Doris Coulson was admitted to Hillview Post Acute and Rehabilitation Center in Little Rock, Arkansas, in January 2016 after Parkinson's disease left her at risk of choking when she swallowed. That April, the facility's operations were taken over by Skyline Healthcare, a New Jersey-based company owned by Joseph Schwartz that was rapidly acquiring nursing homes across the country.
Coulson's medical records were marked "NPO" — nothing by mouth. In September 2016, a nursing assistant found her unresponsive and hanging off the side of her bed. She was taken to a hospital in a coma and died several days later. The chief cause of death was aspiration pneumonia, according to her death certificate. "The doctors said they found scrambled eggs in her lungs," said her daughter Melissa Coulson.
The family filed a lawsuit against Skyline and Schwartz, alleging that cost-cutting at Hillview left Coulson without the care she needed. A judge in 2020 awarded nearly $19 million in damages, but the family has never been able to collect. Schwartz had relinquished all of his property in Arkansas, leaving nothing for the family's lawyer to seize.
In a separate case, federal prosecutors in New Jersey charged Schwartz with orchestrating a $39 million payroll tax scheme connected to his nursing home empire. He pleaded guilty last April to failure to pay IRS taxes withheld from employees and failing to file a financial report for his employees' benefit plan. A federal judge sentenced him to three years in prison, but he served just three months.
In November, President Donald Trump granted Schwartz a full pardon, negating his criminal conviction. The pardon was part of a series of clemency decisions that have benefited well-connected defendants, including political allies with access to the White House and individuals who had spent heavily on lobbyists.
What the Right Is Saying
Conservative defenders of the pardon have argued that clemency is an established presidential power and that Schwartz had already served time for his crimes. They note that he pleaded guilty and accepted responsibility, and that the pardon allows him to move forward with his life.
Some supporters have pointed to the complexity of the civil cases, noting that Schwartz disputed liability and argued that other parties — including a company that took over facilities — bore responsibility for patient outcomes. His lawyers noted that he was self-representing, in poor health and isolating during COVID-19 when the civil case proceeded.
Defenders of the administration's clemency decisions have emphasized the president's authority to grant pardons and argued that second chances are consistent with conservative principles of redemption and limited government intervention in individuals' lives.
What the Left Is Saying
Progressive advocates and Democratic lawmakers have criticized the pardon as part of a broader pattern of clemency decisions that favor wealthy defendants with political connections. They argue that the pardon undermines accountability for corporate negligence in healthcare settings.
Consumer advocacy groups have pointed to the human cost of Schwartz's business practices, noting that patients died or suffered harm while the company prioritized profit over care. The Coulson family's inability to collect any damages despite a court judgment has been cited as evidence of a system that allows wealthy individuals to escape the consequences of negligence.
Lawmakers have also raised concerns about the broader implications for nursing home regulation, arguing that pardons like Schwartz's signal to corporate owners that serious failures in patient care will not result in lasting consequences.
What the Numbers Show
Schwartz was sentenced to three years in prison for the payroll tax scheme but served only three months before receiving a presidential pardon. He was convicted of failure to pay $39 million in payroll taxes withheld from employees and failing to file a financial report for his employees' benefit plan.
The Coulson family was awarded $19 million in damages in 2020 but has collected zero. At least three multimillion-dollar judgments awarded to grieving families remain unsatisfied.
Skyline Healthcare's nursing home empire collapsed by 2018, with much of the chain shutting down. The company expanded rapidly before its financial unraveling.
Trump has granted clemency to several figures in major healthcare fraud cases during his second term, including commuting the sentence of Philip Esformes, a Florida nursing home magnate convicted in a scheme involving about $1.3 billion in fraudulent Medicare and Medicaid claims.
The Bottom Line
The pardon of Joseph Schwartz illustrates the tension between presidential clemency power and accountability for corporate negligence in healthcare. While the pardon wiped away Schwartz's criminal conviction, it does not affect the civil judgments awarded to families of patients who died under his care — judgments that remain largely uncollectible.
The case raises questions about the balance between second chances and accountability for actions that resulted in patient harm. Families like the Coulsons continue to seek recourse, though legal options remain limited.
What to watch: Whether Congress or state regulators take additional action on nursing home accountability, and whether other pardon recipients face similar civil liability efforts. The nomination of Benjamin Landa as ambassador to Hungary, who co-owns nursing homes facing a federal audit alleging $31 million in Medicaid overbilling, remains under scrutiny.