As Aurelia Rios struggled to breathe on the night she died, a nurse's aide at her bedside ignored alarms that warned Rios' pulse rate and oxygen level in her blood were low or nonexistent, state prosecutors said.
During the next hour, a second nurse's aide, who relieved her colleague, also disregarded the danger signs as the equipment continued to beep, authorities said.
Visual alerts were sent to a computer screen to a third nurse's aide, who was supposed to call a staff member to check on Rios.
She, too, failed to act, said prosecutors.
Rios, 72, a mother and grandmother from Central Islip, might have lived, prosecutors said, had the three aides at Medford Multicare Center for Living in Medford and four other staff members -- a respiratory therapist, a nurse, a licensed practical nurse and the nurse in charge of the ventilator unit -- responded to the audible and visual alarms triggered by a pulse oximeter attached to her finger on the morning of Oct. 26, 2012, according to court papers submitted by Attorney General Eric T. Schneiderman.
"That so many workers, and the facility they worked for, failed at their most basic responsibilities is unconscionable -- and it's exactly why we are pursuing both criminal and civil charges in this case," Schneiderman said last month.
On June 5, those seven employees were arraigned in Suffolk County Court in Riverhead on charges that include patient neglect and abuse and falsifying business records. One of the seven is charged with criminally negligent homicide.
Two other staff members were accused of covering up the death and the for-profit nursing home itself is charged with falsifying business records and violating health laws.
Attorneys for the facility, a skilled nursing home with a 40-bed ventilator unit, and the workers, said no crimes were committed and the staff, including the facility's administrator, did not try to cover up Rios' death.
Fighting the charges
All of the defendants have pleaded not guilty.
All of their attorneys have vowed to fight the criminal charges and restore their clients' reputations, which they said have been marred by the arrests.
"Medford runs an exceptional operation and has received high marks during its periodic inspections from the Department of Health," said Andrew Moesel, a spokesman for the nursing home. "We look forward to disproving these allegations in a court of law and showing the high quality of care that the facility provides to all its residents."
The seven employees working the night Rios died are: Kethlie Joseph, 62, of Brentwood, a respiratory therapist; nurses Victoria Caldwell, 51, of Medford, Marianne Fassino, 53, of Shirley, and Kimberly Lappe, 32, of Medford; and nurse's aides Christina Corelli of East Patchogue, Patricia DiGiovanni, 63, of Port Jefferson and Leona Gordon, 35, of Medford.
The supervisors -- who were not on duty when Rios died, but are accused of falsifying business records, tampering with physical evidence and obstructing governmental administration -- are David Fielding, 57, of Lido Beach, the facility's administrator, and Christine Boylan, 49, of Mastic, director of respiratory therapy.
Joseph was charged with criminally negligent homicide, the most serious crime.
Attorneys for Joseph, Fassino, Corelli, Gordon and DiGiovanni declined to address the specific allegations against the defendants detailed in the papers prosecutors have filed.
The nursing home and its five owners also are the subjects of a separate lawsuit filed by Schneiderman this year, alleging they "looted" $60 million from the 320-bed home over the years by paying themselves salaries and profits and by funneling Medicaid funds, money intended for residents' care, to their family-run charities while cutting costs.
The nursing home investigated Rios' death, and the state Health Department, which regulates nursing homes, conducted a separate inquiry after an anonymous employee reported her death to the state. Both investigations found insufficient evidence that Rios was abused or neglected.
Rios was admitted to the ventilator unit on Sept. 28, 2012, for rehab to help wean her off the breathing apparatus, according to what prosecutors said in court records.
Her doctor, Ignor Gutnik, told Dawn Scandaliato, an investigator with the attorney general's Medicaid fraud unit, Rios suffered from respiratory failure, obstructive sleep apnea, chronic obstructive pulmonary disease, obesity and other illnesses and was unable to care for herself, court records said.
Gutnik ordered Rios to be attached, via her tracheotomy tube, to a ventilator, according to court documents. The doctor also ordered that a nurse's aide be at Rios' bedside while she was asleep to make sure Rios didn't disconnect herself from the ventilator, which she had a habit of doing. "Without artificial respiratory ventilation while asleep Rios was at risk of respiratory failure and death," Rios' doctor told Scandaliato, according to court papers.
Rios' daughter, Michelle Giamarino, said her mother was doing well during the four weeks she received rehabilitation at the facility and was expected to go home.
Four assigned to her care
On the day Rios died, four staff members were assigned to care for her: Joseph, Lappe, DiGiovanni and Corelli. The fifth employee, Gordon, was to monitor patient alarms, including Rios', in the ventilator unit.
Prosecutors said Joseph never attached Rios to a ventilator because she failed to review the doctor's order.
Records provided by Cardiopulmonary Corp., a vendor that managed the computer system that operates the equipment at the nursing home, showed that audible and visual notifications were sent continuously from 1:40 a.m. to 3:36 a.m., notifying the staff that Rios' pulse and the oxygen level in her blood were low or nonexistent, according to court documents. The notifications were electronically recorded in computer logs and maintained by the vendor. The logs showed that at 1:43 a.m., Rios' pulse rate dropped to 29 beats per minute and her blood oxygen level plummeted to 1 percent, court records showed.
A normal heart rate ranges from 60 to 100 beats a minute, and under most circumstances, an oxygen saturation level of 90 is considered normal, said Dr. Steven Walerstein, senior vice president for medical affairs and associate chief medical officer at North Shore-Long Island Jewish Health System. He is not involved in the criminal or civil probes or Rios' medical care.
"Once there is no oxygen, the patient is at risk of having a heart attack or heart arrhythmia," Walerstein said.
During these two hours, prosecutors said notifications were sent to Joseph's and Lappe's pagers and to five other locations: in Rios' room, in the hallway outside her room, at the nurse's station and in the nursing and respiratory therapist's offices.
Hallway cameras recording
Joseph was seen several times in the hallways outside Rios' room between 2:04 a.m. and 2:12 a.m., a period of time when the alarms sounded, but she didn't check in on her patient, according to the findings of the attorney general's investigation. From about 2:12 a.m. to 3:58 a.m., prosecutors believe Joseph was in her office, where the notifications were sent.
In the interviews for the nursing home and health department inquiries, DiGiovanni and Corelli said Rios was attached to the ventilator, contrary to what prosecutors allege in court papers.
The women said Rios was asleep and was not in any distress, and the machine next to Rios' bed did not sound, except once, according to court records.
Corelli said she called for help, but investigators said surveillance cameras showed Corelli did not appear in the hallway during the hour she was in Rios' room.
Gordon told health department investigators that Rios' oxygen saturation, concentration of oxygen in the blood, dipped into low territory and notifications were sent out about 1 a.m. and continued on and off, according to what prosecutors said in court records. Gordon said she paged Rios' nurse and respiratory therapist six or seven times during her shift.
Prosecutors said Lappe and Fassino were working at the nurse's station and they were "inches" from the computer screen where Rios' distress signals were flashing, and also disregarded the alerts.
Fassino said she helped Rios about 12:30 a.m. and she was doing "OK and talking," according to what investigators said in court papers. Lappe said the staff did respond to the notifications and Rios was in stable condition.
Caldwell told a health department investigator she went into Rios' room about 3:30 a.m. and changed Rios' pulse oximeter, which measured the degree of oxygen saturation of the circulating blood. At that time, Caldwell said Rios was "alert" and her blood oxygen level was 70 percent. However, prosecutors said surveillance cameras showed Caldwell entered Rios' room for the first time at 3:52 a.m., after Rios was believed to have been dead.
"Without an autopsy, how did they know what was done or not done to cause her death," said Ray Perini, Caldwell's attorney.
At 3:48 a.m., an unidentified nurse's aide, who was not assigned to Rios the night she died but had worked with Rios during her nearly monthlong stay, went into Rios' room and found the patient in bed with the pulse oximeter attached to her finger, an investigator said in court papers.
However, the aide said the device was not registering a signal. The aide told investigators that Rios' "coloring was off" and she looked like she had "passed."
Rios was taken to Brookhaven Memorial Hospital Medical Center in Patchogue, where Dr. Andrew Mapley pronounced her dead when she arrived. Prosecutors said the cause of death was cardiac arrest.
The attorney general's investigators said Boylan and Fielding had received computer logs from Cardiopulmonary Corp. on Oct. 27, 2012, a day after Rios died, but told the health department investigator those records were not available because they can't be produced 24 hours after the incident, an assertion their attorneys said is untrue.
"To the contrary, he produced and turned over all materials, including the records generated by the Bernoulli system," said Fielding's attorney, Brian Griffin of Garden City. "More importantly, the DOH conducted their own investigation and closed the case without a finding of neglect or abuse."
Boylan told the health department investigator when she reviewed Rio's records, "there was no two-hour period on Oct. 25 or Oct. 26, 2012 that respiratory alarms were sounding for A.R. without a staff respond," according to court records.
Attorney William Kephart, also of Garden City, said Boylan told the health department investigator she gave the records to Fielding.
"The idea that they're trying to stick it to her is not fair," he said.
Scott Gross, attorney for Lappe, said she was on break when Rios went into cardiac arrest. He, and some other attorneys, said the alarm records do not show that Rios' machine was sending alerts continuously for two hours.
"I have seen the raw data," he said. "The raw data is not consistent with their theory."