Is Arizona’s registry of vulnerable-adult perpetrators effective?

Arizona is one of 26 states that maintain a registry of known perpetrators of vulnerable adult abuse, neglect and exto ploitation.

But the list, maintained by the state’s Adult Protective Services division, is incomplete and inconsistent.

And many vulnerable adults, their loved ones and the general public don’t know where to find the list, or even how file a complaint about a caregiver, an Arizona Republic investigation found.

Advocates for vulnerable adults say changes to the registry are needed to better protect them.

Numerous allegations against people listed on the registry are horrific:

❚ An assisted living manager ducttaped a resident’s mouth shut.

❚ A paid caregiver abandoned two sick, elderly people in a trash-strewn home.

❚ A Phoenix woman stole $650,000 from her 93-year-old mother and spent the money on items from eBay and the Home Shopping Network.

❚ A caregiver neglected the adult in her care so severely that he suffered gangrene; malnutrition; and black, rotting skin on the back of his hands, feet, legs and buttocks.

❚ A caregiver took a video of a partially naked vulnerable adult living in the group home where she worked and posted it on social media.

‘It has all kinds of holes in it’

Arizona is ahead of many states in tracking abuse of vulnerable adults. And it’s one of only a few states that has an online registry accessible to the public.

But the registry is not publicized, it can be difficult to search and companies that employ caretakers but don’t contract with the state are not required to check it before hiring someone.

The caretakers cited above are named on the list, but it is missing some other high-profile offenders. Other people are included for vague or unknown reasons.

Most of those accused of abusing, neglecting and exploiting vulnerable adults don’t even make the registry. Fewer than 1 in 10 complaints about abuse, neglect (excluding self-neglect) and exploitation of vulnerable adults in fiscal year 2019 were substantiated or verified by state investigators, which raises more red flags for the system’s critics.

Those under investigation by the state aren’t flagged until a finding is made.

“It has all kinds of holes in it right now,” said Erica McFadden, executive director of the Arizona Developmental Disabilities Planning Council.

“We’ve never put the resources in our state system to publicize it, or to manage it, and now we are expecting people to know about it without sharing the information.”

For example, schools, hospitals, and home health companies that don’t contract with the government aren’t required to check the registry before hiring a caregiver.

“If anyone’s name is on that list, they shouldn’t be working with vulnerable adults,” McFadden said.

Issues with the registry are part of a bigger problem that is not unique to Arizona. With no baseline federal requirements for reporting abuse, neglect and exploitation of vulnerable adults, and no designated federal funding to investigate such cases, states are left to figure it out on their own, McFadden said.

“There are no federal requirements like there are for children,” McFadden said.

Two separate state reports issued in response to community outrage about a vulnerable woman impregnated while a patient at Hacienda HealthCare in Phoenix have recommended improving the registry. Some of the debate in a legislative task force on vulnerable adults has focused on the registry, too.

Names that end up on the registry get there at the end of a process that begins with a report or complaint to Arizona’s Adult Protective Services call-in system or its hotline.

How the registry works

Critics point to flaws at the very beginning of that process. The call-in system to make an initial report does not operate 24/7.

Adult Protective Services officials told The Republic they are working on a plan to staff the hotline 24/7. And Adult Protective Services will take online complaints 24/7, but not everyone has access to a computer or knows how to use one to file a report.

State investigators conduct an investigation after a report, and if there’s a recommendation of substantiation, suspected perpetrators are contacted and allowed an opportunity to defend themselves in front of an administrative law judge.

The burden of proof for a perpetrator to be place on the registry is lower than it is for a criminal conviction — “a preponderance of evidence,” which means that the evidence shows it is more likely than not that the maltreatment occurred. That is a lower standard of proof than in a criminal proceeding.

Cases of suspected perpetrators are also reviewed by the Arizona Attorney General’s Office.

A perpetrator’s name is place on the registry only after all appeals are exhausted.

The registry does not require perpetrators to give their fingerprints. McFadden said that means a potential caregiver who has passed a fingerprint clearance may still be on the registry.

Nathan Sutherland, the 37-year-old caregiver who was arrested using DNA

evidence in the rape of the Hacienda patient, is not currently on the registry.

A criminal case could delay the process, and Sutherland’s case is ongoing. He has not been convicted of a crime.

McFadden and other critics suspect the registry’s list of abusers should be longer, given the low rates of substantiation and research that suggests crimes against people who are elderly and disabled are under-reported.

Top offense: Financial exploitation

The most common offenses landing people on the registry are financial, where relatives, friends and paid caregivers forge checks, steal PIN numbers, fraudulently transfer property and coerce the people in their care to sign over power of attorney.

A Republic analysis of the data found that perpetrators had a wide age range — from 15 to 87. The median age for perpetrators in all categories was late 40s. As of Nov. 1, 2019 the list included 1,501 perpetrators.

Among the 197 perpetrators added to the list between Jan. 1 and Nov. 1 of 2019 was paid caregiver Aimee Brisendine, 44, who accepted money to care for two vulnerable, elderly adults in southern Arizona and then abandoned them.

Emergency responders found the victims living amid garbage, urine and feces, their eyes clouded by infection. One needed to be hospitalized. Brisendine was later arrested and sentenced to probation.

In another case added last year, a vulnerable adult living in a residential home walked into traffic on a busy street, was hit by a car and suffered two broken legs, a fractured rib, bruises on both arms and lacerations on their face and lips. The caregiver who was supposed to be checking on the adult, Tiffany Rose Field, 26, was placed on the registry for abuse.

But sometimes it can be difficult to figure out exactly what some people did to land on the list. The descriptions of the offenses on the registry are inconsistent, with some giving a lot of detail while others provide almost none.

In one such example, Jaidee Bader, 63, was added to the registry last year for exploiting a vulnerable adult. The description of the offense says she used “some of the vulnerable adult’s financial resources for purposes which did not directly benefit the vulnerable adult” during 2016 and 2017. Bader was never arrested and does not have a criminal record.

Bader is now working as a medium at Jaidee Bader Mystic Vision in Sun City, which is a community near Phoenix known for having a large population of retirees. On her Facebook page she describes herself as a spiritual person who likes to help others. She offers a range of services, including hypnosis for $85 per hour, and recently co-hosted an evening called “Messages From the Other Side” for $30 per person.

Bader did not respond to emails or calls from The Republic seeking her side of the story. The Republic visited the business, and Bader said she did not want to talk about the registry.

Other issues with the registry: It can’t be searched by the city where the maltreatment occurred. And when abuse, neglect and exploitation occurs in an assisted living facility or nursing home or by an employee of a particular caregiving agency, those companies are not typically named.

Citing the state law that put the registry into effect, the Arizona Department of Economic Security denied a records request from The Republic seeking more details about how and why people get on the registry, including whether any particular facility or caregiving company has showed up in repeat cases.

That means if multiple perpetrators on the list have worked for the same company, it is not apparent on the registry. Not everyone on the registry has a criminal conviction and the registry doesn’t say if they do or don’t.

There also are people with criminal convictions for vulnerable adult abuse, neglect and exploitation who aren’t on the registry.

Missing from the registry: Caregiver who stole $363,325

Among those people missing from the list is Indrani Gaston, who in 2015, at the age of 69, was sentenced to four years in prison for stealing $363,325 from a 93-year-old World War II veteran.

Gaston, who was released from prison in February, had become the vet’s caretaker after his wife died, according to the office of Arizona Attorney General Mark Brnovich, which publicized the case after Gaston was sentenced.

Court records show that Gaston, whose only source of income was Social Security, lost $1.07 million while gambling between 2007 and 2013.

Brnovich’s office is not required to submit criminal cases to Adult Protective Services for its registry.

Two other perpetrators who were not on the registry as of Jan. 6 are Lolita and Joseph Somera, whose prosecution was also handled by Brnovich’s office. The Someras recently pleaded guilty to abuse of a vulnerable adult in connection with the August 2018 death of former Mesa Community College instructor Jon Rager.

Both the Someras are serving 90-day jail sentences and will be on probation for three years when they are released in 2020. Lolita was sentenced Nov. 7 and Joseph was sentenced on Dec. 5.

Rager, 69, died on Aug. 18, 2018, in a room at the Happy Homes Assisted Living Facility in Chandler that was 98 degrees at the time of his death.

The air-conditioning in the home had been broken for two days before Rager’s death, but the Someras did not move Rager and did not contact Cathleen Rager, his wife of 45 years, to tell her of the situation, she said.

Chandler Police Detective Dan Coons testified that Joseph Somera was focused on generating money and profit for the business. The Someras were operating two assisted living facilities with only one other employee besides themselves, he said during Joseph Somera’s sentencing.

Joseph Somera told investigators that he did not believe the home was too warm, court documents show. The Maricopa County Medical Examiner concluded Rager died of end stage renal disease complicated by acute pneumonia.

“Environmental heat exposure” was listed as a “contributory cause of death.”

Cathleen Rager, 73, said she and her husband, met at a social club for tall people in California called the San Fernando Valley Tip Toppers. Jon was nearly 6 feet 3 inches tall, and Cathleen is 6-foot-1. Both spent their careers working with computers. Jon especially loved teaching, Cathleen said.

The couple paid $2,500 per month in cash for Jon to stay at Happy Homes. Cathleen, who is disabled and says she has no other close living relatives, is still hoping to get the $2,500 back she’d already paid to Happy Homes for the month of August 2018.

On registry for 25 years

A similar though confidential state list of people who are known perpetrators of abuse and neglect against children in Arizona as of Nov. 5 included 95,919 names, Department of Child Safety spokesman Darren DaRonco said.

Perpetrators remain on both lists for 25 years.

State law requires the DCS registry to be confidential, and for the APS list to be public. DCS officials said they are not familiar enough with the APS registry to say whether there is any discernible difference between the two. Both require an accusation, investigation and allow for an appeal before a name is placed on the list.

Last calendar year, 9,110 perpetrators were added to the DCS registry of perpetrators of children. By comparison, 411 were added to the APS list of offenders against vulnerable adults, state data shows.

Improving the registry

After the Hacienda HealthCare case, Arizona Gov. Doug Ducey issued an executive order that among other things created a statewide abuse and neglect prevention task force. The task force issued a report on Nov. 1. Among its recommendations were improving the Adult Protective Services registry.

In the long term, the report suggested the state provide funding for a central statewide repository of DCS, Adult Protective Services and fingerprinting information in one data

“Furthermore, DES should continue to work with stakeholders to determine whether the APS Registry can be enhanced to provide a more comprehensive inventory of caregiver complaints,” the report says.

Ducey’s office has said it will be reviewing all the recommendations and will take steps to implement them, “with the goal of ensuring that all of Arizona’s most vulnerable citizens are kept safe from abuse and neglect.”

What the public wants, McFadden said, is an assurance that when they call Adult Protective Services, “that they are actually being served, that there is something being done.”

McFadden, who has studied registries in other states, says Arizona needs to look at how and who the registry is helping.

She said more information would help, meaning the agency doesn’t just say “substantiated” or “unsubstantiated” to close out a case, but to document what Adult Protective Services did to improve the situation. That’s something Colorado’s program does, she said.

Adult Protective Services does not just exist to investigate a case. It also exists to refer people to services, and there should be follow-up to ensure services were received, she said during an Oct. 15 legislative task force meeting.

“What did Adult Protective Services do to make that client’s life better? That’s what we want to know,” she said.