An elderly Christchurch man with advanced dementia was kept locked in a dark room for up to 16 hours a day, trapped in a wetsuit over adult nappies.
Photo: 123rf
Warning: This story details elder abuse that some may find disturbing.
The coroner will not hold an inquiry into the death of an elderly Christchurch man with advanced dementia whose son kept him locked in a dark room for up to 16 hours a day, trapped in a wetsuit over adult nappies.
In findings released on Friday, coroner Mary-Anne Borrowdale stated the cause of 90-year-old Norman Lee’s death was pneumonia and severe heart disease with a background of frailty and dementia and a context of elder neglect as a contributing factor.
A coroner’s inquiry was opened days after Lee died of pneumonia at Christchurch Hospital on 9 July 2020 but was put on hold while criminal and other investigations were underway.
His son David Lee and another person were jailed in 2022 for his abuse and neglect and for stealing more than $220,000 that was spent on cars, entertainment systems, scooters and holidays.
Multiple Healthcare New Zealand carers, a social worker and at least one nurse visited Norman Lee but none raised any concerns until days before police rescued him from the dank, dark room where he was held behind a locked deadbolt in conditions a judge would later liken to torture.
Norman’s daughter Christine Manahi fought to raise the alarm, warning authorities of her fears that David was taking advantage of their parents financially after he moved back into the family home in 2017, according to notes recorded by Health NZ in May 2018.
David had an enduring power of attorney over his father’s property and affairs, while Manahi held an enduring power of attorney over his care and welfare.
The coroner noted the siblings never got along well and the separation of the powers of attorney worsened the situation.
In December 2017 Norman was diagnosed with dementia. HealthCare NZ, a private care agency, was contracted by Health NZ to help meet he and his wife Molly’s increased needs, including assistance with meal preparation and personal care.
A 2018 review found Norman’s dementia was worsening.
Manahi wanted her father to move into a care home after her mother died in November 2018 but David insisted he stay at home and prevented his sister from coming to the house, only allowing his father to make occasional visits to her home.
During these visits, Manahi could tell he was afraid of David but it was not until after she made a complaint to police in November 2019 that officers opened an investigation into David’s suspect financial transactions.
Seven months later, when police searched the family home looking for evidence of financial abuse in June 2020, they discovered the horrific conditions Norman endured.
Police discovered Norman’s living conditions seven months after his daughter laid a complaint.
Photo: RNZ / Angus Dreaver
He was found on a urine stained mattress wearing a wetsuit over an adult nappy, locked in a cold, dark room that reeked of faeces.
The wetsuit zip-cord had been removed so he could not take it off himself.
A large sheet was covering the window, which was taped shut, leaving the room without natural light or ventilation.
The sparsely furnished room had no clock or any other way to tell if it was night or day. Light switches were taped into the off position and an electric heater was taped off.
“The room was cold and damp, in stark contrast to the remainder of the house,” the findings stated.
There was no drinking water in the room and there were two cameras trained on the bed, which would provided police with extensive CCTV footage of Norman’s captivity and abuse.
Norman appeared “small and frail” but was in good spirits. Manahi took him to respite care, where he was found to be dehydrated.
He lived at the facility for the next two weeks but was taken to hospital with pneumonia, where he died in July.
A post mortem found the neglect and his living environment almost certainly increased his frailty, exacerbated his dementia symptoms and increased the risk of pneumonia.
A forensic pathologist noted Norman had been hospitalised with aspiration pneumonia several weeks earlier and was discharged with a prescription for antibiotics.
He was only given two days’ worth of the seven day course, which was later found to be an aggravating factor in the the defendant’s neglect of the elderly man.
On the day she opened her inquiry the coroner was informed by police that David was under investigation for neglecting his father and stealing from him.
Investigations were also carried out by HealthNZ and the Health and Disability Commissioner, which led Borrowdale to pause her inquiry until the investigations and criminal proceedings were concluded.
Borrowdale said she could not close her inquiry until she examined why social workers and carers who went to the Lee family home had not reported any concerns.
In her findings, she said was satisfied the criminal and other investigations into the “tragic and horrific” case established the facts and made a coronial inquiry unnecessary.
Two cameras trained on the bed would provided police with extensive CCTV footage of Norman’s captivity and abuse.
Photo: Unsplash/ Alan J Hendry
The CCTV footage helped police determine that Norman was regularly locked in his room for hours at a time, often from 5pm until 9 or 10am.
Lee, who was incontinent and had no access to a toilet, was zipped into his wetsuit at night.
When he defecated, he had no way to properly clean himself or his bed. He would knock on the door and call for help for up to an hour, the findings stated.
The recordings also showed David screaming at, berating and assaulting his father.
In his evidence, David told the court social workers and home carers had been aware of his methods of dealing with his father and that no-one had raised any concerns.
Judge Callaghan found his evidence was not credible and discounted it.
The judge found David’s sole motivation in keeping his father at home was “uninterrupted access to significant sums of money”.
Trapping the incontinent man in a wetsuit was “a form of torture”, the judge stated.
He found the other person was complicit in the mistreatment.
She had sole daily care of him when David was out of the house, was aware of all elements of the neglect and “did nothing to actually alleviate his suffering”.
David was sentenced to six years jail, while the other person was sentenced to two-and-a-half years jail, which was reduced to 22 months on appeal.
Manahi complained to Health NZ about the overall quality of support and care her father received, and complained the social worker told her brother of her plans to remove their father from his care.
Health NZ conducted an independent review that highlighted systemic issues and gaps and made a dozen recommendations.
RNZ has requested a copy of the review, and asked Health NZ for comment, but it has yet to respond.
After Manahi’s earlier complaints about possible financial and elder abuse in 2018, support services were increased to the Lee home, but despite a visiting nurse noticing Norman was unkempt and confused, no follow-up visit was organised, the coroner said.
In early 2019, Manahi raised her concerns about neglect with the social worker but they found “no evidence of neglect” in a home visit.
HealthCare NZ, a private care agency, was contracted by Health NZ to help meet Norman’s needs.
Photo: Supplied / HealthCare NZ
The same month another social worker raised concerns with HealthCare NZ but was told there were “nil concerns”.
Asked by a nurse during a home visit how he felt living with his son, Norman replied, “terrible and awful”.
In June 2020 the social worker learned of the cameras in the bedroom and David showed her videos of the insanitary and distressing toileting.
He told her he had used the wetsuit to manage his father’s incontinence.
The social worker advised him that it was “unusual” and that she would discuss it with a psychiatrist.
She also learned of the inoperable bedroom heater, that the windows were blocked and the room kept dark.
She said she asked David about the conditions but that he gave “explanations as to why each of these measures assisted with Norman’s care and well-being”.
She did not document the visit until several months later, when she noted she felt “David and his partner had the best intentions to keep Norm safe so that Norm could enjoy the last bit of his life”.
She wrote that prompted her to disclose Manahi’s plans to remove her father from the house.
When the social worker told a consultant psychiatrist about Norman’s living conditions, she was told to step back from the case.
A team meeting the next day concluded the social worker had lost her independence by advocating strongly for Norman to stay in his son’s care against the wishes of Manahi.
Following a confidential employment process, the social worker’s role ended in October 2021.
The Health and Disability Commission declined to release its investigation or comment on why it remained unpublished.
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