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The Never-Ending Murder Case: How Mental Competency Laws Can Trap People With Dementia

As more Americans are diagnosed with the chronic disease, some find themselves in legal limbo.

One afternoon in the fall of 2019, bailiffs guided a gray-haired man in a green sweatshirt and shackles into a courtroom in Haverhill, Massachusetts. The 83-year-old’s eyes scanned the gallery, where two of his children sat near local reporters and TV news crews. Jose Veguilla was being charged with murder — but he didn’t know it.

This article was published in partnership with USA Today.

“You could tell he had no clue what was going on,” said his son, Henry Veguilla. “He was smiling for the cameras like he was at a birthday party.”

Jose Veguilla had developed dementia after a brain injury in 2018 and moved into a series of nursing homes. His children watched their once-docile dad — who would spend hours listening to Spanish sermons on cassette — grow paranoid and prone to anger. One roommate who lived with Veguilla, 76-year-old Robert Boucher, had been asking for weeks to change rooms. One evening, after Veguilla refused to take his medication, he lashed out. A nurse found him standing over Boucher’s bed, a blood-covered walker raised above his head. Boucher was rushed to the hospital, where he died of his injuries.

The county prosecutor recounted the details of the killing to the courtroom. But Veguilla’s face remained placid as he sat, listening to an interpreter translating the proceedings into Spanish.

A psychologist testified about her brief evaluation of Veguilla that day. “He doesn't know the day, the month, or the year,” she told the judge. “He does not remember myself, or his counsel. He has no memory of the circumstances surrounding today.”

Veguilla’s lawyer asked the judge to postpone the arraignment, given his client’s confusion. But the judge said she had no choice but to proceed with the charges. She ordered Veguilla to Bridgewater State Hospital — a prison-like facility ringed with barbed wire and run by the state Department of Correction. There, another psychologist would determine whether he was mentally stable enough to stand trial. If he was found “incompetent,” or unable to proceed with his case, the judge would order him to remain in the hospital until he was “restored.” That usually means prescribing psychiatric medication and therapy until someone understands what is happening enough to be prosecuted.

But dementia is not a mental illness. Veguilla’s memory would only get worse, no matter what medication they put him on. Like a growing number of older people across the country, Veguilla would be swept into a legal system that wasn’t built for someone like him. This restoration process can catch elderly defendants in a revolving door of jails and hospital wards for years, while their cases stall and their minds slip further from reality. As his children watched their father shuffle out of the courtroom that morning, they wondered, would his case ever be resolved?

There’s no national tally of how many people with dementia fall into this legal quagmire. Existing data suggests these cases are rare — just over 1% of people arrested for murder in 2021 were 65 years or older, according to an analysis by The Marshall Project of the most recent national crime figures.

But each case presents a grave dilemma for judges and prosecutors. Do they drop the charges for something as serious as murder, potentially against the wishes of the surviving family? Or do they keep pursuing a likely futile case? It’s the same quandary for cases involving many people with mental illnesses, when their disorders are so severe that they can never stand trial.

Experts fear cases like Veguilla’s are a mounting problem, as the number of people with dementia increases and more of them get entangled in the justice system. Some states have also noted an increase in resident-on-resident assaults in nursing facilities, which can lead to criminal charges.

Such serious violence is uncommon. But aggression can be a frequent side effect of dementia, often when someone is afraid. And if police get involved, courts are often ill-prepared to know what to do next.

A report last year from the American Bar Association, which surveyed legal professionals, healthcare workers and corrections staff nationwide, found one of the biggest problems in dealing with dementia was “the almost unbending insistence of the courts to seek restoration.” The authors recommended that people with dementia no longer be hospitalized for competency restoration at all, as it “has little chance of success [and] may be harmful.”

Instead, many healthcare workers and corrections officials said communities need more long-term nursing facilities with tighter security and well-trained staff. These homes could safely house people with a history of aggressive behavior, rather than locking them in jail or a psychiatric hospital — which may not be able to provide the specialized care they need.

Some facilities are trying to fill that gap. In 2021, MissionCare nursing facility opened a new home in Holyoke, in western Massachusetts, modeled after a similar home in Connecticut. Both facilities are designed to house residents who are often rejected from other nursing homes, with many transferred from state psychiatric hospitals or prisons. Both residences have waitlists to get in.

In multiple cases reviewed by The Marshall Project, older people with serious dementia were arrested and held for weeks or months in jail. Some were sent back and forth between jail and psychiatric facilities after being found mentally incompetent — transfers that can be traumatic for people with cognitive disorders.

In 2016, 84-year-old Don Rebello — a retired law librarian with dementia — stabbed one of his romantic partners, Erik Kleins, in their home in San Francisco. They were in a 25-year-long polyamorous relationship with a third partner, Fred Crawford, who was left with one partner dead and the other incarcerated.

When Crawford visited the San Francisco County Jail, Rebello would ask when Kleins was coming to pick him up. He had no idea where he was. He often forgot the PIN number to use the phone in the visiting room, his lawyer said, leaving the two sitting in silence with their palms against the glass.

Rebello spent two years passing between the county jail and a state psychiatric hospital before a court decided he could not move on with his case. He died in 2020, having finally been released to a secure nursing facility. His partner Crawford died one month earlier.

“From the day he was arraigned, I knew he could never be prosecuted,” said Rebello’s public defender Jennifer Johnson, of her client’s first court appearance. “It was just pointless, he was very sick. But there’s no legal pathway to avoid this.”

Long before Jose Veguilla developed dementia, he was a factory worker and father of five in Lawrence, Massachusetts. He had left his home in Puerto Rico in the 1950s for New York, where he met his wife, Maria. After ending up on disability, Veguilla filled his time cooking, challenging anyone to a round of dominoes, and playing his cuatro, a small guitar-like instrument.

A middle-aged man wearing a white shirt and sunglasses laughs with family members during a party, in a photo from the 1980s.

Jose Veguilla, center, at a family party in the 1980s, in Jersey City, N.J.

Maria moved into a nursing home in 2015, after she was diagnosed with dementia. Veguilla lived on his own until 2018, when he fell and hit his head. He was placed in a medically-induced coma and spent weeks in an Intensive Care Unit. Though he survived his traumatic brain injury, he left the hospital a changed man.

His children knew immediately that something was different. Veguilla started having “mini fits of rage,” his son Henry said, and hallucinations that someone was breaking into his room. Veguilla would phone his daughter, Olga Perez, saying the mafia was trying to kill him and asking her to come rescue him. “We kept saying, that's not our dad,” Perez said. “My dad was sweet. He was strict, but he wasn't an aggressive person.”

After his release from the hospital, Veguilla moved into the same nursing home as his wife. But that didn’t last. One night, after supper together in the nursing home dining room, Veguilla thought his wife was being kidnapped as staff led her to her room. He ended up restrained by multiple employees, and taken in an ambulance to the psychiatric unit of a local hospital.

His family had to find Veguilla a new nursing home, one that was nearby and open to housing someone with his history. Only one facility, the Oxford Rehabilitation and Health Care Center in Haverhill, agreed. Perez said they assured her they could handle her dad’s behavior.

But Perez was uneasy from the moment her dad moved in. On her first visit, it took 45 minutes for someone to greet her. Twice, she said, staff called her to tell her Veguilla had escaped onto the street. “When I walked through the door, I knew I didn’t want him there,” she said. “They weren’t being paid attention to.”

Federal and state records show Oxford has a track record of problems. The facility has a one-star rating (out of five) from the Centers for Medicare and Medicaid Services (CMS). From 2019 to 2021, the federal agency deemed Oxford a “special focus facility” for its “history of serious quality issues,” according to agency records. Oxford has been fined more than $100,000 over the last three years, according to CMS records. In August 2019, a resident reported they were sexually assaulted — but the facility failed to thoroughly investigate the allegation, according to an inspection.

Oxford did not respond to a request for comment. Oxford employees were being re-trained on how to investigate sexual assaults after the August 2019 incident, state inspection records say.

Court records show that Veguilla struggled after he moved into Oxford, where he was recorded wandering and threatening staff. But Oxford’s mental health employees never appeared to follow up with him after his initial intake, or develop any interventions to address his combative behavior, a state review found. It took four months for the facility to assign Spanish-speaking employees to help him when he was upset, state records show. The Centers for Medicare and Medicaid Services ultimately fined Athena Health Care Systems, which owns Oxford, nearly $16,000 over Boucher’s death.

Oxford has since performed a facility-wide audit to identify residents who are at risk of harming other residents, according to state inspection records. The facility told the state they were re-educating staff on creating individualized treatment plans, and that they would hold weekly behavioral meetings to prevent abuse.

In August 2022, a representative of Boucher’s estate sued Oxford and Athena. The suit claims Veguilla had a history of “violent outbursts” and that Oxford failed to provide “effective and person-centered care” to address them, or to stop the fatal beating of Boucher.

A spokesperson for Athena Health Care said she could not respond to questions, given the lawsuit. In responses filed in court, both Oxford and Athena have denied many of the allegations and said Boucher “provoked the attack.”

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The representative for Boucher’s estate and their attorney said they could not comment on an ongoing case. Boucher’s family could not be reached for comment. A jury trial for the civil case is scheduled for 2026.

An occupational therapist who worked at Oxford, Gayle Sinibaldi, testified that Boucher told her he felt threatened by Veguilla and asked repeatedly to be moved. According to the state review, Boucher also had “moderate cognitive impairment” and behavioral problems, and did not speak Spanish. Sinibaldi described him as outgoing and friendly, with a “very young attitude.” But his mood darkened the longer he lived with Veguilla.

“He literally begged me to get him out of there,” Sinibaldi said, in an affidavit included in the lawsuit against Oxford. “To this day, I cannot understand why his simple request to move to another room was not allowed… this man was a human being who they were ignoring.”

Boucher made the same plea to his fiancée, Beatrice Duchesne. The two met in 1987, she said, when he came into her salon for a haircut. Boucher moved into Oxford in 2019, after his leg was amputated from diabetes complications, and he was diagnosed with dementia.

Duchesne said she didn’t think Veguilla should be “let loose” after what happened. But she also blamed Oxford “because they put [Boucher] in a room with someone who was much more severely gone than Bob was.”

Remembering Boucher, she said: “I still have a message from him on my phone. ‘Beatrice, I love you, please get me out of this place.’ I listen to it every day.”

After a judge ordered Veguilla to Bridgewater State Hospital, his children worried about his safety, knowing the facility’s history. A 1960s documentary exposed staffers there bullying patients and force-feeding a man in their care. More recently, despite promised overhauls of the facility, the state Disability Law Center found officers over-relying on forced injections and “a pervasive culture of punishment and intimidation.”

Razor wire surrounds a brick building and courtyard.

Razor wire surrounds the Bridgewater State Hospital in Bridgewater, Mass. in July 2017. Jose Veguilla was one of the oldest patients there.

In a response to the Center's report, state Correction Commissioner Carol Mici disagreed with the group’s allegations, and noted that the facility’s use of restraints and seclusion had decreased significantly.

Veguilla had difficulty adapting to Bridgewater, where he was among the oldest patients, court documents show. He touched other patients’ belongings, stood near them as they slept, and banged on the doors. Once, officers had to pin him down and forcibly inject him with medication. He was threatened by other patients and even assaulted, court filings said. “I am really not sure if this facility is best for a man of his age,” one psychologist wrote.

“We came out crying every time,” his daughter Perez said, of their visits in a crowded room with other patients. “It was like, ‘Oh my god, my dad’s a convict. He can’t survive there.’”

Timothy McGuirk, the deputy director of communications for the Massachusetts Executive Office of Public Safety and Security, which oversees the Department of Correction, said he could not comment on Veguilla’s case, because of privacy laws. He noted that the department “ensures all housing assignments align with a person’s medical, security and rehabilitative needs” and that Bridgewater offers extensive programming and “trauma-informed treatment.”

In November 2019, a court-appointed psychologist confirmed what Veguilla’s children believed: “Mr. Veguilla is unlikely to ever be restored to competence,” she wrote in a report. “His dementia is severe, and the nature of such a disease is chronic and progressive. He truly has no idea as to why he is at [Bridgewater].” Sometimes, Perez said, her dad thought he was at school, or back in Puerto Rico, or at home with his wife, who died in 2020.

But the judge did not dismiss Veguilla’s charges. Instead, every few months, the court convenes to discuss his case. A judge receives the update that Veguilla still has severe dementia and cannot proceed. And they agree to have the same hearing several months later. The hearing in January lasted less than 60 seconds.

Boucher’s girlfriend, Duchesne, said prosecutors have mailed her letters alerting her of each upcoming hearing. But she doesn’t see the point in attending. “Why should I go? I don’t think I’m going to find out anything about Bob,” she said.

A spokesperson for the Essex County District Attorney’s office said he could not comment on an ongoing case.

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“How long is it going to take?” asked Perez. “I don’t understand what they’re getting out of this.”

The U.S. Supreme Court ruled in 1972 that people accused of crimes can only be detained for the “reasonable amount of time” needed to determine if their competency can be restored. But the justices didn’t define “reasonable.” Laws vary from state to state — some have no time limit, others say you can hold people for as long as their prison sentence would be. In Massachusetts, courts must dismiss charges after the amount of time someone would be eligible for parole — which, in murder cases like Veguilla’s, is never. (Judges have the discretion to do so earlier.)

In 2009, Laura Lundquist became the oldest murder defendant in Massachusetts history at 98 years old, after allegedly suffocating her 100-year-old roommate Elizabeth Barrow in a Dartmouth nursing home. Lundquist spent years in a state psychiatric hospital until she died in 2017, with second-degree murder charges still pending.

The victim’s son, Scott Barrow, told reporters in 2014 that he disagreed with prosecuting Lundquist. “It's just an awful thing that happened,” he told the Associated Press. “How could she be held accountable for this when she's not in her right mind?”

Barrow tried to sue the nursing home, who he blamed for failing to protect his mother. But his case was initially barred from court, due to an arbitration clause that shielded the facility from legal consequences. (The arbitration was later vacated and Barrow settled with the home’s insurance company.) Oxford has used a similar argument in its response to the Boucher lawsuit.

Dementia experts say such assaults are often preventable, with adequate staffing, de-escalation training and programming for people with memory loss. But when the worst happens, it can be individuals like Lundquist who are held responsible.

Gerontologist Eilon Caspi, an assistant research professor at the University of Connecticut, has studied hundreds of incidents between residents at long-term care facilities. These interactions are likely to increase, he said, as nursing homes reach crisis levels of understaffing.

“It’s not that people with dementia are inherently aggressive,” Caspi said. “Their emotional, social and physical needs are not being met. They’re reacting in the best way they have when they are living with a serious brain disease.”

An older man sitting near a table in a hospital facility wears a black beanie and a black and blue jacket. His daughter, sisters, granddaughter and son surround him to pose for a photo.

Jose Veguilla, center, with his daughter Olga Perez, far left, and other family members during a visit in May 2023, at the Worcester Recovery Center and Hospital in Worcester, Mass.

Veguilla’s attorney filed a motion at the beginning of the pandemic, asking the court to drop the criminal charges or to transfer Veguilla, given the unlikelihood that he would ever be well enough for trial. The judge agreed to move him to Worcester Recovery Center and Hospital, a more therapeutic facility run by the Massachusetts Department of Mental Health. But they did not dismiss his charges. Veguilla is now also under a civil commitment order to remain in state custody.

The new facility is an improvement, Perez said — Veguilla has his own room and the nurses take good care of him, playing him Spanish music and wheeling him into the courtyard. But it’s still a locked-down facility. When his children visit once a month, they are patted down as though they are entering a prison. They are not allowed to enter his room, share a meal, or spend more than 45 minutes with him. A spokesperson for the state Department of Mental Health declined to comment.

Even if the court dropped the charges, Perez isn’t sure she could find someplace better. “We don’t want him in a nursing home because we don’t trust nursing homes now,” she said.

Veguilla’s condition deteriorated in January, forcing Perez to start thinking about her father’s end of life. The family is hoping that in his final months, the murder charges will be dismissed and Veguilla will be moved to a hospice care facility closer to home. The court and prosecutor have yet to agree.

“At least he's not suffering — he doesn't know what happened,” Perez said. “We suffer because we know what happened, and we see where he’s at. It adds a profound sadness.”

Meanwhile, Veguilla’s criminal case staggers on. At the end of May, an attorney appeared in front of a judge in a courtroom in Salem, standing in for both the prosecution and the defense. “Mr. Veguilla has been found incompetent,” the attorney told the judge, who checked her file: it was the same finding since he was first arraigned in 2019. She set the next court date for September and the hearing adjourned.

Data reporter Weihua Li contributed to this story.

Christie Thompson Twitter Email is a staff writer reporting on mental health, solitary confinement, and prison conditions. Her investigative series with NPR examining violence in double-celled “solitary confinement” won a George Polk Award for Justice Reporting and was a finalist for an IRE Award and the John Bartlow Martin Award.