When 88-year-old Georgia Holzmeister was rushed by ambulance last year to Sutter General Hospital, the emergency room physician described her massive bedsores as among "the worst he has ever seen."
Hospital nurses sprayed the hallways with air freshener to try to mask the foul odor of decaying flesh, according to newly filed court documents.
Holzmeister, suffering from severe dementia, died five days later in what state prosecutors are now calling a case of manslaughter.
Silvia Cata, 52, owner of Super Home Care, was arrested Monday evening at her Sacramento home near Northgate Boulevard and West El Camino Avenue, according to the state attorney general's office.
She faces felony charges of elder abuse and involuntary manslaughter in a unique departure for the California attorney general. Deputy Attorney General Steven Muni, a veteran prosecutor with the state Bureau of Medi-Cal Fraud and Elder Abuse, said he believes this is the first time the state Justice Department has pursued a manslaughter case against a caregiver in connection with an elderly resident's death.
While criminal prosecutions of elder abuse declined precipitously in California in the past decade, the attorney general's office announced plans last year to step up its efforts to build criminal cases statewide.
"The owner of this facility was trusted with the care of vulnerable patients and she abused that trust in a shocking way," Attorney General Kamala Harris said in an email. "Our state's most vulnerable citizens deserve and need our protection, which is why I have prioritized investigating and prosecuting elder abuse cases."
Cata is being held in the Sacramento County jail in lieu of $300,000 bail. If convicted, she faces up to 12 years in prison on the elder abuse charge, which includes two special allegations that the victim suffered great bodily injury, and that the abuse caused her death, Muni said. A conviction of involuntary manslaughter carries a maximum term of four years.
The state Department of Social Services ordered the home closed Tuesday under a temporary suspension order. A woman answering the phone at the Cata residence, who did not identify herself, had no comment and said she would refer The Bee's message to Cata's husband.
While the incidence of elder abuse in California is hard to quantify, the demand for long-term nursing care in the state is clearly expected to skyrocket. The U.S. Census Bureau projected in 2000 that the state's elderly population will have doubled by 2025 to 6.4 million.
Meanwhile, more than half of all complaints in California nursing homes between 2000 and 2005 were related to poor quality of care, and 18 percent of substantiated complaints were related to mistreatment or abuse, according to the attorney general's website.
Holzmeister, who had lived at the facility on Bowman Avenue since 2007, was found unresponsive last June by visiting family members, according to documents filed by the attorney general in Sacramento Superior Court.
Hospital staff soon determined that the blackened, Stage IV pressure sores on her buttocks had resulted in sepsis, a life-threatening condition that occurs when the body develops a severe, toxic response to bacteria or other germs. Pressure sores form when patients lie in one position for extended periods.
Holzmeister died on June 23, 2012, five days after being moved to an area nursing home and placed on palliative care.
Nearly eight months later, the state has determined that the elderly woman's death resulted from Cata's "deliberate and complete reckless disregard for performing the essential duties" as Holzmeister's caregiver, according to the state's declaration in support of the arrest warrant.
Cata was first licensed by the state in 1996 to operate the residential care facility for the elderly in Sacramento's Gardenland neighborhood. She is licensed to care for up to six residents. Cata, her husband and her daughter were the facility's sole providers, according to the court documents.
In the last six years, Cata has had a series of run-ins with state licensing officials. Among other things, she has been cited for alleged "poor record-keeping," dispensing over-the-counter medications without a doctor's order and attempting to care for at least one resident who should have been admitted to a skilled nursing facility instead.
Holzmeister's family had been paying Cata $2,800 a month to care for the woman, an amount later reduced to $2,000 when the family discovered she had been housed with a roommate, documents show.
The woman's family reportedly moved her into the facility in April 2007 on the recommendation of a friend, court documents show. The family toured the facility and found it to be "clean" and acceptable, court records show, noting that Holzmeister "felt comfortable and enjoyed living there."
Family members' visits eventually tapered off to major holidays only as Holzmeister's condition deteriorated and she "could no longer communicate effectively, make eye contact, or recognize them," court documents state.
The crisis began unfolding on June 18, 2012, when Holzmeister's granddaughter received a morning call from Cata that her client "was not doing well, and needed to see a doctor." State documents note that Cata had no specialized medical training.
A doctor recommended that day that a nurse visit the home to evaluate Holzmeister, but the granddaughter reported that "Cata did not want the nurse to come to the facility," court records show.
Later that day, when family members arrived at the home, they found Holzmeister in a recliner, unresponsive, according to state prosecutors.
Hospital medical staff later determined that the woman was "severely dehydrated." A physician informed the family that the pressure sores would require him to surgically remove all the dead tissue, and that the process might go "as deep as to the bone, and leave her (body) exposed and deformed."
The family elected to move Holzmeister to a nursing home and provide comfort care. She never regained consciousness and died on June 23.
Cata told a state investigator that Holzmeister had been "very alert" between June 16 and June 18 and that the bedsores had "developed overnight," according to court documents.
However, Dr. Kathryn Locatell, a specialist in geriatric medicine who examined the woman's medical records, determined that Holzmeister had been neglected and that her pressure sores "must have been present for weeks, if not longer," court records state.
Locatell also found that Holzmeister had suffered sepsis because of the wound and "would not have died when she did but for the severity of these conditions."
Cata is scheduled to appear Thursday in Sacramento Superior Court.