She choked, had gangrene in her leg and, according to the coroner, ants may have infested Givens' body through her feeding tube while she was alive.
If it hadn't been for the coroner, Fleming probably would have thought she died a natural death.
But in Arkansas, bodies no longer go straight from the nursing home to the funeral home as they do in other states: a coroner must be called in. If he suspects neglect or , the death is referred for investigation.
Pulaski County coroner Mark Malcolm pushed for the unusual Arkansas law the first year it took effect. He examined Givens' body and other suspicious nursing home deaths.
"They had lost incredible amounts of weight, they were dehydrated, malnourished, weight loss, bedsores that were all over their body," says Malcolm.
But what happens after a coroner flags suspected mistreatment?
Iowa Republican Sen. Charles Grassley asked the General Accountability Office to find out, using the Arkansas experience.
"GAO investigators found state inspectors understated or overlooked serious problems and failed to hold nursing homes accountable for some neglect deaths," says Grassley.
In fact, if it hadn't been for the coroner and Medicare fraud investigators, the nursing home that cared for Givens might have gotten off the hook, because state inspectors ruled the home provided appropriate care.
The GAO says too often, state regulators go easy on offending nursing homes -- not just in Arkansas, but nationwide.
Arkansas' state inspection agency says despite what the GAO says, they're meeting expectations outlined by federal criteria.
There's a suggestion that maybe whatever criteria you're using is not working properly.
"Could be, could be," says Julie Munsell of the Arkansas Department of Human Services. "I absolutely think that the process can be strengthened, and anytime we see evidence of that we're going to do what we can to strengthen it."
But in Little Rock, just knowing the coroner is watching seems to have made an impact. Three offending homes have closed, questionable deaths are dropping, and once-rampant bedsores are now rarely seen.
So what does that tell Malcom?
"That tells me they know we're coming," says Malcom.
That's about the only comfort Monica Fleming finds these days.
"I just hope that nobody else have to go through this, I really do," says Fleming.
She hopes the horrible circumstances of her mother's death have made nursing homes safer for others.