POCOMOKE CITY -- Police and the shocked residents of this small Worcester County town are awaiting the results of an autopsy to determine if a 91-year-old woman died naturally or was given a lethal dose of a powerful painkiller at the nursing home where she had lived since last fall.
The body of Maidie Lang Shay, who died Jan. 29 at Hartley Hall Nursing Home here, was exhumed yesterday morning in a cemetery outside this Eastern Shore town near the Maryland-Virginia line and was taken to the state medical examiner's office in Baltimore, where tissue samples were to be tested for traces of the morphine-based painkiller Roxanol.
Although a nursing home physician originally listed the cause of death as respiratory failure brought on by pneumonia and other natural illnesses, facility administrators and police began to suspect she may have been the victim of a mercy killing after a bottle of Roxanol was discovered Feb. 6 in an office at the nursing home.
Roxanol is a potent painkiller. Federal law requires that it be kept under two separate locks and that it be administered only by a licensed doctor or nurse according to a doctor's prescription, said Louis Huber, president of Housing and Health Services Inc., the Baltimore firm that manages Hartley Hall.
Mr. Huber said yesterday that although Mrs. Shay was terminally ill when she was moved to the nursing home in October, she was not in pain and was not authorized to receive Roxanol.
Authorities have not said how a Hartley Hall administrator came to find the one-ounce bottle of Roxanol, but sources close to the investigation said an employee either discovered the drug or knew where it was kept and told officials.
Mr. Huber said an internal investigation began immediately. As part of the investigation, Karen Alpaugh, the home's director of nursing, was asked to take administrative leave.
Mr. Huber confirmed that Mrs. Alpaugh, who had been with Hartley Hall since last April, resigned immediately on her own accord.
Soon after she quit her job, three other staff workers -- a registered nurse and two licensed practical nurses -- were placed on administrative leave. So far, police have filed no charges.
Mrs. Alpaugh had worked at similar nursing homes in nearby Princess Anne and Salisbury and was fully licensed, according to Mr. Huber.
Mrs. Alpaugh could not be reached for comment.
Since Mrs. Shay was the sole nursing home resident to have died since the drug was found, hers was the only body exhumed, Mr. Huber said.
Lt. Rick McGee, commander of the Berlin Maryland State Police barracks, said police and the Worcester County state's attorney's office ordered the post-mortem "to allay fears and reduce panic" that had arisen in the Lower Eastern Shore community surrounding rumors that a mercy killing had taken place in the nursing home.
Lieutenant McGee said Mrs. Shay was from the Greenbackville area of Virginia's Eastern Shore, and that he had been in touch with her relatives.
He said the results of the post-mortem would decide what path the case will take.
"If there are traces [of the drug], we have a terrible question to answer," he said. "If there are no traces, it may have been sloppy administrative procedures."
Nursing home officials said they reviewed the facility's records over the last three years but found "no statistical aberration" to indicate an unusual death rate. Mr. Huber said that for a facility its size, it was common to have a death every 15 to 20 days.
Hartley Hall was opened in 1953 to care for the elderly. Sixty-six of its 69 beds are currently occupied, and the facility has been a mainstay of local employment for decades.
Pocomoke City Police Chief P. Frank White said he heard rumors last month that patients were being ill-treated at Hartley Home. An investigation failed to substantiate the street talk, he said.
When they discovered the drug in an office where it should not have been kept, nursing home officials contacted state authorities.