LINDA WERTHEIMER, host:
An investigation by NPR, Frontline and ProPublica has been taking a look at death investigation in this country. We found many medical examiners and coroners' offices underfunded and understaffed. Freeing up cash from legislators can be a tough sell. As one coroner put it, the dead don't vote.
The consequences are severe. Some states don't do autopsies on suicides; others don't autopsy people who die in traffic accidents. And many don't do autopsies on people over the age of 60.
Our investigation found it's a mistake to assume an older person has died of natural causes. Some of the people we spoke to worry that there is a quiet epidemic of what they call gray homicides, going undetected and unpunished.
NPR's Sandra Bartlett looks at a California case that could be the tip of the iceberg.
SANDRA BARTLETT: At 84, Mary McDonough is pretty healthy, and she is thankful she is still living in her own home in Westlake, California. She remembers with sadness making the decision for her husband that she desperately wanted to avoid.
Ms. MARY McDONOUGH: We had promised each other early on we would never put the other one in a nursing home. We would never do that. We were going to - I'll always take care of you, Richard. And he would say, and I'm going to always take care of you.
BARTLETT: Her husband, Richard McDonough, had been a Hollywood TV director.
Ms. McDONOUGH: And he did everything: football games, game shows. He did the Bob Hope shows for 12 years. He loved it. He couldn't wait to go to work every day.
BARTLETT: After Richard retired, he began to develop dementia. And over the years, Mary did her best to take care of him.
Ms. McDONOUGH: You move into their world instead of trying to keep them in yours. It's easier that way.
BARTLETT: Richard's night wanderings became frequent and dangerous. Mary agreed, with her three children, that her 83-year-old husband needed more care than she could give him.
In December of 2006, Mary says they found Silverado.
Ms. McDONOUGH: Oh, it was perfect. It was wonderful. It had grounds around it that - he could walk out any of the doors. They had a little pitch and putt course down the way, and they had a swimming pool. It was a lovely place. It was like a home.
BARTLETT: Silverado was one of the most high-end homes for dementia patients in the country. It's in a rural area, about 90 minutes outside Los Angeles. It costs $7,000 a month for a semiprivate room.
Ms. McDONOUGH: It was expensive. It was expensive. But I always said, after the life he had given me, I certainly could take care of him.
BARTLETT: Mary says Richard seemed less agitated at Silverado, and she thought his care was really good. Then one day, the home called a meeting to tell the families a caregiver had been arrested in connection with the death of one of the residents. Eighty-year-old Elmore Kittower had died a few months earlier. The day after he was buried, his widow received an anonymous call from someone who worked at Silverado. The caller said her husband had been beaten by one of the staff, and that likely killed him.
Mary McDonough was shocked - but wasn't worried about Richard because no one suggested any other residents had been hurt by the caregiver.
Deputy District Attorney Robin Allen says Kittower's body was exhumed, and an autopsy was performed.
Ms. ROBIN ALLEN (Deputy District Attorney, Los Angeles): They found bruising on his face, on his chest, bruising on his arms. There were 28 separate rib fractures on Mr. Kittower. He had a fracture to his sternum, a fracture to his larynx, and he had crushed toes.
BARTLETT: It seems no one noticed any of this when Kittower died and therefore, no one asked for an autopsy. Allen says it happens all the time with the elderly.
Ms. ALLEN: The paramedics did come out. The police did come out. The bruising on his face was obvious. I think that Mr. Kittower needed to be looked at. But unfortunately, I think when you have older individuals, people don't take the bruisings very seriously.
BARTLETT: Elmore Kittower had had a stroke and was bedridden, so his injuries couldn't be chalked up to bumping into things or falling - and the more reason his bruises should have raised suspicions.
Craig Harvey is the chief death investigator for Los Angeles County Coroner's Office. He says they can't investigate deaths if they aren't alerted to them. And in the case of a home like Silverado, it would be up to a doctor or ambulance staff to call the coroner.
Mr. CRAIG HARVEY (Chief Death Investigator, Los Angeles County Coroner's Office): There's no way we can look at every case we should probably be looking at. When you only see one in every three cases, the possibility that a homicide's going to be missed - are pretty great.
BARTLETT: Harvey says the suspicion that elderly homicides are being missed prompted the county to put together a team to review deaths. The team includes the coroner's office, law enforcement, social services and a geriatrician.
District Attorney Allen says once the team started looking, they found a lot of elderly people dying under suspicious circumstances.
Ms. ALLEN: There are just so many that are coming in. I normally have at least 15 active cases on my caseload at any time. It is amazing how many more cases we had than when I entered this unit five years ago.
BARTLETT: Allen says it's hard to prove murder or neglect in the elderly because they have so many medical problems. But she says that doesn't mean coroners and medical examiners should simply stop doing autopsies on older people.
In the investigation into Elmore Kittower's death, Allen says she had a lot of evidence showing the caregiver had beaten and abused Kittower, an 80-year-old man with dementia and multiple health problems.
Ms. ALLEN: The coroner's report indicated that Mr. Kittower died from a blood clot that had dislodged and traveled, and that clot had originated in his leg. Based on the frailty of his health, the doctors believe that they couldn't say to a medical certainty that the actual physical assaults caused his death.
BARTLETT: But the more Allen thought about Kittower and what he had suffered, she decided to charge the caregiver with torture, and the jury agrees that what happened to Kittower and four other residents at the home was torture. The caregiver was sentenced to life in prison.
Ms. MCDONOUGH: This is his career - pictures, John Wayne and Bob Hope.
BARTLETT: During the period when the caregiver was being investigated in 2008, Richard McDonough died. His wife, Mary, says it wasn't a surprise because he'd become very weak. In keeping with his wishes, Richard was cremated. Six months later, a detective came by to talk with Mary and her daughter Molly. He told them caregivers at the home had seen the suspect in the Kittower case beat other residents, including Richard.
Ms. McDONOUGH: What could I have done? That always goes through your mind - what could I have done to stop that? But I never saw anything. He had bruises, and he had maybe a little abrasion here, but so did a lot of the others.
BARTLETT: Mary says she wondered why no one told her sooner that Richard had been a victim.
District Attorney Robin Allen says without the autopsy, the caregiver would have gotten away with abusing those residents.
Mr. ALLEN: I don't think this is such an anomaly, but these things do happen. And when you have an individual who cannot speak for - themselves, an individual who's nearing the end of their life anyway, I think things are missed.
BARTLETT: Allen says if we stop doing autopsies on the elderly, the truth about a suspicious death will go to the grave. And murderers could remain free.
Sandra Bartlett, NPR News.