TAMPA — Mary Hildreth Winston's family says she was clear about how she wanted to die.
In the years before the 65-year-old passed away in her Citrus Park home in 2012, she told her husband and their three grown children not to take her to a hospital or put her in a nursing home. Crippled by an incredibly aggressive type of rheumatoid arthritis that left her bedridden and unable to feed or bathe herself, the retired nurse refused to take anything stronger than ibuprofen. Her bed sores grew, and her limbs twisted.
Her family did as she asked.
But nearly three years after Winston's death, the family members who cared for her are facing possible prison sentences in an extraordinary criminal case that is scheduled to go to trial in Hillsborough County this month. At its core is this question: Was Mary Winston capable of deciding how she wanted to die, or was she a victim of neglect?
Eight months after her death, the Hillsborough County State Attorney's Office charged her 69-year-old husband, Osmond Winston Sr., with aggravated manslaughter of an elderly or disabled person, a first-degree felony that carries a maximum sentence of 30 years. Prosecutors also charged the couple's three adult children — Osmond "Ozzie" Winston Jr., 47, Hyacinth Winston, 45, and Belinda Winston, 41 — accusing the entire family of standing by as their wife and mother died slowly of an infection.
"This is a tough criminal case and very unusual," said Roberta Flowers, a former prosecutor who co-directs Stetson University's Center for Excellence in Elder Law.
"The problem is, you look at that terrible death and there's got to be someone to blame. But the person to blame is the person who had the right to make those decisions," Flowers said. "It all rides on: Does the prosecution have proof she was incapacitated at the time she was giving these instructions?"
When Winston's family called 911 on Oct. 25, 2012, to report that she had died, the Hillsborough detectives who arrived at the family's modest home on Airview Drive were horrified. Photographs of Winston's body, which jurors will likely see, show her lying in bed, frozen in the last position she held before her diseased limbs betrayed her. Her hair was falling out, her skin was decaying, and the sores that family members said appeared months earlier were so large that her rib cage was partially exposed. Detectives noted an "infestation of maggots." The room smelled strongly of urine.
One by one, each member of the Winston family was interviewed by detectives who, transcripts of the interviews show, could barely contain their disgust.
"In 21 years those are probably the worst bed sores I've ever seen," said one detective. "And there are four adults here. … It seems at some point in time, you know, with or without mom's permission, somebody would've … "
In each interview, the family told the same story. Prompted by concern that Winston was losing mobility, they had called a doctor who visited her at home, dropped off some prescription painkillers and pronounced her disease incurable. Although it's possible to manage the symptoms of rheumatoid arthritis for years, even decades, Winston believed she was dying and stubbornly, repeatedly, refused medical treatment, her family said. Instead, from her bed, she directed her main caretaker, her daughter Belinda Winston, to spray Neosporin on her sores and bandage them.
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More than anything, Winston had begged her family to let her die at home in Dominica, the tiny Caribbean island, population 72,000, from which she and her family had immigrated years before, and where residents still praise her as a warm and caring nurse. But there were obvious obstacles to travel, including the fact that Winston could barely move.
"I would cry and I would pray and I would tell her, 'Mom, I'm going to call for you,' and she just … she just kept saying, 'Don't call, don't call,' " Belinda Winston sobbed to detectives during her interview. "She said she knows what hospitals are and she didn't want to go to the hospital."
In court documents, prosecutors do not dispute that Mary Winston refused medical treatment while she was capable of making such a decision. Still, they say there is no concrete evidence, aside from the family's statements, that they were acting on her wishes, that she was ever treated by a physician, or that her disease was terminal. Further complicating matters, Winston left no will or other written documents stating her preferences.
"We reviewed the case, we looked at the facts and the law, and felt like the charges were warranted against these individuals," said Hillsborough state attorney spokesman Mark Cox, who declined to discuss the specifics of the case.
Nicholas Matassini, the defense attorney representing Belinda Winston, said the case centers on long-standing medical and ethical questions about an elderly person's ability to make her own health care decisions.
There are no allegations that Mary Winston suffered from dementia or any other condition that would have affected her thinking, he said. And though rheumatoid arthritis is debilitating, doctors interviewed for this story said it does not typically cause cognitive changes. Prosecutors may argue that her illness left her unable to talk, but Matassini said, "Frankly, it doesn't matter, because she was competent when she voiced her wishes."
"She's got a constitutional right to decide what happens to her body and she can choose to refuse medical care and she did that," he said.
Defense attorneys for Hyacinth Winston and Osmond Winston Jr. are likely to take a different approach and argue that their clients were not responsible for their mother's care. Both children lived on their own and although they visited the family home occasionally, they told detectives that it was their father and youngest sister who mainly looked after their mother. Speaking on behalf of their clients, lawyers for the family either declined interviews or did not respond to requests for comment.
According to Matassini, prosecutors offered each of the Winston family members a chance to avoid a trial by taking a plea deal, which they rejected. In addition to maintaining their innocence, there were consequences to consider — several of them could have faced deportation proceedings if they had pleaded guilty to a first-degree felony.
The greatest challenge for defense attorneys, as they are well aware, is the photographs. Graphic and disturbing, they depict a human body in a condition rarely seen by members of the public.
"I assume, as a former prosecutor, that they (prosecutors) are hoping that the pictures, the severity of the trauma to the body and just the emotion of it is going to cause the jury to find that this family shouldn't have sat there and watched that happen," Flowers said.
"But we have to remember that if we don't allow this woman to make her own decisions, does that mean at a certain age all of us lose the ability to make whatever decision we want to make?"
Contact Anna M. Phillips at firstname.lastname@example.org or (813) 226-3354. Follow @annamphillips.