maricopa.gov

625 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
625
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

maricopa.gov

  1. 1. ELDER ABUSE - A PROSECUTOR’S PERSPECTIVE A training for professionals In Phoenix, Arizona March 15, 2002
  2. 2. Presented by Paul Greenwood, Deputy District Attorney, San Diego County, California
  3. 4. WARNING! <ul><li>The views expressed by the presenter are not necessarily those of the San Diego District Attorney’s Office </li></ul>
  4. 5. ELDER ABUSE IS……... <ul><li>A Crime </li></ul><ul><li>Affecting both provincial & rural areas </li></ul><ul><li>Going unpunished </li></ul><ul><li>Predictable </li></ul><ul><li>Being committed in homes where there are also other forms of abuse </li></ul>
  5. 6. ELDER ABUSE IS EXPLODING <ul><li>Fastest growing age group </li></ul><ul><li>No known cure for dementia etc. </li></ul><ul><li>Victims often do not report </li></ul><ul><li>Third fastest growth job is home care </li></ul><ul><li>Minimal background checks </li></ul><ul><li>High temptation, low risk factors </li></ul>
  6. 7. UNDERSTANDING THE DYNAMICS <ul><li>Fears of many seniors </li></ul><ul><li>Leads to underreporting </li></ul><ul><li>Feelings of shame </li></ul><ul><li>Concern that exposure will lead to loss of independence </li></ul><ul><li>Sometimes accompanied by threats from perpetrator </li></ul>
  7. 8. WHO ARE OUR VICTIMS? <ul><li>Over age of 65 </li></ul><ul><li>Born before 1936 </li></ul><ul><li>Important to understand the events of their lifetime </li></ul><ul><li>Do we know their history? </li></ul><ul><li>How about a refresher? </li></ul>
  8. 9. LESSONS LEARNED FROM DOMESTIC VIOLENCE <ul><li>Self -determination is not the answer </li></ul><ul><li>If not punished, the perp WILL abuse again </li></ul><ul><li>We CAN convict even without the assistance of the victim </li></ul><ul><li>Abuse is a crime against NOT JUST the abused </li></ul>
  9. 10. AVOID STEREOTYPING OF SENIORS <ul><li>Forgetful </li></ul><ul><li>Senile </li></ul><ul><li>Longwinded </li></ul><ul><li>Fragile </li></ul><ul><li>Grumpy </li></ul><ul><li>Disabled </li></ul>
  10. 11. As a result : <ul><li>Lack of investigation by police </li></ul><ul><li>Lack of prosecution by DA’s </li></ul><ul><li>Lack of awareness by public </li></ul>
  11. 12. Prior to our Elder Abuse Unit: <ul><li>Elder Abuse statute existing for 10 years </li></ul><ul><li>Average of 2 or 3 cases a year </li></ul><ul><li>Police received no special training </li></ul><ul><li>Public unaware of reporting procedure </li></ul><ul><li>Prosecutors rejected most financial cases </li></ul>
  12. 13. Since our unit began in 1/96: <ul><li>Increased awareness of public </li></ul><ul><li>Increase in referral calls to APS </li></ul><ul><li>Mandatory training for police </li></ul><ul><li>Vertical prosecutions of all Elder Abuse </li></ul><ul><li>Prosecution of over 300 felony cases </li></ul><ul><li>Increase from 1 to 5 prosecutors </li></ul>
  13. 14. Building awareness level [1] <ul><li>Speaking to community groups </li></ul><ul><ul><li>Kiwanis, Lions & Rotary </li></ul></ul><ul><li>Arranging senior forums </li></ul><ul><ul><li>Day time, door prizes </li></ul></ul><ul><li>Training the police </li></ul><ul><ul><li>Include counter & telephone staff </li></ul></ul>
  14. 15. Awareness level cont’d [2] <ul><li>Reaching first responders </li></ul><ul><ul><li>Paramedics & Fire personnel </li></ul></ul><ul><li>Educating the E.R. nurses & doctors </li></ul><ul><ul><li>Reminder of mandatory reporting </li></ul></ul><ul><li>Encourage banks to train their staff </li></ul><ul><ul><li>Adopt Oregon method </li></ul></ul>
  15. 16. Awareness level cont’d [3] <ul><li>Use the media to communicate </li></ul><ul><ul><li>TV, Radio talk show, newspaper articles </li></ul></ul><ul><li>Form a multi-disciplinary team </li></ul><ul><ul><li>F.A.S.T </li></ul></ul>
  16. 17. Creating/promoting referral line: <ul><li>Every County must have a reporting line </li></ul><ul><li>Billboards </li></ul><ul><li>Posters </li></ul><ul><li>Radio and TV PSA’s </li></ul><ul><li># of calls WILL increase </li></ul>
  17. 18. Elder Abuse Prosecutions: <ul><li>California Penal Code section 368 </li></ul><ul><li>Divided between : </li></ul><ul><li>Physical / Mental abuse </li></ul><ul><ul><li>368[b], a felony </li></ul></ul><ul><ul><li>368[c], a misdemeanor </li></ul></ul><ul><li>Financial Abuse </li></ul><ul><ul><li>368[d]& [e], a felony if over $400 </li></ul></ul><ul><ul><li>368[d]&[e], a misd. if $400 or under </li></ul></ul>
  18. 19. Physical and Mental Abuse: <ul><li>Assaults and batteries </li></ul><ul><li>Aggravated Assaults/Attempted murder </li></ul><ul><li>Sexual assault </li></ul><ul><li>Neglect </li></ul>
  19. 20. Physical and mental abuse cont’d <ul><li>Manslaughter - neglect causes death </li></ul><ul><li>Murder </li></ul><ul><li>Intimidation/Mental & Psychological Abuse </li></ul><ul><li>False Imprisonment </li></ul><ul><li>Torture </li></ul><ul><li>Robbery and extortion </li></ul>
  20. 21. Profile of the physical abuser: <ul><li>Son in his late 30’s or early 40’s </li></ul><ul><li>Living at home with Mom </li></ul><ul><li>Divorced/ returns or single and unmotivated </li></ul><ul><li>Lazy and unemployed </li></ul><ul><li>Drugs, alcohol or gambling </li></ul><ul><li>Feeds habit off Mom </li></ul>
  21. 22. Classic neglect cases <ul><li>Deprivation of medical attention </li></ul><ul><li>Deprivation of food </li></ul><ul><li>Lack of hygiene </li></ul><ul><li>Lack of ventilation, heat or light </li></ul><ul><li>Over-medicated </li></ul><ul><li>Under-medicated </li></ul>
  22. 23. The classic neglected victim <ul><li>Malnourished </li></ul><ul><li>Semi-comatose </li></ul><ul><li>Dehydrated </li></ul><ul><li>Bed sores, rashes, lice </li></ul><ul><li>Coated with fecal matter/ urine stained </li></ul><ul><li>Inadequately clothed </li></ul><ul><li>Untrimmed toenails, matted hair </li></ul>
  23. 24. Signs of neglect <ul><li>Dry lips, pallor or excessive weight loss </li></ul><ul><li>Dirty or inappropriate clothing for weather </li></ul><ul><li>Shivering or low body temperature which might indicate hypothermia </li></ul><ul><li>Lack of dentures, glasses or hearing aid </li></ul><ul><li>Signs of infrequent bathing </li></ul>
  24. 25. Signs of neglect cont’d <ul><li>Physical or mental deterioration with no medical reason </li></ul><ul><li>Confinement </li></ul><ul><li>Elderly person is seen wandering dangerously </li></ul><ul><li>Lack of groceries </li></ul><ul><li>Inadequate or over medication </li></ul><ul><li>Cooking and housekeeping standards that could lead to illness or accidents </li></ul>
  25. 26. Decubitus ulcers <ul><li>Pressure or bed sores </li></ul><ul><li>Break in skin and underlying tissues due to pressure or friction </li></ul><ul><li>Classified Stages 1 - 4 </li></ul><ul><li>Common areas are shoulder blade, elbow, sacrum, hip, inner knee, outer ankle, heel </li></ul>
  26. 27. Reasons for overmedication <ul><li>Lack of understanding - giving medication round the clock instead of as needed </li></ul><ul><li>For convenience, giving all medications at same time </li></ul><ul><li>Giving medication with alcohol or over the counter meds to increase sedative effects </li></ul>
  27. 28. Overmedication cont’d <ul><li>To keep patient docile and compliant </li></ul><ul><li>To control behavior </li></ul><ul><li>To keep from wandering away </li></ul><ul><li>As an alternative to physical restraint </li></ul>
  28. 29. Signs of over-medication <ul><li>Disoriented </li></ul><ul><li>Falls asleep when talking </li></ul><ul><li>Sleeps all day and up all night </li></ul><ul><li>Similar to being intoxicated </li></ul><ul><li>Slurred speech, shaky hands, trambling voice </li></ul><ul><li>Passive behavior </li></ul>
  29. 30. Reasons for undermedicating <ul><li>Thinks that person should not need medication </li></ul><ul><li>Thinks that patient’s mental state is deteriorating because of medication </li></ul><ul><li>Thinks that withholding of meds might hasten patient’s death </li></ul><ul><li>Wants patient to suffer </li></ul><ul><li>Is using meds for own use </li></ul>
  30. 31. Common medications <ul><li>Tranquilizers/Anti-anxiety: Valium Librium Donatal Phenobarbital Ativan Restoril Triazolzam Xanax & Lorazepam </li></ul>
  31. 32. Common medications <ul><li>Pain: Vicodin Tylenol & Codeine Percocet Talwin Oxycondone Dilaudid Morphine Demoral </li></ul>
  32. 33. Common medications <ul><li>Anti-depressants: Paxil Zoloft </li></ul><ul><li>Sleep medications: Halcion Luminal Nembutal Seconal & Dalmane </li></ul>
  33. 34. Evidence Collection <ul><li>Photos / video of living conditions </li></ul><ul><li>Include photos of kitchen, fridge etc </li></ul><ul><li>Bed sheets and mattress </li></ul><ul><li>Diapers </li></ul><ul><li>Clothing </li></ul><ul><li>Prescription meds </li></ul>
  34. 35. Evidence Collection <ul><li>Dangerous/ exposed items putting V at risk </li></ul><ul><li>Non-working call button </li></ul><ul><li>Proof of V’s disorientation - unopened mail, bills unpaid </li></ul><ul><li>Signs of alcohol/drug/gambling abuse by D </li></ul><ul><li>Any living will? </li></ul>
  35. 36. Key persons to contact <ul><li>V’s family members </li></ul><ul><li>Neighbors </li></ul><ul><li>V’s doctor / dentist </li></ul><ul><li>V’s pharmacist </li></ul><ul><li>V’s pastor </li></ul><ul><li>V’s attorney </li></ul><ul><li>V’s bank / financial adviser </li></ul>
  36. 37. Key persons to contact cont’d <ul><li>APS to check on prior history </li></ul><ul><li>Paramedic who first arrived on scene </li></ul><ul><li>E.R. nurse/ physician who first triages and treats victim </li></ul><ul><li>911 dispatcher </li></ul>
  37. 38. Interviewing suspect <ul><li>Length of relationship </li></ul><ul><li>Type of relationship </li></ul><ul><li>Description of duties </li></ul><ul><li>For pay or love? </li></ul><ul><li>Knowledge of V’s age & medical condition </li></ul><ul><li>Reasons for non-action </li></ul>
  38. 39. Interviewing victim <ul><li>Questions to determine orientation </li></ul><ul><li>Mini-mental assessment </li></ul><ul><li>Last time you ate, bathed, visited doctor or dentist </li></ul><ul><li>What meds are you taking </li></ul><ul><li>Your relationship with suspect careprovider </li></ul>
  39. 40. Cross reference with financial abuse <ul><li>Look for signs of financial exploitation </li></ul><ul><li>Documents giving control to suspect - POA - Quitclaim deed - New will - Correspondence, bank statements </li></ul><ul><li>Check book, ATM, pawn slips </li></ul>
  40. 41. Resources <ul><li>Poison Center: 1-800-876-4766 </li></ul><ul><li>Internet - www.safemedication.com </li></ul>
  41. 42. Classic elder abuse murder case
  42. 43. Financial Abuse: <ul><li>Theft </li></ul><ul><li>Credit card fraud </li></ul><ul><li>Real Property transfers </li></ul><ul><li>Home Improvement scams </li></ul><ul><li>Telemarketing & sweepstakes scams </li></ul><ul><li>Investment fraud </li></ul>
  43. 44. Forms of theft <ul><li>By larceny - a taking of property </li></ul><ul><li>By trick - consent is based on deceit or fraud </li></ul><ul><li>By embezzlement - property is entrusted to thief </li></ul><ul><li>By undue influence </li></ul>
  44. 45. Typical theft scenarios <ul><li>Jewelry </li></ul><ul><li>Checks </li></ul><ul><li>ATM card </li></ul><ul><li>Credit card & identity theft </li></ul><ul><li>Transfer of title - POA & quitclaim deed </li></ul><ul><li>Bogus investment scams </li></ul><ul><li>Sweepstakes/telemarketing frauds </li></ul>
  45. 46. Typical theft scenarios cont’d <ul><li>Home improvement scams </li></ul><ul><li>Excessive charging by unlicensed contractors & other merchants </li></ul><ul><li>Theft by undue influence </li></ul>
  46. 47. HOW TO PROVE STEALING? <ul><li>Taking property </li></ul><ul><li>belonging to another </li></ul><ul><li>without consent & </li></ul><ul><li>with intent to permanently deprive </li></ul>
  47. 48. Three prosecutable scenarios <ul><li>Classic case of theft from a competent victim </li></ul><ul><li>Theft from an incompetent victim </li></ul><ul><li>Theft from a marginally competent victim [by undue influence] </li></ul>
  48. 49. SCENARIO # 1 <ul><li>Victim testifies </li></ul><ul><li>Did not give permission </li></ul><ul><li>Did not owe monies to suspect </li></ul><ul><li>Victim is credible </li></ul>
  49. 50. SCENARIO # 2 <ul><li>Victim cannot testify </li></ul><ul><li>Medical testimony that victim suffers from dementia/ Alzheimer’s/ Parkinson's or some other illness that deprives victim of necessary understanding </li></ul><ul><li>Incapacity was present at time of transaction </li></ul>
  50. 51. SCENARIO # 3 <ul><li>Is it theft, a loan, or a gift? </li></ul><ul><li>Victim is marginally competent </li></ul><ul><li>Suspect exploited victim’s vulnerability </li></ul><ul><li>Victim was unduly influenced or was defrauded </li></ul>
  51. 52. Undue Influence <ul><li>Victim ‘was pushed in a direction that he did not want to go.’ </li></ul><ul><li>The influence by suspect was sufficient to remove the voluntariness of the transaction </li></ul><ul><li>No longer free will </li></ul><ul><li>Victim has been evaluated by a geriatric psychiatrist/psychologist </li></ul>
  52. 53. Significance of evaluation <ul><li>Need to assess status of mental capacity </li></ul><ul><li>But distinguish from scenario #2 </li></ul><ul><li>Opportunity for evaluator to render opinion of “susceptibility” </li></ul><ul><li>Looking for vulnerabilty factors </li></ul><ul><li>Opinion is not whether victim WAS unduly influenced - that is for jury </li></ul>
  53. 54. How to prove undue influence? <ul><li>Length of relationship </li></ul><ul><li>Place of first meeting </li></ul><ul><li>Prior spending habits </li></ul><ul><li>Prior “charitability” </li></ul><ul><li>What is left? </li></ul><ul><li>Multiple escalating transactions </li></ul><ul><li>Statements by suspect </li></ul>
  54. 55. Statements of suspect <ul><li>How did they affect & influence victim? </li></ul><ul><li>Can we prove that the statements were false? </li></ul><ul><li>Look for reasons why suspect chose those particular statements </li></ul><ul><li>Examples - need, emergency, opportunity, hint of a threat…... </li></ul>
  55. 56. Look at conduct of suspect <ul><li>The “meeting” </li></ul><ul><li>The cultivating of a friendship </li></ul><ul><li>The outward gestures of affection </li></ul><ul><li>The “other” side - the dark character traits of greed, manipulation, control </li></ul><ul><li>Who can testify to such traits? </li></ul>
  56. 57. Witnesses <ul><li>Bank teller </li></ul><ul><li>Pastor </li></ul><ul><li>Neighbor </li></ul><ul><li>Doctor, pharmacist, optometrist of V </li></ul><ul><li>Family </li></ul><ul><li>Ex- spouse of suspect </li></ul><ul><li>Business contacts of suspect </li></ul>
  57. 58. Evidence collection <ul><li>Best evidence is the video interview </li></ul><ul><li>Bank, credit card statements </li></ul><ul><li>Bank surveillance tapes </li></ul><ul><li>Prior medical records </li></ul><ul><li>Look for the inappropriate purchases </li></ul><ul><li>Ask questions, questions, questions!!! </li></ul>
  58. 59. Be careful about …... <ul><li>Obtaining a consent release form </li></ul><ul><li>If V has mental capacity problems, then do NOT get a release </li></ul><ul><li>Obtain through search warrant or if after case has been issued, through subpoena </li></ul>
  59. 60. How banks can help in the fight against financial elder abuse <ul><li>Adopt the Oregon model [Senior & Disabled Services Division: Aileen Kaye 503-945-6399] </li></ul><ul><li>Offer to conduct the training </li></ul><ul><li>Highlight the bad examples and praise the courageous </li></ul>
  60. 61. How to get the most out of the bank <ul><li>Contact the chief fraud investigator for the bank before serving the search warrant </li></ul><ul><li>Remind them that time is critical - put them on written notice </li></ul><ul><li>Where appropriate, also remind them that this crime could have been avoided </li></ul>
  61. 62. What happens if you discover theft after victim dies? <ul><li>This may still be prosecutable if the case falls within scenario # 2. </li></ul><ul><li>Is there a documented medical history of V’s lack of capacity prior to death and before date of transaction? </li></ul>
  62. 63. What happens if victim dies after investigation begins and before prosecution finishes? <ul><li>Do you have victim on video? </li></ul><ul><li>If scenario #2, the death should not affect the proceedings </li></ul><ul><li>Did the victim testify at a preliminary hearing? </li></ul>
  63. 64. Credit Card fraud: <ul><li>Filling out unsolicited application </li></ul><ul><li>Adding perp’s name as authorized user </li></ul><ul><li>Controlling the mail </li></ul><ul><li>Paying monthly payment by telephone banking </li></ul>
  64. 65. Real Estate scams: <ul><li>Deadly weapon - the POA </li></ul><ul><li>Quitclaim Deed </li></ul><ul><li>Mortgage rip offs </li></ul><ul><li>Living trust sucker - getting to the portfolio </li></ul>
  65. 66. Telemarketing scams: <ul><li>Paul Bell </li></ul><ul><li>Just say No </li></ul><ul><li>Sucker lists </li></ul><ul><li>Use AARP </li></ul>
  66. 67. Home Improvement scams <ul><li>Roofs, driveways, painting </li></ul><ul><li>“Just in the area” </li></ul><ul><li>Work in pairs </li></ul><ul><li>Pick-up truck </li></ul><ul><li>Want cash </li></ul><ul><li>Use inferior materials </li></ul><ul><li>Leave without trace </li></ul>
  67. 68. Remember that ... <ul><li>Some cases are simply not prosecutable </li></ul><ul><li>But you will never know until you try </li></ul>
  68. 69. Seniors and the court process: <ul><li>Getting them to court </li></ul><ul><li>Bringing the court to them </li></ul><ul><li>Waiting at court </li></ul><ul><li>Testifying in court </li></ul><ul><li>After court - to prevent further victimization </li></ul>
  69. 70. Interviewing an elderly victim <ul><li>Venue is important </li></ul><ul><li>Build a rapport </li></ul><ul><li>Look for achievements </li></ul><ul><li>Try to identify areas of vulnerability </li></ul><ul><li>Preserve the interview on video </li></ul>
  70. 71. Elder Abuse case hurdles: <ul><li>The recanting victim </li></ul><ul><li>The “consent” defense </li></ul><ul><li>The “incompetent” victim </li></ul><ul><li>The deceased victim </li></ul><ul><li>Old people die </li></ul>
  71. 72. Red Flags To Keep in Mind <ul><li>Implausible/vague explanations </li></ul><ul><li>Delay in seeking care </li></ul><ul><li>Unexplained injuries - past or present </li></ul><ul><li>Inconsistent stories </li></ul><ul><li>Change in behavior </li></ul>
  72. 73. Clues On Physical Exam <ul><li>Sores </li></ul><ul><li>Unkempt appearance </li></ul><ul><li>Poor hygiene </li></ul><ul><li>Malnutrition </li></ul><ul><li>Dehydration </li></ul>
  73. 74. Patterned Injuries <ul><li>May help to identify object used by the perp </li></ul><ul><li>May be represented as a series of marks that all look the same </li></ul>
  74. 75. Categories of Documentation <ul><li>Written history </li></ul><ul><li>Body diagram </li></ul><ul><li>Photodocumentation </li></ul><ul><li>Conclusion </li></ul>
  75. 76. Written History <ul><li>Legible handwriting </li></ul><ul><li>Patient identification </li></ul><ul><li>Date and time </li></ul><ul><li>Direct quotes </li></ul><ul><li>Record interactions between patient and caregiver </li></ul><ul><li>Specifics regarding timing and mechanism, alleged perpetrator, how it happened </li></ul><ul><li>Avoid perjorative comments </li></ul>
  76. 77. Body Diagram <ul><li>Characteristics of injuries </li></ul><ul><li>Specific locations </li></ul><ul><li>Size and shape </li></ul><ul><li>Color changes </li></ul><ul><li>Swelling </li></ul><ul><li>Tenderness </li></ul>
  77. 78. Photodocumentation <ul><li>Use a good camera </li></ul><ul><li>Identifier (name plate) </li></ul><ul><li>Ring flash </li></ul><ul><li>Serial images </li></ul><ul><li>Images should include those from a distance, close-up and different angles </li></ul>
  78. 79. What Happens If You Don’t Report? <ul><li>Most cases </li></ul><ul><ul><li>Up to 6 months in jail </li></ul></ul><ul><ul><li>Fine up to $1000 </li></ul></ul><ul><ul><li>Both jail and fine </li></ul></ul><ul><li>Great bodily injury or death up to 1 year in jail </li></ul><ul><ul><li>Up to $5000 </li></ul></ul><ul><ul><li>Both jail and fine </li></ul></ul>
  79. 80. Barriers To Reporting <ul><li>Health Care Provider </li></ul><ul><ul><li>Concerns regarding alienating family </li></ul></ul><ul><ul><li>Concerns regarding alienating facility personnel </li></ul></ul><ul><ul><li>Easy to ignore/dismiss </li></ul></ul><ul><ul><li>Lack of knowledge regarding how to report </li></ul></ul><ul><ul><li>Difficult to identify abuse </li></ul></ul>
  80. 81. Seniors and the Court Process <ul><li>Getting them to court </li></ul><ul><li>Bringing court to them </li></ul><ul><li>Waiting at court </li></ul><ul><li>Testifying in court </li></ul><ul><li>After court - to prevent further victimization </li></ul>
  81. 82. Assess the impact of the crime <ul><li>Financial </li></ul><ul><li>Emotional </li></ul><ul><li>Residual </li></ul>
  82. 83. RESOURCES AVAILABLE <ul><li>Internet </li></ul><ul><li>Elder Abuse Listserve run by ABA [contact is : lstiegel@staff.abanet.org] </li></ul><ul><li>AARP </li></ul><ul><li>Oregon Bank project [Dept. of Human Resources : Aileen Kaye 503-945-6399] </li></ul><ul><li>Evidence Code section 1380 </li></ul>
  83. 84. EVIDENCE CODE S. 1380 <ul><li>Video tape ALL elder abuse victim interviews by law enforcement </li></ul><ul><li>Judge has discretion to allow if victim dies or becomes incapacitated </li></ul><ul><li>Interview has indicia of reliability </li></ul><ul><li>Other corroborative evidence </li></ul>
  84. 85. THE GOLDEN YEARS
  85. 86. A Message to Seniors: <ul><li>We respect and honor you! </li></ul><ul><li>We commit to seeking justice for you </li></ul><ul><li>We prosecute with: </li></ul><ul><li>Passion </li></ul><ul><li>Purpose </li></ul><ul><li>Perseverance </li></ul>
  86. 87. Please feel free to contact me: <ul><li>Paul Greenwood </li></ul><ul><li>619-531-3464 </li></ul><ul><li>[email_address] </li></ul>

×