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The Honolulu Advertiser
Posted on: Sunday, February 16, 2003

Man's death sad but not unusual

 •  Abuse of elderly called state's 'hidden epidemic'
 •  Counting up the cases of neglect
 •  Elderly care takes place mostly in caregivers' own homes

By Mike Gordon
Advertiser Staff Writer

Time dulls the pain for Jimmy Nishimoto. He is sleeping better, finally.

Jimmy Nishimoto cannot forget the pain his father, Torao, must have endured in his last days of life in the home of a caregiver. Nishimoto and his father had regarded the caregiver as trustworthy. She was later blamed for his death.

Tim Wright • Special to The Advertiser

But he has not forgotten his father, Torao. That would be impossible.

Not after the way the retired carpenter died on Jan. 19, 2001, at an adult residential care home in Hilo, Hawai'i, that was supposed to protect him.

Jimmy Nishimoto had to go to Hilo Medical Center to identify the body of his 86-year-old father. In the hospital's cool fluorescence he saw an example of elder neglect and abuse he wasn't ready for.

"The viewing of the body, oh, I didn't believe it," Nishimoto said. "I couldn't believe a person's body could be bruised that way."

Neither could the office of the state attorney general, which, in the 18 months before Torao Nishimoto's death, had already prosecuted three adult care home operators whose actions led to the death of a client.

Once again, investigators found a dark, sad story.

There were extensive bruises around Torao Nishimoto's groin that were large, deep and dark purple.

There were small pressure sores on his back, too.

And he was noticeably thinner; he had lost 20 pounds in the last month of his life.

An autopsy found that Nishimoto fractured his hip up to three days before his death and that the break prompted a case of pneumonia, which ultimately caused his death. He weighed just 82 pounds.

"Many times I couldn't sleep," said his son. "I was thinking what he went through with the pain. Why didn't he call me? I could have been right there. I am only three miles away."

Officials never determined how Nishimoto fractured his hip.

The fact that he had suffered without medical treatment, however, prompted a judge to find the care home owner, Francilla Malaka, guilty of the most serious offense the attorney general could charge her with: endangering the welfare of an incompetent person, a misdemeanor.

When paramedics got the 911 call at 1:34 p.m. that day, it sounded routine, said Gary Senaga, the deputy attorney general who prosecuted the case.

An elderly man had fainted.

No one was waiting outside when the paramedics arrived at the two-story home on Nohea Street and no one answered when they knocked on the front door, Senaga said. Because it was a care home, they let themselves in.

They found Nishimoto sitting in a plastic chair at the top of a flight of stairs.

His pulse was weak, his breathing shallow and the rest of his vital signs were almost nonexistent. Nishimoto was dying.

He was pronounced dead at the hospital.

Police were called after doctors discovered the bruises and what later turned out to be the hip fracture. When detectives interviewed Malaka, the care home operator, she was evasive, Senaga said.

"It was very suspicious," he said.

The Nishimoto family could not understand how this could happen. Torao Nishimoto had been under Malaka's care for nearly seven years without a hint of a problem, his son said.

Nishimoto was a union carpenter originally from Kona. For about 25 years he worked on homes, commercial buildings and hotels. He was a meticulous worker, his son said.

"He was pretty good," said Jimmy Nishimoto, a 58-year-old roofing contractor from Hilo. "Every night I remember he would bring home the blueprints from the job site and study it for the next day."

After his father retired, Nishimoto convinced his parents to move to Hilo. Eventually, his mother wound up in a Hilo care home and in April 1994, he placed his father in Malaka's home.

"I thought she was a very good lady who could take care of him," Nishimoto said. "My family used to have faith and trust in her. We don't know what is going on. We only see the surface. Then this thing happens. I was fully surprised."

Torao Nishimoto, shown at his grandson's high-school graduation in 1985, died in January 2001, an apparent victim of elder neglect.

Family photo

But there had been things he found unusual.

Like the lock on the telephone he found during a visit. He'd always wondered why his father never called, Jimmy Nishimoto said.

And during every visit, Malaka shadowed their every move, even when father and son went outside, he said.

"There was no privacy," Jimmy Nishimoto said.

Still, these were not the kind of things that would prompt him to take his father out of the home.

"I had confidence in her," he said. "She was a licensed care giver, right?"

After his father died, he was upset that Malaka did not attend the funeral.

Malaka, 58, maintained her innocence throughout the investigation, which included a Department of Health hearing to revoke her license, and the trial in August, Senaga said.

"Her position was he was fine, no complaints," Senaga said. "They went shopping that morning. They ate breakfast. They had lunch. He had trouble eating because of a denture problem. She said he soiled himself and he was very embarrassed."

At a nonjury trial in Hilo Family Court, Malaka said she was in Nishimoto's room "and he just faded out," Senaga said.

She also blamed the paramedics for Nishimoto's injuries and told the judge that they had dropped him, Senaga said.

"But the medical evidence was too conclusive," he said.

Senaga is convinced that Nishimoto had suffered for days.

"I am sure the defendant was aware or should have been aware that he was severely injured," he said.

In two other elder neglect cases prosecuted by the attorney general in the past three years, the care home operators admitted that they had left the home without providing a qualified caregiver. In both cases, residents died at the hands of another resident.

But the investigation into Nishimoto's death left questions unanswered.

"Before this, she was very diligent about his care," Senaga said. "The suspicion was that she wasn't there for some reason and she was hiding for someone else, covering up.

"But I couldn't prove that," he said. "Everyone in her house said otherwise or said nothing at all."

The judge found Malaka guilty. She faced up to one year behind bars and a $2,000 fine but suffered a stroke and fell into a coma a few days after the verdict. She died 16 days later.

She was buried in the same cemetery — Homelani Memorial Park — where Nishimoto's ashes were inurned.

Malaka's family and friends were furious abut the verdict. They paid for a large ad in the Hawaii Tribune-Herald to tell Malaka's side "of this tragic story."

"The state of Hawai'i is guilty in what, sadly, has amounted to Mrs. Malaka's murder, due to its biased and malicious prosecution," the ad stated.

Malaka, a care home operator for 12 years, was "a woman of strong faith and outstanding character," the ad stated. It noted, too, that there was "abundant evidence" to show that she had been attentive to her client's needs.

The ad blamed Nishimoto's injuries, including the hip fracture, on "rough handling" by the paramedics.

The ad was also critical of the judge's decision during the trial to disallow statements from witnesses who said that Nishimoto was seen walking through a Hilo department store carrying a 40-pound bag of cat food on the day he died.

The entire experience left her "emotionally battered, physically exhausted, financially ruined and character defamed," the ad stated.

Jimmy Nishimoto was shocked by the ad, but his focus remains on trying to cope with the loss of his father and the unanswered questions about his injuries.

In the beginning, when the memory of his father's bruised body was still fresh, he had trouble eating. He had to work hard to keep the memory at bay.

"When I am working, sure I forget about it," he said. "But when you have five or 10 minutes of nothing, the thoughts of my father come back. So then I would try to do something to forget about it."

That is getting easier to do. Time heals.

"I accept that he had passed away and I can't do anything about it," he said.

But the state, he said, has to change the way care homes are monitored. The more inspections, the better, he said.

"One day, we may all be in the same situation," he said. "We will wish they passed a law."

Reach Mike Gordon at mgordon@honoluluadvertiser.com or 525-8012.