Shortly after Christmas, Julia Lucas got a call at home in New York from her mother's nursing home in St. Petersburg. Her mother, ailing with dementia, was getting violent and needed to move to a more secure facility.
So when Lucas wanted to wish her mother a happy birthday on March 2, she called the new nursing home. A man said she wasn't listed in her mother's file. A day later, after some frantic phone calls, a hospital chaplain called.
"He said, 'Do you have anyone there with you? I have something to tell you,' " Lucas said. "Your mother died on Jan. 27 in the emergency room."
Lucas' mother, Anne Whitney Mataix, had been dead for five weeks. Unclaimed, she was turned over to the county, which cremated her body.
Mataix was a 65-year-old woman who led a difficult life, often on the fringes and estranged from her family. But when she died, she had lived for months in a licensed nursing home, had a daughter in contact with her caretakers and had an appointed health care surrogate.
Still, the vulnerable woman's death went unmarked by a system that lost track of the most vital details of her life.
Her nursing home, Boca Ciega Center in Gulfport, said it tried to notify her health care surrogate after Mataix was taken to Bayfront Medical Center.
Bayfront said it used every means it had to find next of kin.
Pinellas County officials tried to find a relative before authorizing cremation.
All the while, insist Lucas and the woman who acted as Mataix's health care decisionmaker, their names and telephone numbers should have been easily accessible in the dead woman's files.
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Lucas, Mataix's only child, readily acknowledges theirs was a strained relationship.
"She just never made great decisions. At one point, she lived in a car for a year,'' said Lucas, 42, a freelance photographer specializing in children. "I always had a fear that if I got too close to her, I would end up like her.''
Over the years, mother and daughter stayed in touch intermittently. One night last September, Lucas had a sense of foreboding and called authorities in Hudson, where her mother last lived. She learned her mother was seriously ill at St. Anthony's Hospital in St. Petersburg.
She flew to Florida the next day and learned that Mataix had been at Bay Pointe Nursing Pavilion in St. Petersburg for several months. No one knew she had a daughter. The nursing home had asked an 81-year-old St. Petersburg woman, Carolyn West, whose mentally challenged sister lived at the home, to be Mataix's health care surrogate.
Mataix recovered and returned to the nursing home. "It was such a relief to have her in a place where she was safe,'' Lucas said.
She said she sent a box of treats and gifts to her mother at Christmas. About a week later, the home called to say Mataix had become too difficult to handle and was being transferred to Boca Ciega Center in Gulfport.
"I said, 'Please make sure I'm still in the file,' '' Lucas said.
She next tried to contact her mother March 2, her 66th birthday. When an employee said she wasn't authorized to speak with Mataix, Lucas called West to intervene. The nursing home told West that Mataix was no longer a patient and had been sent to Bayfront Medical Center.
The next day, hospital chaplain Doug Harrell called Lucas in New York and broke the news.
"He said, 'We tried to find a next of kin and we couldn't find anyone to call,' " Lucas said.
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Who bears responsibility for notifying the right people in cases like these?
Florida law says that when a patient is transferred from a nursing home in an emergency, the staff must notify the patient's legal guardian or representative by phone or in person, as soon as possible, said Shelisha Durden, spokeswoman for the Agency for Health Care Administration in Tallahassee. The patient's file must document the contact.
Silvia Shafi, administrator at the Boca Ciega Center, said the home left two messages on Carolyn West's phone. Further, said Shafi, the facility's responsibility ended once it sent Mataix to the hospital. It was up to Bayfront to notify next of kin of the death.
Lucas doesn't understand why a nursing home would assume a patient wouldn't return from the hospital.
"That just doesn't seem right that this person who can't speak up for themselves was just sent to the emergency room and then the nursing home is no longer involved,'' said Lucas, who has filed a complaint with the state health care agency.
West, the surrogate, said she didn't get any message.
"I have an answering service, and that will show up. They just sloughed it off and said that maybe your answering service wasn't working. However, a month has transpired since she died and no secondary effort was made to tell me that,'' West said.
"Somebody is at fault for this terrible mess. I don't know who is stretching the truth or not telling the truth.''
Over the years, West said she has acted as a health care surrogate for at least eight people at Bay Pointe Nursing Pavilion who had no known relatives.
Bay Pointe officials wouldn't comment for this story, so it's unclear exactly what role West was filling as health care surrogate. Florida allows people to designate a surrogate to make decisions if they become incapacitated. They must sign a document in front of two witnesses, said Elizabeth Wall of Deeb Elder Law in St. Petersburg.
A proxy can be designated if a person is incapacitated and doesn't have a surrogate. The law dictates in order who can act as a proxy, starting with a court-appointed guardian, followed by a spouse, an adult child, parent, sibling, other adult relative or close friend. Wall said nursing homes can designate a clinical social worker if a friend or relative is unavailable.
Wall added that nursing home patients might designate someone the facility suggests because they have no one else.
"In a state like Florida, a retirement state, it's not always easy to find a relative or a responsible party,'' said Mary Ellen Early, senior vice president of public policy for the Florida Association of Homes and Services for the Aging.
Bayfront spokeswoman Nancy Waite said Mataix arrived at the ER at 10 a.m. on Jan. 26 and died shortly after midnight. The staff called the emergency contact listed in her records, but the number was disconnected. Told of the number, Lucas said it belonged to her mother's old boyfriend.
The hospital also called Boca Ciega Center, which said it had no next of kin in Mataix's files. Waite said the hospital also searched through public records. A surrogate would not have been considered, she said, since the hospital sticks to the letter of the law and notifies only next of kin.
Bayfront turned over the body to Pinellas County, which handles indigent cases. Cliff Smith, assistant health and human services director, said the staff tried to find a family member and called the nursing home. Boca Ciega said it had no emergency contact listed. West said she gave that information to officials when they transferred Mataix to the new home.
On Jan. 31 and Feb. 1, Mataix's obituary ran in the St. Petersburg Times. "There are no known survivors,'' it said. After five days, the county authorized cremation of Mataix's body.
In the box Lucas sent her mother at Christmas was a coffee mug with her baby picture on it. She'd like it back.
But no one can tell her where her mother's possessions went.
Times staff writer Stephen Nohlgren contributed to this report. Waveney Ann Moore can be reached at firstname.lastname@example.org or (727) 892-2283.