Warning signs of nursing home abuse ignored

BRISTOL, Va. – Nursing aides say every time someone steps into the frail, elderly woman’s room, she rolls into a fetal position and reaches with both hands between her legs and around her back as if to block sexual advances.

Nearly three years of reacting that way and shifting hands from side to side along her inner thighs have left her flesh tissue thin, red and raw, a current National HealthCare-Bristol nursing aide said.

The hushed whispers at the nursing home here assume the 93-year-old woman’s actions are the psychological remnants of a sexual assault by former employee and convicted serial molester James Wright.

“This is what happened to her, and she’s going to die that way,” said the aide, who requested anonymity for fear of losing her job.

The traumatized woman is among the dozen patients that state detectives say were sexually assaulted at NHC between February 2000 and August 2007.

No one has proven that Wright is solely responsible for all the assaults at NHC. So far, state detectives have linked him to seven of those attacks, including the molestation of the traumatized woman, a Bristol Herald Courier investigation has found. State medical licensing documents also tie Wright to a later rape at another assisted-living facility, where he took a job immediately after leaving NHC.

Somehow, the abuse continued for seven years even though former NHC employees say there were red flags.

The first showed up in February 2000. Waving it was an 89-year-old woman who once cultivated a career as a nurse in Virginia’s coalfields before settling down to raise a family and eventually finishing her days in a nursing home.

She accused Wright of touching her inappropriately, and then warned him to stay out of her room.

In the following years, vague accusations by three other patients sent officers from multiple law enforcement agencies looking for an unknown assailant, Bristol Virginia Police reports show. Each investigation hit a dead end.

NHC contends the attacks could have been stopped had only the abuse been reported up the chain of command to the home administrator.

Yet, police reports and witness accounts seem to depict a supervisory staff that greeted many warnings with skepticism – including when an aide accused Wright of fondling the traumatized woman in August 2007.

At the same time, employee records and witness accounts suggest that NHC-Bristol management also might have harbored concerns about Wright.

In plain sight

NHC-Bristol never fired Wright.

Instead, NHC supervisors allowed him to resign with favorable recommendations on Aug. 31, 2007, amid a crescendo of sexual assault complaints, the Herald Courier found.

A timeline of these complaints was pieced together through interviews with former and current employees, a review of police reports, state licensing records and NHC documents, plus information supplied by sources close to the state investigation.

Five female patients complained of being attacked in the months leading up to Wright’s departure.

Three times, co-workers blamed Wright almost immediately. The other two cases lacked a suspect at the time.

One attack that spotlighted Wright as the prime suspect happened in the first week of July 2007. It was the second assault complaint that year.

A call went out to the Adult Protective Services branch of the Virginia Department of Social Services on July 5, and Bristol police were brought in the next day to talk to an 80-year-old woman.

The resulting police report does not explain why detectives suspected Wright. Nor does it explain why detectives cleared him so soon after talking to him. The file is simply light on notes.

Bristol Police detective Sgt. Steve Crawford expressed dismay at the investigating officer’s lack of details and explanation.

“I don’t know what was done on it,” Crawford said. “When it came back to [Criminal Investigations Division], it was listed as unfounded.”

NHC points to the police investigations, as well as a breakdown of in-house reporting protocol, when explaining how the abuse continued.

“Reports received by our administrator were forwarded to the appropriate authorities for investigation,” Regional NHC Vice President Ray Blevins wrote in an e-mail. “In each of these cases, thorough outside investigations revealed no abuse. We now know that some reports of potential abuse never reached our administrator.”

Two years after police cleared Wright, a new investigation into the complaint was opened, this time by state detectives from the Attorney General’s Office and from the Department of Health Professions, DHP, which regulates medical licenses.

State detectives linked Wright to the attack while also uncovering more abuses. Slightly more than a week ago, he began serving a 60-year sentence for four of the NHC assaults.

References to all the NHC assaults and to the one at Grand Court can be found in state licensing documents that accuse supervisors of either ignoring or failing to report abuse.

Former Director of Nursing Elizabeth Anne Franklin was fined and reprimanded in an informal hearing with DHP’s nursing board. Current Charge Nurse Helen Roberts has an informal hearing with the nursing board set for June 14.

An informal hearing is simply a question-and-answer session between board members, the accused, and his or her defense attorney. Witnesses are not called to testify against the accused.

Current facility Administrator Charlotte Wilson, already questioned in an informal setting with DHP’s board of long-term care administrators, is awaiting a follow-up hearing. This one will be treated more like a court trial, with the AG’s office acting as prosecutor and calling on witnesses. Wilson could lose her license.

All licensing charges reference each victim only by a single, cryptic letter to keep their names confidential. The Herald Courier has determined the identities of 10 patients, but has a policy not to name victims of sexual assault.

How Wright slipped through local investigations remains an unsolved mystery within the Police Department.

Police Chief Bill Price admits shoddy casework by investigators.

“I’m not making any excuses. … It was our job to catch this,” he told the Herald Courier.

Cleared for departure

At the time, Wright’s exit from NHC seemed like an ordinary jump to a similar job at nearby Grand Court Assisted Living.

A solid recommendation by then-NHC Director of Nursing Elizabeth Anne Franklin helped him land the job, internal Grand Court documents show.

Wright applied for the job on July 9, the documents show. Later that month, Franklin told a Grand Court recruiter calling for a reference check that Wright was a good worker who was eligible for rehire at NHC.

The reference-check report, penned by Grand Court recruiter Sue Huff, does not mention any warning that Wright had been the prime suspect in a sexual assault case just days before he applied for the job.

“James should make an excellent contribution to the AL [Assisted Living] staff,” Huff wrote in her report.

Huff also did not jot down whether Wright ever volunteered a reason for leaving the NHC job he’d held for nearly eight years.

Wright’s job should have been in jeopardy since Nov. 22, 2005, when former NHC-Bristol Resident Care Coordinator Amy Edwards dropped a “Final Written Warning” into his personnel file.

One more mistake, Edwards told the newspaper, and he was supposed to be gone.

Edwards said she drafted the warning after another nursing aide accused Wright of a rough bedside manner, and of eating food from patients’ trays.

“[I] looked at his groups of patients and they had more bruises … than other patients,” Edwards said.

A day later, on Nov. 23, 2005, she slipped into Wright’s file an addendum by his accuser. It detailed suspicions that Wright sexually assaulted a particular patient during his first two years at the nursing home.

“I mentioned a lot of stuff that had happened years before that was never taken care of,” Edwards said. “I did it so I would have something on paper.”

Still, the real cause for Wright’s abrupt departure remains a mystery.

There are theories, however.

Switching jobs might not have been a decision left to Wright, said a former NHC co-worker who requested anonymity for fear of repercussion from her current employer.

She recalled talking to Wright one night as he was about to head home after the 11 p.m. shift change.

“He said they [NHC supervisors] told him he had to resign,” the former co-worker said. “He told me he had already got a job at Grand Court, but that it was less money.”

A day late

Wright wasn’t the only employee to leave NHC in a shroud of mystery.

So did Franklin, who worked with NHC for nearly 12 years. She joined the company in 1996, transferred from Athens, Tenn., to Bristol in 1998, and six years later became director of nursing.

She handed in her resignation and left NHC-Bristol during the first week of August 2008, said sources close to the state investigation.

Franklin never had a going-away party, the source added, despite having worked at the Bristol home for nearly a decade.

Her resignation might have been partially tied to the same July 5, 2007, investigation that briefly regarded Wright as the top suspect.

It was Franklin who reported that assault to Adult Protective Services, but on July 6, 2007 – a full day after learning a patient had complained of being molested.

Franklin admitted the delay during an April 12, 2009, licensing hearing held by the Virginia Board of Nursing, which falls under the Department of Health Professions.

The first rumblings of molestation in that case were actually made on July 4, Bristol Police reports show. That day, two nursing aides separately told supervisors how a female patient became startled at the sight and sound of someone snapping on latex medical gloves.

“She said ‘What are you going to do, [molest] me like that boy did last night?’ ” former aide Cynthia Aldrich said.

The woman, a lifelong Bristol resident, was a mother of four with 15 grandchildren and great-grandchildren. She would die in her own home slightly more than a year after the attack.

Wright, said former co-workers, cleaned the bed-ridden woman on July 3, some time during the 3-11 p.m. work shift.

Supervisors fielded the first accusation hours later.

It was reported by the aide that replaced Wright for the 11 p.m.-to-7 a.m. shift. The aide, interviewed by the Herald Courier, has requested anonymity for fear of repercussions from her current employer.

Aldrich, who worked the following, 7 a.m.-to-3 p.m. shift that continued into July 4, said she made the second complaint.

The next day, on July 5, Aldrich penned the patient’s statement for supervisors.

Hours later, Regional NHC Vice President Blevins called the victim’s daughter, the police report shows.

The patient arrived at the Bristol Regional Medical Center emergency room at 4:30 p.m. on July 6 for an evaluation, the police report adds.

Later that month, Blevins slapped Franklin with her first company reprimand, said a source close to the state investigation. It was because she waited a day to call APS.

Another reprimand landed in her file in May 2008, sources said. Upper management blamed her for the poor ranking that NHC-Bristol sustained in a surprise state inspection the previous November.

Franklin resigned nearly two months after receiving the second reprimand.

She now co-owns and runs The Gathering Place adult day care in Bristol, Tenn.

In-house investigation

On a September day in 2003, then-NHC Resident Care Coordinator Edwards examined a 91-year-old woman with a wound that immediately sparked fears of sexual abuse.

Years later, the bruise would elicit from Franklin and Wilson questionable accounts over how they handled the situation.

Simply put, their descriptions of events differ from Edwards’ recollection.

By 2003, Edwards already had encountered all sorts of scars and skin abrasions from years of feeding, bathing and dressing elderly patients.

But the perfectly round mark found on this woman was different.

“I had never seen a bruise on somebody’s rectum like that,” Edwards said. “That is the only time working [at NHC] that I suspected sexual molestation by anybody.”

A former NHC nursing aide told the Herald Courier that Edwards spent at least a week chasing down nurses and aides to see if anyone knew what caused the bruise.

It was Wright who first offered what Edwards said she accepted as a plausible, and less than nefarious, explanation. He suggested the bruise had been caused by a procedure called a disimpaction, which means that a nurse relieved a constipated patient by hand.

“In my head I was actually relieved,” Edwards said. “Until this point, I’d thought this person had been … molested.”

Details of her investigation were a major sticking point for the state officials presiding over Franklin’s and Wilson’s recent licensing hearings. That’s mainly because no one ever told police or state investigators about the suspicious bruise.

In separate licensing hearings, both Franklin and Wilson said the in-house investigation discounted all notions of sexual assault, so they never saw a need to report a possible crime.

They also discounted Edward’s conclusion that a disimpaction procedure caused the bruise, which Wright originally suggested.

Controversy swirls around Wright’s mere connection to the disimpaction theory simply because of suspicions that he might have performed the procedure, a source close to the state investigation said.

The bruise was discovered during the work shift following Wright’s, a state official said at Franklin’s hearing.

Edwards said she does not remember whether Wright said a nurse removed the impaction or took credit himself. And Wright, as a nursing aide, would not have been legally qualified to remove an impaction, licensing officials have noted. Such a task should have been left to the higher-skilled nurses.

So if he took the credit, state officials pointed out during the licensing hearings, then he should have been fired as soon as Edwards handed her written findings to Franklin. Additionally, there would have been a legal duty to report Wright’s admission to law enforcement, state officials said. Such a report was never made, said sources close to the state investigation.

Instead of a disimpaction, Franklin and Wilson said the injury likely happened when nursing aides rolled the bed-ridden woman onto a sling used to weigh immobile patients. One of the stabilizer bars running along each side of the sling must have jabbed into her, their in-house investigation concluded.

Edwards, according to their testimony, had been tasked with questioning employees while Wilson set out to see if a scale could cause such a bruise.

The entire file for that investigation is missing, however. Franklin, when asked in her hearing why they even thought to look into the sling scale as a possible cause, said she couldn’t remember, and did not have any notes to help refresh her memory.

“The files to this investigation, with all the notes and things, have been misplaced, and without that, all I can tell you that I’m 100 percent sure about is what area I advised Ms. Edwards to start with,” Franklin testified. “How it evolved into the weight scale, I can’t answer that.”

Franklin added that she would have personally conducted the administrative part of the investigation, but Edwards needed the experience.

“Miss Edwards did my part so that she would understand the process, because she was new to her position and would have to do it if I wasn’t there,” Franklin testified. “Miss Wilson was aware, and we gave that documentation to her as part of the internal investigation.”

Edwards told the Herald Courier a different version of events; Franklin, when showed the bruise, shrugged her shoulders and walked out of the patient’s room.

“[Franklin] never told me to do the investigation,” Edwards said. “I took it upon myself. I was afraid it wouldn’t be investigated.”

She also doesn’t recall an investigation focused on the sling scale.

Doubts

Sources say a collage of snapshots decorate the nursing home’s third floor, much like an elementary school hallway is adorned with crayon sketches drawn by children.

Only, these photos capture the wrinkled smiles of the nursing home’s patients.

One wide grin noted by a current NHC employee belongs to a woman standing next to a llama. The animal was part of a traveling petting zoo that stopped outside the home years ago.

The smiling woman is the traumatized patient who now spends her days balled up in a fetal position.

Her assault, and the manner in which the complaints were handled, illustrates the skepticism that witnesses said surrounded some abuse claims. Franklin argued during her licensing hearing that an in-house investigation found the woman was never attacked. The former nursing aide who cried assault misunderstood what she saw, Franklin said.

Former aide Patty Davenport hurls obscenities every time she describes walking in on Wright as he reached around from behind the patient with both hands and grabbed her chest.

“He wasn’t just brushing up against [her],” Davenport said.

Davenport said she cursed and screamed at Wright to leave. She said more obscenities followed when she described the incident to Charge Nurse Roberts, and then later to Franklin.

Davenport said she quit less than a month later because no one seemed to take her seriously. Work records show she quit on Aug. 28, 2007, two days before Wright left to start work the next week at Grand Court.

Slightly more than a year had passed, and Davenport had moved several times, before a private detective with lots of questions knocked on her front door. A local law firm had hired him to research the complaints of families claiming patient abuse at NHC.

State investigators would show up at Davenport’s door several months later, hot on the trail that the private investigator told them to follow. They also would ask about the time she caught Wright grabbing the patient’s chest.

Franklin counters that an in-house investigation concluded Wright was changing the patient’s clothes.

“It’s easier to undress the patient from behind because they will spit, hit and punch,” Franklin testified at her licensing hearing.

Wright will serve 15 years in prison for the incident, however.

mowens@bristolnews.com | (276) 645-2546

Sources: Interviews with named and unnamed sources; Bristol Virginia Police reports; Bristol Virginia Circuit Court case files and hearings; Grand Court employee records; National HealthCare-Bristol in-house investigation records; International House of Pancakes employee records; Virginia Board of Nursing licensing documents and hearing for Elizabeth Anne Franklin; Virginia Board of Long-Term Care Administrators licensing documents and hearing for Charlotte Wilson; Virginia Board of Nursing licensing documents for James Wright and Helen Roberts.
Timeline created by Heather Provencher | TriCities.com and Mike Owens| Bristol Herald Courier