Several former employees of a San Luis Obispo assisted living facility testified over the past two weeks that its owner was “very engaged” when it came to admissions, but that a 65-year-old resident with dementia who was killed crossing the street should never have been taken there.
The Manse on Marsh owner Christopher Skiff, 54 — along with his former executive director, Gary Potts — has pleaded not guilty to two charges of involuntary manslaughter and elder abuse resulting in death related to the 2014 death of 65-year-old facility resident Mauricio Edgar Cardenas.
The trial began with opening statements Nov. 15 and has since featured testimony for the prosecution, which is represented in this case by the California Attorney General’s Office, since The Manse on Marsh is a state-licensed facility and the investigation was conducted by the state Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse.
Deputy Attorney General Mark Cumba, who is trying the case, indicated that the prosecution expects to rest Monday.
Cardenas was hit and killed by a car on the evening of Dec. 21, 2014, as he tried to run across Los Osos Valley Road in the dark about 10 miles from the facility.
Cardenas, who had been diagnosed with dementia prior to his admission to the Manse on Marsh, was a problematic client in his roughly eight months at the facility, drinking alcohol excessively and coming and going without alerting staff, according to court records and testimony.
He was also an avid daily jogger whom Manse staff and Sheriff’s Office deputies tried in vain to have wear a GPS ankle monitor, staff reported to a special agent investigating the case. A doctor had given him approval to leave the facility unattended, according to testimony.
While Manse is equipped to care for elderly residents with a variety of physical ailments as well as mild cognitive issues and other symptoms of normal aging, state law requires additional licensing for facilities seeking to care for people with dementia.
The state alleges Skiff and Potts knew their facility was not licensed to care for Cardenas and conspired to admit residents with dementia and related symptoms while also keeping a minimal staff on hand, ultimately resulting in Cardenas’ death.
But calling the incident a “tragedy,” Skiff’s attorney, Robert Sanger, disputes that the facility couldn’t take Cardenas, whose medical records also showed diagnoses of mild cognitive impairment, which the facility was licensed to care for.
Furthermore, Sanger argues, the DOJ got involved following complaints from “disgruntled ex-employees” after the the CHP and the state Department of Social Services did not find that a crime or other violation occurred related to Cardenas’ death.
Potts, 63, will be tried separately. If convicted of both charges and attached sentencing enhancements, both Skiff and Potts each could face a maximum of eight years in state prison, the Attorney General’s Office previously said.
‘Why are we taking this man?’
Since opening statements two weeks ago, jurors have heard the state’s case from DOJ Special Agent Sherry Zamanigan, several former employees, a motorist on the road when Cardenas was hit, and a paid expert on senior living centers testifying on behalf of the DOJ.
Jane Lefebre, who worked in sales at the Manse before Cardenas moved in, testified Nov. 19 that Cardenas’ family wanted him moved into the facility but was told in January 2014 that they couldn’t accept him due to his 2012 dementia diagnosis, she said.
“It wasn’t an appropriate setting for him,” Lefebre said.
Despite that, Lefebre said she attended stand-up meetings every workday that included a “hot list,” or a list of potential move-ins who had some barrier to admission. Skiff attended these meetings, she said, and Cardenas’ name was on the list.
After Cardenas’ family toured other local facilities, they returned to Manse, again seeking Cardenas’ admission and again Cardenas’ name was put on the list. Lefebre said another employee raised concerns about that, but Skiff didn’t respond.
“It was dropped,” she said.
Under cross-examination, however, Lefebre testified that she never saw Skiff personally make any admissions decisions, and though she said she wasn’t fired from the Manse, her separation “involved lawyers.”
“You don’t like Mr. Skiff, do you?” Sanger asked.
“That has nothing to do with anything,” Lefebre said.
Lefebre left the facility before Cardenas moved in.
Katrina McMillian, who was the director of wellness at the Manse from 2012 to 2014, testified that Skiff was “very engaged” in meetings involving the “hot list” and capacity.
McMillian recalled seeing Cardenas’ records listing Cardenas’ medical issues and saw that his primary diagnosis, dementia, was crossed out and MCI (mild cognitive impairment), was scribbled on the document.
“It was like a shock that it was filed,” McMillian said.
She also said Potts would insist that she keep her staff levels down, sometimes having as few as three people working the entire facility, which is licensed to house up to 100 people.
But McMillian testified under cross that, as a mandated reporter, she never reported any abuse while she worked there, and even asked Potts for her job back after leaving in 2014.
Kris Jacobson, a nurse at the facility who first contacted the DOJ about the Manse, said she notified the state that Potts was able to persuade a physician to change Cardenas’ primary diagnosis. She testified that she was involved in that process.
“I did not make the decision — it was all the people around me,” Jacobson said. “I said, ‘Why are we taking this man?’”
In her testimony, Zamanigan told jurors that she had conducted an investigation in 2014 into alleged neglectful conduct by Jacobson, but did not find any evidence.
She described later being contacted by Jacobson about Cardenas’ death, interviewing several Manse employees, and ultimately serving a search warrant at the facility, where they seized administrators’ records related to Cardenas.
Zamanigan said that Skiff was polite and cooperative during the search, but later was unwilling to submit to an interview.
Symptoms of dementia
On Friday, jurors heard from Manuel St. Martin, a Los Angeles-based psychologist, attorney, and expert on senior healthcare.
Asked by Cumba about Cardenas’ excessive alcohol use, his depressed mental health and his frequent confusion, St. Martin said those symptoms correspond with those of dementia.
Regardless of whether Cardenas’ records held by the Manse showed dementia as a primary or secondary diagnosis, the facility shouldn’t have taken him, St. Martin said.
“Whether it’s primary diagnosis or secondary diagnosis, it doesn’t matter,” he said. “The symptoms are going to be the same.”
He added that a facility that didn’t have a licensed dementia care plan wasn’t going to be able to care for a dementia resident, who would be “at risk of inadvertently harming themselves.”
Asked by Cumba about who is responsible for care standards at senior living facilities, however, St. Martin replied: “The administrator.”
When Cumba tried to lead St. Martin to say “owner,” Sanger objected, noting to Superior Court Judge Craig van Rooyen that Cumba “got an answer he didn’t like.”
Van Rooyen sustained Sanger’s objection.
The trial is scheduled to resume Monday.