Johnnie Esco was a 77-year-old woman with Alzheimer’s when she died of pneumonia in 2008, said deputy attorney general Steven Muni at the beginning of the trial of Donna Palmer on Wednesday, outlining the trial to the jury. She had stayed at Marshall Medical Center in Placerville, and, after her pneumonia was dealt with, she was transferred to the El Dorado Care Center, where Palmer was the director of nurses. Due to the care she received — or lack thereof — she died. Palmer was thus charged with elder abuse.
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Defense attorney Patrick Hanly, in his opening statement, called the case one of “lack of supervision.” He said there was “zero, nada, zilch” evidence of elder abuse. Palmer only went off of the information on the patient charts, handled by licensed vocational nurses and certified nursing assistants under her. The charts showed that Esco had bowel movements, but she died of a severely impacted colon. Palmer, he said, simply went off the information on the charts. She was “tough” and demanded her nurses do a good job to the point where they were afraid of her should they do something wrong, but she did not commit elder abuse.
Muni called his first witness, Judy Eyolfson, Johnnie and Don Esco’s daughter, to the stand. Eyolfson was herself a surgical nurse, having just retired from the Air Force as a lieutenant colonel.
She described her mother’s Alzheimer’s as “mild” in that Esco always knew her family and could carry on conversations, but was sometimes confused as to where she was. She was not, however, end stage Alzheimer’s, she told Muni.
Esco was on a high-fiber diet, taking prune juice and laxatives. Despite this, she said, in January 2008, she had to be manually disimpacted at the hospital after complaining of “not feeling empty.” The next month, she complained it was hard to breathe and, after measuring her oxygen saturation, Eyolfson took her mother to Marshall Hospital, to be admitted with pneumonia.
Her mother did well at Marshall, she said, but had to be disimpacted again. Eyolfson was with her parents when her mother was transported to EDCC. Before the pneumonia, she said, her mother “had always been a terribly active person.” She specifically told the doctors about her mother’s bowel condition.
Esco became lethargic, requiring help to walk around. One weekend, she was excited to go to church; the next, she just wanted to lie down. Eyolfson would check the charts and ask questions of the aides every day, but they reassured her everything was fine. She ran into Dr. Brad Barnhill, Esco’s primary care physician, who, at Eyolfson’s insistence, checked Esco’s abdomen. After finding it distended, he wrote a plan of care to follow.
Eyolfson later introduced herself to Palmer, who also checked Esco’s charts and saw everything was fine. In the late evening of March 5, 2008, Esco was transferred back to Marshall. At 2 or 3 a.m., Eyolfson and Don Esco went home to rest. They returned the next morning around 8, only to find Johnnie Esco in respiratory distress from a pulmonary embolism.
Defense attorney Patrick Hanly noted that Esco was not disimpacted just once at Marshall in the two weeks before she died, but three times. When asked if she thought her mother was abused and neglected at Marshall because of this, she said no. She also didn’t feel the need to report it.
During a previous interview, she said she hadn’t thought she met with the director of nurses, but she said she recognized Palmer in court.
Next, Muni called Rebecca Smith, the floor nurse who was charged with taking care of Esco. Smith had also been charged with elder abuse and was formerly a co-defendant of Palmer’s until she took a plea deal.
Smith noted that there never seemed to be enough time in a shift to get everything done, and had gone to supervisors multiple times to tell them this. Consequently, her charting of patients’ conditions suffered greatly, she said, and she was not good at charting. “My charting was bad,” she said bluntly.
She also testified she discovered Esco with a ring missing from a finger and the skin where it was supposed to be shredded. There were also bruises on Esco’s jaw and chest that were unexplained.
When Esco’s condition worsened and she became severely impacted, Smith called Barnhill but got another on-call doctor, who told her to send Esco over. She told her supervisor, Donna Eileen Pielin, who in turn told Palmer, who told them to get the on-call doctor to rescind the order. It wasn’t until the next day, when a similar situation occurred, but the on-call doctor insisted. By then, it was too late. She refuted what Pielin had previously testified that, due to only having a fever, Smith did not want to send Esco over.
Smith admitted to being “a little intimidated” by Palmer.
She noted she relied on certified nursing assistants, CNAs, and their charting. She had believed Esco had bowel movements and had no reason to believe there was a problem. But, there were empty spots, showing the CNAs did not do their job; not uncommon due to lack of time.
The final witness of the day was Pielin. She also felt there was a lack of time, often not taking a lunch, but saying she did. There were usually about 30 patients on an average day.
Pielin, the p.m. shift lead, was not aware of any bowel issues with Esco until she needed to be transferred to Marshall. Like Smith, she relied on charts. Pielin stressed that she had to get permission from, not just notify — a point Hanly would later press — Palmer before a patient was transferred. She also recounted the story of Smith finding Esco with a fever and calling the on-call doctor.
Palmer was “not someone that you challenged,” Pielin said. “She’s not a very nice lady.” She noted she was afraid of her.
The day after the order was rescinded, when she called the on-call doctor, she was told that she should have sent Esco over the day before and to do it now. Under Hanly’s questioning, it was revealed that there were no calls to the on-call service used by Barnhill and Dr. Amrit Singh, the on-call doctor the second day. March 5, the first day, showed three calls from Smith.
Cross-examination by Hanly mostly consisted of pointing out inconsistencies with previous testimonies, depositions and notes written by Pielin on the matter. Whether she had called Palmer or she had told Smith herself to rescind the order, a topic Hanly came back to often, was not something Pielin had opened up about during the initial investigation as she was afraid of losing her job, she said.
During the time she had given testimony prior to the trial, she said she had been going through a hard time in her life. She was admitted to a mental hospital for a week, she told Hanly on redirect examination. She said she tried to be truthful, and “had a lot of regrets” not giving all the information she had. As for the inconsistencies during her testimonies, which Hanly repeatedly questioned her on, Muni asked if her health was a factor in her stress levels during the testimonies.
As she pulled over her silver hair, revealing it to be a wig with fuzz for hair underneath, she said it was. She had found a lump in her breast, which later turned out to be cancer, and had been going through radiation and chemotherapy. She had also been dealing with the death of her mother at the time of the second deposition, on top of the mental breakdown.
However, in January of 2012, when Special Agent Tina Kang of the Attorney General’s Office and Muni’s second chair during the trial, questioned Pielin in her home, she was completely truthful, she said. “The truth needed to come out.”
When questioning returned to Hanly, Pielin said she could not remember if Kang asked about the inconsistencies.
Pielin stepped down from the stand, ending the trial for the day.