The coroner said "acute bronchopneumonia" killed 85-year-old Isabel Miller in 1986. But Carole Herman and Charlie Fish are convinced that the system is equally to blame.
Herman and Fish are trying to prove that Miller--who also had uterine cancer, bedsores infected nearly to the bone, and bruises when she died--was a victim of neglect by Placer County and state officials, her doctor and her nursing home.
At the time of her death at Hilltop Manor Convalescent Hospital in Auburn, Miller was blind, bedridden and a ward of the Placer County public guardian's office.
Herman and Fish are waiting for results of a Placer County grand jury investigation into Miller's case, based largely on 215 pages of documents they compiled. Herman calls it the "last chance" in a long, costly, complicated and frustrating battle.
Officials in the Placer County district attorney's office, about 110 miles northeast of San Francisco, wouldn't comment on the status of the grand jury investigation or when it is expected to end.
"Isabel Miller's a perfect example of how the system is an absolute failure," Herman said. "Unless we do something now, in the next 20 years with the growing elderly population, it's going to get worse and worse."
Teresa Hawkes, deputy director of licensing and certification in the state's Department of Health Services, said she will review the case and materials Herman provided because she is new to the job and unfamiliar with what happened to Miller.
"What I've committed to Carole to do is look at it myself," Hawkes said. "Since I'm new, I have no preconceived notions. . . . So basically I said I'll look at the thing again to see if there is a further need for investigation."
But for most state officials and administrators at Hilltop Manor, it's an open-and-shut case.
Jack Scheidegger, chief of the bureau of Medi-Cal fraud in the state attorney general's office, said his office determined that no fraud was involved.
"For this specific case, it is 2 years old. It is closed. They've gone through every process they can," said Lauren Wonder of the state Department of Aging.
"From what I understand . . . it was thoroughly investigated. The allegations in this particular case were not founded," said Lewis Yost, the district manager for Hilltop Manor.
Herman, 45, founded the Foundation Aiding the Elderly (FATE) when her aunt died in a nursing home from infected bedsores.
Her battle in that case ended with the firing of Jack R. Drury, head of the Department of Health Services regional office that licenses and monitors hospitals and nursing homes. He was dismissed in 1985 after a department investigation found him guilty of "inexcusable neglect of duty" and "dishonesty."
Fish, 74, founded the National Assn. of Nursing Home Residents and Relatives when his brother died in a nursing home after slipping and hitting his head in a bathtub. He said his group has 2,700 members in 17 states and is growing.
The Miller case--one in which the county acted as her conservator--has united these two grass-roots advocates for the elderly.
A conservatorship turns legal guardianship of an individual over to another person or agency who decides where the wards will live, how they can spend money and how doctors will treat them.
Some even lose the right to vote.
There are an estimated 30,000 conservatorships in the state, 10,000 of which are handled through public guardian offices in the state's 58 counties.
Public guardians serve in the same capacity as regular conservators and must abide by the same regulations. They take over a case when there is no friend or family member willing to do so.
In California, there also are court investigators who check every petition for conservatorship and regularly review active conservatorships.
Although Miller had all these safeguards, there is dispute about whether her case was handled properly.
The nursing home and county officials got a temporary restraining order against Fish and members of his organization to prevent them from visiting Miller or any other patient without county or hospital administrators present.
Fish and Herman wrote several letters to officials, pleading for medical care for Miller. They say the letters were ignored.
Letters also went to the attorney general's office after Miller's death asking for an investigation, and at least four letters were written to the state Department of Health Services and the Placer County Public Guardians office complaining about Miller's lack of care.
Neglect of Duties Charged
Fish and Herman also filed a complaint with the state Department of Aging against Hilltop's ombudsman, Donna Lewis, for allegedly neglecting her duties.
County and state officials claim Miller was a Christian Scientist and refused care for her ailments. In such cases, invasive medical procedures can only be approved with a court order.
But Miller's conservatorship papers make no mention of her being a Christian Scientist. The documents also show the judge decided she was unable to give informed medical consent.
In addition, Fish has a tape recording of Miller asking for medical care. Her physician, Dr. Gordon Seck, who took care of her while she was in the nursing home, said she had been his patient for at least eight years.
Seck said bedsores are "not that common," but claimed Miller's developed after she went into a coma about four months before she died.
But Barbara Kahl, the deputy public guardian assigned to the Miller case, said she saw Miller three weeks before she died and although she was bedridden, she was not in a coma.
Kahl said Miller was in a coma for perhaps the last three days of her life.
Officials also claimed Miller was suffering from senility, which was confirmed after an autopsy showed she suffered from severe cerebral arteriosclerosis.
Herman and Fish say Miller was not senile. But if officials believed she was, that was even more reason to get Miller medical help if she had been refusing treatment, they argue.
Herman and Fish are hammering away at these inconsistencies, trying to get someone to listen. So far, they've had little luck, other than a $3,000 fine by the health department against Hilltop Manor for failure to "continually assess" Miller's needs and notify her doctor of changes in her condition.
The nursing home is currently appealing the fine.
Michael Noonan, the ombudsman coordinator who defended his volunteer at Hilltop Manor, said Fish was intimidating the volunteer and other Hilltop Manor employees.
However, Noonan in no way condones the bedsores Miller was suffering from. He said bruises also could have stemmed from Miller thrashing in bed and hitting her arms on the bed rails.
'Bad Nursing Care'
"There is no excuse for bedsores. That's just bad nursing care," he said. But he added, "The argument they are making that this lady was neglected to death doesn't carry any weight from our point of view."
Herman and Fish, however, are not giving up.
"At this point, all I want (the grand jury) to do is say that those responsible for the care of Isabel Miller failed to provide it," Fish said.
"I would like to see an investigation into the conservatorship program in Placer County because this is a very well-documented case. Why was this woman allowed to die this way?" asked Herman.