Case scenarios

Case scenarios information for DPPC.

Abuse allegations

As DPPC continues to identify new ways to effectively educate the public about the problem of abuse of persons with disabilities, the most important role that anyone can perform is to report suspected abuse to the DPPC Hotline at 1-800-426-9009 or 1-888-822-0350 TTY.

Every month DPPC's 24 hour Hotline receives hundreds of reports alleging physical abuse, sexual assault, financial exploitation, emotional abuse and neglect. Every case investigated is personally challenging and highly complex and requires the expertise of many to ensure safety and optimal outcome. Provided here are several examples of abuse allegations.

Case #61502

The Alleged Victim (ALV) came into the day program with bruising on biceps. ALV reported that the staff from residence came behind ALV, grabbed ALV and pinched hard. The bruises are similar to fingerprint marks.

Case #62241

The ALV sustained a bruise to the eye, face and stomach. Residential staff provided conflicting statements to the day program staff concerning the origins of the injuries. This is the third incidence of injuries for the ALV since 10/2004.

Case #62820

ALV has unexplained bruises on arms and legs. Reporter observed that ALV had bruises on both upper arms. There were multiple bruises and they were big. ALV also had some small bruises on both of legs.

Case #63420

ALV sustained numerous injuries after reportedly falling over a fan. The ALV may have been mixing alcohol and medication which may have caused the fall. The bruising does not appear to be consistent with ALV's report of a fall, but ALV denies abuse by the Alleged Abuser (ALAB).

Case #64789

The reporter states that the ALV came back to the respite location with bruises and abrasions on the chin and face. The ALV doesn't want to disclose the details of the injury. At the time, the ALV was with the ALAB, the mother.

Case #66952

In fiscal year 2006, ALAB #2 failed to notice the ALV leave the residence. ALAB #1 was backing up the van and ran over the ALV. Both ALABS dragged the ALV in the house and attempted to change the ALV's clothes in an attempt to hide what had happened. ALABS then called 911. When emergency personnel arrived, ALABS told paramedics ALV had fallen in the driveway. Police became involved, suspecting ALV had been sexually assaulted, given the seriousness of the injuries.

Examples of 19C investigations

The following APS 19C investigations depict the various types of reports that DPPC, the SPDU and municipal police investigate. The cases have been summarized and highlight the complexity of the report, the investigation process and case outcome.

Case #66359

Alleged sexual assault by guardian — the legal challenges

It was reported that the alleged victim (ALV), a person with an intellectual disability, was allegedly being sexually assaulted by her father who was also her legal guardian. The report of suspected abuse was received on a Friday afternoon and the ALV, who lived in a community residence during the week, was planning to spend the weekend alone with her father, the alleged abuser (ALAB) at the ALAB's home. On that Friday evening DPPC's Legal Unit obtained an emergency protective order utilizing the Emergency Judicial Response System by meeting the on-call judge at a local police department. The Emergency Protective Order required the ALAB to stay away from the ALV during the ensuing weekend and required a further hearing on the matter the following Monday. Accordingly, DPPC secured in hand service of the emergency protective order upon the ALAB by the local police department in the town in which the ALAB resided.

Because of the nature of the allegation, a criminal investigation was initiated by the State Police Detective Unit assigned to DPPC. Both the assigned criminal and adult protective service investigators closely collaborated on the investigation.

In response to the initial court hearing, ALAB hired an attorney and entered into a stipulated agreement in which the ALAB agreed to have no contact or to see the ALV during the pendency of the criminal/civil investigation. All other matters before the Court including the replacement of the ALAB as guardian for the ALV were put off to a later date.

Because of the legal advice the ALAB received from his attorney, initially, neither the ALAB nor other family members agreed to be interviewed by the investigators. Some four weeks passed before the ALAB and his other adult children agreed to be interviewed. During this four week period the investigation had proceeded. As a consequence of the interviews with the ALAB and other family members, other potential witnesses were identified who needed to be interviewed.

Despite the fact that the prolonged delay in the investigation's conclusion was caused by his clients' refusal to be interviewed, the ALAB's attorney, in an attempt to have the Court intervene in DPPC's investigation filed several pre-trial discovery motions including, but not limited to, interrogatories, requests for production of documents, deposition subpoenas. DPPC with the cooperation and assistance of the Department of Developmental Services' Deputy General Counsel filed opposition to each based upon the following:

No triable issue of fact in the case. The ALAB and DPPC had agreed for the provision of protective services and had agreed to replace the ALAB as guardian with two of his other adult children once the investigation had been completed.

Because the issues pending before the court had been mutually resolved by the parties, there was no current dispute for the Court to resolve.

Discovery requests for documents pertinent to the investigation are not appropriate during the course of an ongoing criminal investigation, where such disclosures could jeopardize the investigation.

Discovery requests for documents pertinent to the investigation are statutorily prohibited because of the on-going investigations and because the documents sought are not public records.

Regarding the deposition subpoenas submitted by the ALAB's counsel, the Probate Court quashed one of the depositions; but permitted the other deposition of a second "witness" to go forward without DPPC's requested limiting instruction to protect the witness from having to divulge confidential information during the deposition.

DPPC filed an appeal of the Probate Court's ruling to a single justice of the Appeals Court. The Appeals Court accepted the filing of the appeal without requiring a reconsideration hearing in the Probate Court, and then took the unusual step of calling the parties before the Appeals Court for oral argument on the appeal. After the hearing, the single justice issued a decision in favor of the DPPC stating,

"Given the lack of case or controversy, as well as an ongoing criminal investigation, a deposition at this time is premature. As such, the Commission's request to quash the deposition subpoena of (Witness #2) is allowed."

The impact of this decision is significant. The Appeal Court's decision reinforces the correctness of DPPC's interpretation of the requirements of M.G.L. c. 19C that unless there is a case in controversy and until the completion of the criminal investigation in the matter, there can be no deposition of witnesses. Counsel for ALAB did not file an appeal of the single justice's decision to the full bench of the Appeals Court. Consequently, the decision of the single justice remains instructive in the ability of DPPC to fend off attempts to use legal processes to disrupt the investigative process.

Ultimately, both the criminal and civil investigations, because of insufficient evidence were not able to substantiate the allegation of sexual abuse against the ALAB. However, because of the investigation and the involvement of DPPC, the ALAB was removed as guardian and a new guardian was appointed for the ALV.

Case #44463

Rape of a person with a disability by a family friend

It was reported to DPPC's 24 hour Hotline that a female with moderate to severe intellectual disability, the alleged victim (ALV) in this case, was pregnant for a second time. The ALV's first pregnancy was ten years prior and the ALV maintained that the father of the child was someone from her high school. After ALV's first baby was born, the ALV's time in the community was limited by family.

Ten years later, the ALV became pregnant a second time. The case was screened in for omission on the part of the ALV's mother and father after the ALV reported that a cousin was responsible for the pregnancy. The clinical assessment and competency evaluation determined that the ALV was unable to consent to a sexual relationship. In the course of the DPPC investigation, it was discovered that a plumber who was a friend of the family visited the ALV's home weekly for 10 years. During DNA testing, the plumber/family friend was the only male suspect who refused to be tested. When the plumber's DNA was obtained by a private investigator hired by the family, the donor match was 99.5% to the second child and 99.7% donor match to the ALV's first child.

The ALV's parents thought that by limiting ALV's community time they were keeping the ALV safe. The DPPC investigation unsubstantiated omission of care against the ALV's parents. The ALV's sister and mother were appointed the ALV's legal guardians. The ALV's parents were providing care to the ALV and her two children. The plumber/family friend, the perpetrator was arrested, prosecuted and found guilty of two counts of rape and received a sentence of 8-10 years in state prison.

Case #62859

Abuse or malicious reporting?

On July 6, 2005, DPPC's Hotline received a report that the Alleged Victim (ALV) had been left under the supervision of a 10 year old child. When the ALV's Personal Care Attendant (PCA) arrived at the ALV's home for work, she reported that she found the ALV home alone with a 10 year old female. The PCA reported that she observed the 10 year old child naked and sitting on the ALV's face. The PCA also reported having previously observed the 10 year old undressing the ALV, fondling the ALV's breasts and hitting and kicking the ALV. ALV was reported to have bruises all over her body. ALV is a female who has severe intellectual disabilities. She is non-verbal, non-ambulatory, and requires total care. ALV is also a diabetic and has a seizure disorder.

DPPC assigned the case to the Department of Developmental Services (DDS) to conduct an investigation under the jurisdiction of M.G.L. ch.19c. The case was also referred to the Hampden County District Attorney's office for review. The case was deferred to the local police department for investigation, however the criminal investigation determined that there was insufficient evidence to prosecute the case and the APS investigation was authorized to proceed. DSS was also notified, due to the alleged involvement of a minor child.

The DMR Investigator found insufficient evidence to substantiated abuse. The PCA denied reporting that ALV had bruises all over her body or that she witnessed the child sit on ALV's face. The PCA also denied that she witnessed the child grab ALV's breasts or mistreat the ALV. Two other PCAs reported that they had never seen the child abuse the ALV or act inappropriately toward the ALV. The Investigator did not observe any signs of bruising on the ALV. The PCA who reported the alleged abuse had been fired the same day that she allegedly witnessed that the ALV had been left in the care of the child. The investigator unsubstantiated the abuse. The Investigator recommended that DDS conduct periodic unannounced visits to the home to monitor the ALV's care.

DSS conducted a home visit, and due to insufficient evidence, the case was closed.

Case #64028

The 79ib victim — neglect by son and friend

This alleged victim (ALV) was discovered by an employee from the Department of Children and Families (DCF) during their 51A investigation of alleged abuse/neglect in regards to minor children living in the home. DCF contacted DPPC's 24 hour Hotline. DPPC assigned the case to an adult protective service investigator at the Massachusetts Rehabilitation Commission (MRC). The ALV resided in the home with her adult son, Alleged Abuser I (ALAB I) and a friend Alleged Abuser II (ALAB II) which were the two Alleged Abusers (ALAB) in this case. When the investigator from MRC arrived at the home, ALAB II screamed for the ALV to come down the stairs. The ALV descended the stairs on her buttocks. The ALV resided in a two story home. She slept in one of the four bedrooms on the second floor. The bathroom, kitchen, living room and a bedroom were on the first floor. The ALV often urinated and soiled herself when she was unable to make it to the bathroom on the first floor. She required a wheelchair for accessibility. There was no wheelchair in her home. She would go up and down the stairs on her buttock to use the bathroom or to get food. The home had debris piled four feet high which included animal droppings with only paths through rooms. The MRC investigator found the ALV to have flies and lice all around her open wounds. The ALV was taken to the local hospital with the assistance of local police. The ALV was suffering from starvation, a severe case of untreated psoriasis and insect infestation. The ALV's weight was 79 pounds from a previous 150 pounds. The investigator in this case substantiated abuse against the two alleged abusers. In this case, the victim was found competent to make decisions for herself. The Board of Health was notified about the condition of the home. The home was later condemned by the local Board of Health. The victim was supported and encouraged to stay in a long term care facility. The victim has gained weight and her medical condition has stabilized.

Case #65332

The 69 lb victim — neglect by husband, daughter and PCA

It was reported to DPPC's Hotline that a woman, the alleged victim (ALV) in this case, was being neglected. DPPC assigned the case to an APS investigator at the Massachusetts Rehabilitation Commission (MRC). The MRC investigator conducting the DPPC investigation discovered the ALV in a third floor bedroom lying on a filthy mattress. The ALV had suffered a brain aneurysm in 1995. She requires prompts to eat, and is unable to attend to any of her personal care. She speaks only in utterances and does not respond to questions. The ALV resided in the family home with her husband, the husband's girlfriend and three of her adult children. Due to the condition of the ALV, the investigator called an ambulance and the ALV was transported to a hospital and admitted for treatment. At the time of admittance the ALV weighed 69 pounds and was suffering from malnutrition and decubiti (bedsores). DPPC had a temporary guardian appointed to ensure her safety. Following hospitalization, the ALV was placed in a long term care facility. The investigation revealed the following information: One of the daughters residing in the home served as her mother's surrogate and was to hire a personal care attendant to provide for her mother's needs. It was determined that the ALV had not been receiving this care and that the daughter had been receiving more than $1,000 a month for this care. The daughter was signing and submitting time sheets for a personal care attendant (PCA). The MRC investigator substantiated abuse in this case against the victim's husband, the PCA and the daughter who served as the surrogate. During the course of the DPPC investigation the victim turned 60 and in collaboration with Executive Office of Elder Affairs (EOEA), DPPC secured a permanent guardian for the victim. The case was investigated criminally due to the level of alleged neglect and possible Medicaid fraud. The criminal case is pending. The victim continues to reside in a long term care facility and has no contact with the family.

Case #64920

The 59 pound victim — neglect by spouse

In August of 2001, a woman was vacationing in Maine after moving into her brand new home. She was the primary source of income for her family and she was getting ready to return home when she suffered a stroke. There is a current multi million dollar malpractice lawsuit pending for the initial treatment that she had received. As a result of the stroke she is paralyzed on her left side, requires the use of a wheelchair, and 24-hour care. The woman and her family received many outpatient services after her discharge from rehabilitation center. The woman resided with her husband and two adult step children. She also has two biological children from a previous marriage, with whom communication was cut off shortly after the she became disabled.

Four years later, the woman, the alleged victim (ALV) in this case, was taken to a local emergency department by her stepdaughter. The ALV was slumped in her wheelchair, cyanotic, her temperature was 96.7 and she weighed 59 pounds. She had decubitus ulcers (bedsores), one was to the bone. She was foul smelling and had excrement under her nails, in her mouth, on her torso and on her lower extremities. The ALV was immediately intubated and placed in the intensive care in critical condition. The severity of the ALV's condition necessitated an immediate call to the local police. The local police and the hospital staff notified DPPC Hotline of the situation. The intake was reviewed and DPPC assigned the case to a Massachusetts Rehabilitation Commission (MRC) investigator and a DPPC oversight officer. The case was simultaneously reviewed by the State Police Detective Unit (SPDU) assigned to the DPPC in which the trooper contacted the local district attorney's office. The district attorney's office assigned the criminal matter to a crime scene investigator and to the local police department for criminal investigation.

DPPC has had previous involvement regarding the ALV. Each allegation was investigated and services were offered by the protective service agency. Each time services would be put into place but eventually discontinued by the ALAB or the ALV. The ALV was determined competent at the time of the previous incidents. This information was shared with the district attorney's office and local police. The police were initially unable to locate the husband, the Alleged Abuser (ALAB), or stepchildren to conduct interviews. The ALAB did not go to the hospital and did not answer his door. The MRC APS investigator was asked by law enforcement to assist and she was able to schedule the interviews and the multi-disciplinary team continued throughout the investigation. The police and MRC APS investigator met the ALAB and stepdaughter at the home of the ALV and ALAB. The investigators found in the bed that the ALV slept, stained sheets and bugs. The investigators then asked the ALAB what the ALV ate on a daily basis; he was asked to produce such items and none of these items were found in the home. The ALAB also indicated that the ALV did not like to eat. The ALAB was asked how the bedsores were being treated. The ALAB was then again asked to produce these supplies and none were located in the home. None of the ALV's prescribed medications were current; there were only expired bottles in the home.

Miraculously, the ALV survived; however this situation became more complex. The hospital indicated that the ALV did not have the capacity to make informed decisions about her medical care. The health care proxy was the ALAB. DPPC legal counsel and oversight officer, hospital social worker and legal counsel, the district attorney's office and investigators needed to find a solution to keep the ALV safe and not jeopardize the criminal case. Through extensive collaboration with all the parties involved, DPPC legal counsel petitioned the probate court for guardian of the person and estate and asked that an attorney with expertise in these matters be appointed. DPPC was successful in obtaining a temporary guardianship of the person with the recommended attorney appointed by the courts. The ALAB refused to cooperate with the temporary guardian by providing the necessary financial information to obtain entitlements for the ALV. Future court appearances were necessary to continue to maintain the ALV's safety and to ensure that she received all necessary services.

This ALV is currently in a long-term care facility receiving rehabilitative care. She has had several surgeries and has gained over 20 pounds. She has also reconnected with her biological daughter and her family. DPPC has supported the biological daughter to become the sole permanent guardian of the ALV. The ALV continues to reside in a long term care facility. The ALV's health has improved and the ALV receives visits from her biological family all the time. DPPC substantiated abuse against the husband. The criminal issues are pending.

Case #66223

Neglect by sibling

The DPPC was made aware of allegations of abuse as a result of an anonymous phone call received by the Council on Aging regarding the ALV and her elderly mother. Upon entry into the home the ALV was identified as a female with profound intellectual disabilities and cerebral palsy. She required 24 hour care. She was not enrolled in a DDS day program although she had been previously determined eligible for services. The residence was a two family home where the ALV and mother lived on the first floor and the brother lived on the second floor.

The first floor apartment was observed to have no running water, the toilet did not work and the overall house was extremely dirty. The ALV had been observed in the home wearing only a wet diaper and a shirt. A jar was being used for urine. It was reported that the ALV had sustained bed sores which were infected. The Board of Health had concerns about the condition of the home. The ALV's brother was the legal guardian for both the ALV and the mother. He was also considered the primary caregiver. The brother had been refusing outside care provider services for years. Although the ALV's aged mother had been the caregiver for the ALV, given her age and declining health the investigator determined that she was no longer able to adequately care for her daughter.

The ALV and the mother were removed from the home and placed in a nursing home. Upon medical examination it was discovered that the ALV was suffering from severe malnourishment and sepsis (blood poisoning as a result of a urinary tract infection). The ALV had been suffering from years of medical neglect. Both conditions were attributed to the long term medical neglect by the mother but more recently by the brother. The investigator substantiated abuse against the brother only. ALV's mother was not held accountable, as she was no longer in the role of caregiver.

The ALV was moved to a nursing home and was appointed a new legal guardian. DDS is seeking permanent residential placement for the ALV. The ALV's mother was appointed a legal guardian through the Council on Aging and remains in a nursing home.

Case #66489

Physical abuse by residential staff

On March 2, 2006, a call was made to the DPPC Hotline and received by DPPC's overnight vendor. The allegation reported was that one direct care staff person witnessed the Alleged Abuser (ALAB), another direct care staff person, punch the Alleged Victim (ALV), a man with an intellectual disability, mental illness and seizure disorder. The ALV sustained bruising near his rib area as a result of the punch and from being pulled to a sitting position on a couch. The incident occurred on February 27, 2006. The witness reported the incident two days later to a supervisor. The case was initially not screened criminally.

During an interview with the DPPC investigator the witness stated that he was sitting next to the ALV in the living room. The ALV went to get up out of the chair and the ALAB punched the ALV, grabbed him by the shirt and forcefully pulled the ALV back down into the chair. The witness indicated that this act by the ALAB was intentional and the ALV was scared. The ALAB reportedly used the "F" word when he grabbed the ALV. The ALV tried to move away after being hit and pulled by the ALAB. The witness stated that the punch was so forceful that he could hear it. When checked, the ALV's side was red and there was a subsequent bruise in the area. After the incident, the witness brought the ALV to his room, cleaned him up and stayed with the ALV until he fell asleep.

The ALAB reported that he did not know about the incident until a few days later when he came back for his shift. The ALAB stated that the shift was "normal" and nothing unusual happened. The ALAB denied grabbing and punching the ALV. The ALAB stated that no one working that shift hit the ALV and that he had never seen anyone hit the ALV. The ALAB went on to say that he had an issue with another staff that was working that day and that he had issues with the administration. The ALAB indicated that a possible reason for his being accused of assaulting the ALV was that he had prior "issues" with the administration of the facility. Record review showed that the issues the ALAB had with administration were all issues that were legitimate to be documented and addressed by an employer. The APS investigator concluded in the DPPC investigation report that the ALAB abused the ALV.

The completed DPPC investigation report, substantiating abuse against the ALAB, was reviewed by the State Police Detective Unit (SPDU) assigned to DPPC. The case was re-screened criminal and forwarded to the district attorney's office. The case was assigned for criminal investigation and investigated by the local police department. The pictures that were in the possession of the DPPC investigator were forwarded to the police detective. The detective interviewed the witness and the ALAB. The ALAB was later charged with two counts of Assault & Battery on a Person with an Intellectual Disability.