California regulators routinely have conducted cursory and indifferent investigations into suspected violence and misconduct committed by hundreds of nursing assistants and in-home health aides -- putting the elderly, sick and disabled at risk over the past decade.
In 2009, the state Department of Public Health quietly ordered its investigators to dismiss nearly 1,000 pending cases of abuse and theft -- often with a single phone call from Sacramento headquarters. The closing of cases en masse came after officials determined their swelling backlog had become a crisis.
Four years later, state investigators are opening and closing investigations into suspected abuse without ever leaving their desks, The Center for Investigative Reporting and KQED have found. In some instances, caregivers who have sexually assaulted or abused patients have retained their licenses and moved to other facilities.
An estimated 160,000 nursing assistants and in-home health aides are employed throughout California. These workers -- all regulated by the Department of Public Health -- are certified to work in hospitals, nursing homes, mental-health facilities, developmental centers and private homes.
Since the mass dismissal of cases in 2009, the overwhelming majority of allegations of abuse and misconduct have been closed without action. The state also has dramatically reduced the number of license revocations for aides suspected of abuse and misconduct.
And it mostly has stopped referring cases to the California Department of Justice for possible prosecution of crimes, according to state prosecutors and the Department of Public Health.
In addition, the department's Southern California investigations office, which once had 11 full-time examiners, is nearly empty.
Internal documents show abuse cases from Los Angeles, San Diego, Santa Barbara and Riverside mostly now go to Sacramento headquarters. There, investigators rarely receive approval from supervisors to visit nursing and group homes where abuse and neglect have been alleged.
For some who have worked in the system, the state has abandoned its duty to protect the vulnerable.
"I would tell anybody, do not count on the government taking care of you," said Brian Woods, former director of the Department of Public Health's West Covina office.
From 2004 to 2008, the state's health regulators accumulated more than 900 cases in Southern California, including alarming allegations that involve suspicious deaths.
"I was appalled," said Marc Parker, who was the public health department's investigations chief for much of the past decade. "There were hundreds and hundreds and hundreds of unassigned, uninvestigated complaints in file drawers."
Then, on top of their normal workload, investigators were ordered by supervisors in Sacramento to begin clearing the backlog at a rapid pace, until nearly all the cases were dismissed by 2011. On average, cases had lingered for two years before they were cleared.
In interviews, state officials said they are tackling the problem. Dr. Ron Chapman, director of the Department of Public Health, said the backlog of cases was "inexcusable (and) should not have occurred."
"We've made lot of progress since then," he said. "So today, any complaints that come in, they get screened within 48 hours, and we're not building a backlog today."
Little is known about these cases because they were not fully investigated. But internal case logs kept by the state in Sacramento offer a chilling, yet faintly detailed outline of allegations -- including suspicious deaths, severe injuries, numerous sexual assaults, egregious neglect and theft of belongings.
One log entry lists a caregiver who allegedly "hit, peed on and seduced" a patient, but does not list a facility, city or county. More than 230 log entries simply read "physical or sexual abuse" and little else beyond a date and county where the alleged incident took place.
Public health regulators have all but stopped alerting the California Attorney General's Office of patient deaths alleged to involve abuse. From 2007 to 2009, the department referred a total of 88 deaths to state prosecutors for investigation into elder abuse, according to figures from the attorney general. During the following three years, that number dropped to 14.
Regulators sent two death cases to prosecutors in 2011 and three in 2012.
One case that has remained unsolved is the suspicious death in 2006 of Elsie Fossum, a 95-year-old woman who lived at Claremont Place Assisted Living in Southern California. Fossum was a teacher and librarian in eastern Los Angeles County for most of her life and moved into Claremont two years before she died.
Although she had been found severely injured on the floor of her bedroom, the California Department of Public Health dismissed it as an accidental fall from bed. The department closed the abuse allegation in February, classifying it as unsubstantiated.
With injuries to her mouth so severe that she stopped eating and drinking, Fossum died of dehydration in a hospice three weeks after she was found injured. A nursing assistant at the facility who was caring for Fossum at the time of her injuries -- and who had made repeated disparaging remarks about the elderly woman, according to state records -- quit soon after the injuries and took a similar job at a nearby facility.
Now, seven years after Fossum died -- and following questions from reporters -- the Los Angeles County Sheriff's Department has opened a criminal inquiry into the death. The case remains unsolved, and the nursing assistant, Sabrina Bengoa, has not been charged with a crime. She did not respond to requests for comment by phone or at her home.
"When you've got agencies looking at it, you figure they're going to find something if something's there," said Jim Fossum, Elsie's nephew who lives in Brainerd, Minn. "Not that they'd just put the thing away and forget about it, essentially."
Another failure came in March 2008, when nursing aide Jason Joslin physically abused one or more patients at a Riverside County health care facility, according to state logs. No action followed until November 2011, when the state spiked Joslin's California certification and added his name to a federal exclusion list, maintained to alert the public to bad caregivers.
But by then, Joslin had moved to Seattle and obtained a nursing assistant license there, regulatory records show. Joslin, who was licensed in Washington state by August 2010, did not respond to requests for comment sent by email and social media.
Under the administrations of Govs. Arnold Schwarzenegger and Jerry Brown, the number of nursing assistants and in-home health aides removed from the job for crimes against the sick and vulnerable has declined sharply.
In 2006, the department revoked or denied a caregiver's certification in 27% of complaints it investigated. That figure shrank to 7% three years later as regulators eliminated the backlog.
Meanwhile, the number of cases closed without action has soared. Statewide, public health investigators in 2012 finished 81% of their cases without taking action against an accused caregiver, up from 58% in 2006.
The Department of Public Health is fixing how it handles allegations against nursing assistants, Anita Gore, an agency spokeswoman, said in a prepared statement. "Organization and operation of the Investigations Section, including Southern California, are currently being addressed."
State officials said they can't explain why there has been a steep drop in the number of abuse deaths forwarded to law enforcement.
"We don't understand that decline in numbers," said Chapman, the public health director. "It's very concerning to me, and we're looking into it."
This story was produced by the independent, nonprofit Center for Investigative Reporting, the country's largest investigative reporting team. For more, visit cironline.org. The reporter can be reached at email@example.com. KQED reporter Mina Kim and CIR senior data reporter Agustin Armendariz contributed to this report.