Carolyn Osborn vividly remembers the day in July two years ago when the nurse from Cross Timbers Care Center in Flower Mound telephoned.
We have a little bit of a problem with your mother, the nurse said. She has a couple of ant bites. Don't worry though; your mother is OK. It's nothing to get upset about.
Osborn, a longtime Lewisville resident, is not a particularly threatening-looking woman, but as the owners of Cross Timbers Care Center would learn, she's not somebody to be toyed with--especially when it comes to her mother's care.
The 59-year-old mother of two sits on a living-room couch with one leg tucked under her as she describes what happened to her mother at what was advertised to be an upscale and relatively new nursing home, just a five-minute car ride away from her middle-class neighborhood. To hear Osborn tell it, Stephen King might have dreamed up the nursing home for his latest horror novel.
After hearing from the nurse on that day in 1998, Osborn quickly drove from Dallas to the Flower Mound care center. What she found when she arrived would mortify her. She would cry about it first, then she would become furious. She's suing the owners of the nursing home where her 89-year-old mother, bedridden and unable to speak, was made prey to a mass of fire ants that stung her hundreds of times before anyone noticed. Carolyn Osborn tries to convey the sense that her mother was not just an invalid largely muted by stroke and abandoned in a nursing home. Her mother was not dead, a vegetable, abandoned, or deserving of her fate, Osborn says. No one is.
Sixty-five years before her daughter found her in a nursing home, propped up in a chair and wearing a look of terror, a 25-year-old Alice Joy Miller toiled in the cotton fields near Bowie. She was attending school at North Texas State College (now the University of North Texas). She majored in business and was engaged to be married. Her family wasn't rich, and Miller's father insisted that if she wanted a wedding dress and honeymoon clothes, she would have to earn the money and pay for them, so that summer she picked cotton.
On September 15, 1933, in a small Baptist church in Alvord, Joy Miller wed Ewell Taylor in what was supposed to be a quiet ceremony attended only by the couple, the preacher, and his wife. Taylor's new husband was a cotton gin supervisor and, at 33, was considered too old to be a bachelor. The ceremony went well, but before the newlyweds could leave for their honeymoon in Fort Worth, the groom's friends suddenly appeared. They grabbed Taylor and spirited him across the Red River and into Oklahoma, leaving his bride standing at the church in her hard-earned beige wedding dress.
"They just kind of swept him up in the car and took him off," says Betty Evans, another daughter. "On the second day, mother was just beside herself about what might have happened."
Ewell Taylor wouldn't return to her for two days. When he finally did appear, his bride was fuming. As part of what was known as a "shivaree," or a sort of predecessor to today's bachelor party, Ewell Taylor was held captive, and he and the boys stayed up playing dominoes (at least that was his story). So two days late, the newlyweds finally left on their honeymoon. Joy Taylor was wearing (also hard-earned) white gloves, a round hat, and a two-piece navy blue suit with a matching purse. The story of her wedding and of her husband's disappearance was one of Joy Taylor's favorites. As the years passed, she would retell the story to her children and grandchildren.
The couple would have three children, two girls and a boy. In 1958, Ewell Taylor was diagnosed with multiple sclerosis. Three years later, he died. By then, Joy Taylor's son and oldest daughter had moved out, but Carolyn, a senior in high school, stayed with her mother, partly to help pay the bills.
While raising her family, Joy Taylor was a devoted wife and "wonderful homemaker," Betty Evans says. "She was very picky about her home, and she was that way with herself too," Evans says. "She took pride in what she wore, if it matched, and if she was made up."
As Joy Taylor's health deteriorated with age and the onset of diabetes, she and her three adult children, Carolyn Osborn, Betty Evans, and Robert Taylor, decided to move her into a nursing home in Bowie in early 1994. She was still in her hometown, and daughter Betty Evans was not far away. Taylor's health wasn't terrible, and she could still move around without a great deal of trouble.
But in 1995, Evans needed knee-replacement surgery, meaning that her regular visits to the Bowie nursing home would have to end. Osborn volunteered to take over care of her mother. A longtime Lewisville resident, Osborn decided to move her mother to a facility nearby. She and her mother visited several of the nursing homes in the area, and Cross Timbers seemed ideal. Not only was it merely four miles from Osborn's house, it was new, had room for another Medicaid patient, and seemed upscale and orderly. Osborn says she would have liked her mother to stay with her at her own house, but it wasn't possible to have somebody there with her mother all the time, which by now was necessary. Taylor's diabetes needed regular monitoring, and she had become incontinent. She moved into Cross Timbers in November 1995.
The family made her room at Cross Timbers homey, decorating it with posters of Texas Rangers baseball players (Taylor became an avid fan in her 70s) and other personal touches. Taylor's room was so comfortable-looking that the nursing home staff would show it to prospective tenants as an example of how cozy a nursing home room can be. Without fail, Osborn visited every day--sometimes twice a day. She paid for a bedside telephone that allowed her mother to call anytime. The grandchildren also regularly visited, and--unlike some of the elderly, who are essentially warehoused in nursing homes--Joy Taylor was taken out frequently. Sometimes family members would collect her and take her to Osborn's home for a special dinner or holiday. Sometimes, she'd stay at her daughter's house overnight.
"I could take her to the mall. I could take her to Ranger games. We could bring her to the house. That was the best part," Osborn says.
As she always had, Taylor worried about her appearance. She frequently prodded her daughters for reassurance that they would take care of her looks if, for some reason, she became unable to do it herself.
"Even if she went to a Ranger game, it was important to her that she look good," Osborn says. "She always wore makeup. She never quit wearing makeup. I would put lipstick on her when she was a resident out there."
Osborn's frequent and unannounced visits began to irritate staff members, Osborn says. She began taking care of things for her mother that seemed like the responsibility of the home. She'd fetch ice for her mother's roommate or sweep the floor. Initially, it did not bother her, helping out like that, but to Osborn the home seemed to be getting more short-staffed all the time.
"For the most part, in the beginning, it was things that I could stay on top of," she says. "It wasn't life-threatening. It wasn't something like, I felt like I've got to get her out of there."
Her mother's deteriorating condition seemed to parallel that of the home. The little things seemed to get bigger. The home changed owners in late 1997, and the staff was a stream of new faces and never enough of them.
"I spent all the time that I would have liked to have spent visiting with my mother...doing things that they hadn't done all day," she says. "I can't even begin to tell you the things I witnessed out there, from neglect to just, you know, people putting on their call lights and nurses going up there and not doing anything and not answering."
Taylor began suffering "mini" strokes that left her unable to move and largely mute. She was put on a feeding tube that went directly into her stomach. Her blood sugar needed monitoring, and she needed to be moved regularly to prevent her lungs from filling with fluid.
"The doctor recommended that she not lay in bed, that she be gotten up every couple of hours in the morning and a couple of hours in the afternoon to prevent pneumonia," Osborn says.
Osborn badgered the staff to move her mother at proper intervals, but it appeared to her that wasn't being done.
"I think family may have to step in and do a lot of things...[But] if they don't change their diaper or you find them soaked through and there is a pad under their chair and it is soaked through...that is nothing but not being turned." Osborn says. In addition, her mother's feeding tube was not being cleaned like it was supposed to be. Her mother wasn't getting regular snacks to maintain her blood-sugar level, and she wasn't even getting fresh water when she needed it, Osborn says. Once, Osborn discovered that before going off-shift, a nurse recorded her mother's blood-sugar level 12 hours into the future--for the next morning.
By early 1998, Osborn could barely keep up with the new staff members. She reported problems to the nurses' aides, the director of nursing, and the administrator and met with the family council. She says that she didn't go to state authorities because she wanted to go through the proper channels.
"I told my sister, 'we are going to have to move her. I don't know what we are going to do but we are going to have to move her,'" Osborn says. "But you can't just check out. You can't move someone in her situation just overnight."
Already worried about what was happening to her mother in her absence, Osborn appeared at the nursing home one Monday in June 1998 and found that nursing home staffers had apparently injured her mother's foot while moving her from her bed to a chair, Osborn says. Toenails were ripped and bloodied, and her entire foot was black and blue for weeks. Osborn contacted the state and told them about what happened. The state took no action. She put her mother's name on the waiting lists at other nursing homes. Before the incident with her foot, nothing at the home seemed to be threatening to her mother's life, but her feelings changed after the injury. "I was concerned for her safety and for her life," Osborn says.
And the worst was yet to come.
Experts say one of the few things they really know about Solenopsis invicta, better known to Texans as the fire ant, is that the species seems bent on taking over the planet. The fire ant arrived in the United States in 1918, coming through Mobile, Alabama, on cargo shipped from South America. Since then, efforts to stop its spread have failed miserably. The ants are thriving in most southeastern states from Texas to North Carolina. Most recently, the United States Department of Agriculture reported that the ants appeared in southern California and New Mexico.
"We can't ever have any hope of eradicating fire ants," says Homer Collins, an entomologist with the USDA in Gulfport, Mississippi. "Fire ants continue to spread despite efforts of state and federal agencies to retain their spread."
The spread of the ants is troubling because, unlike other aggressive species, fire ants are known to attack and kill for no apparent reason. Scientists are confounded by the insect's traits, which remain a mystery despite years of study.
"Most things have some kind of behavior which we can rationalize and explain and make sense. Like, we all know that you go hit a flower that has a honey bee on it and it doesn't sting you; it goes and buzzes off," says Justin O. Schmidt, a research entomologist with the Center for Insect Science at the University of Arizona.
"The only time they attack you is when you are threatening their babies or their colonies. Almost all forms of life are that way, but fire ants are one of those oddballs. There's many ants that hurt a whole lot more than fire ants, but again, they don't go out of their way usually to sting you. But for some reason fire ants will--automatically," says Schmidt, who specializes in the study of stinging insects.
As anyone who has accidentally crossed a fire ant's path knows, the tiny insect aggressively attacks its target without regard to the size of the victim. The ants are known to attack and dismember fledglings in the nest and newborn calves on the prairie. By weight, fire ant venom is as powerful as a cobra's, scientists say.
"Fire ants clamp onto their targets with powerful jaws and sting their victims repeatedly," according to the USDA. "Each sting injects a dose of venom that causes a burning sensation. The stings raise itching blisters that can become infected. In sensitive victims, the stings can cause anaphylactic shock [symptoms include breathing difficulties and fainting] or even death."
Schmidt, who devised the "Schmidt Pain Index" to measure the pain of insect stings to humans, rates the fire ant bite as a one on his scale of one to five. The sting of a honeybee is a two. At the top of the scale, five, is the sting of a tarantula hawk, which "blows out your mental circuits and ability to withstand pain," Schmidt says.
The sting of one ant is unpleasant. The sting of many ants is torturous, at least in the eyes of law enforcement. In Jackson, Mississippi, police in 1998 filed charges of aggravated assault against three men accused of pouring fire ants on four other men to induce them to talk about a robbery. In February, a Florida man was charged with a felony for ordering his 9-year-old daughter to sit on an anthill as punishment. The child was bitten all over her body. Her father was sentenced to 15 years in prison for torturing her and for "punishing" his other children in similarly brutal ways.
Schmidt says receiving many, many fire ant bites would be like taking hundreds of burning hot needles and pressing them repeatedly onto your skin.
"If I were strapped down over a fire ant colony and couldn't move and had no control over my own personal safety or flight, it's got to be absolute, sheer terror. It's nothing else I could imagine it would be," he says.
Cross Timbers is a brick one-story building designed to fit in with the middle-class neighborhood that rises around it. The lawn outside the home is brown, and windows are covered with a dark, screen-like material. If it weren't for the few cars parked in front, the home would appear closed. Inside, the lobby is tastefully lit and has the feel of a reception area in a hotel. On a recent afternoon, a man in a wheelchair is parked on the lobby's lush green carpet waiting for--something. He stares vacantly out the double doors leading to the parking area. Around him, the room is appointed with framed oil paintings and flowers. A brass and glass chandelier is at the center of a vaulted ceiling, and the dark furniture is trimmed with rich woods. At one corner is a polished piano, and on the opposite wall, near the nurses' station, is a large color television tuned to a network news program. Nobody pays attention to the television or the woman in a wheelchair who is yelling "da, da, da, da" over and over. Down the hall, past two nurses who don't look up as a visitor walks by, nursing home patients lie in their beds staring at televisions or the ceiling.
The only bad thing the general public has ever heard about Cross Timbers is a 1997 report that the home lost its Medicaid certification because of "recurring health-code violations." A story published in the Fort Worth Star-Telegram at the time said that "none of the violations posed imminent threats to the patients' health or safety." The article quoted a director as saying Cross Timbers is the "most high-class home in the state of Texas...This is a palace. Our residents are happy here." The Star-Telegram reported that the problems included such things as nurses' failing to be properly licensed, dirty utensils, and an employee who didn't wash his hands after sneezing. A month later, the paper reported that the home was recertified after its operators had fixed all the problems and received a "perfect score" on a state inspection.
Things at the home were less than perfect a year later, two days after Taylor was attacked. On that day in late July 1998, a resident sat in street clothes in a wheelchair in the hall. He had a heavy growth of beard and was asked if he would like a shave.
"Do anything you'd like to do" he said. "I'll be looking like Santa Claus pretty soon."
Other residents had long, jagged fingernails with "dried brown substance" under them, and one had "a foul odor to both hands." One resident hadn't been showered for a week and, on this particular day, another was still in her pajamas at noon.
After breakfast that day, the elderly residents were wheeled from the dining room to the front of the nurses' station. They stayed there. One woman had large pieces of scrambled eggs on her face and chest. Others had dried food on their clothes.
Then there were the ants. Workers told state officials that fire ants had been inside Cross Timbers as early as June 10. Several rooms were treated for ants, but by the first week of July the staff knew they had a serious problem. When staff members ran out of pesticides, they sprayed ants with Right Guard deodorant, they told state workers.
By July 21, fire ants were massing in colonies outside the Cross Timbers Care Center, and they were coming inside for food and drink. They were in the halls and offices. They were in the kitchen. They were in the dining room on the tables. They were in closets, patients' rooms, and in 16 of the home's 78 beds. A staff member picked up a lei from one of the resident's rooms and was about to smell it when he saw ants crawling from it. A resident says she pulled a pair of panties that was covered with ants from her drawer. They had taken over her drawer, she told a state worker.
Fire ants were on the patients. One nurse said that she saw a fire ant crawling on a resident's cheek and that a family member alerted a staff member after seeing fire ants on their relative's chair as she ate. Another resident, who had fire ants in her bed, had been bitten extensively on and under her left arm just three days before.
Although it has happened in nursing homes with fatal results, nobody has ever witnessed the process of a fire ant attack from start to finish on someone like Taylor, who can't move or cry out.
The way it works is this: A fire ant scout walks around looking for something to kill, drink, or carry back to the nest.
"Normally, what happens is you'll have a few ants come to a food source," says the USDA's Homer Collins. "Those in turn will pass the word, transfer a product we call pheromones, which is a chemical form of communication. What that form of communication says is, 'Hey, nest mates, come help me bring this food source back to the nest.'
"They may originally come into the room looking for food, and if there's food in the room, then the first workers will recruit others. You start off with a few, but as time goes by you can have hundreds or even thousands of crawling, foraging workers that enter the nursing home. It would take several hours for enough ants to be recruited to the room, and then all of the sudden they start stinging the victim."
In Joy Taylor's case, the ants were attracted to her legs, inner thighs, and groin.
"That would be an attractive area, where it has odors and potential things indicating maybe food or something for the ants, so they would be focusing on a place like that," Schmidt says. "Of course, that area has a lot of nerves.
"Your crotch area is not only more protected, but it also needs all kinds of sensory systems for its normal functions--reproduction among other things," he says. "You can well imagine that it's not going to feel very good."
No one knows at what time the ants started in on Taylor, so no one knows how long the attack lasted. But the evidence they left behind proved that the attack was intense. Just before 8 a.m., one of the staff members spotted ants on Taylor's bed. They pulled back the covers and saw ants and hundreds and hundreds of stings all over Taylor's legs, inner thighs, and on and inside her vagina. They took toilet tissue and began picking off the ants off and cleaning up the blood, tossing bloodied tissues on the floor. (Carolyn Osborn later found ants in blood-soaked tissues on the floor along the baseboard of her mother's bed.)
More than six hours after the ants were first seen on Taylor, a nurse's aid reported finding dead fire ants in Taylor's pubic hair. Tears were streaming down Taylor's face. Osborn got the call.
"When I walked in, she had the look on her face that I knew something was wrong," Osborn says. "I kind of looked around, and she was sitting in a chair, and they had her feet propped up, and I threw back the blanket that they had on her because I was looking at her arms and her legs to see where the ants had bit her. I couldn't find any.
"I was looking, and I threw the blanket back and saw they didn't have a diaper on her, and I cannot tell you the horror that I felt when I saw where she had been bitten and what they looked like at this point. Of course I immediately hugged her, and I was just in tears when I saw what had happened to her, and then after I consoled her, and then I just flew out of the room and I went down to find the director of nursing.
"I said, 'A couple of ants, what are you talking about?' They made light of the situation. I said, 'Have you seen it?' I asked the nurse. They were just as nonchalant about it as you could possibly be.
"From the time they had seen them, they had festered, they had pus in them and she [the supervisor] was very shocked herself," Osborn says. "She admitted to me, yes, it's much worse than what she'd seen earlier.
"I can't tell you how upset I was. There were hundreds and hundreds of bites...she could not call for help, and she could not move. To me that is inhumane."
Carolyn Osborn says she's not an emotional person, but in the telling of finding her mother and going home after the attack, she sniffles and becomes teary.
"I can't even tell you what it was like that night. I came home; my sister and I cried and talked on the phone for hours. I was so upset."
After the attack, Taylor's physical condition rapidly deteriorated, Osborn says.
"I saw her immediately go down after she was stung by the ants. I'm not saying she didn't have some problems--she was 90 years old," she says. "But she was holding her own as well as she could, and for months there she was doing fine. As far as her taking a turn for the worse, she definitely took a turn for the worse after the attack."
The family wanted to move Taylor right after the attack but it took them about three more weeks to find an open bed. On September 26, after being moved back to the nursing home in Bowie, Joy Taylor died. Osborn says she's convinced that the attack hastened the arrival of her death.
Schmidt, whose expertise includes the effects of insect venom, isn't familiar with Taylor's case in particular but says the fire ant toxins would typically not have affected Taylor physically for more than a few days, and he doubts her death was directly caused by the attack.
"If she lived a month, I would almost automatically say it was not directly related to the toxicity of the venom," he says.
Workers from the Texas Department of Human Services Long Term Care Regulatory branch went to the home after they heard from Osborn. They interviewed nursing home employees and told home operators that the ants would need to be eradicated within 24 hours or the facility would be closed. The state fined the home $275,000 in administrative penalties. The home, is owned and operated by Delta Health Care Services and managed by Tutera Health Care Management, a Kansas City, Missouri-based health care management company that manages about 50 nursing homes in 10 states. The latter company has not paid the state fines and is appealing the matter. No hearing date is set or apparently is being set for the appeal, a spokeswoman at the Texas Department of Human Services said. The federal regulatory agency for nursing homes proposed a $29,800 fine. The Tutera management group paid $18,500, a spokesman for the Health Care Finance Administration says. (Even though the Tutera group name was on the check to the federal government, a Tutera spokesman says Cross Timbers Inc. actually paid the fine.) The state agency also ordered all sorts of changes at the home as part of a "plan of correction." The number of staff members was supposed to be increased, patients were supposed to be cleaned regularly, and a comprehensive pest-control plan was supposed to be implemented. According to Rosemary Patterson at the Texas Department of Human Services, Cross Timbers had no other major incidents after Taylor's attack in 1998.
Joy Taylor's three children are suing Cross Timbers Care Center and the owners and managers. Carolyn Osborn says they want to send all nursing home owners the message that you cannot treat the elderly as her mother was treated. The federal fine was a joke, and the state fine is being appealed and will probably go away, she says. The lawsuit, which alleges that Taylor suffered mental anguish, physical pain, and disfigurement, names more than a half-dozen defendants including Tutera Health Care Management, Delta Health Inc., and the nursing home administrator at the time of the attack.
Lawyers for most of those named in the lawsuit declined to comment on Taylor's case because a trial is pending, they say. Neither the current owners nor those at the nursing home would comment. The owner of the Lewisville pest-control company that serviced the home before the ant attack did not return several telephone calls seeking comment. The trial is scheduled for December in Denton County.
"To me, if people don't take a stand and you sweep things under the rug and you say, 'Oh well, you know, that just happens in nursing homes,' it's going to keep happening," Osborn says. "We have to bring things out into the open to make a difference."
Apparently, she's right. Even those involved in watching nursing homes or those interested in fire ant behavior don't seem to have a common pool of knowledge related to nursing home attacks or ant-induced deaths. Taylor's case wasn't reported in the press, and no experts had heard of her. Another quiet attack took place in Fort Worth the late 1990s, when ants swarmed on an elderly man in a nursing home just as they did on Taylor. The victim's family sued but quietly settled the case last year. Other attacks, even those reported to state agencies, don't get much attention from the press.
But, at least some state long-term health care watchdogs may finally be realizing the problem. Mike Merchant, urban entomology specialist with the Texas Agricultural Extension Service in Dallas, traveled to New Orleans last month to talk to state health care regulatory agents from southern states about just how dangerous and traumatic fire ant attacks in nursing homes can be.
The other problems Osborn encountered at the home are pretty much standard for Texas nursing homes, which are plagued by staffing shortages and financial problems, those familiar with the operations say. Nursing home operators complain to legislators that the regulations are too stiff and annual inspections excessive. Beth Ferris, legislative representative for Texas Advocates for Nursing Home Residents in Austin, says even those homes that aren't called "bad" are not very good places to stay. The state inspects the homes annually and will send agents to a home if a serious problem is reported.
"They tell us 10 percent are bad. Even the ones in the middle--the gray area, I call it--people are neglected, they are abused, and a lot of this is because they don't have enough staff to take care of it," she says. "It all boils down to that."