By Karlyn Barker
Washington Post Staff Writer
Tuesday, May 16, 2006; B01

The men and women in the photography class, all of whom have mental disabilities, were having lunch when Marsha H. Thompson arrived. The head of the District's mental retardation agency greeted several people by name, then noticed that one man's walker was broken. In a flash, she was on her cellphone, issuing urgent instructions to get it repaired.

"There are macro issues and micro issues," said Thompson, who had dropped by the program in Northeast during a long day of staff meetings and visits in the field. "This is one of those micro days."

Since taking over the troubled Mental Retardation and Developmental Disabilities Administration last spring, Thompson's major challenge has been to fix chronic, critical failings that have impaired care for hundreds of people, among the most vulnerable in the city.

The agency is responsible for delivering a range of services for the developmentally disabled, everything from help with shopping for some who live in their own apartments to 24-hour care for those in fragile health who live in group homes.

By Thompson's count, she is the 17th or 18th administrator in the past dozen years. Combined with high turnover among other government officials, this has made it difficult to carry out a consistent reform effort, she and others said.

"Change should have happened a long time ago," Thompson said in a recent interview. The agency's critics "want people to come in with the thunder and lightning of God because people's lives are at risk. And they are at risk. I understand the frustration."

She also shares it. When the District recently brought in two new contractors to take over operations at 16 group homes, Thompson had to turn to several D.C. agencies to help with the transition. She personally walked the out-of-state vendors through the laborious paperwork.

"Moving a bureaucracy," she said glumly, "is like punching your arm into a wall full of jello."

Though praised for her hard work and experience, Thompson said she, like her predecessors, has become a flash point for those who are fed up with the agency's performance.

"Marsha Thompson is more knowledgeable and better than what we've had -- but that's setting the bar really low," said D.C. Council member Adrian M. Fenty (D-Ward 4), who chairs the human services committee that oversees Thompson's agency.

The council voted last week to cut nearly $15 million from the mental retardation agency's budget, approving about $61 million instead of the $76 million requested. Fenty and other members complained that Thompson's agency had overspent its budget while providing "a deplorable level" of services.

Since 1976, the District has been mired in a federal class-action lawsuit stemming from its poor care of the mentally disabled, many of whom also have serious physical disabilities. There are concerns about group home deaths and injuries, health care, staff training and the city's failure to set up services that can be paid for with matching federal funds.

Thompson's agency has more than 200 employees and oversees about 90 residential and day program contractors and about 2,000 people who live in 360 group homes and some apartments.

She is working on several levels to achieve improvements, including hiring an expert to help the District get Medicaid funding for many of the costly services it now pays for with local money. She is beefing up case management and other internal oversight. And she hopes by August to move agency employees from three dreary, dilapidated buildings around the city -- one of which has no elevator for disabled clients -- into a single downtown office complex.

Thompson, 52, a sixth generation Washingtonian, has a degree in speech pathology. She left graduate school at Howard University to help the Washington Hearing and Speech Society with special education programs at St. Elizabeths Hospital and Forest Haven, then the city's institution for the mentally retarded.

Later, after marriage and three children, including a son with a developmental disability, Thompson worked in the group home system. In 1998, after her boss was convicted of Medicaid fraud involving the company's activities in Ohio, Thompson and a partner took over four group homes the firm had in the District. There were serious problems with care and upkeep at the homes, but Thompson said they "got things fixed and certainly made people's lives better."

After a divorce and a new marriage, Thompson began work for the mental retardation agency in 2002. With her unique perspective as an agency manager and former group home operator, she was a valuable resource two years later when the deputy mayor for children, youth, families and elders assumed operational control of the agency. She was named interim administrator in April 2005 and appointed outright by Mayor Anthony A. Williams (D) in December, at a salary of $105,000 a year.

Thompson's energetic, hands-on approach has pleased many advocates, group home operators and relatives of those with disabilities. They praise her commitment but say problems persist no matter who is at the agency's helm.

"We've had a revolving door scenario to fix a broken system," said Mary Lou Meccariello, executive director of The Arc of the District of Columbia, which provides a range of services to the developmentally disabled. "There are long-standing issues that would challenge anybody."

Sandy Bernstein, of University Legal Services, which represents former Forest Haven residents, said Thompson's need to get so personally involved in daily operations, including attending some individual service plan meetings for clients, "shows how dysfunctional the agency is."

And because decision-making for services is spread out among several agencies, including the Department of Health and the Department of Consumer and Regulatory Affairs, she said Thompson "lacks the authority to control everything that affects the people the agency is responsible for serving."

Thompson said the authority is "very fragmented," which is why she reports to a deputy mayor to help cut red tape. The agency recently brought in a chief operating officer to concentrate on day-to-day operations so Thompson can focus on strategic planning.

"A lot of people don't realize what it takes to support people safely," Thompson said. "It's a hard job, which doesn't mean it shouldn't be done right."