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Wednesday, March 1, 2000

By Kathryn Bender, Star-Bulletin
State Deputy Attorney General Michael Parrish points to the type
of sores found on Chiyeko Tanouye, an elderly patient at a care home.

operator pleads guilty
in death of patient

Raquel Bermisa's manslaughter
conviction is believed to be the
first of its kind in the U.S.

By Rod Ohira


SEVENTY-NINE-YEAR-OLD Chiyeko Tanouye suffered a horribly painful death last August caused by open sores eating away rotting flesh to the bone.

The state says the tragedy is that Tanouye didn't have to die that way.

In prosecuting Raquel Bermisa for murder, state Deputy Attorney General Michael Parrish said the licensed operator of a Pearl City care home failed to provide proper medical attention for Tanouye, who was diagnosed with symptoms of decubitus ulcers in June 1999.

"There's no excuse, it was there, and for whatever reason, she didn't attend to it," state investigator Fred Domingo said of Bermisa.

"Pressure sores are preventable if a professional licensing person attends to the problem."

Bermisa, 40, pleaded guilty yesterday to manslaughter by omission and was released on her own recognizance until her sentencing in April by Circuit Judge Richard Perkins.

She is facing a one-year jail sentence, Parrish said.

Tanouye's family is satisfied with the outcome and is not seeking jail time, Parrish said. But the state wants jail time to send a clear message about elder abuse.

"We believe there are many other cases like this out there," state Attorney General Earl Anzai said of Tanouye's death. "Our office intends to vigorously investigate and prosecute elderly abuse and neglect."

Sores the size of grapefruit

Tanouye died from sepsis, a systemic inflammatory response syndrome, resulting from decubitus ulcers, also known as pressure sores.

The sore holes can be as large as a grapefruit, Parrish said.

Tanouye, who had been placed in Bermisa's care home four months before her death, had two large sores on her buttocks and smaller ones on a heel and toe.

Bermisa, who was licensed in 1995 to operate a five-bed care facility, failed to schedule and attend follow-up doctor's appointments for Tanouye and did not implement the treatment plan directed by Tanouye's treating physician, Parrish said.


What to look for:
Bullet Low body weight
Bullet Dehydration
Bullet Decubitus ulcers or pressure sores

What to do:
Bullet Call Adult Protective Services, 832-5115, to report suspicious injuries

It takes about 40 days for decubitus to go from a reddening stage to deep open sores, Parrish said.

When Bermisa took Tanouye to the emergency room at Kapiolani Medical Center at Pali Momi last Aug. 9, the victim's condition was at its worst stage.

Tanouye's case was classified as an "attended death," which means a physician was present to determine cause of death, so an autopsy and police notification is not necessary.

But there was enough suspicion that the hospital reported the death to authorities, triggering the state's investigation.

"In this case, proper reporting took place," Parrish said, noting that many other similar cases may be slipping through the cracks because there's no mechanism in place for reporting.

An escalating problem

There are no statistics available on deaths due to neglect or elder abuse, but state officials say it's a growing problem.

"From the stories we've heard from emergency personnel, (the Tanouye) case is not unusual," said Dewey Kim, supervisor of the state Medicaid Investigations Division.

"In many cases, the person is already dead before getting to the emergency room. By the time law enforcement gets involved, it's too late."

Unlike physically abused children, elderly victims are harder to spot since they are not often in public view. Anzai calls it a "hidden crime."

The Tanouye case is believed to be the first homicide prosecution of a care-home operator for neglect in the United States, Anzai said.

"We need to start calling the crime what it is," Kim added. "It's a homicide, manslaughter. This is a huge problem on the mainland, an epidemic in a lot of states."

Marilyn Seely, director of the governor's Executive Office on Aging, said there are about 203,000 Hawaii residents older than 60 and that Adult Protective Services receives about 400 abuse complaints a year.

There are about 500 licensed care homes locally, she said.

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