FOR THE FIRST TIME IN MARYLAND--
ASSISTED LIVING FACILITY OWNER WHO DID NOT PROVIDE HANDS-ON CARE, CONVICTED OF FELONY NEGLECT

Maryland Attorney General J. Joseph Curran, Jr., announced today that the owner of an assisted living facility, Erlinda Sarabia, was convicted of felony neglect of a vulnerable adult and Medicaid fraud in relation to her ownership of Millersville Home Care in Millersville. This case marks the first time in Maryland that an owner of an assisted living facility who did not herself provide hands-on care was convicted of neglect. Anne Arundel Circuit Judge William C. Mulford, II, sentenced Sarabia to three years in years in jail, all but 18 months suspended, with the remaining term to be served on home confinement. Judge Mulford placed Sarabia on three years probation. As special conditions of her probation, Sarabia is to pay restitution of $17,269.61 to the state Medicaid program and the defendant is to make a charitable contribution to a health care organization in the amount of $25,000 prior to the end of her probation. Finally, the judge ordered that during the term of her sentence, Sarabia may not own, operate, direct or in any way participate in any assisted living facility.

As the owner of the facility, Sarabia, 69, of Pasedena, was responsible for hiring staff that were competent and able to care for the residents for whom MHC had contracted to care and Sarabia routinely contracted for persons who required Level 3 care, which is the highest level of care for persons with the greatest needs. Instead, Sarabia hired people to care for between 8 and 11 MHC residents who had no prior experience in health care. One woman, who Sarabia designated as the assisted living manager, had been a secretary in the Philippines for a construction company for 20 years and had never cared for any vulnerable adults. The other primary caregiver had just finished a two-year program in hotel management and similarly lacked any hands on care experience. When the manager was hired in 2001, she told Sarabia that she had no experience taking care of people. The defendant told her that she would only have to care for one woman who was able to walk on her own and all she would be required to do was get her meals and supervise her.

Despite hiring people with no experience in health care, and providing no care herself, Sarabia contracted to care for persons in very serious condition, including Thelma W., and Ava H. According to the statement of facts presented, the lack of understanding by the staff and failure of care by MHC is documented in the condition of two of these residents upon their arrival at the emergency room in the fall of 2003. Ava arrived at the hospital on October 15, 2003 with stage IV decubitus ulcers on 40% of her body. She had gangrene in one of her legs. She had dead flesh and maggots in one of her feet. The State’s testimony would be that Ava was left unmoved and untreated for more than two weeks at MHC prior to her hospital admission. Ava was emaciated, described as just “bones and skin” and was severely dehydrated. Although she could feel pain, she could not speak. She was contracted in both arms and both legs. Her decubitus ulcers were on her elbow, hip, hand, knee, sacrum and feet. The skin on one of her feet was nearly completely gone.

Yet the care notes for Ava, written by the assistant living manager, describe none of these conditions. The notes for October reference only a “wound on feet” or “bedsore on back.” There is no indication in any of the notes of any understanding or acknowledgment of Ava’s horrific and life-threatening condition. In fact, when the emergency medical team that arrived on October 15 to take Ava to the hospital, they were told by the staff that Ava “has a sore with a bone sticking out, and its oozing ” and that it had been that way “for about a week. Ava died from her wounds on October 17, 2003.”

The State also presented photos of Thelma taken on September 4, 2003 that show serious skin ulcers on both feet taken by a podiatrist who advised the manager about the decubitus ulcers. Yet, the care note for September 4, 2003 reads only that the foot doctor “cut her toe nails.” There is no evidence of any care being given to Thelma regarding her feet thereafter.

Fifteen days later, Thelma was taken to the emergency room because she had passed out. She was dehydrated and emaciated, despite her having a gastronomy tube. Thelma arrived at the emergency room with nine decubitus ulcers, four of which were stage 3 or 4. Yet, the notes from her care giver make no mention of bedsores or wounds. The only mention of any skin issue appears on September 18, 2003: “Noticed a bad smell coming from her bruises on left and right butt. Lips are dry.” No treatment is given for the “bad smell” or the “bruises.”

Thelma was a Medicaid recipient and Sarabia was paid for caring for her for all of 2003. Because the care provided was substandard and failed to meet the legal requirements, the defendant was convicted of defrauding the Medicaid program by billing for providing Level 3 care to Thelma when no such care was given.

The defendant was the owner and operator of MHC. Sarabia earned a living from this facility and controlled the finances, hiring of staff and, most important, had the final say in whom she would accept at MHC and what level of care the residents would require. She was required by law to “ensure” compliance with the regulations in the knowledge and skill levels of her staff.

These cases were prosecuted by the Medicaid Fraud Control Unit of Maryland Attorney General’ s Office who has jurisdiction to prosecute crimes in assisted living facilities in Maryland.