Sara Vartola wanted to be a good neighbor.
She didn't want to be nosy, but she wanted to be friendly and helpful. But over the months, the Bhatias next door became more reclusive and declined help. So, she'd wave when she saw them and contented herself with making sure they raised their blinds every day. It's what she could do.
When she heard 85-year-old Shakun Bhatia's screams on the evening of July 9, she had no idea what she was going to find.
The Bhatias' story is one that first responders and social workers are all too familiar with. Sometimes, there's only so much society can do to help those in need.
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The Bhatias had always been quiet neighbors. When Vartola and her husband moved into their Madera Highlands home a few years ago, they'd see Shakun Bhatia and her adult son, Rajan Bhatia, at the mailbox every so often. On a few occasions, Rajan asked Vartola's husband, George Hadjichristou, for help with the air conditioner or some other small project.
Over time, they learned the Bhatias were from India and Rajan was an engineer living in Washington state when he suffered a traumatic brain injury in a car accident on a trip to Arizona.
When they moved in, Vartola got the impression Shakun was taking care of Rajan, who was unable to work and always seemed somewhat disheveled. But when Shakun broke her hip a short time later, Vartola said the roles reversed. It was Rajan who began caring for his mother, who had begun showing signs of dementia.
"Over the last year, we saw them less and less. We saw Rajan mostly," Vartola said.
The couple came to realize the Bhatias had hired someone to deliver food and take them to doctor appointments.
On July 9, shortly before 8 p.m., the Sahuarita Police Department received a 911 call. Vartola and her husband heard Shakun screaming, and when they ran next door they found Rajan, 53, motionless in a chair. Vartola's husband was unable to move Rajan out of the chair to begin CPR.
Rajan was declared dead and Shakun was taken to the Crisis Response Center in Tucson after she begged to be given an injection "so she could die," according to police records.
A police sergeant was so appalled at the conditions inside the home he called the Town of Sahuarita's building inspector, who quickly condemned the two-story, four-bedroom home on East Mowry Wash Lane.
Officers found the home in "disarray and filled with bugs," according to a report. There were piles of garbage inside, rotten food smeared on the floors and open containers of spoiled milk throughout the house.
In his notes, the inspector wrote: "From the doorway looking into the front room, kitchen and foyer it was determined to be unfit for human occupancy based on insanitary conditions, containing filth and contamination including food-human feces-etc. and would constitute a hazard to the occupant per the 2018 International Property Maintenance Code Section 108.1.3."
Vartola was shocked and saddened when she saw the home.
"We assumed the house probably wasn't in great condition," because they'd noticed signs of neglect, she said.
Rajan had started leaving the garbage cans at the curb and weeds started to take over the yard.
"But we definitely didn't realize it was as bad as it was," she said.
There were others who did know, however.
Police, fire visits
Sahuarita Police and Green Valley Fire District crews were at the Bhatias' home four times from Aug. 9, 2018 to April 4, 2019. The following details were gleaned from SPD reports:
•Aug. 9, 2018: Sahuarita officers were dispatched to the home at the request of an Adult Protective Services worker who had not seen Shakun since June. She was worried because Shakun had medical issues and had missed several doctor appointments. The investigator noted she smelled a foul odor at the house and saw numerous bags inside and outside the home.
The responding officer found Shakun asleep in a wheelchair. Rajan told the officer his mother didn't have medical issues and said they missed her appointments because he wasn't allowed to drive. The officer observed flies and bugs in the home "due to the amount of piled trash in the residence." The officer reported his findings to APS.
•Aug. 17, 2018: Sahuarita officers were dispatched to the house because Rajan wasn't allowing GVFD in the home to medically assess his mother. GVFD had been asked to check on her by a doctor from United Healthcare Physicians. The same APS investigator who had called SPD on Aug. 9 informed officers she had to threaten to kick down the door Aug. 14 before Rajan would allow her to check on his mother. The investigator noted she was in the process of finding a company to clean the Bhatias' home. Rajan eventually allowed GVFD crews inside.
• Sept. 13, 2018: Sahuarita Police officers transported both Bhatias to a Tucson hospital to undergo court-ordered mental health evaluations. Because of privacy laws, it is unclear what happened after that point. Psychiatrists may file Petitions for Treatment depending on what they find. When filed, a judge may order treatment, either inpatient or outpatient.
•Oct. 13, 2018: Sahuarita officers were sent to the home because Rajan wasn't allowing GVFD inside to do a "lift assist" for his mother. He eventually allowed personnel into the home. The officer noted flies and bugs inside the home due to the trash piled up inside. "There was a foul odor as well inside the residence," according to his report. The officer contacted APS.
•April 4, 2019: Sahuarita police were dispatched to the home after two Neighborhood Watch members reported bags of groceries on the porch for several days. They reported seeing trash inside the home through a window, but no one answered the door. It was noted in the report that the occupants had "various mental health and medical needs."
The officer found Rajan outside and he denied that he or his mother needed medical help. He said he'd left the groceries outside because he was tired and couldn't bring them in. The officer reported that Rajan told him the same story about his car accident four or five times within a matter of a few minutes. When he allowed the officer inside to check on his mother, the officer noticed a foul odor, several containers of spoiled milk and trash "piled up all around the house/rooms along the perimeter." He also noted dirty dishes on every counter and old food containers that had been left out. The Bhatias told the officer that both of their refrigerators were broken and one of their two freezers was broken. They said they "had been mainly eating pizza from different restaurants."
"Rajan Bhatia advised that they had been in contact with Pima County Council on Aging, as well as any other organizations they could find, but no one had been out to help them," the report stated. "(They) both began asking me for help around the house."
According to the report, an APS investigator said they'd be out to the house within five days to check on the Bhatias and a Pima Council on Aging supervisor said that when they'd spoken with Shakun the previous month she denied needing help so they put her on a wait list.
According to the officer's report, he "urged (the supervisor) to change them from the wait list and send out resources as soon as possible. (She) said they would do their best."
"Rajan Bhatia thanked me several times and said that they would be OK until APS or the Council on Aging helped them," the report stated.
According to the Pima County Office of the Medical Examiner, Rajan died of a pulmonary emboli three months later. What happened from April 4 to July 9 is unknown.
Because of privacy laws, it will never be known what services, if any, were offered to the Bhatias or what help they accepted. It is also unknown what happened to Shakun following her trip to the Crisis Response Center the evening her son died.
Tasya C. Peterson, director of communications for APS, said the agency can neither confirm nor deny any involvement in any case.
Lisa Reams, president of programs and services for the Pima Council on Aging, said her agency is prohibited from discussing specific cases.
Speaking in generalities, Reams said PCA is not a crisis service. When someone calls seeking help and it's an emergency where safety is a factor, the council immediately calls APS. Otherwise, call-takers ask questions to ascertain how vulnerable the caller is. They are then prioritized and placed on a list to receive services.
There have been times when people have been placed on a list for 12 to 18 months and PCOA checks on them every 90 days to see if their circumstances have changed, Reams said.
Since November, the PCOA and APS have worked together to help adults in the most serious self-neglect cases in Pima County, said Jennifer Caragan, an intensive services specialist with the PCOA. So far, 30 clients have received intense, time-consuming help dealing with such issues as hoarding, safety and unsanitary conditions. The Emergency Case Management System program is a two- to three-month program. When finished, clients are typically stable enough to exit the program. The remaining clients are admitted to other programs.
Not everyone is willing to accept help, Caragan said.
If someone is competent, "we have to respect their life choices. Their homes may not be kept the way you or I would, but they have that right," she said.
Last year, APS officials told the Green Valley News that the state was asked to investigate 71 self-neglect cases in the Green Valley/Sahuarita area from July 1, 2017, to April 30, 2018.
In 31 cases, investigators found reason to believe the senior or vulnerable adult were neglecting themselves; 11 cases were still being investigated.
The neglect may be because of their own choice, or because they have a physical or mental impairment that makes them vulnerable and unable to protect or care for themselves, officials said.
On Friday, Peterson, the APS spokeswoman, said via email that APS doesn't have the authority to take custody of adults or control of their assets. If an individual’s capacity is in question, APS may have the adult evaluated by a physician who will determine and document whether they have the ability to make their own decisions, Peterson wrote.
The process to declare someone incapacitated requires court action, she wrote. If the physician determines the adult can no longer make decisions and manage on their own, APS will petition the court to appoint a guardian/conservator.
However, if the physician’s statement indicates that the adult can make their own decisions, the adult cannot be declared incompetent at that time, Peterson wrote.
Privacy rules prevented Peterson from addressing whether APS was behind the mental health evaluations conducted on the Bhatias in September 2018, or whether the agency sought to determine if the Bhatias were incapacitated.
Pima County Superior Court records do not reflect any recent guardian/conservator appointments in the case. They do show that Shakun was appointed her son's guardian following his car accident in October 2004, when he was in a coma. The guardianship was terminated in June 2005.
If someone is competent, APS tries to provide help in their home before exploring moving into a facility, Peterson wrote.
"The goal is to keep the person in the least restrictive environment as possible, which is often their own home."
Sydney Peters, one of two Neighborhood Watch members who called police in April, was unaware of Rajan's death, Shakun's hospitalization and the condemnation of the house until a reporter told him. He's angry.
The police department, fire department and APS should have made Neighborhood Watch aware that the Bhatias were in a vulnerable state, he said.
"I call it depraved indifference," Peters said. "Neighbors should have been alerted that something was going on in that home. If people in the neighborhood had known, they could've checked in on them."
Since moving to Madera Highlands from New Jersey 10 years ago, Peters said he has been surprised about the level of apathy he's encountered. People look at the Neighborhood Watch program as "something evil" and generally just don't seem to care about their neighbors' well-being.
"We live in communities with gates and where HOAs seem more concerned about the condition of someone's house than what's going on inside," he said.
Sahuarita Police Sgt. Michael Falquez and Green Valley Fire District Chief Chuck Wunder said privacy laws prohibit their agencies from discussing specific cases with anyone.
Wunder and Falquez said first responders often encounter people who decline help for a variety of reasons, including mental health issues such as depression.
There are a lot of people in Green Valley who are terrified that accepting help would ultimately lead to being removed from their homes, Wunder said.
"If somebody opens the door to help it may expose the complexity of the situation that’s going on there and they’re truly afraid that we’re going to take the first step to having them removed, and that’s frightening," Wunder said. "Commonly, our first step might be to reach out to their children or their loved ones and we’re often discouraged from making that phone call. If I call their son or their daughter, they’re afraid they are going to come get them and take them back to Michigan or wherever that is, or put them in a home, so they frequently discourage that phone call."
Paramedics often encounter patients who are competent to make their own decisions and yet refuse to take care of themselves because they're ready to die, Wunder said.
"Depression is a huge issue here and it can lead to self-neglect. 'I just don’t care anymore. I’ve lived long enough. My spouse left me and it’s time to go,’" Wunder said. "We see that kind of thing and those are the ones who become desperate and we have a hard time connecting with them. 'I don’t care anymore.' How do you respond to someone who says. 'I don’t care anymore?' Especially if there’s a mental capacity there."
Dealing with people who need help and can't or won't accept help – for whatever reason – is tough, he said. It's also difficult to be patient when the system doesn't respond as quickly as you would like.
"Firefighters are just wired to fix the problem. We go. We show up. We have a solution," Wunder said. "We have a culture here that we’re going to improve the situation so we take care of the spouse, we feed the dog, whatever, but it’s got to be better when we leave than when we arrived. Mental health doesn’t work that way."
A few years ago, GVFD invited APS to attend classroom training, Wunder said. During the training, the crews vented some frustration with APS caseworkers because they thought they moved too slowly, he said. APS workers explained the term "self-determination," and that people have rights, Wunder said.
"We started learning that people have a right to live with garbage all around them, they have the right to live the way they want," Wunder said. "Those things are frustrating, but we now have a better understanding of that. Now at least we know."
Falquez agrees that people can't be forced to accept help.
"We want to help people and give them the services they need, but everybody has constitutional rights, so we can’t force people to get mental health treatment," Falquez said. "We can only do so much. The system only allows for so much. We’re the greatest country on Earth and we have the greatest freedoms, so just because somebody is mentally ill doesn’t mean they lose their right to live their lives the way they want to."
Town of Sahuarita records show three homes have been condemned in Sahuarita over the last five years due to unsanitary conditions.
Just because someone lives in a $250,000 home doesn't mean they don't suffer from a mental illness or live in squalor, Wunder said.
"You never know who it’s going to be," Wunder said. "Most people would be surprised it could well be your neighbor. There are people who appear to be normally functioning adults outside, you see them at church, the local restaurants, and yet they live in conditions we would consider unacceptable because they have a mental illness. We can’t see that from the outside."
Wunder and Falquez said they strongly encourage people to get to know their neighbors so they'll be more comfortable asking for help when they need it and so people will be able to spot problems.
"I’d like to believe that here in our community, just because it is such a great community, we do a better job than some do. But it is hard to be a nosy neighbor. It’s a balancing act," Wunder said. "I think sometimes we perceive that first step of reaching out to somebody is being a nosy neighbor as opposed to being a friendly neighbor, and that’s unfortunate."
Vartola, the Bhatias' neighbor, said that after Rajan died, she spent time with the man the Bhatias had hired to deliver their food and drive them to appointments.
He told her that in recent months the Bhatias had begun refusing his help and would no longer allow him into their home, despite the fact they'd become friends. Looking back, he now believes it was because the house had fallen into such bad shape, Vartola said.
She also met some of the Bhatias' family members. They live back East and hadn't seen the Bhatias in 15 to 20 years.
It is now up to them to decide what happens to the house, she said.