Asked on the stand why a resident with dementia was admitted to his senior living home even though the facility wasn’t licensed to care for him, Christopher Skiff said he wasn’t involved in the decision.
“I was not consulted,” Skiff, owner of The Manse on Marsh, testified Tuesday.
Skiff, 54, has pleaded not guilty along with The Manse on Marsh’s former executive director, Gary Potts, to two felony charges of involuntary manslaughter and elder abuse related to the 2014 death of 65-year-old facility resident Mauricio Edgar Cardenas.
Cardenas, who had been diagnosed with dementia prior to his moving into the facility in downtown San Luis Obispo, was struck by a car Dec. 21, 2014, as he walked or jogged in the dark roughly 10 miles from the facility on Los Osos Valley Road. Cardenas had been a difficult resident to care for in his short time at the facility, former staffers testified, and would come and go without alerting anyone.
The facility had been cited by the state Department of Social Services in 2007 and 2008 for accepting residents with dementia or Alzheimer’s Disease diagnoses despite not possessing the required licensing and a not having a dementia care plan for staff. The facility was beginning the licensing process in 2009 when it withdrew, according to evidence presented during the trial.
One employee told a state investigator that the facility’s unlicensed acceptance of residents with dementia was “an accident waiting to happen.”
Skiff and Potts were arrested in August 2017 following a dramatic search of the facility by agents with the California Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse.
The state alleges that Skiff and Potts conspired to admit residents with dementia and related symptoms, knowing that Manse on Marsh was not licensed to care for them. In Cardenas’ case, the state alleges that Skiff ordered staff to urge a physician to re-evaluate Cardenas, who was eventually admitted with a recorded primary diagnosis of mild cognitive impairment.
But Skiff’s attorney, Robert Sanger, disputes that the facility couldn’t take Cardenas with the mild cognitive impairment diagnosis, and has argued that the DOJ got involved after receiving complaints from “disgruntled ex-employees,” even though the CHP and Department of Social Services did not find that a crime or other violation occurred related to Cardenas’ death.
Potts is being tried separately from Skiff. If convicted of both charges, both men could face a maximum of eight years in state prison, the Attorney General’s Office previously stated.
The trial began Nov. 15. Over two weeks, Mark Cumba, a deputy state prosecutor with the California Attorney General’s Office, called to the stand several former employees, who testified that Skiff was very engaged in the sales and operations of the facility.
The former employees said the Skiff and other staff hosted daily meetings that featured a “hot list” — a white board listing prospective residents whom each had medical and other barriers to admission, as well as an “action plan” for how to get them in. Employees testified that they expressed concern to Skiff and Potts over Cardenas being on that list, but he was admitted shortly after anyway.
The prosecution rested Monday.
On Monday afternoon, Sanger called to the stand Ron Freeman, the Manse’s director of sales from April 2014, shortly before Cardenas was accepted, to February 2016.
Freeman testified that he remembered Cardenas was accepted to the facility with a diagnosis of mild cognitive impairment and had a doctor’s permission to leave the Manse unattended. Freeman remembered Cardenas as “a very pleasant resident” who to his knowledge never left and got lost.
Freeman said he didn’t recall Cardenas needing any help with his memory; rather, he said he thought Cardenas needed to be able to socialize with others with the same mental capacity, not in a dementia care facility.
“I believe he would not have thrived in that kind of community,” Freeman said. “I feel he would have felt trapped and frustrated.”
Asked by Sanger of Skiff’s attitude toward his residents, Freeman said he believed Skiff cares very deeply for them.
The defense also called Alysha Loumakis-Calderon, a former licensing program manager for the state Department of Social Services who now consults for healthcare and social service professionals specializing in patients with dementia and mental illness.
Loumakis-Calderon, who said she’s being paid roughly $3,000 to testify for the defense, examined the Manse’s medical and administrative records for 2014, and testified that the Manse’s staff “definitely went above the standard” for record-keeping and other compliance issues.
She said Cardenas’ medical record listing dementia as a diagnosis was very unusual in that, despite the diagnosis, the physician “let (Cardenas) have all these freedoms,” which is more consistent with a patient with a mild or temporary form of impairment, not long-term dementia, she said.
Loumakis-Calderon told the jury she found it “compelling” that neither CHP nor DSS issued any citations or recommendations for charges after they investigated Cardenas’ death.
When he took the stand Tuesday, Skiff was direct and polite in his responses, but at times became passionate and intense when speaking of his facility’s level of care and his feelings about his residents.
After Skiff walked jurors through photos and floor plans of the facility, Cumba asked Skiff if he would ever ignore a staff’s concerns about a prospective resident. Skiff said that often those concerns would go to Potts, his No. 2.
Asked about the Manse’s DSS citations in 2007 and 2008, Skiff explained that the Manse was going through top-level personnel changes at the time, and he was also away more than usual for a medical issue.
Skiff said he only learned of Cardenas’ dementia diagnosis after his death. Though Cardenas was refused admission to the Manse in 2014 because of the diagnosis, Skiff said he was not involved in that decision. He said he later learned Cardenas’ name was added back to the “hot list” at the request of Cardenas’ family.
He said he didn’t remember a former employee expressing concerns to him about Cardenas being on the list, as she previously testified. Asked by Cumba about another former employee’s testimony that Skiff told a nurse to urge a doctor to change Cardenas’ dementia diagnosis, Skiff replied: “No, and it doesn’t work like that.”
Skiff said the Manse’s decision not to apply for a dementia care plan and therefore not accept dementia patients was “a policy I approved and someone else violated.”
The owner testified that he had a “passing” relationship with Cardenas, but was very sad to hear of his death.
Sanger displayed for jurors an internal business document titled, “The Manse Way,” written by Skiff, outlining the facility’s “Biblical principles” and other guidelines.
“Sometimes (residents) can feel like they don’t matter anymore. We want to give them purpose in life,” Skiff said. “We want to be distinctly different, a better quality, than you would see in a typical nursing home.”
Skiff said some of the “above-and-beyond” policies, such as a required three-minute response time to answer residents’ calls for service, became a point of contention for some of his staff, including some who testified against him.
“Some of them didn’t care for it,” he said.
One part of “The Manse Way” discussed helping residents meet requirements to stay at the facility: “Seniors who do not meet the entrance criteria under state law will find us working hard to improve their situation so they can legally join us.”
Asked about that, Skiff testified that a dementia diagnosis is a “life-changing event,” and that patients and their families should seek second opinions from other physicians before restricting their loved one’s freedom and livelihood.
“You want to be sure about these things,” he said.