Group Home Residents Said to Face 'Serious Risk'

By Daniel LeDuc
Washington Post Staff Writer
Tuesday, May 13, 2008

Nearly 18 months into Mayor Adrian M. Fenty's administration, a court monitor has found continued "serious deficits" in the care of mentally and physically disabled residents of the District's group homes.

The District's performance is worse than it was a year ago on more than half of 13 health-care indicators, including effective tracking of residents' food consumption and the supervision of mind-altering medications, according to the latest report by federal court monitor Elizabeth Jones.

"The findings overall are very troubling. Our monitoring concludes that the health care provided . . . fails to meet minimally acceptable standards of care," Jones wrote. Residents "remain at very serious risk."

Still, city officials said they have made great strides in the past year and announced yesterday that they had reached a tentative agreement with the Justice Department, which had intervened in the case. The agreement calls for new programs and initiatives, with specific timelines, meant to improve care over the coming months.

Acting D.C. Attorney General Peter Nickles questioned some of the findings in Jones's latest report and said "the ship is moving forward and not backward."

The monitor's report is the latest in a series of dismal evaluations in recent years that are part of a three-decade-long lawsuit. U.S. District Judge Ellen S. Huvelle, who appointed Jones, plans to hold a hearing Thursday. In the case, brought by attorneys for some group-home residents, the D.C. government has been accused of exposing the residents to severe neglect. In previous reports, Jones has said the care by some providers was so deficient that people have died.

Improvements have been slow over the years. Once Fenty (D) took office last year, Nickles pledged immediate reform, saying the city's past performance was "not acceptable." While in private practice, Nickles had sued the city over treatment of the homeless and mentally retarded.

Last year, Fenty reorganized and gave a new name to the city agency charged with overseeing the approximately 2,000 residents of group homes. He appointed a nationally recognized advocate for the disabled, Judith E. Heumann, to head the Department of Disability Services. New programs were planned to improve care, and Nickles said the initiatives cost more than $4 million.

In a response to Jones's report, attorneys for the city wrote that the newly named agency "is swiftly moving away from its history as a reaction-based, poorly functioning agency to a new proactive, disciplined agency with a focus on creating the infrastructure necessary to provide the individuals it serves with choice, flexibility and contemporary supports and services of the highest quality."

Attorneys for the plaintiffs in the lawsuit hope to persuade Huvelle to force more drastic overhauls of the agency, saying that not enough has been done to make significant changes for better care.

"The system is very unstable. It's more unstable than we've ever seen it," said Sandy Bernstein, legal director of University Legal Services, which represents about 630 group-home residents who are part of the class-action lawsuit filed in 1976. "We are very concerned that, despite the progress the District has made, the health care and services the residents receive are worsening."

In March 2007, Huvelle ruled that the District had failed mentally retarded residents and called their care "wholly inadequate." She stopped short of a court takeover of the city agency responsible for the care, urging the District and attorneys for the residents to come up with a plan for improvement.

But Bernstein said the latest report was a sign that not enough had been done. She said she would not join in the agreement with the Justice Department and instead would push for Huvelle to put the agency into receivership. That is something that Nickles vowed to fight, saying the litigation was hindering efforts to improve care.

Jones's report, filed late last week, indicates that there has been little recent improvement. It acknowledges "strengthened" supervision of case management but said "legitimate questions remain about the thoroughness of this work."

Most glaringly, it highlights 13 health-care indicators, comparing performance on them over the past several months with the same period a year ago. In 10 categories, the District has slipped.

One area of decline involved whether lab work and doctor-ordered tests are completed for residents. The report cited the case of one man who has a history of rectal bleeding and requires a colonoscopy. It said he has had to wait at least four months for a doctor to order the tests. The District has yet to file court papers for a guardian to oversee his treatment.

As for monitoring of mind-altering medications, the report documented the case of a woman whose patient file said she has no side effects from her medications. Yet nurses for the monitor found repeated instances in which the woman exhibited abnormal tremors.

Another cited category of decline involved whether effective systems are in place for tracking residents' food intake and bowel movements -- key health indicators.

"The need to establish effective tracking systems has been discussed repeatedly in my reports," Jones wrote. "After four years, this finding is of utmost concern. The consequences of this ongoing failure to monitor critical information cannot be excused."

In written comments on the report, District officials disputed some of Jones's methodology.

Although the 13 criteria Jones examined have been the basis of each of her reports over the years, she has not checked the same patients each time, and that has made it difficult to draw conclusions about trends in care, the District's response said.

And although Jones found declines in 10 of the 13 categories, the city cited declines in six, including the timeliness in which lab work and doctor-ordered tests are conducted. Still, it acknowledged, "clearly, there is room for improvement."