The federal government has threatened about $6 million in funds from Forest Haven, the problem-plagued D.C. facility for the mentally retarded, based on a confidental report of an informal inspection of the institution.
The warning, issued by regional director of health standards Gerald F. Szucs, is based on a graphic 10-page report that found an apparent wide-spread lack of staff supervision and adequate patient care at the 400-patient facility in suburban Laurel.
The report, a copy of which has been obtained by The Washington Post, indicates that the inspector saw:
Force-feeding of a patient, in which a Forest Haven staff member "grabbed (the patient's) hair to pull the head up, shoved the spoon of soft food (grits) in the client's mouth and followed immediately with prune juice. This method is not acceptable and could cause a client to choke."
Insects in a kitchen area, and an infestation of flies in many other areas.
Lack of supervision in many units, and an apparent lack of recreational and rehabilitative programs. In one unit, the inspector found patients left to lie or sit on the floor while a staff aide "sat back . . . reading her pocket book." The aide complained that there was not enough staff to conduct meaningful programs, according to the report.
"(What appeared to be a puddle of urine and an open safety pin on the floor" in one dormitory.
A lack of any toilet seats, toilet tissue, paper or cloth towels in any of the bathrooms in one dormitory, where residents, nevertheless, were allowed to use the bathrooms without supervision. In the same dorm, residents had no call lights in their bedrooms or any other way of communicating with nursing personnel.
A large stockpile of clothing in one unit, including "as many as 9 new bras per female resident." But in that unit not a single female patient was observed wearing one of the new brassieres.
"The report speaks for itself and does not reflect that the facility is in compliance with the regulations governing institutions for the mentally retarded," Szucs wrote in a Sept. 5 letter to James Buford, director of the city's Department of Human Services.
Szucs added that "this letter is provided to alert you to our view of the seriousness of the situation that exists at Forest Haven and our inability to support financially a facility whose efforts do not result in compliance."
At stake are federal Medicaid funds that subsidize the care of the mentally retarded. Szucs recommended in his letter to Buford that the city give "serious consideration" to declaring Forest Haven ineligible for the federal funds. If the city refuses to do so, Szucs reminded Buford, the federal government is empowered to withhold the funds unilaterally.
Officials at Forest Haven declined to comment on the allegations contained in the report. Repeated attempts to telephone Buford for comment were unsuccessful. Szucs said he still has not received any response from he city, and this week sent a second letter to Buford, repeating the warning of a fund cutoff.
The findings are the latest in a series of reports of substandard care, overcrowding and inadequate facilities at the sprawling Forest Haven complex. oFederal officials have repeatedly criticized conditions at the facility, calling them in 1976 "improper, inconsistent and inadequate," and issuing a similar threat of a money cutoff.
Later that year, the parents of Joy Evans, a 6-year-old mentally retarded girl who died at Forest Haven, sued the District for providing "only the most meager custodial care." In 1977, a U.S. District judge order the improvement of care at the facility and further ordered that the city gradually abolish Forest Haven, placing all its patients in community-based facilities by 1987. At that time, there were more than 1,000 mentally retarded residents at the complex. Now, about 400 remain.
Reports of incidents persisted, and last July an investigation was begun into allegations that thousands of dollars were missing from personal bank accounts of residents.
One of the report's most serious allegations concerns a lack of supervision and rehabilitative programs at Forest Haven. Some of the worst conditions cited in the past have been corrected -- such as the discarded practice of locking several dozen residents in a room to wallow in their own waste. But the current report, prepared after an Aug. 12-15 inspection, does cite conditions consistent with what Szucs called a "history . . . of noncompliance" with federal guidelines.
"Not all residents are gotten up out of bed, because there are not enough wheelchairs," the federal observer wrote. The inspector asked about rehabilitative materials in one unit where 12 residents were spending the day, and the attendant produced two shoes to be laced and unlaced, two jigsaw puzzles, both of which had pieces missing, and one coloring book and crayons. There is a new swimming pool, but it is empty "because there is no life guard," the inspector wrote.
Szucs said that if the city does not voluntarily declare Forest Haven ineligible for the federal funds or supply information showing why the funds should be continued, the government would take action, which would probably include sending in a formal inspection team. He said the inspection that produced the report was not a formal one, and thus could not be used as a basis for cutting off the monies.