Philadelphia trial: Girl wth CP had multiple, severe bed sores that caseworkers should have noticed

From The Philadelphia Inquirer:

MultiEthnic Behavior Services Inc. was supposed to make sure that 14-year-old Danieal Kelly (pictured) from cerebral palsy and unable to walk, was receiving medical care and being well-fed at her home in West Philadelphia.

Instead, Kelly was suffering from starvation, and the bedsores on her back were so severe in the weeks before her death in 2006 that anyone coming near the girl would have been shocked by the "disgusting" odor, said Cindy W. Christian, co-director of a children's health center at Children's Hospital of Philadelphia.

"They were multiple and severe, the most severe they could be," Christian testified at the federal health-care-fraud trial of four employees of the now-defunct agency.

The teenager and her family were considered "at risk" by the city's Department of Human Services, which subcontracted supervision to MultiEthnic. A caseworker, Julius Juma Murray, was supposed to have been making twice-weekly visits to the home.

After Kelly's death, nine MultiEthnic employees were charged with billing the city for services they never provided to her and other children, and with fabricating and destroying subpoenaed documents. Five have pleaded guilty. Four, including Murray, are on trial in U.S. District Court.

Kelly was "severely malnourished and was suffering from starvation" at the time of her death, Christian said. She weighed 42 pounds but should have weighed about 88, she said.

"She had terrible muscle mass at the time of her death," she said, even considering the effects of cerebral palsy.

Under questioning by U.S. Attorney Bea Witzleben, Christian said the smell of decomposing flesh from what physicians call "pressure sores" could not have been masked by the incense Kelly's mother reportedly used at the home.

Christian said the odor would have been present and the bedsores visible on July 24, 2006, the last time Murray claimed he visited the home.

The sores develop from a lack of movement combined with poor nutrition and a lack of medical care. There was also a sore on Kelly's collarbone, apparently caused by pressure from her chin's resting on the skin.

According to court documents, Murray said he tried to visit the house twice during the next 11 days before Kelly's death, but on one occasion no one answered a telephone call and on another no one answered the door.

Witzleben has presented testimony from about a half-dozen former MultiEthnic workers who said pressure from managers to fabricate reports on supposed home visits was implicit.

Yesterday, one former caseworker, Sokunthea Chan, said he had been explicitly asked for fake reports by defendants Mickal Kamuvaka and Solomon Manamela, two of the agency's four co-founders. Chan said he fabricated 60 percent of his progress reports and similar documents during his four years at the agency. Each family's files had to complete or MultiEthnic risked losing its city funding, witnesses have said.

Chan, a Cambodian immigrant who now works as a translator, said he failed to make the visits because his clients often lived in "very dangerous areas far away from each other" and he did not want to spend the money on gasoline. Other families did not want to let a caseworker in their homes, and Chan said he was allergic to the tobacco used by some families.

Under cross-examination, Chan admitted that he had received company memos warning employees not to fabricate reports, but said the requirement was not enforced.

Like other caseworkers who have testified, Chan had little or no experience in social work and said he received virtually no training from agency supervisors.

Chan, who was testifying under a grant of immunity, said he was ashamed of his conduct.

He also testified that after Kelly died and MultiEthnic learned that DHS would audit agency records, he and other employees and managers shredded so many documents that the company's shredder overheated and broke down.