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    maricopa.gov maricopa.gov Presentation Transcript

    • ELDER ABUSE - A PROSECUTOR’S PERSPECTIVE A training for professionals In Phoenix, Arizona March 15, 2002
    • Presented by Paul Greenwood, Deputy District Attorney, San Diego County, California
    •  
    • WARNING!
      • The views expressed by the presenter are not necessarily those of the San Diego District Attorney’s Office
    • ELDER ABUSE IS……...
      • A Crime
      • Affecting both provincial & rural areas
      • Going unpunished
      • Predictable
      • Being committed in homes where there are also other forms of abuse
    • 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
    • UNDERSTANDING THE DYNAMICS
      • Fears of many seniors
      • Leads to underreporting
      • Feelings of shame
      • Concern that exposure will lead to loss of independence
      • Sometimes accompanied by threats from perpetrator
    • WHO ARE OUR VICTIMS?
      • Over age of 65
      • Born before 1936
      • Important to understand the events of their lifetime
      • Do we know their history?
      • How about a refresher?
    • LESSONS LEARNED FROM DOMESTIC 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
    • AVOID STEREOTYPING OF SENIORS
      • Forgetful
      • Senile
      • Longwinded
      • Fragile
      • Grumpy
      • Disabled
    • As a result :
      • Lack of investigation by police
      • Lack of prosecution by DA’s
      • Lack of awareness by public
    • 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
    • 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
    • Building awareness level [1]
      • Speaking to community groups
        • Kiwanis, Lions & Rotary
      • Arranging senior forums
        • Day time, door prizes
      • Training the police
        • Include counter & telephone staff
    • Awareness level cont’d [2]
      • Reaching first responders
        • Paramedics & Fire personnel
      • Educating the E.R. nurses & doctors
        • Reminder of mandatory reporting
      • Encourage banks to train their staff
        • Adopt Oregon method
    • Awareness level cont’d [3]
      • Use the media to communicate
        • TV, Radio talk show, newspaper articles
      • Form a multi-disciplinary team
        • F.A.S.T
    • Creating/promoting referral line:
      • Every County must have a reporting line
      • Billboards
      • Posters
      • Radio and TV PSA’s
      • # of calls WILL increase
    • Elder Abuse Prosecutions:
      • California Penal Code section 368
      • Divided between :
      • Physical / Mental abuse
        • 368[b], a felony
        • 368[c], a misdemeanor
      • Financial Abuse
        • 368[d]& [e], a felony if over $400
        • 368[d]&[e], a misd. if $400 or under
    • Physical and Mental Abuse:
      • Assaults and batteries
      • Aggravated Assaults/Attempted murder
      • Sexual assault
      • Neglect
    • Physical and mental abuse cont’d
      • Manslaughter - neglect causes death
      • Murder
      • Intimidation/Mental & Psychological Abuse
      • False Imprisonment
      • Torture
      • Robbery and extortion
    • Profile of the physical abuser:
      • Son in his late 30’s or early 40’s
      • Living at home with Mom
      • Divorced/ returns or single and unmotivated
      • Lazy and unemployed
      • Drugs, alcohol or gambling
      • Feeds habit off Mom
    • Classic neglect cases
      • Deprivation of medical attention
      • Deprivation of food
      • Lack of hygiene
      • Lack of ventilation, heat or light
      • Over-medicated
      • Under-medicated
    • The classic neglected victim
      • Malnourished
      • Semi-comatose
      • Dehydrated
      • Bed sores, rashes, lice
      • Coated with fecal matter/ urine stained
      • Inadequately clothed
      • Untrimmed toenails, matted hair
    • 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
    • Signs of neglect cont’d
      • Physical or mental deterioration with no medical reason
      • Confinement
      • Elderly person is seen wandering dangerously
      • Lack of groceries
      • Inadequate or over medication
      • Cooking and housekeeping standards that could lead to illness or accidents
    • Decubitus ulcers
      • Pressure or bed sores
      • Break in skin and underlying tissues due to pressure or friction
      • Classified Stages 1 - 4
      • Common areas are shoulder blade, elbow, sacrum, hip, inner knee, outer ankle, heel
    • Reasons for overmedication
      • Lack of understanding - giving medication round the clock instead of as needed
      • For convenience, giving all medications at same time
      • Giving medication with alcohol or over the counter meds to increase sedative effects
    • Overmedication cont’d
      • To keep patient docile and compliant
      • To control behavior
      • To keep from wandering away
      • As an alternative to physical restraint
    • Signs of over-medication
      • Disoriented
      • Falls asleep when talking
      • Sleeps all day and up all night
      • Similar to being intoxicated
      • Slurred speech, shaky hands, trambling voice
      • Passive behavior
    • Reasons for undermedicating
      • Thinks that person should not need medication
      • Thinks that patient’s mental state is deteriorating because of medication
      • Thinks that withholding of meds might hasten patient’s death
      • Wants patient to suffer
      • Is using meds for own use
    • Common medications
      • Tranquilizers/Anti-anxiety: Valium Librium Donatal Phenobarbital Ativan Restoril Triazolzam Xanax & Lorazepam
    • Common medications
      • Pain: Vicodin Tylenol & Codeine Percocet Talwin Oxycondone Dilaudid Morphine Demoral
    • Common medications
      • Anti-depressants: Paxil Zoloft
      • Sleep medications: Halcion Luminal Nembutal Seconal & Dalmane
    • Evidence Collection
      • Photos / video of living conditions
      • Include photos of kitchen, fridge etc
      • Bed sheets and mattress
      • Diapers
      • Clothing
      • Prescription meds
    • Evidence Collection
      • Dangerous/ exposed items putting V at risk
      • Non-working call button
      • Proof of V’s disorientation - unopened mail, bills unpaid
      • Signs of alcohol/drug/gambling abuse by D
      • Any living will?
    • Key persons to contact
      • V’s family members
      • Neighbors
      • V’s doctor / dentist
      • V’s pharmacist
      • V’s pastor
      • V’s attorney
      • V’s bank / financial adviser
    • Key persons to contact cont’d
      • APS to check on prior history
      • Paramedic who first arrived on scene
      • E.R. nurse/ physician who first triages and treats victim
      • 911 dispatcher
    • Interviewing suspect
      • Length of relationship
      • Type of relationship
      • Description of duties
      • For pay or love?
      • Knowledge of V’s age & medical condition
      • Reasons for non-action
    • Interviewing victim
      • Questions to determine orientation
      • Mini-mental assessment
      • Last time you ate, bathed, visited doctor or dentist
      • What meds are you taking
      • Your relationship with suspect careprovider
    • 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
    • Resources
      • Poison Center: 1-800-876-4766
      • Internet - www.safemedication.com
    • Classic elder abuse murder case
    • Financial Abuse:
      • Theft
      • Credit card fraud
      • Real Property transfers
      • Home Improvement scams
      • Telemarketing & sweepstakes scams
      • Investment fraud
    • 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
      • By undue influence
    • Typical theft scenarios
      • Jewelry
      • Checks
      • ATM card
      • Credit card & identity theft
      • Transfer of title - POA & quitclaim deed
      • Bogus investment scams
      • Sweepstakes/telemarketing frauds
    • Typical theft scenarios cont’d
      • Home improvement scams
      • Excessive charging by unlicensed contractors & other merchants
      • Theft by undue influence
    • HOW TO PROVE STEALING?
      • Taking property
      • belonging to another
      • without consent &
      • with intent to permanently deprive
    • 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]
    • SCENARIO # 1
      • Victim testifies
      • Did not give permission
      • Did not owe monies to suspect
      • Victim is credible
    • SCENARIO # 2
      • Victim cannot testify
      • Medical testimony that victim suffers from dementia/ Alzheimer’s/ Parkinson's or some other illness that deprives victim of necessary understanding
      • Incapacity was present at time of transaction
    • SCENARIO # 3
      • Is it theft, a loan, or a gift?
      • Victim is marginally competent
      • Suspect exploited victim’s vulnerability
      • Victim was unduly influenced or was defrauded
    • 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
      • No longer free will
      • Victim has been evaluated by a geriatric psychiatrist/psychologist
    • 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
    • How to prove undue influence?
      • Length of relationship
      • Place of first meeting
      • Prior spending habits
      • Prior “charitability”
      • What is left?
      • Multiple escalating transactions
      • Statements by suspect
    • 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…...
    • Look at conduct of suspect
      • The “meeting”
      • 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?
    • Witnesses
      • Bank teller
      • Pastor
      • Neighbor
      • Doctor, pharmacist, optometrist of V
      • Family
      • Ex- spouse of suspect
      • Business contacts of suspect
    • Evidence collection
      • Best evidence is the video interview
      • Bank, credit card statements
      • Bank surveillance tapes
      • Prior medical records
      • Look for the inappropriate purchases
      • Ask questions, questions, questions!!!
    • 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
    • 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
    • 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
    • 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 V’s lack of capacity prior to death and before date of transaction?
    • 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?
    • Credit Card fraud:
      • Filling out unsolicited application
      • Adding perp’s name as authorized user
      • Controlling the mail
      • Paying monthly payment by telephone banking
    • Real Estate scams:
      • Deadly weapon - the POA
      • Quitclaim Deed
      • Mortgage rip offs
      • Living trust sucker - getting to the portfolio
    • Telemarketing scams:
      • Paul Bell
      • Just say No
      • Sucker lists
      • Use AARP
    • Home Improvement scams
      • Roofs, driveways, painting
      • “Just in the area”
      • Work in pairs
      • Pick-up truck
      • Want cash
      • Use inferior materials
      • Leave without trace
    • Remember that ...
      • Some cases are simply not prosecutable
      • But you will never know until you try
    • Seniors and the court process:
      • Getting them to court
      • Bringing the court to them
      • Waiting at court
      • Testifying in court
      • After court - to prevent further victimization
    • Interviewing an elderly victim
      • Venue is important
      • Build a rapport
      • Look for achievements
      • Try to identify areas of vulnerability
      • Preserve the interview on video
    • Elder Abuse case hurdles:
      • The recanting victim
      • The “consent” defense
      • The “incompetent” victim
      • The deceased victim
      • Old people die
    • Red Flags To Keep in Mind
      • Implausible/vague explanations
      • Delay in seeking care
      • Unexplained injuries - past or present
      • Inconsistent stories
      • Change in behavior
    • Clues On Physical Exam
      • Sores
      • Unkempt appearance
      • Poor hygiene
      • Malnutrition
      • Dehydration
    • Patterned Injuries
      • May help to identify object used by the perp
      • May be represented as a series of marks that all look the same
    • Categories of Documentation
      • Written history
      • Body diagram
      • Photodocumentation
      • Conclusion
    • Written History
      • Legible handwriting
      • Patient identification
      • Date and time
      • Direct quotes
      • Record interactions between patient and caregiver
      • Specifics regarding timing and mechanism, alleged perpetrator, how it happened
      • Avoid perjorative comments
    • Body Diagram
      • Characteristics of injuries
      • Specific locations
      • Size and shape
      • Color changes
      • Swelling
      • Tenderness
    • Photodocumentation
      • Use a good camera
      • Identifier (name plate)
      • Ring flash
      • Serial images
      • Images should include those from a distance, close-up and different angles
    • What Happens If You Don’t Report?
      • Most cases
        • Up to 6 months in jail
        • Fine up to $1000
        • Both jail and fine
      • Great bodily injury or death up to 1 year in jail
        • Up to $5000
        • Both jail and fine
    • Barriers To Reporting
      • Health Care Provider
        • Concerns regarding alienating family
        • Concerns regarding alienating facility personnel
        • Easy to ignore/dismiss
        • Lack of knowledge regarding how to report
        • Difficult to identify abuse
    • Seniors and the Court Process
      • Getting them to court
      • Bringing court to them
      • Waiting at court
      • Testifying in court
      • After court - to prevent further victimization
    • Assess the impact of the crime
      • Financial
      • Emotional
      • Residual
    • RESOURCES AVAILABLE
      • Internet
      • Elder Abuse Listserve run by ABA [contact is : lstiegel@staff.abanet.org]
      • AARP
      • Oregon Bank project [Dept. of Human Resources : Aileen Kaye 503-945-6399]
      • Evidence Code section 1380
    • 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
    • THE GOLDEN YEARS
    • A Message to Seniors:
      • We respect and honor you!
      • We commit to seeking justice for you
      • We prosecute with:
      • Passion
      • Purpose
      • Perseverance
    • Please feel free to contact me:
      • Paul Greenwood
      • 619-531-3464
      • [email_address]