A former director of nurses for the El Dorado Care Center appeared in court for an day-long hearing to determine whether there was enough evidence to be formally arraigned.
Donna Palmer, who has been charged with elder abuse after patient Johnnie Esco, 77, died after receiving care at EDCC.
Deputy Attorney General Steven Muni, the prosecutor, began the hearing by calling his first witness, Donna Eileen Pielin, a licensed vocational nurse who took care of Esco while at EDCC.
Pielin was a shift supervisor, in charge of admitting patients between 2:30 p.m. to 11 p.m.
On March 5, 2008, she became aware of Esco after a charge nurse, Rebecca Smith — who recently plead to charges related to the matter — came to Pielin and told the LVN that she had called a doctor at Marshall Hospital over whether to send Esco back to the hospital for a fever she had. Esco had been transferred to EDCC from Marshall to recover after fighting off pneumonia.
Pielin testified that Smith had said she “didn’t want to send her to the hospital for a little temperature,” but Pielin insisted that they should call Palmer for permission to move. Palmer told Pielin to have the transfer order rescinded. Pielin called Dr. Amrit Singh back, who told here “If you can take care of it in-house, fine.”
The next evening, Pielin acted as charge nurse due to lack of staff. Esco was again brought to her attention as she had bruising on her chin. A CNA later advised her that Esco still had a fever. While Esco’s husband, Don, was at the foot of the bed, Pielin listened to Esco’s lungs and for bowel sounds, as Esco had a history of constipation. “I was listening for gurgles,” Pielin said, an indication that the bowels are working properly. “If I heard anything, it was faint,” she recalled. She palpated Esco’s abdomen and Esco “flinched, maybe moaned.”
Pielin paged Singh again and called Palmer, who again told Pielin to have the order rescinded. When Singh called back, he said, “I told you to send her yesterday, now send her.” Palmer relented and Pielin began the paperwork and called 911 to have Esco transferred back to Marshall.
When Muni asked why Pielin didn’t send Esco the first time, Pielin said it was “Pretty much what (Palmer) said goes.” When asked if she was afraid of Palmer, Pielin said “She was my boss. I was self-supporting and needed the work.” She did note, however, that it was “very unusual, both nights” for the transfer order to be rescinded, which had never happened before.
Defense attorney Patrick Hanly focused on previous depositions given by Pielin, pointing out that multiple times under oath she had not mentioned the calls to Palmer. “I didn’t lie,” Pielin told Hanly, “I just withheld information.” She didn’t mention the calls as she was “fearful of consequences,” she said, later saying, “I just didn’t want to get anyone in trouble or lose my job.” The first time she tried to transfer Esco, she told Singh that Esco had been given Tylenol and that they wanted to wait until the morning to see what would happen. Esco was never given the medicine.
Hanly also showed records that Pielin had never called Singh via Dr. Bradley Barnhill’s answering service — Singh was on-call for Barnhill — and that only Smith had made calls to the doctor. “It’s pretty clear…you didn’t call Dr. Singh,” Hanly told her, to which Pielin replied, “I did talk with Dr. Singh on March 6.”
Next called to the stand was Debra Gard, a Department of Justice special agent who investigated the case. She testified that Don Esco, who died Oct. 8, had spoken with nurses constantly to the point where staff found him “somewhat annoying,” informing them of his wife’s constipation problems. On March 4, 2008, the Escos had dinner together, Gard said, and Don was packing Johnnie’s bags to go home. The next day, Don found his wife non-responsive and bruised, a complete turnaround from the previous night. March 6, Johnnie had worsened. She was transferred to Marshall. At 11:04 a.m. the next day, Johnnie was pronounced dead.
Gard also testified that Barnhill expected EDCC to come up with a plan for addressing the constipation, for which Esco had to have her bowels disimpacted multiple times while at Marshall. Had they done so, Gard said, Barnhill anticipated a full recovery. Upon returning to Marshall, however, Dr. Ben Housel found Esco’s rectum distended about 4 inches and whole, undigested pills in her rectum.
Last called to the stand was Dr. Kathryn Locatell, brought on as an expert witness in the fields of elderly medical care and care facilities. Locatell again went over the narrative of the case, noting that Esco had to be disimpacted three times on Feb. 20, two days before being admitted to EDCC.
Locatell testified that some of Esco’s charts had been improperly documented, with numbers overwritten and standardized notations not being used. Despite marks noting that Esco had bowel movements, Locatell said, Esco’s bowels were impacted to her colon, perforating the colon — also known as the small intestine — or causing “some other infectious process,” what Locatell called a “catastrophe.” The distended rectum would cause a loss in blood supply and allow the stool bacteria to permeate the body, she said. A perforation could lead to stool in the abdominal cavity. The compression on the blood supply also led to a blood clot in her left leg and possibly in her lung, she said. In short, the impacted colon, Locatell said, was a “sentinel event” or “something that shouldn’t happen, a ‘never event’ like giving the wrong blood or operating on the wrong limb.”
She again said that the note-taking was “substandard,” saying that some shifts had no notes whatsoever regarding bowel movements. On the days there was a note, it was unlikely to have really happened, given the major impaction. She also noted that Esco was said to have physical therapy on March 6, though she was unresponsive when Don arrived in the morning. From March 1 to March 5, she was said to have eaten all of her food, including breakfast, which “I don’t find credible.” She said it contradicts other records and evidence. On March 4, nurse Joyce Davenport noted there was no constipation.
Locatell was also present at Esco’s autopsy on Sept. 21, 2009, a year and a half after her death. As her body had been embalmed and hermetically sealed, it was well-preserved. Locatell said Esco’s colon was full of stool, though it had softened from the embalming fluid. “It’s unlikely, in my opinion, that she would have a full colon, full of stool,” unless she had no bowel movement in the 13 days at EDCC, she said.
“The quality of care was extremely poor,” Locatell said. She noted it was a failure of standard, different from abuse and neglect, which even Marshall faced with some substandard care, but was still better than EDCC. When asked whether the treatment at EDCC was abuse and neglect by Hanly, she said, “I do not know,” as she was unqualified to make that legal judgment, though her testimony indicated that she believed so. She noted from the charts that there was “evidence that EDCC (charts are) not credible, not that Marshall is credible.”
Hanly noted that the cause of death did not list sepsis — or impacted colon, but pulmonary embolism, which Locatell did not agree with.
After she was excused, Judge Daniel B. Proud found there was enough evidence for an arraignment on information, which was scheduled for Jan. 18, 2013 at 1:30 p.m. in Department 2.