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The patient who was pushed, Eufemia Van Rysseghem, had walked into another resident's room and refused to leave. But Bruce says the aide purposely and roughly shoved the 77-year-old woman in the chest. "They were like little kids playing a game trying to shove each other out of the door, but this is a full-grown nurse's aide doing this to an Alzheimer's patient."
The February 11 incident was not the first time Bruce had lodged a complaint against the Spring Branch-area facility. And it would not be the last call made to HPD on Van Rysseghem's behalf. Since then, George Salazar, who says he is Van Rysseghem's common-law husband, has contacted police on five other occasions. He has called officers from nearly every facility she has been housed at since authorities separated them last summer.
Van Rysseghem lived with Salazar for five years. Last June management at their northeast Houston apartment complex contacted Adult Protective Services, alleging that Salazar had verbally and physically abused Van Rysseghem. An ambulance whisked Van Rysseghem away to Ben Taub Hospital, where doctors determined the Alzheimer's patient had dementia and could no longer care for herself.
Then the Harris County probate court system, established to guard the interests of incapacitated residents, stepped in.
A probate judge appointed a temporary guardian to protect her. Since July that guardian has moved Van Rysseghem from a series of hospitals, nursing homes and other facilities. But as a ward of the probate system's security net, her health has declined, her personal belongings have been stolen, and her meager life savings has been emptied.
Three different attorneys have been designated to watch over her. Combined with another attorney, whose court-approved fees included charges for checking her own law office's messages, the lawyers took the majority of Van Rysseghem's savings in fees. And the guardianship that was supposed to save her from Salazar's alleged mistreatment has put her in a nursing home with an egregious record of neglect and abuse.
Esabelle Molina-Morris, an investigator for Adult Protective Services, met Van Rysseghem in June when she checked on an apartment manager's complaint that the elderly woman often wandered the apartment complex grounds, crying.
In a letter to probate court, Molina-Morris recounted an incident in which strangers returned Van Rysseghem to the complex after they found her roaming near the Eastex Freeway at Tidwell. Salazar says they were in his truck when she simply opened the door and walked away. When he made a U-turn to retrieve her, she had disappeared, he says.
In mid-June, Molina-Morris responded to another call and took Van Rysseghem to a personal care home, which Van Rysseghem tried to leave. In a few days doctors transferred her to Ben Taub. Salazar checked her out of the hospital before doctors could evaluate her.
Then the couple were evicted from their apartment and fell from APS's radar for two weeks. On July 1 they had dinner at a taqueria with Salazar's relatives, but Van Rysseghem refused to leave after the meal. Frustrated, Salazar called the police for help getting her into his truck. Instead, an ambulance took her to Ben Taub. The hospital barred Salazar from seeing her because he was under investigation by APS.
Salazar considered the situation legalized kidnapping. He called TV stations, the FBI and Congressman Gene Green. He even picketed the hospital for a few days in November with homemade signs. In his zeal to call attention to his wife, he became a nuisance.
"It's a concentration camp," he says of Ben Taub. "We haven't been cited. We didn't violate laws. We are victims of circumstances. We don't have no civil rights."
A court investigator visited Ben Taub and decided that Van Rysseghem needed a guardian. Salazar applied, but on September 30 Probate Judge Mike Wood appointed attorney Ann Ellis as temporary guardian. He also ordered Salazar not to visit Van Rysseghem without supervision.
Van Rysseghem's thick glasses are missing a lens, but she wears them anyway. Her rosary, Salazar says, is also gone. She appears feeble, her lips quivering. She cannot say why she's in the hospital, only repeating in Spanish that she's scared. Once a bank clerk, she used to speak English fluently. Now she seems to have forgotten how. Salazar helps her into some slippers. One time, he says, he arrived at Ben Taub to find her nude, draped only in a blanket.
In January, Salazar's attorney at the time, Suzanne Kornblit, helped him obtain visitation rights without supervision. Kornblit noticed that Van Rysseghem stopped eating and acted agitated and combative when Salazar was not allowed to visit. "His presence is beneficial, not harmful, to his wife, as she will eat for him, put clothes on for him, and is generally happy when he comes to see her," she wrote in a motion to modify visitation.
But Salazar notes he could get visitation rights only after he removed his name in January from bank accounts he shared with Van Rysseghem. Under standard probate procedures, that money was then transferred to a guardianship account controlled by guardian Ellis.
Van Rysseghem's estate of more than $24,000 has since been exhausted. Salazar fired Kornblit in March because he thought she and Ellis had conspired to drain his wife's money. But Ellis says she had to pay herself, three other attorneys, two nursing homes and a funeral home, adding that she has worked for free on this case for the past two months. "I bought her funeral instead of paying myself," says Ellis, who earned more than $12,000 from the case. "There's no law that requires I have to do that. Had I not done that, she would be buried by Harris County."
Still, the curious fact remains that Salazar never paid Kornblit. Instead, the $200-an-hour attorney who had been privately retained by Salazar was paid nearly $4,000 out of Van Rysseghem's estate, in fees approved by the court.
When asked about Kornblit's fees, Judge Wood says, "I would be surprised if she's being paid of out of the estate." But after learning he signed the orders approving her fees, Wood reconsiders. "In general, I would not pay fees for an applicant, but this is apparently a very unusual case. [Kornblit] was instrumental in getting back assets from [Salazar] to the estate," he says. "Apparently there were funds put into a joint account with rights of survivorship, and he could have taken all that money, and she was able to get it back to Ann Ellis. She said although she represented Salazar, she and Ellis spent a lot of time chasing down the estate."
Also approved in her fee application were two $20 charges, one for each time the Houston Press left a message with her secretary. Kornblit did not return any of those calls. She also charged for receiving messages from Salazar and for her secretary admonishing him for speaking to the Press. Ellis says she reviewed the fees, but does not remember them since "that was months ago." Wood approved the fees in January.
Wood says he usually does not approve fees for checking messages. "I ordinarily wouldn't approve a fee for a phone call that was not completed, either way, whether the call is being called or received. It depends on the merits of the situation," he says. "I don't know for sure I would approve fees for talking to the press. That's not something in the ward's interest." He added that his staff attorney reviews the fees more closely than he does, but he has recently changed staff attorneys.
Ellis says she foresaw the money running out, which is why she placed Van Rysseghem in a nursing home that accepts Medicaid. At the end of January, Van Rysseghem moved to Heritage Sam Houston. The facility, which touts itself as Alzheimer's-certified, is just over two years old, yet already has a bad reputation with the state.
Salazar visited daily and says the conditions he found his wife in drove him to call the police. According to him, she sustained numerous bruises, but no one seemed to know how she got them. Sometimes he found bloodied cuts on her head or her sitting soaked in urine. Once, he found blood on her panties, another time human waste on the floor. He is also concerned that no one there can speak Spanish and communicate with her. "They already took her money. Why do they treat her this way? Why do they want her dead?" he says.
Ellis says Salazar's reports of abuse are unsubstantiated because the district attorney's office did not file charges and because she personally spoke to everyone involved, including Van Rysseghem's doctors. "I believe there was no abuse found after a thorough investigation by me," she says.
Had Ellis's investigation included a look into the state's records, she would have found that the Department of Human Services cited the facility for abuse and "immediate jeopardy to resident heath or safety." During an August inspection, the agency observed some residents soaked in urine, some covered in feces and some nude because the facility had run out of gowns. Employees were untrained, their backgrounds unchecked; they failed to keep residents from abusing each other. One resident had stabbed another in the head with a knife during breakfast and pushed another to the ground, causing a broken hip. DHS fined the facility $2,000 a day until it could clean up its act and temporarily suspended its Medicaid and Medicare payments.
Although Heritage Sam Houston shaped up in a month, by January inspectors found violations again. In February DHS again fined Heritage Sam Houston and suspended its Medicaid and Medicare payments. This time, it referred the case to the attorney general's office for a possible civil suit.
Heritage Healthcare Management, which operates Heritage Sam Houston, recently closed its Fort Worth-area location after similar problems plagued it. Chief Operating Officer Chris Callahan says the company has made changes at Sam Houston, which has been hit with more than $60,000 in fines. "We've switched administrators and reviewed our policies," he says. Sam Houston has seen five different administrators in 15 months.
While many families have moved relatives from Heritage Sam Houston, some feel they can't because very few nursing homes maintain Alzheimer's units and accept Medicaid. Those were the same reasons Ellis cited for placing Van Rysseghem there.
"There are not many places in the city of Houston, in the state of Texas, what they call a lockdown facility," says Bruce, who witnessed the pushing incident against Van Rysseghem. "It's like a jail; the people can't get out unless they're escorted out by a visitor or family member, which is the only way you can have it for their own safety. I don't like it, but there's no other way if you're not able to take care of a loved one at home."
On March 26 Van Rysseghem was taken to the Spring Branch Medical Center emergency room. "It was an emergency, something about getting hurt, that she fell down," Salazar says. "But they're always telling you they fell down." Micki Krchnak, a case manager at the hospital, says Van Rysseghem was brought in for "confusion" and "altered mental state."
That same week Salazar called the police again during a visit. He says Van Rysseghem seemed heavily drugged, could barely open her eyes and hadn't walked in days, so he massaged her limbs and released restraints across her abdomen. Krchnak and nurse Redia Thomas say he was fondling Van Rysseghem and that they asked Salazar to leave. He called the police, but when an officer arrived, he told Salazar to leave or he'd arrest him for trespassing.
At a hearing earlier this month, Wood signed a restraining order prohibiting Salazar and his family from seeing Van Rysseghem. Salazar constantly interfered with her care, he said; no facility will take her if he continues to behave like that. "You can call the police every day, every hour, but it's not helping her," Wood said from the bench. Without money or an attorney, Salazar made a futile effort to show the judge snapshots of her condition at the nursing home.
Wood also ordered the Press not to publish photos or comments that may have been obtained from Van Rysseghem during a visit to Spring Branch Medical Center with Salazar.
Because Van Rysseghem now has no money, her case is being turned over to the Harris County Guardianship Program, which assigns caseworkers to manage the affairs of incapacitated indigents. Once again, Salazar has put in an application for guardian. Wood is skeptical. "I have a feeling that Mr. Salazar will lose interest when he finds out he won't get paid," he says. But Salazar points out that he voluntarily signed off the joint bank accounts without claiming any funds from them. He says he doesn't care about money, he just wants his wife back.
That prospect looks doubtful. Without money, Van Rysseghem depends on the very system that rendered her penniless. She remains in the hospital, sleeping in a sedated haze, probably not even aware that she has no more visits to look forward to.
E-mail Melissa Hung at firstname.lastname@example.org.