California regulators have conducted only cursory investigations into hundreds of cases of suspected violence and misconduct allegedly committed by nursing assistants and in-home health aides over the past decade, state officials concede - putting elderly, sick and disabled patients at risk.

State investigators are opening and closing investigations into suspected abuse without ever leaving their desks, the Center for Investigative Reporting and KQED have found. In some instances, caregivers who have sexually assaulted or abused patients have retained their licenses and moved to other facilities.

An estimated 160,000 nursing assistants and in-home health aides are employed throughout California. These workers - all regulated by the state Department of Public Health - are certified to work in hospitals, nursing homes, mental health facilities, developmental centers and private homes.

In 2009, the Department of Public Health ordered its investigators to dismiss nearly 1,000 pending cases of abuse and theft after officials determined that the swelling backlog had become a crisis. Since then, the overwhelming majority of allegations of abuse and misconduct have been closed without action. The state also has dramatically reduced the number of license revocations for aides suspected of abuse and misconduct.

And it mostly has stopped referring cases to the California Department of Justice for possible prosecution, according to state prosecutors and the Department of Public Health.

For some who have worked in the system, the state has abandoned its duty to protect the vulnerable.

"I would tell anybody, do not count on the government taking care of you," said Brian Woods, former director of the Department of Public Health's office in West Covina (Los Angeles County).

Hundreds of cases

From 2004 to 2008, the state's health regulators accumulated more than 900 cases, including allegations that involve suspicious deaths.

"I was appalled," said Marc Parker, who was the Public Health Department's investigations chief for much of the past decade. "There were hundreds and hundreds and hundreds of unassigned, uninvestigated complaints in file drawers."

Then, on top of their normal workload, investigators were ordered by supervisors in Sacramento to begin clearing the backlog at a rapid pace, until nearly all the cases were dismissed by 2011. On average, cases had lingered for two years before they were cleared.

In interviews, state officials said they were tackling the problem. Dr. Ron Chapman, director of the Department of Public Health, said the backlog of cases was "inexcusable (and) should not have occurred."

"We've made a lot of progress since then," he said. "So today, any complaints that come in, they get screened within 48 hours, and we're not building a backlog."

Little is known about these cases because they were not fully investigated. But internal case logs kept by the Department of Public Health offer a chilling, yet faintly detailed outline of allegations - including suspicious deaths, severe injuries, numerous sexual assaults, egregious neglect and theft of belongings.

Vague information

One log entry lists a caregiver who allegedly "hit, peed on and seduced" a patient, but does not list a facility, city or county. More than 230 log entries simply read "physical or sexual abuse," but little else beyond a date and county where the alleged incident took place.

Public health regulators have all but stopped alerting the state attorney general's office of patient deaths alleged to involve abuse. From 2007 to 2009, the department referred a total of 88 deaths to prosecutors for investigation into elder abuse, according to figures from the attorney general. During the following three years, that number dropped to 14.

One case that has remained unsolved is the suspicious death in 2006 of Elsie Fossum, a 95-year-old woman who lived at Claremont Place Assisted Living in Southern California. Although she had been found severely injured on the floor of her bedroom, the Department of Public Health dismissed it as an accidental fall from a bed. The department closed the abuse allegation in February, classifying it as unsubstantiated.

Criminal inquiry

With injuries to her mouth so severe that she stopped eating and drinking, Fossum died of dehydration in a hospice three weeks after she was found injured. A nursing assistant at the facility who was caring for Fossum at the time of her injuries - and who had made repeated disparaging remarks about her, according to state records - quit soon after the injuries and took a similar job at a nearby facility.

Now, seven years after Fossum died - and following questions from reporters - the Los Angeles County Sheriff's Department has opened a criminal inquiry into the death. The case remains unsolved, and the nursing assistant has not been charged with a crime. She did not respond to requests for comment by phone or at her home.

Under the administrations of Govs. Arnold Schwarzenegger and Jerry Brown, the number of nursing assistants and in-home health aides removed from the job for crimes against the sick and vulnerable has declined sharply.

In 2006, the department revoked or denied a caregiver's certification in 27 percent of complaints it investigated. That figure shrank to 7 percent three years later.

No action taken

Meanwhile, the number of cases closed without action has soared. Statewide, public health investigators in 2012 finished 81 percent of their cases without taking action against an accused caregiver, up from 58 percent in 2006.

The Department of Public Health is fixing how it handles allegations against nursing assistants, Anita Gore, an agency spokeswoman, said in a statement, "Organization and operation of the investigations section, including Southern California, are currently being addressed."

State officials said they can't explain why there has been a steep drop in the number of abuse deaths forwarded to law enforcement.

"We don't understand that decline in numbers," said Chapman, the public health director. "It's very concerning to me, and we're looking into it."