Fighting for Flora: Family, hospital battle over 90-year-old kept in psychiatric unit for 20 months

Sandra Derosa and Vivian Sarlo

When Flora Derosa was diagnosed with Alzheimer's disease, she knew she had to plan for her long-term care. She met with a lawyer and established a plan that gave power of attorney to two of her daughters should she become incapacitated.

She is now 90, and her disease is advanced. She is living in the Enhanced Life Unit at Hillsborough County Nursing Home in Goffstown against her family's wishes and her legal directives.

Daughter Sandra Derosa said the family can do nothing about it. She said Elliot Hospital "stole" her power of attorney after her mother was locked in its geropsychiatric unit in Manchester for over 560 days.

Elliot officials refused to comment, but Derosa and her sister Vivian Sarlo provided correspondence between the two parties showing the case stemmed from a dispute over Flora's medications. The Milford family contends that when they stood up for their mother, the hospital used intimidation to make them back down, including an unsupported abuse complaint filed against Derosa and Sarlo that banned them from visiting her mother for two months.

"We were being advocates. That's all. We were being advocates for our mother," Sarlo said. "Isn't that what you are supposed to do?"

The daughters never imagined a hospital would fight a dying woman's directives.

"Who knew they could trump that?" Derosa said.

Flora's family has appealed the court decision, but aren't hopeful. They want others to know their story to protect themselves from "granny-snatching" - a term that has come to describe a hospital taking guardianship of an elder despite them taking legal steps to ensure their final wishes are protected.

Elaine Renoire of the National Association to Stop Guardian Abuse said hospitals fighting families for guardianship over treatment disputes happens "far too often" in the United States, but is not widely reported, especially when the patient is elderly.

The battle begins

Sarlo owns a real estate agency, and Derosa is a respiratory therapist at a sleep lab near Boston. For years, Flora would spend half the week at Sarlo's home and the other half at Derosa's so the daughters could still work while honoring Flora's wishes to live at home.

In 2014, it got to be too much. Flora refused to get back into Derosa's car after a trip to the grocery store, was taken by ambulance to Elliot Hospital and eventually sent to Hillsborough County Nursing Home. Flora's agitation grew worse in the nursing home and she was eventually brought to the Elliot geropsychiatric unit in October 2015.

According to the paperwork provided by the family, the goal was to get Flora calmer through medication so she could return to a nursing home.

The daughters didn't disagree with the goals, but found the medications adversely affected their mother's health. They showed photos of Flora and her 70-pound weight gain with ankles so swollen her compression socks were cutting into her skin. Sarlo said the drugs were the equivalent of "chemical restraints" to "make the nurses' jobs easier."

Derosa put her concerns in emails to doctors and asked for her mother to be put on medications that had calmed her in the past because "I know my mother. I know what works."

Renoire said that's where they went wrong. She said when going against a doctor's orders "you stand a chance to lose everything and that's the sad part."

"I think a lot of it, and this is my own personal opinion, if you have a medical background, that offends the hospital because they are supposed to be all-knowing," Renoire said. "If a family complains too much, they have had it with you."

The hospital's case

Derosa ordered a stop to the antipsychotics in September 2016, and the hospital filed a complaint with the state Bureau of Elder Abuse that was immediately dismissed. A few weeks later, Sarlo was banned from visiting her mother, which is documented in correspondence between the family and the hospital.

Derosa said she backed off and "had nothing to do with medication" until January 2017, when they found out Flora was being given morphine several times a day.

"That's what they do when you're dying," Sarlo said. "It wasn't for pain. It was to keep her sedated and keep her chemically restrained."

Derosa ordered it stopped. The hospital responded by filing the court action to have Derosa's power of attorney revoked. The family was told through written correspondence that Hillsborough County Nursing Home would only take Flora back "if Sandra is not POA (power of attorney)."

The family said the reason the nursing home wouldn't take her back is because Elliot staffers "lied" about their mother's agitation in records to justify the use of heavy drugs. They pointed to an example of where the hospital recorded Flora as "ramming the walls with her walker." Sarlo said her mother couldn't walk because of the weight gain and neuropathy in her feet.

"No one wanted her then," Derosa said.

Judge Patricia Quigley sided with the hospital, removing Derosa's power of attorney and appointing a guardian. The details of her decision are not public record.

"We lost our mother that day. It's like my mother died," Derosa said. "We'd do everything for my mother because she would do anything for us. Now we can't."

Guardianship in NH

State laws define when guardians are to be appointed. The purpose of the law is "to "encourage the development of maximum self-reliance in the individual; to encourage rehabilitative care, rather than custodial care for incapacitated individuals; and to impose protective orders only to the extent necessitated by the individual's functional limitations."

In 2016, the state had 917 appointed guardians overseeing incapacitated adults, but the state Justice Department would not say how many of those involved elderly patients. It would not say how many of those cases involved a hospital making the petition.

According to state law, the guardian only has to see Flora once a month and file an annual report. Flora's guardian is paid for with what's left of her estate - her dead husband's Social Security check.

"The spirit of this law is not to be used for this reason," Sarlo said.

Renoire's group works to raise awareness about the issues of guardianship and is involved in legislation aimed at protecting families like Flora's. She said the group has been unsuccessful in getting laws passed to strengthen power of attorney rules.

"The laws around powers of attorney need revamping, and people need to be aware of how to do a good one," she said. "We're not lawyers, but we need to be like ones."

Protecting yourself

According to Renoire, Flora made a mistake when she started her planning by giving power of attorney to only to two people.

One was Derosa and the other was her daughter Dolores, who died of brain cancer two years ago.

Renoire said a person should name at least four or five people in their directives. She explained that if one can't serve, another can take over, making it harder for a hospital to seek guardianship.

But Renoire warns "nothing is ever full-proof." She also said her group has found that judges often side with hospitals over family.

"There is a propensity for a judge to think that the family is bad, and sometimes they are," she said.

Sarlo and Derosa said the court case was a "disaster" for them. They had difficulty finding an attorney. When they got to court, their lawyer was unaware it was a hearing where both sides would present their case and never filed an appearance to represent them. They said the hearing went for two hours but they had only 10 minutes to present their case, and Derosa was the only one allowed to testify despite a room full of family members there to support Flora.

"I've talked to hundreds of people over the years, and I have yet to find one that has had a lawyer that didn't make a fatal mistake," Renoire said. "You have to guide them. You have to do the work yourself."

If a guardian is appointed, Renoire tells families to "pick their battles," correspond only in writing, ask for a response and try to be professional. She said this is the hardest part for families because they are emotional and concerned for their loved ones.

"Give an Academy Award-winning performance, and by that I mean, bite your tongue," she said. "Treat them nice so they treat you nice."

Flora today

Susanna Fier, Elliot vice president of public affairs and marketing, issued a statement in support of the psychiatric unit, but would not talk about Flora's case.

"We are the only provider in Manchester offering any inpatient beds to this population of patients in need of care," she wrote. "Importantly, in the state of New Hampshire, there are very few hospitals offering inpatient geriatric psychiatric beds, Elliot Hospital being among those few organizations who have remained true to serving community need, including the growing needs of the mental health population."

The hospital moved Flora back to Hillsborough County Nursing Home two weeks ago. Two days later, she was back in the emergency room after falling out of bed and breaking two ribs, her daughters said. She is now back at the nursing home.

The daughters said they are working with the guardian and hoping she will allow them to bring Flora home when her dying hours are near. The guardian did not respond for comment.

No date has been set for the family's appeal. Renoire said such appeals "are rarely successful."

"Remember, we're talking about old folks, and there is never a win," Renoire said. "I usually say 'Save your money.'"

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire’s aging population and seeking out solutions. Union Leader reporter Gretchen Grosky would like to hear from readers about issues related to aging. She can be reached at ggrosky@unionleader.com or (603) 206-7739. See more at www.unionleader.com/aging.

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Fighting for Flora: Family, hospital battle over 90-year-old kept in psychiatric unit for 20 months