- 1. ELDER ABUSE -A PROSECUTORS PERSPECTIVE A training for
professionals In Phoenix, Arizona March 15, 2002
2. Presented by Paul Greenwood, Deputy District Attorney, San
Diego County, California 3. 4. WARNING!
- The views expressed by the presenter are not necessarily those
of the San Diego District Attorneys Office
5. ELDER ABUSE IS...
- Affecting both provincial & rural areas
- Being committed in homes where there are also other forms of
abuse
6. ELDER ABUSE IS EXPLODING
- Fastest growing age group
- No known cure for dementia etc.
- Victims often do not report
- Third fastest growth job is home care
- Minimal background checks
- High temptation, low risk factors
7. UNDERSTANDING THE DYNAMICS
- Concern that exposure will lead to loss of independence
- Sometimes accompanied by threats from perpetrator
8. WHO ARE OUR VICTIMS?
- Important to understand the events of their lifetime
- Do we know their history?
9. LESSONS LEARNED FROMDOMESTIC VIOLENCE
- Self -determination is not the answer
- If not punished, the perp WILL abuse again
- We CAN convict even without the assistance of the victim
- Abuse is a crime against NOT JUST the abused
10. AVOID STEREOTYPING OF SENIORS
11. As a result :
- Lack of investigation by police
- Lack of prosecution by DAs
- Lack of awareness by public
12. Prior to our Elder Abuse Unit:
- Elder Abuse statute existing for 10 years
- Average of 2 or 3 cases a year
- Police received no special training
- Public unaware of reporting procedure
- Prosecutors rejected most financial cases
13. Since our unit began in 1/96:
- Increased awareness of public
- Increase in referral calls to APS
- Mandatory training for police
- Vertical prosecutions of all Elder Abuse
- Prosecution of over 300 felony cases
- Increase from 1 to 5 prosecutors
14. Building awareness level [1]
- Speaking to community groups
-
- Include counter & telephone staff
15. Awareness level contd [2]
- Reaching first responders
-
- Paramedics & Fire personnel
- Educating the E.R. nurses & doctors
-
- Reminder of mandatory reporting
- Encourage banks to train their staff
16. Awareness level contd [3]
- Use the media to communicate
-
- TV, Radio talk show, newspaper articles
- Form a multi-disciplinary team
17. Creating/promoting referral line:
- Every County must have a reporting line
18. Elder Abuse Prosecutions:
- California Penal Code section 368
-
- 368[d]& [e], a felony if over $400
-
- 368[d]&[e], a misd. if $400 or under
19. Physical and Mental Abuse:
- Aggravated Assaults/Attempted murder
20. Physical and mental abuse contd
- Manslaughter - neglect causes death
- Intimidation/Mental & Psychological Abuse
21. Profile of the physical abuser:
- Son in his late 30s or early 40s
- Divorced/ returns or single and unmotivated
- Drugs, alcohol or gambling
22. Classic neglect cases
- Deprivation of medical attention
- Lack of ventilation, heat or light
23. The classic neglected victim
- Coated with fecal matter/ urine stained
- Untrimmed toenails, matted hair
24. Signs of neglect
- Dry lips, pallor or excessive weight loss
- Dirty or inappropriate clothing for weather
- Shivering or low body temperature which might indicate
hypothermia
- Lack of dentures, glasses or hearing aid
- Signs of infrequent bathing
25. Signs of neglect contd
- Physical or mental deterioration with no medical reason
- Elderly person is seen wandering dangerously
- Inadequate or over medication
- Cooking and housekeeping standards that could lead to illness
or accidents
26. Decubitus ulcers
- Break in skin and underlying tissues due to pressure or
friction
- Common areas are shoulder blade, elbow, sacrum, hip, inner
knee, outer ankle, heel
27. Reasons for overmedication
- Lack of understanding - giving medication round the clock
instead of asneeded
- For convenience, giving all medications at same time
- Giving medication with alcohol or over the counter meds to
increase sedative effects
28. Overmedication contd
- To keep patient docile and compliant
- To keep from wandering away
- As an alternative to physical restraint
29. Signs of over-medication
- Falls asleep when talking
- Sleeps all day and up all night
- Similar to being intoxicated
- Slurred speech, shaky hands, trambling voice
30. Reasons for undermedicating
- Thinks that person should not need medication
- Thinks that patients mental state is deteriorating because of
medication
- Thinks that withholding of meds might hasten patients
death
- Is using meds for own use
31. Common medications
- Tranquilizers/Anti-anxiety: Valium Librium Donatal
Phenobarbital Ativan Restoril Triazolzam Xanax & Lorazepam
32. Common medications
- Pain: Vicodin Tylenol & Codeine Percocet Talwin Oxycondone
Dilaudid Morphine Demoral
33. Common medications
- Anti-depressants: Paxil Zoloft
- Sleep medications: Halcion Luminal Nembutal Seconal &
Dalmane
34. Evidence Collection
- Photos / video of living conditions
- Include photos of kitchen, fridge etc
35. Evidence Collection
- Dangerous/ exposed items putting V at risk
- Proof of Vs disorientation - unopened mail, bills unpaid
- Signs of alcohol/drug/gambling abuse by D
36. Key persons to contact
- Vs bank / financial adviser
37. Key persons to contact contd
- APS to check on prior history
- Paramedic who first arrived on scene
- E.R. nurse/ physician who first triages and treats victim
38. Interviewing suspect
- Knowledge of Vs age & medical condition
39. Interviewing victim
- Questions to determine orientation
- Last time you ate, bathed, visited doctor or dentist
- Your relationship with suspect careprovider
40. Cross reference with financial abuse
- Look for signs of financial exploitation
- Documents giving control to suspect - POA - Quitclaim deed -
New will - Correspondence, bank statements
- Check book, ATM, pawn slips
41. Resources
- Poison Center: 1-800-876-4766
- Internet - www.safemedication.com
42. Classic elder abuse murder case 43. Financial Abuse:
- Telemarketing & sweepstakes scams
44. Forms of theft
- By larceny - a taking of property
- By trick - consent is based on deceit or fraud
- By embezzlement - property is entrusted to thief
45. Typical theft scenarios
- Credit card & identity theft
- Transfer of title - POA & quitclaim deed
- Sweepstakes/telemarketing frauds
46. Typical theft scenarios contd
- Excessive charging by unlicensed contractors & other
merchants
47. HOW TO PROVE STEALING?
- with intent to permanently deprive
48. Three prosecutable scenarios
- Classic case of theft from a competent victim
- Theft from an incompetent victim
- Theft from a marginally competent victim [by undue
influence]
49. SCENARIO # 1
- Did not owe monies to suspect
50. SCENARIO # 2
- Medical testimony that victim suffers from dementia/
Alzheimers/ Parkinson's or some other illness that deprives victim
of necessary understanding
- Incapacity was present at time of transaction
51. SCENARIO # 3
- Is it theft, a loan, or a gift?
- Victim is marginally competent
- Suspect exploited victims vulnerability
- Victim was unduly influenced or was defrauded
52. Undue Influence
- Victim was pushed in a direction that he did not want to
go.
- The influence by suspect was sufficient to remove the
voluntariness of the transaction
- Victim has been evaluated by a geriatric
psychiatrist/psychologist
53. Significance of evaluation
- Need to assess status of mental capacity
- But distinguish from scenario #2
- Opportunity for evaluator to render opinion of
susceptibility
- Looking for vulnerabilty factors
- Opinion is not whether victim WAS unduly influenced - that is
for jury
54. How to prove undue influence?
- Multiple escalating transactions
55. Statements of suspect
- How did they affect & influence victim?
- Can we prove that the statements were false?
- Look for reasons why suspect chose those particular
statements
- Examples - need, emergency, opportunity, hint of a
threat...
56. Look at conduct of suspect
- The cultivating of a friendship
- The outward gestures of affection
- The other side - the dark character traits of greed,
manipulation, control
- Who can testify to such traits?
57. Witnesses
- Doctor, pharmacist, optometrist of V
- Business contacts of suspect
58. Evidence collection
- Best evidence is the video interview
- Bank, credit card statements
- Look for the inappropriate purchases
- Ask questions, questions, questions!!!
59. Be careful about ...
- Obtaining a consent release form
- If V has mental capacity problems, then do NOT get a
release
- Obtain through search warrant or if after case has been issued,
through subpoena
60. How banks can help in the fight against financial elder
abuse
- Adopt the Oregon model [Senior & Disabled Services
Division: Aileen Kaye 503-945-6399]
- Offer to conduct the training
- Highlight the bad examples and praise the courageous
61. How to get the most out of the bank
- Contact the chief fraud investigator for the bank before
serving the search warrant
- Remind them that time is critical - put them on written
notice
- Where appropriate, also remind them that this crime could have
been avoided
62. What happens if you discover theft after victim dies?
- This may still be prosecutable if the case falls within
scenario # 2.
- Is there a documented medical history of Vs lack of capacity
prior to death and before date of transaction?
63. What happens if victim dies after investigation begins and
before prosecution finishes?
- Do you have victim on video?
- If scenario #2, the death should not affect the
proceedings
- Did the victim testify at a preliminary hearing?
64. Credit Card fraud:
- Filling out unsolicited application
- Adding perps name as authorized user
- Paying monthly payment by telephone banking
65. Real Estate scams:
- Living trust sucker - getting to the portfolio
66. Telemarketing scams:
67. Home Improvement scams
- Roofs, driveways, painting
68. Remember that ...
- Some cases are simply not prosecutable
- But you will never know until you try
69. Seniors and the court process:
- Bringing the court to them
- After court - to prevent further victimization
70. Interviewing an elderly victim
- Try to identify areas of vulnerability
- Preserve the interview on video
71. Elder Abuse case hurdles:
72. Red Flags To Keep in Mind
- Implausible/vague explanations
- Unexplained injuries - past or present
73. Clues On Physical Exam
74. Patterned Injuries
- May help to identify object used by the perp
- May be represented as a series of marks that all look the
same
75. Categories of Documentation
76. Written History
- Record interactions between patient and caregiver
- Specifics regarding timing and mechanism, alleged perpetrator,
how it happened
- Avoid perjorative comments
77. Body Diagram
- Characteristics of injuries
78. Photodocumentation
- Images should include those from a distance, close-up and
different angles
79. What Happens If You Dont Report?
- Great bodily injury or death up to 1 year in jail
80. Barriers To Reporting
-
- Concerns regarding alienating family
-
- Concerns regarding alienating facility personnel
-
- Lack of knowledge regarding how to report
-
- Difficult to identify abuse
81. Seniors and the Court Process
- After court - to prevent further victimization
82. Assess the impact of the crime
83. RESOURCES AVAILABLE
- Oregon Bank project [Dept. of Human Resources : Aileen Kaye
503-945-6399]
- Evidence Code section 1380
84. EVIDENCE CODE S. 1380
- Video tape ALL elder abuse victim interviews by law
enforcement
- Judge has discretion to allow if victim dies or becomes
incapacitated
- Interview has indicia of reliability
- Other corroborative evidence
85. THEGOLDENYEARS 86. A Message to Seniors:
- We respect and honor you!
- We commit to seeking justice for you
87. Please feel free to contact me:
