Anyone know of any AD experts in Central Ohio? Or anywhere in the state, for that matter???

Brad,Thanks for posting. I will be in touch with you soon.

So that others will not have to keep referring back I'll repost this this on the new page.

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Lisa's Lawyer ---Posted April 03, 2008 04:24 PM (From Page 2 of this thread)

"Forum Members,

I am one of the lawyers defending Lisa Cox.

I am taking this very unusual step of reaching out to your forum because this prosecution is very unusual and sets an extremely dangerous legal precedent -- prosecuting family members who try their best to care for a sick elderly member at home.

Lisa Cox is not guilty of what she has been accused of. She will not be pleading guilty. The Prosecutor wants her to serve 4 years in prison.

Publicly, I can share with you that Evelyn Cox was under the care of a doctor and skilled in-home nursing when she died. Lisa provided plenty of love, concern, compassion, and care over many months. In fact, just a few days before she died Lisa took her to the doctor because she was concerned about Evelyn.

In home nurses came twice a week. Lisa did not have Power of Attorney nor any legal means to put Mrs. Cox into a skilled nursing home. Moving out was not an option for Lisa because she couldn't bear abandoning "Granny" (which is what she called her). Nor could she force her to eat. Ensure through a straw could only go so far.

It bears repeating - she had no legal right to make any medical decisions for Evelyn. Doctors and nurses were in the loop. Adult Protective services was never presented as an option to her.

Clearly, this prosecution has struck a chord with many of the forum members. As more and more of us are called upon to care for our sick and elderly parents and other family members, we cannot let the government prosecute those very same family members for homicide. That is now happening to Lisa Cox in Marysville, Ohio. She has a 6 year old little boy who needs her and a husband who loves her.

I am calling upon anyone who may be able to assist Lisa's defense by way of suggestions, ideas, possible witnesses, expert witnesses, or any other form of aid to her defense. Due to the rarity of this type of prosecution, past case examples are non-existent.

It would be best to e-mail me privately at brad.koffel@kjlaws.com.

Thank you,


Brad Koffel
KOFFEL & JUMP
Columbus, OH
614-481-7215
brad.koffel@kjlaws.com

Posts: 1 | Registered: April 03, 2008"
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Going back to the beginning of this post I remember googling, and trying to find more info specifically on the people involved in setting up this prosecution. That Coroner has impressive credentials, etc. However, I wondered then and still do, whether he actively worked with anyone on bringing charges in the four years between the first DA's refusal to prosecute, and the next DA's taking office. Did he even care in between? Or was this dredged back up because:

#1, there was a new election?

#2, The coroner is, around the time this prosecution was instigated, involved in creating and serving on a new commission, or project addressing care and consequences of taking care of loved ones in the home. So was this pulled out of the files to use as a carrot to fetch publicity or funding for his endeavors?

That is what gave me the initial impression that this is a "politically motivated" prosecution.
I really don't know anybody's motivations, but 4 years between death and prosecution attempts bothers me.

I would imagine that amongst the defense expert witnesses, there would be Neurology, Hospice, Social Work, Nursing, and hopefully someone with a very strong professional background with the Alzheimer's Organization. Since Alz. Org. has MSW's and LCSW's, they may be a good source for input for the defense.

My gosh, the cost to the defendant - can you just imagine? Who amongst us would be able to absorb such costs? Not many I'd bet.

This is just the worst state of affairs. However, I do wish to hear the prosecution's evidence as we have heard the stance of the defense. It is important to gain knowledge to fully understand exactly what happened. We still don't know so all we can do is wonder and suppose.

If the defendants are indeed innocent of the charges, this is truly dreadful.

If I am remembering correctly, the atty. mentioned that Lisa had no legal right to admit the deceased to a nursing home. But that still could have been accomplished.

He also mentioned that Lisa was never informed of APS as an avenue for assistance. APS could have gone to court and arranged for the deceased to be removed from the home to proper care.

HOWEVER, that being said, if Home Health and other providers were in the home or in the loop as mentioned, they are certainly mandated reporters to APS; and if Home Health DID make the report as stated earlier, then why was the deceased not removed from the home asap and much earlier?

Certainly this is curious. And if APS did come in at the behest of Home Health, then the defendants were aware of APS. Something just doesn't fit quite right here. Perhaps I am not understanding clearly from lack of sufficient information.

We tend to think of politically motivated prosecution, but we just do not know what the facts are. I did call the prosecution's office and left my name and telephone number and requested someone get back to me. I related the interest re the case on the Forum, but of course, the call was not returned.

We'll soon know more.

(hi--returning member; mother has AD approx 8 yrs)

I'm wondering what happened at the doctor's office if Lisa took her granny there a few days prior to death.

The ants. I don't get it. When someone dies, does the body then empty the bladder and bowels? Then the ants are drawn to the odor of death? I can't imagine that everyone from family to home health would have ignored ants crawling all over the bed and bedsores prior to death.

Holding my breath until testimony begins. Five years too late in my eyes if they had a case.

There's another case in Illinois where ants were in the urine and feces (no dementia mentioned). Two daughters were caregivers for their mother at home:

"Upon their arrival, they found the elder Barry covered in bed sores, her own urine and feces, and ants, according to coroner’s inquest testimony.

The home also was in a state of disarray and had intense odors, according to testimony.

Barry died one week later from pneumonia, enhanced by her history of bladder cancer, malnourishment, dehydration and neglect, coroners said."

http://www.kcchronicle.com/articles/2008/02/28/news/local/doc47c54533e072e769982950.txt

If you copy & paste the following link it brings you to the NBC Ohio web page that has the latest update. It also has a video so I could watch Lisa and Dennis in court.


http://www.nbc4i.com/midwest/cmh/news.apx.-content-articles-CMH-2008-03-21-0026.html

I am Lisa's brother and I can tell you that this case IS politically motivated. Check out this link. http://www.co.union.oh.us/GD/Templates/Pages/UC/UCDetail_Alternate.aspx?page=3&TopicRelationID=202&Content=3333

Mr. Phillips had this seminar five days before the Cox's indictments. If the nurse or doctor had seen a problem, then why didn't they turn Lisa in? Because they know what happens with this disease. I am only 35 and was diagnosed with COPD. If my wife fails to see if my lips or nails turn blue and die, can she be tried for manslauter too? I will never get to see Mrs. Cox's age. I believe Mrs. Cox wanted to die, in fact I know she did. I work with a nephew of hers and he told me her husband was her everything and she missed him. If I was in that position, and couldn't feed myself, or wipe my hind end, I would spit my food out too. Although we all know that you dont want or have an appetite to eat with this disease. We need a little more common sense, less text books and less POLITICAL GAIN. Lisa did everything she could and the docs and nurse knew of her condition, so why aren't they being charged? Lisa said that Mrs. Cox would call out Archie(her husband name) out of the blue. I can assure you that Mrs. Cox is rolling in her grave right now. This is a fatal disease and no one can do nothing to stop it. Sure she was "wasting away", just like my COPD will do to me. This case just needs thrown out. This is just a waste of tax payers dollars just to get publicity and gain from these substandard politicians. They are supposed to be in office to help people, not hurt the actual people who cared and did everything they could.

Chris

Interesting that his list of "Who should attend" doesn't include caregivers... unless he considers us to be in the "other" category.

NDuke: Do you mean by "who should attend", the discussion of medical personnel by the investigator?

I think that in court, not much mileage if any could be won by a lay person testifying as to one case. The "expert" witness can address the population of patients as a "whole", and their "expertise" carries great weight. Of course, each side will have their own experts; each in opposition to the other.


If this isn't what you meant, I'm sorry.

Johanna---I think that NDuke meant who should attend the seminar about stopping elder abuse in the link posted Linda's brother.

I opened the link and the list included "Law enforcement, social workers, clergy, nurses, physicians, nursing home administrators, mandated reporters, and others interested in ending abuse of the elderly".

Personally, I think that packing the courtroom with caregivers might be a good idea. It is a shame that the seminar was held in January...A few irate caregivers could have made it more lively.

*nod* skericheri is exactly right.

I, for one, would be VERY interested in knowing EXACTLY what constitutes Elder Abuse. And if it's preventing an elder from losing weight through refusal to eat... I would like to know exactly how law enforcement would do it when the medical industry can't.

Okay; now I get it. I went to the site and read the brochure for this "No Fee" Conference. It appears to have been sponsored by the DA's office.

The suggested attendance did focus on the professionals who are in the category of professionally "mandated reporters". However, the invitation also suggested attendance for, " . . . others interested in ending abuse of the elderly."

Law enforcement are part of the mandated reporting system and are often the first responders on a scene, so it is appropriate for them to attend such a conference.

This conference was about ALL kinds of abuse; not just "refusal to eat."

I wonder if this conference information was marketed to the general public. Continuing education credits were given to those who must have continuing ed as part of their continuing licensure.

There are so many factors that could be implicated in the profound changes in a compromised elderly patient with dementia.

Pneumonia? Always a risk. Silent aspiration is often a problem and goes unidentified unless there is a series of repetitive pneumonias without overt cause. There is no choking or coughing with food/fluid ingestion with silent aspiration. A simple Swallow Test under fluoroscopy would diagnose this or rule it out.

In Silent Aspiration, the individual will take in food/fluid; chew and swallow. Part of the food/fluid goes down the esophagus, and part goes down the trachea to the lung. There is no coughing, no choking; etc. My mother actually had this and I witnessed her fluoroscopic exam. It was a bit shocking.

Aspiration most often occurs with thin fluids but also can occur with the patient's own secretions such as saliva and mucous.

When this happens - pneumonia follows.

And then there is the "silent" UTI. That brings about behavioral and functional changes including not wanting to eat.

Then there is dentition; if it is poor and there is dental pain, it often goes unexpressed by the patient who refused to eat or drink, and down goes the weight. Hopefully, an MD or RN will ID the issue. BUT - we had a patient with this in the hospital. He was in acute care for five days having all sorts of tests. Poor old fellow; everything negative. MD couldn't figure it out. The day of discharge, the patient was sitting at the nurses station. They tried to give him water from the cooler and he grimaced for all he was worth - there it was; cavities to the roots. It happens.

Decubiti? If the patient is 63 pounds; skin over bone, there is no muscle mass, there is no protein in the body to assist with maintaining skin integrity or in healing of treated wounds. Infection frequently follows this. At that weight and in that cachectic state, decubiti could occur in the very best of settings with good care.

There is so much more. I have attended seminars regarding elder abuse and they can be quite shocking. But there is a HUGE difference between egregious, purposeful neglect, overt abuse and the actual decline of the compromised dementia patient under good care where these are causative issues beyond the caregiver's control, (or even the MD's control.)

Not to mention the patient just stops taking anything in and no amount of intervention short of putting in hyperalimentation or G-tube feedings would circumvent the outcome. And we all know, that would be grossly inappropriate.

It still has me confounded that if Mrs. Cox was seeing the doctor over the several years she declined, AND home health was coming in to the house on a routine basis, how none of them appear, (at this point with the knowledge we have), to get a Swallow Test, to remove the patient from the home with APS. If their bloomers were in an uproar, to suggest a G-Tube feeding . . . . so many questions. All the balls still in the air.

At this point, there is so little logic and no sense to this. Unless there is something earth shaking and objective coming from the prosecutor, this entire situation is a travesty.

The son had DPOA. It truly was up to him to secure properly trained staff for his mother, and to recognize with the professional's help when Mom could not longer appropriately be cared for at home. He did not live in a vacuum. The caregiver was untrained, very young, and didn't know what she didn't know. And even if she was more experienced, how could the decline be prevented if the causative factors were not dealt with at the MD and Home Health level? And why was hospice not advised by HH or the MD?

No, this just makes no sense.

We shall have to wait to see. The end of June for trial date isn't it?

"Update on Lisa's case,

Jury trial to begin on 6/02/08 @ 9:00 am."

I suppose the best hope is that the best hope is that the defense finds the right experts to testify, and that these experts have the ability to convince others of what REALLY happens with dementia end of life stage. But it seems like a long shot to me because as a caregiver, I have seen so many so called "experts" in care who have no hands-on experience to add to their "book learnin'". Sure they see the patient for 15 minutes several times a year and might be able to predict what's in store, but so few ever know how to help the caregiver overcome many of the obstacles that they face. The standard line from almost every health care worker I have seen for either parent is "it's time to put them in a facility".

Maybe nurses are far better experts on AD/dementia than the best schooled doctor. There's a lot to be said for practical experience. So much that books can't get through.

This zealot really scares the HECK out of me. I know what I have been through with both parents and I see the so called "victim" in this case lying in my dad's bed. He dropped from 154 to about 130 in three months between doctor visits last year... and the last time he was weighed he was 119... he's getting so tight with his contractures that I am afraid he will give himself pressure sores *just* by being contracted. He was on an air pressure mattress and still was getting pressure sores daily... even with me getting up many times a night and turning him... Now he's in a bed that costs as much as a small car and the pressure sores are healing, but most people don't have the situation that I "lucked into" that got us the bed approved by Medicare. Medicare places every obstacle possible in the way to keep of most caregivers to keep the elderly in late stages actively dying... and Medicare is primary insurance for almost 100% of the elderly in this country.

*sigh*... too much coffee this morning.

I can't believe this went beyond a grand jury inquest. You'd think, unless there is something earth shattering we haven't heard yet, that professionals would have been brought in to testify, addressing BOTH sides of the issue. They could have even looked into nursing home patients with same diagnosis, how they quite eating, lose weight, get bedsores, and die, even in the best places. Even forcing tube feedings wouldn't help. The body simply would NOT use the nutrients. IT'S NATURE TAKING ITS COURSE!

Johanna,

Thank you for the phone call on Friday. Your input has been an enormous help. I have forwarded your thoughts and comments up the ladder and they were well received.

The work continues, and hopefully, we can put this case to bed BEFORE the expected trial date in June.

Folks, do not get me wrong. As an investigator, my ONLY job is to collect and report facts. Some facts work in favor of a client and some work against the client. That being said, I believe in Lisa Cox and what she has told me. Otherwise, I would not be working on this case.

Was Lisa completely prepared to provide care for Evelyn? No, she was not. That is why in-home nursing was at the home twice a week. On top of in-home nursing, Evelyn was under the care of a primary care physician, neurologist and a surgeon.

If the situation was THAT bad, why did one of the four professional medical persons not report anything to APS, as required by law?

Whether I like it or not, Lisa MAY be convicted in this case. Not because she failed to provide care, but because her level of care giving capabilities were not those of a nurse or doctor. If she IS convicted, this will set a precedent that, in my eyes, will completely overturn the medical profession in regards to elderly patients.

We, as humans, are not "designed" to live forever in our physical form. If a conviction is handed down, does this mean that every elderly person is not allowed to die? Will this mean that every elderly person will have to enter a nursing home or hospice unit at the first onset of AD/Dementia? What about the families who cannot afford to place their loved one in one of these forms of 24/7 care facilities? Does this mean the family will face charges as soon as the person dies, or in this case 4.5 years later? When this trial starts, it will be four weeks shy of the fifth anniversary of Evelyn's death.

One of the emotions Lisa is facing at the moment is one in which she feels like she is on an island, with no one around.

In my conversation with her, yesterday 4/12/08, we discussed everything that has transpired in the past week, and I shared with her some of the comments listed here on the DB. I explained to her this case is not only being talked about in Central Ohio, but in the four corners of our nation. I read the locations fo those of you who posted in this thread and I think she was a bit overwhelmed. She asked me to pass along her thanks and gratitude for your kind words and input.

I thank each of you, as well, as your comments and insights have helped me in my education of AD and dementia.

For those of you interested, there will be a rally to support Lisa Cox at the Hampton Inn in Marysville, Ohio @ 1900 Hours on Thursday, April 17, 2008. Any and all who wish to attend, are invited to help show support to Lisa and her young family.

Rick

No, it's not too much coffee NDuke. You are an extremely intelligent person who is knowledge based and is very well grounded. Your heart is very kind and you care. You are correct in what you say.

So many dragons to be slain, so many mountains to climb, and the largest barrier for effective dealing with all of this is the lack of infrastructure to bring the appropriate care to our LO's when they are VERY compromised.

We're not looking for the Ritz here, just the basics, but it's completely ludicrous to witness the lack of common sense, insight and assitance set forth by M'care, M'caid, etc.

Even the criteria for hospice is insufficient and beyond being outdated - and it was before the ink was dry on the pages. Those who set the criteria into place obviously never spent time with a LO with dementia. AND, they obviously are not aware of the path that different dementias take right up until the end.

For instance, FTD patients often stay alert and oriented with retained memory and speech right up until the end. Stage 7 for criteria waltz's right past that scenario. There are no "outlier" categories set into place for the diagnoses encompassing the various dementias and their differences which are indeed eventually fatal.

And yes, I do agree with you on the other issue, NDuke. There is a very poor understanding on a reality basis by many of the healthcare professionals.

So easy for people to utter pat phrases and platitudes, who mindlessly use their reference books to put a "plan" together for what they "think" should be done and then off they go. Now, this does NOT pertain to all healthcare workers - there are some marvels out there who DO get it. But there is a significant number who do not.

Sometimes the social workers or licensed nurses who saw Mother reminded me of Ferdinand sitting in the field of flowers sniffing the perfumed air and then trotting off, oblivious to all else. No connection whatsoever. Bless those who were wise and competent and able to understand what was the actual truth and dynamics of the matter where the rubber hit the road.

I always oriented my staff of RN Discharge Planners and Social Workers to "listen" to the family and to ask many questions regarding the challenges facing families. What are 8 or 10 hour days on the job for us is the absolute quality of life for that patient and the family. What we do or don't do will affect that family unit far into the future in ways we cannot begin to fathom. So listen and explore and think out of the box.

But even with my experience, I did not fully grasp the purest understanding of it all until I began to deal with dementia with my mother and step-dad on a daily basis. One cannot begin to describe the essence of the challenges.

There are holes in the criteria for hospice, for equipment, for skilled care, etc. that one can drive a semi through. We are the people. It is OUR taxes and OUR government.

Isn't it, "government of the people, by the people and for the people" and not government TO the people? Seems to me that is being forgotten. Our legislators appear to forget that they are working for US. I'm sorry, that particular piece of business tends to drive me to the brink. I suppose that's because we are impotent to do anything about it anymore.

In the case of Evelyn Cox, it appears that all systems failed. I cannot think of any other explanation for the length of time that things DIDN'T happen that the providers should have set into place in a concrete manner. Could this truly have been failure all the way around? If so, how in the world could that have continued for the length of time it did?

It simply does not compute as it is so far out of the realm of appropriateness.

We'll have to wait and see.

Dear Rick: Our postings must have crossed. I am glad to be of assistance.

Hopefully, Lisa will be exonerated if all holds up in court. What a dreadful experience for her and her family. I can only imagine the feelings of panic.

You are correct in that this case is being followed nationally. What comes into play from the prosecution and through the defense is, as you say, extremely important.

May the rally be very well attended and bring some solace to Lisa and her family.

I still am confounded by the lack of what DIDN'T happen with the physicians, (especially the primary), and home health. Of course this confoundedness is based upon what I have learned to this point.

Hopefully, no one will have gone back and amended their written notes in records, and the integrity of what did and did not happen over those few years will be intact and bring some clarity to the case.

Best wishes in that the truth will out,

Diana,

The problem with a grand jury, even if it is necesary to our legal system, is that only one side presents evidence to the grand jury: the prosecution. There are no defense witnesses, or defense attorneys, for that matter, allowed in the grand jury trial.

Grand jury witnesses would have included the coroner in this case. Because the death certificate lists three causes of death, none of which are "normal", the grand jury, most likely, had no choice but to indict.

It may not be a perfect system of justice, but it is all we have at the moment. The benefits to being charged are spelled out in our Constitution, in that we have the right not to incriminate ourselves, we have a right to a jury of our peers, we have the right to face our accusers, and we have the right to cross-examine the prosecution's witnesses.

While there are always three sides to the story, (prosecution, defense, and the facts), it is ultimately going to fall into the hands of the jury to reach the final conclusion. A jury will be asked to find "beyond a reasonable doubt" that either Lisa did do this or did not do this. They will be asked to acertain whether a "reasonable" person in the same situation would have acted as Lisa did.

I believe, when our evidence is presented, the jury will have no other choice but to exonerate Lisa Cox in this matter.

Rick

Noticed the following at the bottom of one of Rick's postings:

"For those of you interested, there will be a rally to support Lisa Cox at the Hampton Inn in Marysville, Ohio @ 1900 Hours on Thursday, April 17, 2008. Any and all who wish to attend, are invited to help show support to Lisa and her young family."

If someone on our forum attends, please post your observations.