Steve Duin: Benjamin Alfano's final weeks are spent in isolation, cut off from his family (Part 2)

Steve Duin: Benjamin Alfano's final weeks are spent in isolation, cut off from his family (Part 2)


Published: Monday, February 27, 2012, 4:30 PM Updated: Monday, February 27, 2012, 8:44 PM

By Steve Duin, The Oregonian The Oregonian

 Benjamin Alfano was moved to Park Forest Care Center, a nursing home four blocks off Northeast 82nd Avenue, on Christmas Eve 2010. He was unhappy there and attempted to escape the center in January 2011. Then he was sent to a locked-door facility in Gresham. He died about four weeks after that.

Benjamin Alfano, in the end, had MS and dementia. While he never lost his passion for gnocchi, he often forgot what he ate for breakfast.

Chris Farley, his court-appointed guardian, was characteristically blunt: Ben, she wrote, was "completely unable to act in his own best interests. He lacks the judgment and insight to keep himself from harm."

Yet one month after Farley shipped the 72-year-old amputee to Park Forest Care Center for Christmas, Alfano did what anyone in his right mind would do:

He bolted.

In one last desperate grab for freedom, Ben scurried out the door of the dour nursing home on his scooter, racing down four blocks of Northeast Beech Street before the care center posse reined him in just shy of 82nd Avenue.

One week later, Alfano was locked away in the Alzheimer's unit at Powell Valley in Gresham.

Four weeks later, he was dead from a shattered heart.

The loneliness and isolation Ben Alfano endured in those final weeks still haunts his four youngest children, given that it was engineered by the Oregon Department of Veterans' Affairs and their father's court-appointed guardian and lawyer.

In the four years Alfano lived at Raleigh Hills Assisted Living, those children -- Steven, David, Mary and Lisa -- were faithful stewards. Judy Bridges, the Raleigh Hills administrator at the time, said the sons were particularly devoted: "They were always there. Steven always took Ben to his appointments. Steven made all the arrangements, not the VA."

Richard Pagnano, Ben's court-appointed attorney, and Farley, the guardian, didn't believe that involvement served their client's interests. In February 2009, Pagnano wrote letters to Ben Alfano's doctors warning them not to disclose medical information "to any third parties, including the former temporary guardian, Steven Alfano."

Farley told court visitor Anne Perretta that the ODVA's Ziggy Szczepanski -- the conservator of Ben Alfano's estate -- informed her that at least one of his sons was guilty of "financial abuse" and possibly "psychological abuse."

Farley could handle that. Her firm -- Farley, Piazza & Associates -- is "good at dealing with difficult families, difficult clients," she said last week. "Those are the cases that interest me the most."

The guardian -- appointed by Washington County Circuit Judge Rita Batz Cobb -- informed Raleigh Hills that Ben Alfano's sons were no longer welcome at his medical care conferences.

"She made it very clear to the staff and to me that she was calling the shots about how Ben was going to live his life," Bridges said. "She wanted total control."

View full sizeDoug Beghtel/The OregonianSteven Alfano, Lisa Alfano (center) and Mary Alfano-Lupton are at odds with the state over the care and guardianship of their father, Benjamin Alfano.

Farley also wanted Raleigh Hills out of the picture. In a report submitted three weeks before Alfano died, Farley said Raleigh Hills provided "too low a level of care ... In fact, the family and care facility insisted on a private caregiver who spent eight hours a day with the protected person paid out of pocket by him. I could see no purpose to a private caregiver in a care facility setting."

How about companionship?

Or the fact that Alfano adored Ana Coco, his caregiver, and could easily afford her attention?

"Ben was lost without her," Bridges said.

As they discovered in December 2010 when Coco took a two-week vacation to Honduras.

Grumpy and frustrated, Alfano refused to take his meds, including the antibiotics for the pressure sores on his 90-pound frame. Bridges said the staff was familiar with Ben's mood swings, but she alerted his doctor, Melanie Doak, and sent Ben to the ER at the VA Medical Center.

Farley moved quickly. The wounds were potentially "life-threatening," she said, and Raleigh Hills was "not licensed to provide IV antibiotics." When the VA hospital "refused to admit him for that purpose," Farley said, she had no choice but to ship him to Park Forest, where her partner once housed her father.

Without first being told where he was going, as required by my reading of Oregon law, Alfano was transported to Park Forest on Christmas Eve.

Did that nursing home ever provide him with that indispensable IV procedure?

Why, no. "Skilled nursing staff," Farley concedes, persuaded Alfano to take the meds orally, "eliminating the need for IV antibiotics."

The damage was done. Ben was separated from everything and everyone he loved. He was constantly asking his children and the ODVA-hired help if he could return to Raleigh Hills.

As Bridges would later write in an affidavit, "I believe with all my heart that the move killed him."

Transfer trauma, I believe it's called. Pagnano, the court-appointed attorney, presented a CLE on it at the Oregon Convention Center in 1999.

"It can be very stressful on a person to leave the environment to which he/she has become accustomed," he wrote. "Therefore, surrogate decision-makers should strive to continue the placement of the person they are protecting, if at all possible."
In all fairness, Pagnano dutifully filed an objection to his client's Dec. 24 move to Park Forest.

On Jan. 6.

With nowhere else to turn, Ben Alfano revved up his scooter on a smoking break and attempted his great escape Jan. 24. Park Forest then declared him a "flight risk" and Farley sent him to the locked-door memory care unit at Powell Valley.

Pagnano said Ben was "happy as a clam" at Powell Valley. Farley decided the trauma in his life was the result of his children's interference, including daughter Mary "visiting in excess of the time constraints the guardian has established." Her lawyer, Sibylle Baer, notified the children that "these behaviors, coupled with the threatening, abusive, offensive, and disrespectful emails and phone calls directed to the guardian by family over the last six weeks," meant the following:

The family was not allowed to contact Farley. And Ben was allowed only one phone call and one visit from a family member per day.

In the last two months of Ben's life, Mary Alfano-Lupton spent 15 nights at the Pony Soldier Inn on Northeast Sandy to be close to her father. When her husband was traveling, she was forced to take her daughter, Emily, out of school for a week and bring her to Portland with her.

Yet on Farley's orders, Alfano-Lupton was told she could not visit her father on what turned out to be the last Sunday of his life. Frank Alfano, Ben's older brother, was also turned away at the Powell Valley door.

"He'd already had his 'quota' of visitors," Frank Alfano said. "You would think in a place like that, where they isolated him, it would be in his best interest if he had family around him. He was really lonely out there. He clung to Mary."

On Feb. 18, 2011, Ben had an angiogram; Mary's request to accompany him to the hospital was denied.

In subsequent days, family visitors said they found their father in serious pain but were told by Baer and Powell Valley staff that he was "at baseline."

On Feb. 23, however, Ben's wound-care nurse from Innovative Senior Care Home Health in Portland arrived at Powell Valley, took one look at Ben and called 9-1-1.

Only when Alfano reached the VA, Baer says, did he begin having chest pains.

"A silent heart attack," Farley insists. "There were no red flags."

Yet Mary Alfano-Lupton, a cardiac tech at Overlake Hospital in Bellevue for seven years, says VA cardiologists told her this:

The hole was blown in her father's heart several days earlier, and the delay in getting him to the hospital eliminated the possibility of surgery.

Only because Ben Alfano's children had retained the advance directive for end-of-life decisions -- the only say they weren't forced to surrender -- were they with him at the end.

"The last thing my dad did with me before he passed," Mary said, "is ... he scooted very close to my face, he cupped his hands around my cheeks, and he whispered to me, 'Mary, I love you so much.'

"I loved him desperately, and I miss his love desperately, here on this earth."

Please read complete article at link below:


http://www.oregonlive.com/news/oregonian/steve_duin/index.ssf/2012/02/benjamin_alfanos_final_weeks_a.html

Editor's note: "Yet on Farley's orders, Alfano-Lupton was told she could not visit her father on what turned out to be the last Sunday of his life. Frank Alfano, Ben's older brother, was also turned away at the Powell Valley door."  This type of cruelty is regularly adminstered by the Probate Court of Cook County. A Probate Court of Cook County judge ordered Lois Jones to not come within 10,000 yards of her WWII veteran father while he was a patient at the Heinz VA Hospital.  Lucius Verenus, Schoolmaster, ProbateSharks.com

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