrator at the home said Watson did not want to talk to a reporter about what had happened.
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