Special Reports

A failure to protect: Sexual abuse in nursing homes

John C. Campbell and Mae Campbell in 1990, on their 50th wedding anniversary. They were residents of Hazard Nursing Home. Mae Campbell no longer lives there. John Campbell died in 2001.
John C. Campbell and Mae Campbell in 1990, on their 50th wedding anniversary. They were residents of Hazard Nursing Home. Mae Campbell no longer lives there. John Campbell died in 2001.

Mae Campbell, 88, a Baptist preacher's daughter, modest in her dress and demeanor, was sexually abused twice as a resident of Hazard Nursing Home, according to the depositions of two former nursing home employees.

Campbell, who has Alzheimer's, was sitting in the hallway of the home last year when, within sight of a nursing supervisor and other staff members, a male resident walked up and ejaculated on her face, according to a former nurse's aide.

Three months later she was sexually abused by another male resident who performed a similar sexual act, according to the deposition of a former nurse. The nurse said a supervisor told her not to tell anyone and that no harm had been done to Campbell.

As a result of the incidents, the cabinet for Health and Family Services issued the Perry County facility a Type A citation saying a resident's life or safety had been endangered because of violations of state regulations.

Under state law, nursing home officials and staff members are required to report incidents of abuse, neglect and exploitation to the cabinet. Hazard Nursing Home did not, according to cabinet spokeswoman Beth Fisher.

"The facility failed to protect residents from unwanted sexual contact, failed to report the allegations to appropriate state agencies and failed to thoroughly investigate the allegations of sexual abuse," said the state's citation in the Campbell case.

Hazard Nursing Home officials did not return telephone calls requesting comment.

In May, Campbell's sons sued the nursing home, saying that neither they nor authorities were contacted about the sexual abuse.

"Someone at the nursing home should have told us what was going on," said John C. Campbell Jr., a son. "If they had, we could have protected Mom. ... We could have gotten her out of there."

The office of Attorney General Jack Conway is reviewing the citation in Mae Campbell's case for possible criminal prosecution.

The Herald-Leader does not normally identify victims of sexual abuse. However, John Campbell said the family is identifying his mother to bring public attention to the problem of sexual abuse in nursing homes so that it might not happen to others.

A Herald-Leader investigation found that since 2007, nine Kentucky nursing homes received Type A citations for cases involving sexual abuse and assault. At least two other cases of sex abuse have been documented that did not receive Type A citations.

The abuse was committed by staff members, residents and visitors. In one case, a registered sex offender abused a woman when he visited a nursing home.

There were cases in which, despite warnings to nursing home officials by staff or family members, residents' sexual abuse of fellow patients went unchecked by nursing home officials.

Three of the cases have been criminally prosecuted since 2007.

Pamela Teaster, a University of Kentucky professor who is doing national research on sex abuse in nursing homes, said she suspects that such abuse is under-reported and "woefully" under-prosecuted.

'No actual harm'

Were it not for an unrelated wrongful death case, state officials and family members might never have known about the abuse of Mae Campbell.

When former Hazard nurse's aide Debbie Salley was deposed in the wrongful death case, she said that she had quit working at the nursing home in 2009 after witnessing the episode in the hallway. Salley said she thought the nursing home should have better protected Campbell.

State investigators agreed, according to the citation, which did not identify Campbell, but described the incidents involving her. The home failed to monitor the man involved in the May 18, 2009, hallway incident even though he had previously exposed himself to Campbell and two other female residents, the citation said.

Sandy Noble, a former nurse who also was deposed in the wrongful death lawsuit, said she found a second male resident with Campbell in a room where he had blocked the door. He was nude from the waist down and Campbell had semen on her.

According to the deposition, the nursing supervisor told Noble "to go on and keep working and ... not to be discussing it with anyone," and that "there was no actual harm done to the patient."

The facility failed to monitor Campbell's abuser in the second incident even though he had been seen in bed with another cognitively impaired female resident in 2008.

Both of the perpetrators were receiving injections of the drug Depo-Provera to manage their aggressive sexual behaviors, but they were not being properly monitored, according to the citation. The state documents said the two men were still at the nursing home as of June 1.

'To protect and care'

Hazard attorney Jeff Morgan said the nursing home didn't tell the Campbell family about the incidents even after Salley and Noble revealed it. Morgan, who was interviewing the two in the wrongful death case, notified Campbell's sons John Campbell and Rodney Campbell, of their mother's alleged abuse. He now represents them.

After one of the incidents, Mae Campbell complained her throat was sore and she had soreness and bruising of her inner thighs, Morgan said. Mae Campbell also had complained of men trying to hurt her. Morgan said he found out through his investigation that those complaints were never thoroughly vetted.

"We paid good money for Hazard Nursing Home to protect and care for Mom," John Campbell said in a statement. "And it was explained to us when we admitted her that we would be notified of everything that affected Mom. And we were not."

When cabinet officials learned of the alleged sexual abuse of Campbell, they conducted an on-site investigation, issued the Type A citation and sent it to the attorney general, Fisher said.

The state sends all of the most serious nursing home regulatory violations to the attorney general's office for possible criminal prosecution.

Mae Campbell, her family said, was a retired hospital dietary supervisor at Mary Breckenridge Hospital in Hyden and the wife of the hospital's electrician.

Her husband, John C. Campbell, fell ill after he retired at 75 and entered Hazard Nursing Home. Mae Campbell visited him there every day until he died in 2001, her son said. In 2005, she entered the home herself.

John Campbell said his mother was a Christian, modest in her dress and demeanor, and "a very proud person."

After Morgan told Campbell's sons about the abuse, they transferred her to a nursing home in Manchester, where she remains.

A SWAT team for abuse

Other sexual abuse cases cited by the cabinet since 2007 include one in which the facility failed to protect an 89-year-old woman from sexual abuse from a 44-year-old resident and a facility that failed to protect a resident from sexual abuse by a visitor.

In several cases, nursing home officials failed to monitor residents who had aggressive sexual behavior. In one, a male resident targeted nine female patients, in another case, 14 patients.

A male nurses' aide in a Western Kentucky nursing home sexually abused two female residents. In two cases, nurse's aides used cell phones to distribute nude or inappropriate photos and recordings of residents.

Sexual abuse of nursing home residents is such a problem in Kentucky that Sherry Culp, director of the Nursing Home Ombudsman Agency of the Bluegrass began holding classes for nursing home staff members to prevent it in 2004.

At that time, she said, one out of every 100 complaints she received was sexual in nature.

Culp said the number has declined in the last five years.

Over a 12-month period in 2009 and 2010, three out of approximately 1,500 complaints she received were related to sexual abuse, Culp said.

Teaster and her fellow researchers have reported that some nursing home staff confuse assault with consenting activity among residents or assume that there is no harm to residents with cognitive problems.

All adult protection workers should be trained in investigating sexual abuse in nursing homes and each case should be investigated by a SWAT team that includes police and a nurse trained in sexual assault, she said.

Teaster also said it is critical that elderly and disabled suspected victims be examined by specially trained forensic experts so that evidence can be collected.

"A lot of cases don't move to prosecution because they don't have the evidence," she said.

Related stories from Lexington Herald Leader