By Scott Higham and Sari Horwitz
Washington Post Staff Writers
Monday, September 10, 2001
Second of four articles
Bent over in her wheelchair, her spine twisted by scoliosis, NickiColma Spriggs died at age 15 in the hallway of a Delaware nursing home on Thanksgiving Day 1998. Her body looked like an upside-down L.
A child of the District, Nicki had been sent to Delaware in 1992. During the next six years, child protection workers who were her guardians under D.C. law and a federal court order failed to monitor the curvature of her spine and promptly arrange corrective surgery. Her back pitched sideways, slowly and painfully, until it was set at a right angle, with her head tipped at the side of her body.
"We really didn't pay attention to the children who were sent to live outside the District, and that's sad for me to say, because I was involved," said Pablo Ruiz-Salomon, a former social worker at the D.C. Child and Family Services Agency who supervised Nicki's foster-care case during the last year of her life. "By the time we started to look at that facility and others, and scrutinize what was going on with Nicki, it was too late."
What happened to Nicki Spriggs, one of 229 D.C. children who died from 1993 through 2000 after they or their families came to the attention of the child protection system, exposes the many ways in which the system can fail to protect abused and neglected children. Nicki is among 40 children who lost their lives after government workers failed to take key preventive actions or placed the children in unsafe homes or institutions, a Washington Post investigation found.
Even though Nicki had a court-appointed attorney, three D.C. Superior Court judges, four agency supervisors and eight different District social workers assigned to her case, she was visited just twice during the six years she spent in Delaware. A surgeon there examined Nicki in 1992 and scheduled a follow-up appointment for six months later. But he did not see her then, and he did not see her again for six more years.
Finding safe places for severely disabled foster children like Nicki has been a decades-long problem in the District. Child protection officials are forced to look beyond the city to such states as Florida, Pennsylvania and Delaware, where institutions and nursing homes have built wings and added floors to capture the lucrative market in hard-to-place foster-care children.
"The kids were basically dumped," said Jerome G. Miller, who was chief of Child and Family Services from 1995 to 1997. "They were stashed and forgotten."
When Nicki came under the protection of the District in 1990 -- after her mother had neglected her -- a nursing home near the Delaware Bay with a new 36-room pediatric wing seemed the perfect place for the disabled girl from Northeast Washington.
Then-D.C. Superior Court Judge Gladys Kessler signed the transfer papers in 1991. Nicki would live at the Harbor Healthcare and Rehabilitation Center in Lewes, Del., a three-year-old private, for-profit facility with 180 beds. Such care usually costs at least $65,000 a year in Medicaid funds. D.C. agency social workers would be responsible for reporting to the judge on Nicki's condition and progress.
"It was always worrisome, sending these children out of the District," Kessler, now a U.S. District judge, said in a recent interview. "You have to rely on the agency to keep track of them, and they just wouldn't do it."
On Jan. 30, 1992, Nicki made the 101-mile trip to Lewes. She was 8 years old with the mind of an infant, unable to walk or talk or eat on her own. She had cerebral palsy, spastic quadriplegia, scoliosis and severe mental retardation.
She also had a savior: her grandmother, Willie Mackall, 53, who tried to make up for the absence of her daughter. Twice a month, Mackall made the two-hour journey to Lewes, her bus fare paid by Harbor Healthcare. She would take Nicki outside in her wheelchair, pushing her down hills and finding places where the two could watch flags snap against metal poles in the bay breeze.
Shortly after her arrival, Nicki was examined by Kirk W. Dabney, an orthopedic surgeon at the Alfred I. duPont Hospital for Children in Wilmington. Dabney wrote in a medical report that the curvature of Nicki's spine measured 33 degrees, a moderate arch. He scheduled follow-up exams to take more X-rays, monitor her spine and examine her wheelchair.
"She will continue to have reevaluation on a six-month basis with X-rays of her spine and pelvis," Dabney wrote in a Sept. 14, 1992, report.
But that did not happen.
A Succession of Social Workers
Soon after Nicki went to Lewes, her social worker left the case, notifying the next worker: "The case is stable and intensive services [are] no longer required."
Within two years, Judge Kessler was named to the federal bench and left Nicki's case. By the end of 1994, Nicki's next social worker had come and gone without visiting Nicki and had failed to file a report updating Kessler's replacement, then-Superior Court Judge Colleen Kollar-Kotelly, court records show.
In 1995, Child and Family Services assigned a new social worker to the case, Laura Hoffman. That year, Hoffman traveled to Delaware to visit Nicki. It would be three more years before another D.C. social worker would visit her.
Hoffman, a year out of college, wrote to the judge that the facility was "clean and well managed." Her report did not mention the condition of Nicki's spine. Several months later, Nicki's case was transferred to yet another social worker.
By the mid-1990s, D.C. Child and Family Services had become known as one of the most chaotic child protection agencies in the nation. A federal judge assumed direct supervision of it in 1995. He named his own director, Miller, who discovered that nearly 120 severely disabled District children were living in institutions outside the city. He also learned that his social workers were not visiting the children.
"We had social workers recommending that they stay in these places without ever meeting the kids," Miller said in a recent interview.
'Very Damaging Evidence'
Willie Mackall said her granddaughter's care started to slip at Harbor Healthcare as the number of workers in the pediatric wing appeared to dwindle. Mackall said that Nicki had bedsores and that her hair was matted and falling out from the back of her head. Mackall put up a sign in the room: "Please Feel Free to Comb Nicki's Hair."
Mackall said the medical staff didn't realize that Nicki's hip was dislocated until she told them that one of her granddaughter's bones was pressing against her skin. Surgeons would later operate on her hip.
"They would leave her in bed all day and all night," Mackall said. "I asked, 'Where is everyone?' They said, 'They're gone. We were paying too much money to all of those people.' "
Mackall said she tried to notify Nicki's D.C. social workers, but "it was so hard getting in touch. They always told me they were out in the field."
Mackall didn't realize that Delaware nursing home licensing division officials shared her misgivings about Harbor Healthcare. On June 11, 1997, a team of nursing home regulators inspected the facility. The regulators issued a 59-page survey report detailing patient-care violations. Patients complained that they were forced to sit in their own urine and feces for hours and were permitted to take no more than two showers a week because of staff shortages. "You feel worse than scum," one resident told the regulators.
After the regulators issued their report, Delaware's director of public health deleted 22 pages of patient-care violations before allowing the report's release. The report and the director's deletions became front-page news in Delaware.
State Sen. Robert Marshall (D), concerned about "very damaging evidence of poor care being provided to residents of that nursing facility," held a public inquiry. Ellen Reap, the Delaware official who ran the licensing division, testified that "improper influence and backroom deals" between state public health supervisors and nursing home operators were compromising the quality of care.
Despite all the publicity, D.C. records do not reflect that city social workers or the judges who handled Nicki's case knew of the Delaware report or hearings.
A Six-Year Delay
About this time, D.C. Superior Court Judge Cheryl M. Long took over Nicki's case. After reading the file, the judge became furious. At a court hearing, she questioned why Nicki remained in a wheelchair that no longer fit the contours of her arching back. She asked why Nicki had not been considered for spinal surgery.
"I don't want to see her just sit there like a bump on a log and have no life except to get pain meds all the time," the judge said during a Feb. 5, 1998, hearing. "I don't know what their problem is. I hear one weird story after another about what's going on there. It doesn't make any sense."
Long ordered Child and Family Services to investigate. The task fell to Clairessa D. Lattimore, an agency employee. On March 2, 1998, she called Dabney, the orthopedic surgeon who had last examined Nicki six years earlier.
The surgeon told Lattimore that Nicki was scheduled for an appointment the same afternoon of their phone conversation. He described the visit as a "regular" medical appointment. Lattimore wrote in a report to the judge that "Dr. Dabney was unaware of why there would be a six-year delay in keeping appointments."
Eleven days after Lattimore's call, Dabney wrote to the District that he was "uncertain" as to why there had been a delay. The surgeon, who did not respond to recent requests for an interview, told Lattimore at the time that he wanted to schedule Nicki "as soon as possible for her surgery."
Two weeks later, Lattimore went to Delaware. She interviewed administrators and doctors and collected records prepared by Wilson Choy, an orthopedic surgeon and Harbor Healthcare consultant. Choy had operated on Nicki's dislocated hip in 1997. The doctor wrote, "This is not a case of neglect, but a neurogenetic type that progressed rapidly," according to Lattimore's report.
Choy added that Nicki's severe curvature "occurred recently." But Lattimore pointed to radiology reports dating back to 1996, indicating "a severe scoliotic curve to the dorsal lumbar spine."
Judge Long had heard enough.
"She's in a desperate, delicate condition," the judge said during an April 17, 1998, court hearing, a month after she ordered the investigation. "Every time we get within an inch of somebody actually ordering a wheelchair for her, they say, 'Oh, can't do it. Gotta do a spine operation. Gotta do this. Gotta do that.' And they keep putting off. Putting it off. Putting it off. And I keep wondering, 'What in the world is going on?' "
While Judge Long tried to help Nicki, a new supervisor at Child and Family Services was trying to make sense of her file. Pablo Ruiz-Salomon said in a recent interview that the agency's paperwork was woefully incomplete, lacking specific details about Nicki's medical care.
Ruiz-Salomon supervised the agency's kinship care unit, which he said was not set up to handle children with special needs like Nicki. The unit, created to oversee children placed with relatives, had become a "dumping ground" to relieve heavy caseloads, he said. Agency records show that the unit's six social workers were supervising 31 boys and girls apiece, nearly double the federal court-ordered limit of 17.
"What we were doing was putting a finger in the dike," Ruiz-Salomon said. "When you came in in the morning, you would just hope there wasn't a fatality."
After Judge Long ordered the investigation of Harbor Healthcare, Nicki's case had become a top priority at Child and Family Services. The agency began to believe that the curvature of Nicki's spine would eventually damage her heart and lungs, Ruiz-Salomon said.
Concern also was growing at Harbor Healthcare. When staffers there read Lattimore's report, they became worried that they were about to be blamed. They traveled to the District to see the judge.
Jennifer Kihn, the nurse in charge of Nicki's pediatric wing at the time, recently told The Post that she and her supervisor had notified the judge that nurses at the facility wanted to schedule surgery for Nicki but that they needed authorization from her legal guardian, Child and Family Services.
Kihn said D.C. social workers kept leaving the agency before consent forms could be signed to pay for the surgery.
"If she didn't have the surgery, her lungs could collapse and her heart could fail," Kihn said. "It was outrageous. I know social workers are overwhelmed. I would never want to be one, because it's so hard to keep on top of everything. But too many hands were in the pot, and it was too confusing."
Three orthopedic surgeons examined Nicki's spine, and two of them concluded that her "life would be prolonged with the surgery," according to a July 7, 1998, report prepared by agency social worker Judah Campbell, who was now in charge of Nicki's case. Campbell told the judge she had called Dabney, the surgeon who examined Nicki six years earlier. Dabney told Campbell he needed approval from Child and Family Services to operate.
Two months later, Dabney said he was still waiting for approval.
"I have had an extreme amount of difficulty communicating with your agency," he wrote in a Sept. 18, 1998, letter to Child and Family Services. "After not receiving any response and after leaving several messages, I was finally able to get to speak to Ms. Judith [sic] Campbell."
Dabney noted that he reexamined Nicki on Aug. 10, 1998, and measured the curve of her spine at 100 degrees, a 67-degree deterioration since he had first seen her six years earlier. "I have since left two messages with your agency in [an] attempt to speak once again with Ms. Campbell, but have not received any return phone calls."
Dabney concluded: "If NickiColma's surgery is delayed much longer, her curve may progress to an inoperable magnitude. One would then question as to whether or not your agency would be negligent in allowing this child to have proper care.
"I am extremely concerned about this patient and would appreciate a follow-up and a finalization."
The surgery was eventually set for Dec. 2, 1998, according to court records. On Thanksgiving Day, six days before the scheduled operation, Nicki was found dead in the hallway of the nursing home.
One Final Mistake
Someone at Harbor Healthcare called Child and Family Services, requesting permission to release Nicki's body to a funeral home. A social worker gave the go-ahead, and Nicki's body was embalmed before an autopsy could be performed, according to medical records.
Jonathan L. Arden, the District's chief medical examiner, said Nicki's body should not have been embalmed, which can make it difficult to determine the cause of death. In Nicki's case, he said, it did not change his conclusion: The dramatic curvature of her spine factored into her death.
"The severe scoliosis compromised her respiratory system," Arden said. "It raises some very important issues as to whether she was receiving adequate care."
In February 1999, three months after Nicki's death, Delaware regulators discovered that at least five other pediatric patients had died at Harbor Healthcare from April 1998 through February 1999. The regulators turned the information over to the state attorney general's office.
Today, few people responsible for Nicki's care are willing to speak publicly about what happened. An assistant attorney general in Delaware said his office is investigating the deaths of the six children, including Nicki. "The investigation is ongoing. That's all I have to say," he said.
Chris Evans, Harbor Healthcare's administrator, initially consented to an interview, then requested that questions about Nicki's medical care be put in writing. "Confidentiality obligations prevent the facility from responding," Adam Balick, an attorney for Harbor Healthcare, wrote back.
The nursing home closed its pediatric wing in July. The facility cited several reasons, including "the negative political and operating environment created by certain parties who oppose children being taken care of in nursing homes," according to a letter Harbor Healthcare mailed to caretakers of its patients.
Dabney, the orthopedic surgeon, did not respond to phone messages or a certified letter sent to his office requesting an interview.
Choy, who operated on Nicki's hip, told The Post that he noted a "mild to moderate" curve of her spine at the time of the 1997 hip surgery -- even though a radiology report had documented a "severe" curvature a year earlier. Choy responded that he and the radiologist who wrote the earlier report might have different opinions about what constituted a severe curvature.
Choy also said he does not know why Dabney didn't see Nicki for six years.
"Kids get lost in follow-ups," Choy said. "No one was watching out for her."
A pediatrician for patients at Harbor Healthcare, Santosh B. Reddy, said he had assumed that orthopedic surgeons were monitoring Nicki's spine during her six-year stay at the facility. "I guess someone else was following up. I just don't know," he said.
Sondra Jackson, the last receiver named by the federal court to run Child and Family Services, did not respond to requests for an interview.
Russell D. Torwelle, Nicki's court-appointed attorney, declined to discuss his client's care. "I'm not going to get into this," he said before hanging up.
Of the eight social workers assigned to Nicki's case during the six years she spent in Delaware, only two remain at the agency, including Judah Campbell. She did not respond to phone messages or a certified letter requesting an interview.
Of the six social workers who have left the agency, five could not be located or did not return calls seeking comment. Laura Hoffman, the worker who visited Nicki in 1995, said she could not recall details about Nicki's case. But she said children in general were put at risk because there was not enough time to devote to cases.
"We were inundated by cases," said Hoffman, who joined the agency in 1994 with a master's degree in social work from Temple University. "There was not enough time to do the things we needed to do. And nothing ever came to fruition to get kids the things that they needed. Everything took a year and a day."
Hoffman left the agency after three years and no longer works in the field.
Judge Long remains on the Superior Court bench. Because she continues to supervise the case of Nicki's sister, she said she could not comment.
But the judge did try to make Child and Family Services pay a small price for its handling of Nicki's case.
A few days after Nicki died, Long convened a court hearing on Dec. 2, 1998, the day of the scheduled surgery. Paul Kratchman, an attorney for Child and Family Services, promised that his agency would reimburse Nicki's grandmother for the funeral expenses.
But Mackall never received a check. On April 14, 2000, Long issued a final court order, forcing the agency to pay Mackall $3,578 -- nearly 17 months after she laid Nicki to rest.
Database editor Sarah Cohen and Metro researcher Bobbye Pratt contributed to this report.