Adriana Suciu, V. Washington Department Of Social & Health Services
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Opinion
Filed Washington State Court of Appeals Division Two
July 12, 2022
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II ADRIANA SUCIU, No. 55887-4-II
Appellant,
v. UNPUBLISHED OPINION
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES,
Respondent.
WORSWICK — Adriana Suciu appeals the superior court’s order affirming a final
order of the Board of Appeals (Board) of the Department of Social and Health Services
(Department), in which the Board determined Suciu neglected a vulnerable adult. Suciu
was the primary caregiver for Doris, a 96 year-old bedfast vulnerable adult. A nurse
observed repeated bruising on Doris and contacted the Department’s Adult Protective
Services (APS). APS substantiated a neglect finding against Suciu, and Suciu appealed
to the Office of Administrative Hearings. After a five-day hearing, an Administrative
Law Judge (ALJ) issued an initial order affirming the Department’s findings. The Board
affirmed the initial order and filed a published order. Suciu filed for judicial review and
the superior court affirmed the Board’s decision.
On appeal, Suciu assigns error to multiple findings of fact and argues that
substantial evidence does not support the Department’s findings, that the Department’s No. 55887-4-II
conclusions of law were not supported by those findings, and that the superior court erred
when it affirmed the Board’s final order. We disagree and affirm.
FACTS
I. BACKGROUND
Suciu was a paid caregiver at the Heaven Home Health Adult Family Home. 1 Doris was
a bedfast, nonverbal, 96 year-old, vulnerable adult who entered hospice care at the home
beginning in July 2017.
On admission to Suciu’s home, Doris’s guardian—her son, Tim—entered into a June 30
negotiated care plan with Suciu for Doris’s care. The June 30 plan noted that Doris was
unsteady on her feet and was a fall risk but was somewhat verbal and mobile, able to undress and
feed herself to an extent. It noted that Doris bruised easily. The negotiated care plan stated that
Doris had dementia and was taking Haloperidol, also called Haldol, which had a side effect of
causing a person to bruise easily.
Doris also had Physician Orders for Life Sustaining Treatment (POLST) dated May
2017, which stated that she was not to receive CPR if she had no pulse and was not breathing,
and that for medical interventions she was to receive “comfort measures only.” Admin. Record
(AR) at 282. These included “medication by any route, positioning, wound care, and other
measures to relieve pain and suffering,” and using “oxygen, oral suction, and manual treatment
of airway obstruction as needed for comfort.” AR at 282.
1 Suciu’s husband John Suciu, also referred to in the record as Ioan, is the home’s co-owner and manager. He was not cited by the Department.
2 No. 55887-4-II
Suciu filed an incident report on July 5 that said Doris fell and had a bruise on her left
knee. On July 6, Suciu filed an incident report that Doris fell while getting out of bed, resulting
in a cut to Doris’s head and multiple bruises to her wrist and body. The incident report contained
notes dated July 8-11, noting “many falls” and other injuries to Doris, but it is unclear from the
record on appeal when Suciu added these notes to the report. AR at 607.
Suciu filed another incident report on July 12, which noted bruising to Doris’s left
shoulder and lower left leg. Suciu noted that Doris fell, was very agitated, not sitting still, and
was aggressive with staff. Suciu filed another report on July 13 that stated Doris fell again, and
noted bruises to Doris’s head. In a July 16 incident report, Suciu again noted she “found [Doris]
w[ith] a bruise on her r[ight] corner eye.” AR at 610. On July 25, Suciu reported Doris was
again agitated and had bruises on her lips, leg, and hand. Once again, Suciu added notes to the
report from subsequent days, but it is unclear when Suciu added to the report.
For the duration of Doris’s stay at the home, she was also visited multiple times a week
by registered nurses who would examine her and file short reports. One nurse who routinely saw
Doris was Heidi Bishop. On July 14Bishop noted Doris had “random bruising to extremities and
face.” AR at 612. Suciu also kept a log of Doris’s medications and how much she administered
and took progress notes on her patients.
On August 4 and August 8, Nurse Bishop recorded that Doris’s bruising to her face
“remain[ed]” and that Doris had a cut on her left hand. AR at 624. On August 11, Bishop
reported the bruising to Doris’s face was “resolving.” AR at 625. On August 22, Bishop
reported Doris was “well palliated,” but again noted bruising to Doris’s upper lip, forearms, and
hands. AR at 342, 625.
3 No. 55887-4-II
On September 1, Suciu filed an incident report that Doris became agitated, got up from
her bed, and fell on the carpeted floor. Suciu noted bumps and bruises to Doris’s head and
tailbone. Once again, Suciu added notes to this report, dated on the following days that stated
Doris appeared to be healing, but it is unclear from the record when Suciu added these notes.
Nurse Bishop’s notes from the same day do not mention any bruising. Bishop’s notes from
September 5 state that Doris reported pain from her backside. On September 12, Bishop noted
that she planned to decrease visits to once weekly.
On October 28, Suciu filed an incident report that Doris was agitated and hit her head on
the wall. Suciu reported that she did not know “exactly what happen[ed]” but that Doris had
bumps and bruises to her head. AR at 641. Again, the report was annotated in the following
days, with a note dated November 1 that stated Suciu noticed an additional bruise in the middle
of Doris’s head. On November 1, Nurse Bishop noted edema to Doris’s face and that she was
going to increase her visits to twice weekly. On November 9, Bishop reported the bruising to
Doris’s face was resolving.
Around this time, in November 2017, Doris’s condition deteriorated, resulting in her
hospitalization and an updated negotiated care plan. Doris returned to Suciu’s care after leaving
the hospital, but was bedfast and nonverbal. The updated negotiated care plan from November 1
states that Doris was unable to talk anymore and had become totally dependent on others for
physical mobility. The updated plan stated that Doris was not able to reposition herself in bed.
It further stated that Doris was no longer able to feed or dress herself. The plan again stated that
Doris’s face bruised easily because of the Haldol medication.
4 No. 55887-4-II
On December 20, Suciu filed another incident report that Doris had bruising to her head.
Suciu noted that she accidentally hit Doris in the head with her elbow while trying to reposition
Doris. On December 21, Nurse Bishop recorded that Doris had swelling to her right cheek with
lesions at the corner of her mouth. Bishop noted the lesions were resolving on December 26.
On January 2, 2018, Bishop recorded Doris had “generalized bruising” but noted on
January 9 that the bruising to Doris’s forehead and the right side of her neck was resolving. AR
at 673-74. On February 20, Suciu filed an incident report in which she stated Doris had a cut on
her left hand. On February 27, Nurse Bishop again noted that Doris appeared well palliated and
Free access — add to your briefcase to read the full text and ask questions with AI
Filed Washington State Court of Appeals Division Two
July 12, 2022
IN THE COURT OF APPEALS OF THE STATE OF WASHINGTON
DIVISION II ADRIANA SUCIU, No. 55887-4-II
Appellant,
v. UNPUBLISHED OPINION
WASHINGTON STATE DEPARTMENT OF SOCIAL AND HEALTH SERVICES,
Respondent.
WORSWICK — Adriana Suciu appeals the superior court’s order affirming a final
order of the Board of Appeals (Board) of the Department of Social and Health Services
(Department), in which the Board determined Suciu neglected a vulnerable adult. Suciu
was the primary caregiver for Doris, a 96 year-old bedfast vulnerable adult. A nurse
observed repeated bruising on Doris and contacted the Department’s Adult Protective
Services (APS). APS substantiated a neglect finding against Suciu, and Suciu appealed
to the Office of Administrative Hearings. After a five-day hearing, an Administrative
Law Judge (ALJ) issued an initial order affirming the Department’s findings. The Board
affirmed the initial order and filed a published order. Suciu filed for judicial review and
the superior court affirmed the Board’s decision.
On appeal, Suciu assigns error to multiple findings of fact and argues that
substantial evidence does not support the Department’s findings, that the Department’s No. 55887-4-II
conclusions of law were not supported by those findings, and that the superior court erred
when it affirmed the Board’s final order. We disagree and affirm.
FACTS
I. BACKGROUND
Suciu was a paid caregiver at the Heaven Home Health Adult Family Home. 1 Doris was
a bedfast, nonverbal, 96 year-old, vulnerable adult who entered hospice care at the home
beginning in July 2017.
On admission to Suciu’s home, Doris’s guardian—her son, Tim—entered into a June 30
negotiated care plan with Suciu for Doris’s care. The June 30 plan noted that Doris was
unsteady on her feet and was a fall risk but was somewhat verbal and mobile, able to undress and
feed herself to an extent. It noted that Doris bruised easily. The negotiated care plan stated that
Doris had dementia and was taking Haloperidol, also called Haldol, which had a side effect of
causing a person to bruise easily.
Doris also had Physician Orders for Life Sustaining Treatment (POLST) dated May
2017, which stated that she was not to receive CPR if she had no pulse and was not breathing,
and that for medical interventions she was to receive “comfort measures only.” Admin. Record
(AR) at 282. These included “medication by any route, positioning, wound care, and other
measures to relieve pain and suffering,” and using “oxygen, oral suction, and manual treatment
of airway obstruction as needed for comfort.” AR at 282.
1 Suciu’s husband John Suciu, also referred to in the record as Ioan, is the home’s co-owner and manager. He was not cited by the Department.
2 No. 55887-4-II
Suciu filed an incident report on July 5 that said Doris fell and had a bruise on her left
knee. On July 6, Suciu filed an incident report that Doris fell while getting out of bed, resulting
in a cut to Doris’s head and multiple bruises to her wrist and body. The incident report contained
notes dated July 8-11, noting “many falls” and other injuries to Doris, but it is unclear from the
record on appeal when Suciu added these notes to the report. AR at 607.
Suciu filed another incident report on July 12, which noted bruising to Doris’s left
shoulder and lower left leg. Suciu noted that Doris fell, was very agitated, not sitting still, and
was aggressive with staff. Suciu filed another report on July 13 that stated Doris fell again, and
noted bruises to Doris’s head. In a July 16 incident report, Suciu again noted she “found [Doris]
w[ith] a bruise on her r[ight] corner eye.” AR at 610. On July 25, Suciu reported Doris was
again agitated and had bruises on her lips, leg, and hand. Once again, Suciu added notes to the
report from subsequent days, but it is unclear when Suciu added to the report.
For the duration of Doris’s stay at the home, she was also visited multiple times a week
by registered nurses who would examine her and file short reports. One nurse who routinely saw
Doris was Heidi Bishop. On July 14Bishop noted Doris had “random bruising to extremities and
face.” AR at 612. Suciu also kept a log of Doris’s medications and how much she administered
and took progress notes on her patients.
On August 4 and August 8, Nurse Bishop recorded that Doris’s bruising to her face
“remain[ed]” and that Doris had a cut on her left hand. AR at 624. On August 11, Bishop
reported the bruising to Doris’s face was “resolving.” AR at 625. On August 22, Bishop
reported Doris was “well palliated,” but again noted bruising to Doris’s upper lip, forearms, and
hands. AR at 342, 625.
3 No. 55887-4-II
On September 1, Suciu filed an incident report that Doris became agitated, got up from
her bed, and fell on the carpeted floor. Suciu noted bumps and bruises to Doris’s head and
tailbone. Once again, Suciu added notes to this report, dated on the following days that stated
Doris appeared to be healing, but it is unclear from the record when Suciu added these notes.
Nurse Bishop’s notes from the same day do not mention any bruising. Bishop’s notes from
September 5 state that Doris reported pain from her backside. On September 12, Bishop noted
that she planned to decrease visits to once weekly.
On October 28, Suciu filed an incident report that Doris was agitated and hit her head on
the wall. Suciu reported that she did not know “exactly what happen[ed]” but that Doris had
bumps and bruises to her head. AR at 641. Again, the report was annotated in the following
days, with a note dated November 1 that stated Suciu noticed an additional bruise in the middle
of Doris’s head. On November 1, Nurse Bishop noted edema to Doris’s face and that she was
going to increase her visits to twice weekly. On November 9, Bishop reported the bruising to
Doris’s face was resolving.
Around this time, in November 2017, Doris’s condition deteriorated, resulting in her
hospitalization and an updated negotiated care plan. Doris returned to Suciu’s care after leaving
the hospital, but was bedfast and nonverbal. The updated negotiated care plan from November 1
states that Doris was unable to talk anymore and had become totally dependent on others for
physical mobility. The updated plan stated that Doris was not able to reposition herself in bed.
It further stated that Doris was no longer able to feed or dress herself. The plan again stated that
Doris’s face bruised easily because of the Haldol medication.
4 No. 55887-4-II
On December 20, Suciu filed another incident report that Doris had bruising to her head.
Suciu noted that she accidentally hit Doris in the head with her elbow while trying to reposition
Doris. On December 21, Nurse Bishop recorded that Doris had swelling to her right cheek with
lesions at the corner of her mouth. Bishop noted the lesions were resolving on December 26.
On January 2, 2018, Bishop recorded Doris had “generalized bruising” but noted on
January 9 that the bruising to Doris’s forehead and the right side of her neck was resolving. AR
at 673-74. On February 20, Suciu filed an incident report in which she stated Doris had a cut on
her left hand. On February 27, Nurse Bishop again noted that Doris appeared well palliated and
noted she would decrease her visits to once weekly.
On May 1, Suciu filed an incident report that Doris had bruising to her left eye and lips.
Suciu appeared to report that the bruising was caused by Doris pressing her fingers against her
face while sleeping on her left side and that Suciu reported the bruising to Nurse Bishop. In
Nurse Bishop’s notes from May 2, she noted Doris had a large bruise to her left forearm and
upper lip but that Doris appeared well palliated. On May 9, Bishop reported Doris had
“generalized upper body bruising.” AR at 704.
On June 2, Suciu filed another incident report in which she reported Doris had bruising to
her face and neck. Suciu noted Doris became agitated, kept her mouth closed, and could not
breathe. Suciu stated Doris needed help and that she opened the side of Doris’s mouth for Doris
to breathe through, after which Suciu gave Doris an extra dose of Haldol to calm her. Suciu’s
report appears to state that Doris’s bruises appeared after this event. Nurse Bishop’s notes in the
following days do not suggest any major trauma, state that Doris had edema to her face, and that
she appeared well palliated.
5 No. 55887-4-II
On June 14, a report was made to APS that Doris had purple bruising on her left check to
temple that looked fresh and a fading bruise around her right eye. The report stated that when
the reporter went to take Doris’s blood pressure, Doris flinched, and that this raised the reporter’s
suspicions of possible physical abuse.
That same day, APS removed Doris to Legacy Salmon Creek Hospital for examination.
Medical records from the hospital showed that Doris had bruises to her left temple, cheek, ear,
chin, shoulder, hip, and leg. Hospital records show that medical staff there requested an APS
report as well, apparently unaware that Doris was transferred to the hospital because of the APS
report. Hospital staff created a case with police for them to come take pictures of Doris’s
injuries.
II. APS INVESTIGATION
The Department assigned Regina Quirk, an APS investigator, to investigate the report
regarding Doris. Quirk spoke to the person who made the APS report, who told Quirk that
Doris’s arms and legs were contracted to the point where she could not have injured herself and
that her injuries were inconsistent with her health conditions. Quirk went to Suciu’s home when
Doris was removed to the hospital and saw bruising along Doris’s forehead that extended down
her cheek, and some on the right side of Doris’s nose. She also noticed that Doris’s ear and neck
appeared swollen with yellow bruises. Quirk noticed that Doris was in nearly a fetal position
with her arms and legs contracted.
After Doris’s examination at the hospital, she was discharged to a hospice center. A
nurse at the hospice center reported to Quirk that by June 20, Doris’s bruising had started to fade
6 No. 55887-4-II
and heal, and she displayed no new bruising. The nurse also reported that Doris had not been
agitated and required no Haldol while at hospice. Doris died at the hospice center on June 25.
Quirk interviewed Nurse Bishop, who told Quirk that she was concerned about the way
Suciu handled patients—that Suciu’s demeanor was rough and impatient. In a June 26
declaration to APS, Bishop stated that on May 2, she had noted bruising to Doris’s chin,
forearms, and upper lip. According to Bishop, when Bishop asked Suciu how it had happened,
Suciu told Bishop it happened because she had to pry Doris’s mouth open to brush Doris’s teeth.
Bishop stated that she instructed Suciu to cease brushing Doris’s teeth and not force care.
Bishop then stated she subsequently saw significant bruising on Doris on June 6 and 13
“consistent with . . . forced oral care.” AR at 191.
On June 20, Quirk conducted an unannounced interview at the Suciu home. Quirk asked
Suciu if Suciu required an interpreter, but Suciu declined. 2 Suciu reported to Quirk that after
November 2017, Doris was no longer able to raise her hands to feed or dress herself and was
completely dependent on the caregivers. However, Suciu told Quirk that Doris was able to raise
her left finger and often slept with her finger in her mouth, which caused the bruising to Doris’s
face. Suciu made comments to Quirk that she did not want Doris to die and would put her
fingers in Doris’s mouth to help her breathe.
APS also sent Jenifer Jones, a registered nurse, to inspect and investigate the Suciu home.
Suciu reported to Jones that she would put her fingers in Doris’s mouth to try to pry her teeth
apart to get Doris to breathe.
2 Suciu’s first language is Romanian.
7 No. 55887-4-II
In September 2018, APS concluded its investigation and found that it was more likely
than not that:
On [or] around and between November 1, 2017 and June 14, 2018, while a caregiver to a vulnerable adult, you did not follow protocol when the vulnerable adult could not breathe and you caused unnecessary bruising to the vulnerable adult when brushing the vulnerable adults [sic] teeth and moving the vulnerable adult in her bed. You did not prevent physical or mental harm to the vulnerable adult while acting as the vulnerable adult’s caregiver.
AR at 120.
III. PROCEDURAL HISTORY
Suciu appealed the APS finding to the Office of Administrative Hearings. The ALJ
conducted five days of hearings. The parties did not dispute that Doris was a vulnerable adult.
Suciu, Nurse Bishop, Quirk, and Advanced Registered Nurse Practitioner (ARNP) Charlotte
White all testified.
A. Hearing, Testimony, and ALJ’s Initial Order
Suciu testified with the aid of an interpreter. Suciu’s report stated:
[Doris] became very agitated and making big sounds around 11, noon. Not sleeping and caregiver, [Suciu], I notice that she is in pain due to her left side – it was right side – face infection. Caregiver, [Suciu], giving her (Inaudible) two tablets, 650 milligram, and . . . was relieved. [Doris] became calm, restful (Inaudible). [Doris] raised her left hand up with pointing finger to stop when agitated, unable to talk, or said anything. Caregiver tried to comfort her by talking with her and wash her face gentle.
2 Verbatim Report of Proceedings (VRP) at 25-26.
Suciu testified that she did not pry open Doris’s mouth to help her breathe, but that she
administered medication. Suciu testified that on June 2, 2018, Doris had clenched down on a
sponge when Suciu was trying to brush her teeth with it. Suciu testified she waited for Doris to
release the sponge. She testified that the June 2 incident report blended the events of two
8 No. 55887-4-II
incidents: one where Doris became agitated during tooth brushing, and another where she
became agitated when her son was visiting in May, her face turned blue, and Suciu used a
syringe in Doris’s mouth to administer medication.
Quirk testified that Suciu told the APS reporter that Doris’s bruises were caused by Suciu
prying Doris’s mouth open after she clenched down on a toothbrush. Quirk testified Doris was
unable to move her arms when Quirk observed her on her removal to the hospital. Quirk next
testified that Suciu told Quirk that when Doris had a hard time breathing, Suciu would shake
Doris and pry her mouth open, and then Doris would gasp for air. Quirk testified that when she
asked Suciu if she was trained to pry open Doris’s mouth, Suciu responded, “no,” but then asked
what she was supposed to do. 3 VRP at 70. Quirk then testified that Suciu stated she knew
about the Do Not Resuscitate (DNR) order in the POLST, but stated, “Did you want me to let her
die? I was providing hospice.” 3 VRP at 70. Quirk further testified that she asked if Suciu had
been delegated authority to open Doris’s mouth in such circumstances, and Suciu said no.
Quirk also read some of Jones’s report into the record. 3 VRP at 100-101. According to
Jones’s report, Suciu relayed a similar story to Jones, telling Jones she would
put her fingers in [Doris’s] mouth and try to pry her teeth apart to get her to breathe. [Suciu] demonstrated the procedure using her own finger, own mouth, and index finger. [Suciu] opened her lips, clenched her teeth and placed an index finger on each side of her mouth, and stretch her lips by pulling the corners of her lips out. [Suciu] stated she knew CPR. She stated [Doris] was do not resuscitate, but I did not want her to go.
3 VRP at 101.
Nurse Bishop was asked about whether, in the context of Doris’s POLST, what would
constitute “comfort measures,” or “manual treatment of airway obstruction as needed for
comfort.” 1 VRP at 83. Bishop testified that “manual treatment would be if someone was
9 No. 55887-4-II
choking on food, is how I would interpret that. And you could do a . . . finger sweep to remove,
um, food.” 1 VRP at 84. Bishop testified that she would not recommend shaking someone who
quit breathing because it would not be a comfort measure. Likewise, she testified that people on
hospice are “expected to die a natural death. And if they are not breathing, there is no reason
why you would open their mouth.” 1 VRP at 85. Bishop further testified that after November
2017, Doris was “virtually immobile” and that her arms were so contracted that Bishop could not
straighten them to take her blood pressure. 1 VRP at 65-66.
Bishop testified that when she asked Suciu about the bruising, Suciu stated it was caused
by holding Doris’s mouth open while Suciu brushed her teeth. “[Suciu] stated that it was
because they have to hold her chin and upper lip to pry her mouth open to brush her teeth.” 1
VRP at 69. Bishop also testified that she tried to educate Suciu on not forcing Doris’s mouth
open, to forgo using a toothbrush, and that using a sponge to gently wipe a patient’s teeth was
more appropriate.
Nurse Bishop testified, however, that the word “pry” was “probably” Bishop’s word, not
Suciu’s because Bishop did not note it as a quote in her notes. 1 VRP at 106. Suciu testified that
“[Nurse Jones] must have understood that I opened [Doris’s] mouth, but I didn’t open her
mouth.” 2 VRP at 69. Suciu further testified that “[Jones] understood that I put my fingers in
her mouth to pry it open, but I did not, uh, do that.” 2 VRP at 70.
Nurse Angela Stewart, from the hospice center, also testified. Stewart testified that she
had cared for Doris before Doris entered Suciu’s care, and that she was surprised at the level of
deterioration as well as Doris’s bruising on her readmission to the hospice center. She testified
that Doris had bruising to her face and hip that were in various stages of recovery, which
10 No. 55887-4-II
suggested to Stewart that the bruises had occurred at different times. Stewart further testified
that Doris was unable to move her arms when she was admitted to the hospice center in June.
She testified that Doris did not suffer any further bruising while at the hospice center.
Stewart then testified that forcing the mouth open is not a comfort measure and is not standard
practice for a hospice patient who has stopped breathing.
ARNP Charlotte White, a hospice nurse who examined Doris, also testified. Nurse White
testified that in her February 2018, examination of Doris, Doris was unable to move her arms.
She testified that Doris was very fragile and that Doris’s forearms and hands would bruise easily.
However, White also testified that she would not expect bruising to the face of a patient with
limbs as contracted as Doris’s arms, and that with careful repositioning of a patient, bruising on
the face is not normally seen.
Later in the hearing, Suciu admitted that she re-wrote records and shredded other pages
from Doris’s file. She testified, “So, I re-described the situation in January of 2019 in more
detail with, um – to have a more accurate, um, information of what happened, according to my
own recollection, and shredded the other papers.” 5 VRP at 15. She further testified, “I looked
over the old file and wrote new pages, rewrote new pages, . . . to accurately describe my
recollections, and then didn’t save the old pages. I shredded the old pages. I didn’t realize that I
had to keep them, which I’m sorry about.” 5 VRP at 16. Suciu testified that she added notes to
some parts of her reports because she had a hard time reading the originals. She also testified
that she “added more information from memory.” 5 VRP at 8.
The ALJ entered an initial order affirming the Department’s finding of neglect against
Suciu. The ALJ found Suciu’s records to be unreliable because of her admitted alteration of
11 No. 55887-4-II
them after the APS investigation began. The ALJ found that Suciu lacked credibility. The ALJ
concluded that Suciu’s acts or omissions constituted a pattern of conduct that failed to avoid or
prevent physical harm to Doris, a vulnerable adult, under former RCW 74.34.020(16)(a) (2019). 3
B. Board of Appeals and Final Order
Suciu petitioned the DSHS Board of Appeals for review of the ALJ’s initial order. The
Board entered a final order affirming the ALJ’s finding of neglect. AR at 1. The Board entered
numerous findings of fact and conclusions of law. Relevant here, the Board found:
7. Ms. Bishop observed bruises to Doris’s face, and [Suciu] explained that she had to hold Doris’s mouth open to brush her teeth, which caused bruises. Ms. Bishop told [Suciu] that, because Doris was a hospice patient, she should use a sponge to wipe Doris’s mouth and teeth instead of a toothbrush, and should not pry Doris’s mouth open.
8. [Suciu] observed Doris having episodes of agitation, when her face would turn red and she would stop breathing. During these episodes, [Suciu] would open Doris’s mouth to assist her breathing. This was not medically authorized because Doris was on hospice care and was to receive comfort measures only. ....
24. In entering these findings, it was not necessary to decide what actually happened, or to be persuaded beyond a reasonable doubt as to the true state of affairs, nor must the persuasive evidence be clear, cogent, and convincing. As the triers of fact, the ALJ and Review Judge need only determine what most likely happened.
25. The ALJ found, and the undersigned reviewer concurs, that it was more likely [than] not that Doris did not inflict bruising to herself, and that the bruising occurred because of the acts or omissions of [Suciu]. It is also more likely than not that [Suciu’s] records were re-written by [Suciu] for potentially self-serving reasons. Therefore, many of [Suciu’s] records, including the medication logs, incident reports, and other documents in those records, may be false, misleading,
3 As explained in detail below, former RCW 74.34.020(16) describes acts that constitute neglect. The ALJ also found that the elements of former RCW 74.34.020(16)(b) were not met because Suciu’s acts or omissions did not constitute a “clear and present danger” to Doris. AR at 45.
12 No. 55887-4-II
or otherwise unreliable. It is further found that [Suciu]’s, and her husband’s testimony, was not as credible as the testimony of the other witnesses in this matter.
26. These credibility findings are based on the following reasons:
1) [Suciu] and John both testified that Doris could move her left arm, hand, and finger during the time periods at issue in this case.
2) John testified at the hearing that the bruises on the right side of Doris’s face were caused by Doris biting down on a sponge about two (2) weeks prior to June 14, 2018. He also testified that Doris would rub her face on her pillow and this could cause the bruising.
3) [Suciu] testified that when she moved Doris using a blue pad, Doris’s arm or forehead would sometimes hit the wall, causing a “thump.”
4) Charlotte White is an RN and Nurse Practitioner who also provided care for Doris. She testified that Doris was unable to move her finger or hand by at least February 2018, because Doris was so contracted. Ms. White did not observe the bruises to Doris that were present on June 13, 2018. However, she testified that, given Doris’s contracted state, she would be shocked to see the bruising in so many different areas on Doris’s body and in various stages of healing.
5) Ms. Bishop testified that Doris could not have voluntarily placed her own left hand on the left side of her face. Ms. Stewart testified that she did not observe Doris move her own hands.
6) Ms. Bishop, Ms. White, and Ms. Stewart are all medical professionals, and each testified that Doris could not have caused the bruising to her own face. Ms. White testified that Doris’s face could not have been bruised by sleeping with something under her face.
7) The bruises observed by Ms. Bishop on June 13, 2018, were in various stages of healing, which means that they occurred at different times. This means that at least some of Doris’s bruises occurred prior to June 13, 2018.
8) Ms. Stewart saw that by June 20, 2018, Doris had no new bruises and her existing bruises were healing. Ms. Quirk also visited Doris on June 20, 2018, and saw that the bruises were healing and fading and that Doris had no new bruises.
9) [Suciu] and John both had a motivation to characterize Doris’s bruising as self-inflicted, because it was in [Suciu]’s interest to show that her acts or
13 No. 55887-4-II
omissions did not cause the bruising. Ms. Bishop, Ms. Stewart, and Ms. White are all registered nurses, with specialized training, who have no obvious motivation to provide misinformation or biased opinions. It is therefore found that Doris did not cause the bruising to herself. Although Ms. Bishop testified that Haldol can increase the risk of bruising, and Doris was regularly administered Haldol, every medical professional witness who was asked (besides John and [Suciu]) testified that the bruises could not have occurred as the result of lying on a pillow, sleeping with something under her face, or other similar behaviors.
AR at 3, 5-7.
The Board also entered multiple conclusions of law. Relevant here, the Board concluded:
15. To prove neglect in this case under RCW 74.34.020(12)(a), [4] the Department was required to prove three (3) basic elements by a preponderance of the evidence. These elements were: (1) [Suciu] had a duty of care toward Doris; (2) [Suciu] engaged in a pattern of conduct or inaction; (3) this pattern of conduct or inaction resulted in [Suciu’s] failure to provide the goods and services necessary to maintain Doris’ physical or mental health, or resulted in Doris experiencing physical or mental harm or pain. Pursuant to the Findings of Fact, as outlined above, the Department has proven each of these elements by a preponderance of the evidence.
16. [Suciu’s] negligent actions occurred from December 14, 2017, through June 13, 2018, when she ([Suciu]) caused bruising on Doris’s face by incorrectly cleaning Doris’s mouth, and by prying Doris’s mouth open for procedures that were not medically necessary. Specifically, [Suciu] neglected Doris pursuant to RCW 74.34.020(12)(a), because: (1) She ([Suciu]) had a duty of care toward Doris; (2) [Suciu] repeatedly caused bruising to Doris’s face by incorrectly cleaning Doris’ mouth and by prying Doris’ mouth open for procedures that were not medically necessary, even after being informed by Nurse Bishop, that [Suciu]’s actions were causing the bruising and were unnecessary for a hospice patient; and (3) [Suciu]’s actions resulted in Doris experiencing physical harm or pain as evidenced by Doris’s facial bruising that was documented by Nurse Bishop on December 14, 2017, December 26, 2017, April 11, 2018, May 2, 2018, June 6, 2018, and June 13, 2018.
4 Throughout its conclusions of law, the Board cited to RCW 74.34.020(12)(a). This appears to be a scrivener’s error. The Board plainly quotes and applies the standard from former RCW 74.34.020(16)(a), neglect of a vulnerable adult.
14 No. 55887-4-II
17. Additionally, the multiple bruises on Doris’s right shoulder, right hip, and right tibia, documented on June 13, 2018, also supported a determination that [Suciu] neglected Doris pursuant to RCW 74.34.020(12)(a). Specifically, the hearing’s medical testimony established that bruises on legs, hips, or shoulders are not typically seen on a bedbound patient, Doris could not have inflicted these bruises on herself, and these bruises occurred separately, and over a period of time in which Doris could only reposition with [Suciu]’s assistance. Therefore, Doris’s inability to move on June 13, 2018, along with the age, nature, and position of her bruises, demonstrated a pattern of conduct by this caregiver Appellant that resulted in Doris being bruised and injured, and substantiated [Suciu]’s neglect of Doris pursuant to RCW 74.34.020(12)(a).
18. The undersigned has considered the Initial Order, the Petition for Review of Initial Decision (Appeal), the Response, and the entire hearing record. The initial Findings of Fact are adopted pursuant to the modifications outlined above. The initial Conclusions of Law cited and applied the governing law correctly and they are adopted and incorporated as conclusions for this decision. Any arguments in the Petition for Review of Initial Decision (Appeal) that are not specifically addressed have been duly considered, but are found to have no merit, or to not substantially affect a party’s rights. The procedures and time limits for seeking reconsideration or judicial review of this decision are in the attached statement.
AR at 13-15.
C. Superior Court
Suciu petitioned for judicial review of the Board’s final order in April, 2020. The
superior court held a hearing, heard argument, and affirmed the Board’s final order.
Suciu appeals.
ANALYSIS
Suciu assigns error to the Board’s findings of fact 7, 8, 24, and 25, arguing that these
findings are not supported by substantial evidence. Suciu further argues that the Board erred
when it entered conclusions of law 15-18. We disagree.
15 No. 55887-4-II
I. LEGAL PRINCIPLES
The Administrative Procedure Act (APA), chapter 34.05 RCW, guides our review of the
validity of an agency order. RCW 34.05.570(3); Raven v. Dep’t of Soc. & Health Servs., 177
Wn.2d 804, 816, 306 P.3d 920 (2013). When reviewing an agency action, we sit in the same
position as the superior court, and apply the standards of the APA directly to the record before
the agency. Tapper v. Emp’t Sec. Dep’t, 122 Wn.2d 397, 402, 858 P.2d 494 (1993).
Under RCW 34.05.570(3)(e), we review the Board’s factual findings for substantial
evidence in light of the whole record. The appellant has the burden to prove error. RCW
34.05.570(1)(a). We review findings of fact for substantial evidence and we will uphold the
findings if they are supported by “a sufficient quantity of evidence to persuade a fair-minded
person of [their] truth or correctness.” Raven, 177 Wn.2d at 817 (quoting Port of Seattle v.
Pollution Control Hr’gs Bd., 151 Wn.2d 568, 588, 90 P.3d 659 (2004)) (internal quotation marks
omitted). “We do not reweigh evidence or judge witness credibility, but instead, defer to the
agency’s broad discretion in weighing the evidence.” Whidbey Envtl. Action Network v. Growth
Mgmt. Hr’gs Bd., 14 Wn. App. 2d 514, 526, 471 P.3d 960 (2020). The Board’s unchallenged
findings are verities on appeal. Karanjah v. Dep’t of Soc. & Health Servs., 199 Wn. App. 903,
907 n.1, 401 P.3d 381 (2017).
We review de novo an agency’s conclusions of law and its application of the law to the
facts. Raven, 177 Wn.2d at 817. We grant substantial weight to the agency’s interpretation of
the law on subjects within the agency’s area of expertise. Woldemicael v. Dep’t of Soc. & Health
Servs., 19 Wn. App. 2d 178, 181-82, 494 P.3d 1100 (2021) (published in part).
16 No. 55887-4-II
Former RCW 74.34.020(16) (2019)5 provides:
“Neglect” means (a) a pattern of conduct or inaction by a person or entity with [1] a duty of care that [2] fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that [3] fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or (b) an act or omission by a person or entity with a duty of care that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult’s health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.42.100.[6]
WAC 388-76-10400(3) provides:
The adult family home must ensure each resident receives: .... (3) The care and services in a manner and in an environment that: (a) Actively supports, maintains or improves each resident’s quality of life; (b) Actively supports the safety of each resident; and (c) Reasonably accommodates each resident’s individual needs and preferences except when the accommodation endangers the health or safety of the individual or another resident.
The standard of proof before the Board is a preponderance of the evidence. WAC 388-
02-485. “This standard means that it is more likely than not that something happened or exists.”
WAC 388-02-485.
5 RCW 74.34.020(16) has since been recodified in the same section with identical text. 6 The consequences of a neglect finding are severe because under RCW 74.39A.056(2)-(3), a person found to have neglected a vulnerable adult under chapter 74.34 RCW will be placed on a permanent registry and will not be permitted unsupervised access to vulnerable adults or children in any Department-administered programs and will not be granted a new adult family home license. See also WAC 388-76-10120(3)(d)(iii) and DSHS Secretary’s List of Crimes and Negative Actions for Use by All Programs Administered by DSHS (May 2022), https://www.dshs.wa.gov/sites/default/files/bccu/documents/Secretary%E2%80%99sCrimesListf orALLPrograms.pdf.
17 No. 55887-4-II
II. FINDINGS OF FACT
Suciu argues that substantial evidence does not support the Board’s findings that Suciu
exhibited a pattern of conduct or inaction that failed to maintain Doris’s physical or mental
health, or that Suciu failed to avoid or prevent physical or mental harm or pain to Doris. Suciu
specifically assigns error to the Board’s findings of fact 7, 8, 24, and 25. The Department argues
that substantial evidence supports each of these findings. We agree with the Department.
A. Finding of Fact 7: Nurse Bishop’s Instructions to Suciu on Brushing Teeth
Suciu argues that substantial evidence does not support the Board’s finding of fact 7 from
its final order. Specifically, she argues that there was no evidence that she “pried” open Doris’s
mouth. We hold that substantial evidence supports finding of fact 7. The Board found:
7. Ms. Bishop observed bruises to Doris’s face, and [Suciu] explained that she had to hold Doris’s mouth open to brush her teeth, which caused bruises. Ms. Bishop told [Suciu] that, because Doris was a hospice patient, she should use a sponge to wipe Doris’s mouth and teeth instead of a toothbrush, and should not pry Doris’s mouth open.
AR at 3.
In a June 26 declaration to APS, Nurse Bishop stated that on May 2, she had noted
bruising to Doris’s chin, forearms, and upper lip. According to Bishop, when Bishop asked
Suciu how it had happened, Suciu told Bishop it happened because she had to pry Doris’s mouth
open to brush Doris’s teeth. Bishop stated that she instructed Suciu to cease brushing Doris’s
teeth and not forcing care. Bishop then stated she subsequently saw significant bruising on Doris
on June 6 and 13 “consistent with . . . forced oral care.” AR at 191. APS investigator Quirk
testified that Suciu told the APS reporter that Doris’s bruises were caused by Suciu prying
Doris’s mouth open after she clenched down on a toothbrush.
18 No. 55887-4-II
Nurse Bishop then testified that when she asked Suciu about the bruising, Suciu stated it
was caused by holding Doris’s mouth open while Suciu brushed her teeth. “[Suciu] stated that it
was because they have to hold her chin and upper lip to pry her mouth open to brush her teeth.”
1 VRP at 69. Bishop testified that she tried to educate Suciu on not forcing Doris’s mouth open,
to forgo using a toothbrush, and that using a sponge to gently wipe a patient’s teeth was more
appropriate.
Nurse Bishop testified, however, that the word “pry” was “probably” Bishop’s word, not
Suciu’s because Bishop did not note it as a quote in her notes. 1 VRP at 106. Suciu also
testified that on June 2, 2018, Doris had clenched down on a sponge when Suciu was trying to
brush her teeth and that Suciu had waited for Doris to release the sponge.
Here, Nurse Bishop’s declaration to APS, her testimony consistent with that declaration,
and Quirk’s testimony all stated that Suciu told Bishop that she had forcibly opened Doris’s
mouth when trying to remove a toothbrush. Conversely, Suciu testified that Doris clenched
down on a sponge and that she let Doris release it in her own time. Taking these facts in light of
the whole record, including the negative credibility findings entered against Suciu, Suciu’s
inconsistent statements concerning Doris’s oral care, the consistent report and testimony of
Nurse Bishop, and the Board’s findings that Suciu was less credible than the other witnesses,
there is substantial evidence to support finding of fact 7 by a preponderance of the evidence.
B. Finding of Fact 8: Suciu Opened Doris’s Mouth to Assist Her Breathing
Suciu argues that substantial evidence does not support the Board’s finding of fact 8 from
its final order because she was allowed “manual treatment of airway obstruction as needed for
comfort” under the POLST. Br. of Appellant at 32. She also argues that she was actually giving
19 No. 55887-4-II
Doris medication. We hold that substantial evidence supports finding of fact 8. The Board
found:
8. [Suciu] observed Doris having episodes of agitation, when her face would turn red and she would stop breathing. During these episodes, [Suciu] would open Doris’s mouth to assist her breathing. This was not medically authorized because Doris was on hospice care and was to receive comfort measures only.
The record is replete with instances where Suciu stated Doris would become agitated. In
her reports, Suciu stated Doris needed help and that she opened the side of Doris’s mouth for
Doris to breathe through, after which Suciu gave Doris an extra dose of Haldol to calm her.
Then Suciu later testified that she did not pry open Doris’s mouth to help her breathe, but that
she administered medication.
Quirk testified that Suciu told Quirk that when Doris had a hard time breathing Suciu
would shake Doris and pry her mouth open, and then Doris would gasp for air. Quirk testified
that when she asked Suciu if she was trained to pry open Doris’s mouth, Suciu responded, “no,”
but then asked what she was supposed to do. 3 VRP at 70. Quirk testified that Suciu stated she
knew about the DNR but stated, “Did you want me to let her die? I was providing hospice.” 3
VRP at 70. Quirk testified that she asked if Suciu had been delegated authority to open Doris’s
mouth in such circumstances, and Suciu said no.
Doris’s POLST stated that in the event Doris stopped breathing she was to receive
“comfort measures only.” AR at 282. Nurse Bishop was asked about whether, in the context of
Doris’s POLST, what would constitute “comfort measures,” or “manual treatment of airway
obstruction as needed for comfort.” 1 VRP at 83. Bishop testified that “manual treatment would
be if someone was choking on food, is how I would interpret that. And you could do a . . . finger
20 No. 55887-4-II
sweep to remove, um, food.” 1 VRP at 84. Likewise, she testified that people on hospice are
“expected to die a natural death. And if they are not breathing, there is no reason why you would
open their mouth.” 1 VRP at 85. Hospice Nurse Stewart testified that forcing a mouth open is
not a comfort measure and is not standard practice for a hospice patient who has stopped
breathing.
Here, Suciu’s testimony conflicted with the medical records she recorded and the
statements she made to Quirk. The Board also found Suciu lacked credibility. In light of the full
record, Doris’s POLST, Suciu’s records, and Quirk and Bishop’s testimony, substantial evidence
supports the Board’s finding of fact 8.
C. Finding of Fact 24: Preponderance Standard Explained
Suciu next argues that substantial evidence does not support the Board’s finding of fact
24. We disagree. The Board found:
24. In entering these findings, it was not necessary to decide what actually happened, or to be persuaded beyond a reasonable doubt as to the true state of affairs, nor must the persuasive evidence be clear, cogent, and convincing. As the triers of fact, the ALJ and Review Judge need only determine what most likely happened.
AR at 5.
Suciu does not dispute that the Board properly applied the appropriate preponderance of
evidence standard. Instead, Suciu argues that the Board was not “entitled to pick and choose
between various hypotheticals as to which was most likely to have happened.” Br. of Appellant
at 33. Although the Board clumsily stated the preponderance standard as “what most likely
happened,” (instead of whether it is “more likely than not that something happened,” WAC 388-
02-0485) it is clear from viewing the whole record that the Board did not entertain supposition or
21 No. 55887-4-II
hypothetical, but instead relied on five days of testimony and months of medical records, and
made factual determinations. Suciu’s argument fails.
D. Finding of Fact 25: Doris Did Not Inflict Bruising to Herself
Suciu then argues that substantial evidence does not support finding of fact 25. We
disagree. The Board found:
25. The ALJ found, and the undersigned reviewer concurs, that it was more likely [than] not that Doris did not inflict bruising to herself, and that the bruising occurred because of the acts or omissions of [Suciu]. It is also more likely than not that [Suciu’s] records were re-written by [Suciu] for potentially self-serving reasons. Therefore, many of [Suciu’s] records, including the medication logs, incident reports, and other documents in those records, may be false, misleading, or otherwise unreliable. It is further found that [Suciu]’s, and her husband’s testimony, was not as credible as the testimony of the other witnesses in this matter.
AR at 5-6.
ARNP White, Nurse Bishop, and Nurse Angela Stewart each testified Doris lacked the
ability to self-inflict the bruising to her face, and none of them observed that Doris was able to
move her left hand or arm after November 2017. Doris was severely constricted in her arm and
leg movement.
Suciu admitted that she re-wrote records and shredded other papers. 5 VRP at 15. She
testified, “So, I re-described the situation in January of 2019 in more detail with, um – to have a
more accurate, um, information of what happened, according to my own recollection, and
shredded the other papers.” 5 VRP at 15. She further testified, “I looked over the old file and
wrote new pages, rewrote new pages, . . . to accurately describe my recollections, and then didn’t
save the old pages. I shredded the old pages. I didn’t realize that I had to keep them, which I’m
sorry about.” 5 VRP at 16. Suciu testified that she added notes to some parts of her reports
22 No. 55887-4-II
because she had a hard time reading the originals. She also testified that she “added more
information from memory.” 5 VRP at 8.
We do not review credibility determinations. Whidbey Envtl. Action Network, 14 Wn.
App. 2d at 526. Based on the nurses’ testimony, and taken in light of Suciu’s non-credible
records and testimony, substantial evidence supports the Board’s findings that Doris more likely
than not did not inflict bruising on herself.
Accordingly, we hold that substantial evidence supports all the Board’s contested
findings of fact. Suciu does not challenge the remainder of the Board’s findings and they are
verities on appeal. Karanjah, 199 Wn. App. at 907 n.1.
III. CONCLUSIONS OF LAW
Next, Suciu assigns error to conclusions of law 15, 16, 17, and 18. The Department
argues that the Board’s conclusions were supported by the findings of fact and not in error. We
agree with the Department.
We review de novo an agency’s conclusions of law and its application of the law to the
facts. Raven, 177 Wn.2d at 817.
A. Conclusions of Law 15 and 18
As an initial matter, Suciu assigns error to the Board’s conclusions of law 15 and 18.
However, Suciu does not argue these issue in her brief. Accordingly, we need not address them.
See Long v. Snoqualmie Gaming Comm’n, 7 Wn. App. 2d 672, 690, 435 P.3d 339 (2019) (“We
need not address an issue that a party does not argue in its brief.”).
B. Conclusions of Law
Suciu assigns error to conclusions of law 16, and 17. The Board concluded:
23 No. 55887-4-II
16. [Suciu’s] negligent actions occurred from December 14, 2017, through June 13, 2018, when she ([Suciu]) caused bruising on Doris’s face by incorrectly cleaning Doris’s mouth, and by prying Doris’s mouth open for procedures that were not medically necessary. Specifically, [Suciu] neglected Doris pursuant to RCW 74.34.020(12)(a), because: (1) She ([Suciu]) had a duty of care toward Doris; (2) [Suciu] repeatedly caused bruising to Doris’s face by incorrectly cleaning Doris’ mouth and by prying Doris’ mouth open for procedures that were not medically necessary, even after being informed by Nurse Bishop, that [Suciu]’s actions were causing the bruising and were unnecessary for a hospice patient; and (3) [Suciu]’s actions resulted in Doris experiencing physical harm or pain as evidenced by Doris’s facial bruising that was documented by Nurse Bishop on December 14, 2017, December 26, 2017, April 11, 2018, May 2, 2018, June 6,2018, and June 13, 2018.
17. Additionally, the multiple bruises on Doris’s right shoulder, right hip, and right tibia, documented on June 13, 2018, also supported a determination that [Suciu] neglected Doris pursuant to RCW 74.34.020(12)(a). Specifically, the hearing’s medical testimony established that bruises on legs, hips, or shoulders are not typically seen on a bedbound patient, Doris could not have inflicted these bruises on herself, and these bruises occurred separately, and over a period of time in which Doris could only reposition with [Suciu]’s assistance. Therefore, Doris’s inability to move on June 13, 2018, along with the age, nature, and position of her bruises, demonstrated a pattern of conduct by this caregiver Appellant that resulted in Doris being bruised and injured, and substantiated [Suciu]’s neglect of Doris pursuant to RCW 74.34.020(12)(a).
AR at 14.
As noted above, the Board’s citations to RCW 74.34.020(12)(a) are a scrivener’s error.
The Board plainly quotes and applies the standard from former RCW 74.34.020(16)(a), neglect
of a vulnerable adult. Although Suciu assigns error to these conclusions, she does not argue that
the Board cited to the wrong legal standard, but instead assigns error to the conclusions the
Board drew after applying the law as it was under RCW 74.34.020(16)(a). Reviewing these
conclusions de novo, we apply former RCW 74.34.020(16), which provides:
“Neglect” means (a) a pattern of conduct or inaction by a person or entity with [1] a duty of care that [2] fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that [3] fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or (b) an act or omission by
24 No. 55887-4-II
a person or entity with a duty of care that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult’s health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.42.100.
1. Nexus
First, Suciu argues that there is no nexus here between Doris’s bruising and her stay at
Suciu’s home. We disagree.
Although the Department is not required to prove causation, our Supreme Court has held
that RCW 74.34.020(12) requires a nexus between the injury and the conduct of the alleged
perpetrator. Raven, 177 Wn.2d at 831.
To be clear, the plain language of RCW 74.34.020(12) does not require that the alleged perpetrator of neglect be the only actor with problematic conduct. But the statute does require that the alleged perpetrator’s actions or conduct fail to provide goods or services, or avoid harm to the ward. This is not a tort causation standard, but it plainly requires a nexus.
Raven, 177 Wn.2d at 831.
The findings of fact clearly support that Doris’s bruising happened while in Suciu’s care.
ARNP White, Nurse Bishop, and Nurse Angela Stewart each testified Doris was severely
constricted in her arm movement, lacked the ability to self-inflict the bruising to her face, and
none of them observed that Doris was able to move her left hand or arm after November 2017.
25 No. 55887-4-II
Doris’s bruising had started to fade and heal when she was removed from Suciu’s home, and
Doris displayed no new bruising.7
Moreover, when Doris had a hard time breathing, Suciu would pry Doris’s mouth open,
which was not medically authorized. Suciu also told Nurse Bishop that she held Doris’s mouth
open to brush her teeth, which caused the bruising. But Suciu later gave a conflicting statement
to Quirk that the bruises were the result of Doris sleeping with a finger in her mouth. These
findings of fact all support the conclusion that a nexus exists between Doris’s injuries and her
stay and Suciu’s home.
2. Pattern of Conduct or Inaction That Fails to Provide for or Prevent Physical
or Mental Harm to the Vulnerable Adult
Suciu argues that there were only two incidents where Doris’s bruising may have been
caused by Suciu’s repositioning Doris, and that otherwise the June 2, 2018, tooth brushing
incident was the only other event that caused Doris’s bruising. Suciu argues that two or three
isolated incidents do not constitute a pattern under former RCW 74.34.020(16)(a), and that
Doris’s bruising was attributable to Doris’s frailty and isolated injury incidents during Suciu’s
repositioning Doris. We disagree for two reasons. First, the record shows that Doris had a
longer history of bruises than those in Suciu’s incident reports, which could not be attributed to
Haldol alone because of Doris’s inability to move. Second, those incident reports that Suciu
7 Doris’s apparent healing when she was removed from Suciu’s home is not, by itself, dispositive of a nexus. See Raven, 177 Wn.2d at 830-31 (describing that where a patient removed from a care home was apparently recovering in a rehabilitation facility, her death at the facility prevented the court from concluding what would have happened had the victim returned to the home; “The record gives no reason to conclude that pattern would not have continued even after [the patient] had returned from a temporary placement outside the home.”).
26 No. 55887-4-II
submitted, as well as her other records, are of questionable credibility because of her
manipulation of the records.
a. Pattern of Conduct or Inaction
Suciu argues that two or three isolated incidents do not a pattern make. We need not
determine how many incidents are required to create a “pattern” under former RCW
74.34.020(16)(a) because the record shows more than the two or three isolated incidents Suciu
argues caused Doris’s bruising.
To the extent we can rely on them, Suciu filed multiple incident reports describing
bruising to Doris in 2017: July 5, July 17-25, September 1, October 28, and December 20. Nurse
Bishop noted bruising to Doris’s head on December 14 and 26, 2017, and April 11, May 2, and
June 6 and 13, 2018. On June 13, Doris also had bruises to her shoulder, hip and tibia.
Moreover, Nurse Bishop saw the bruising after the tooth brushing incident and told Suciu
to modify her method of care, and then observed more bruising at a later checkup. ARNP White,
Nurse Bishop, and Nurse Stewart also testified that Doris’s bruises were in various stages of
healing, which suggested they had been caused over a period of time. AR at 3, 6, 41. From this,
we can conclude that a pattern of conduct or inaction existed on Suciu’s part that had a nexus to
Doris’s bruising under former RCW 76.34.020(16)(a).
b. Failure to Provide Goods and Services That Maintain Physical or Mental Health of a Vulnerable Adult or Fails to Avoid or Prevent Physical or Mental Harm or Pain to a Vulnerable Adult
Suciu next appears to argue that Doris’s bruises were caused by different events that
either do not amount to a pattern or are not attributable to Suciu’s conduct. Suciu argues that her
repositioning of Doris may have caused bruises on two occasions, and that Suciu’s manipulation
27 No. 55887-4-II
of Doris’s mouth when Doris struggled to breathe was a different event that caused bruising.
Suciu further argues the bruising could be attributed to Doris’s Haldol prescription.
But when taken together, in light of the record as a whole, these events show a pattern of
treatment by Suciu—whether from repositioning or other actions—that resulted in Doris’s
consistent bruising that went beyond what would have been expected from Haldol alone. As the
Board’s uncontested finding of fact explains, “[E]very medical professional witness who was
asked (besides John and [Suciu]) testified that the bruises could not have occurred as the result of
lying on a pillow, sleeping with something under her face, or other similar behaviors.” AR at 7.
Although Doris bruised easily because of her age and the administration of Haldol, the
pattern and location of the bruises, Suciu’s description to APS investigator Jones of opening
Doris’s mouth to open her airway, and Suciu’s inconsistent explanations for the bruising to
Doris’s face, all support the Board’s finding that Suciu’s “unnecessary” actions caused Doris’s
bruising. Accordingly, we conclude that under former RCW 74.34.020(16)(a), either Suciu
failed to provide goods and services to maintain Doris’s physical health, or Suciu failed to
prevent physical harm to Doris, which resulted in significant bruising to Doris. Thus, we
conclude that the Board’s conclusions of law 16 and 17 were not error.
4. Act or Omission That Demonstrates a Serious Disregard of Consequences of Such a Magnitude as To Constitute a Clear and Present Danger To the Vulnerable Adult’s Health
Next, Suciu argues that she did not commit an act or omission that demonstrated a serious
disregard of consequences in violation of former RCW 74.34.020(16)(b). We agree.
The Board made no finding that Suciu violated RCW 74.34.020(16)(b). Indeed, in
conclusion of law 17, the Board ruled that Suciu “demonstrated a pattern of conduct”—wording
taken directly from former RCW 74.34.020(16)(a), not (b). AR at 14. The Board also adopted
28 No. 55887-4-II
and incorporated the ALJ’s findings and conclusions from the initial order. AR at 14-15. And
the ALJ found no basis to conclude Suciu’s acts or omissions constituted a “clear and present
danger” to Doris under RCW 74.34.020(16)(b). AR at 45. Accordingly, we hold that although
Suciu neglected Doris under former RCW 74.34.020(16)(a), there was no finding of neglect
under (16)(b).
CONCLUSION
We hold that the Board’s findings of fact are supported by substantial evidence. We
further hold that the Board did not err in its conclusions of law and properly applied law to facts.
Accordingly, we affirm.
A majority of the panel having determined that this opinion will not be printed in the
Washington Appellate Reports, but will be filed for public record in accordance with RCW 2.06.040,
it is so ordered.
Worswick, J. We concur:
Maxa, J.
Cruser, A.C.J.
Related
Cite This Page — Counsel Stack
Adriana Suciu, V. Washington Department Of Social & Health Services, Counsel Stack Legal Research, https://law.counselstack.com/opinion/adriana-suciu-v-washington-department-of-social-health-services-washctapp-2022.