The D.C. group home and day-care facility responsible for Patrick Dutch, the severely retarded man who died unnoticed Friday in 99-degree heat in the back seat of a van that was supposed to take him to school, said yesterday that they are changing their policies to provide better supervision of people in their care.
City officials, case managers and social workers struggled yesterday to understand how the absence of Dutch, 41, who was deaf and couldn't talk, was not noticed for five hours. His body was found in the van 7 hours after the city-contracted group home thought he had been dropped off at a day program.
Dutch, who lived in a group home at 47 Quincy Pl. NW and communicated primarily by making "dribbling" sounds with his mouth, was found curled up in the back seat. Officials at the home said he could not be seen through the van's tinted windows.
The D.C. medical examiner said it could take several weeks before the cause of death is determined.
"I'm shocked, saddened and sickened by what happened," said Mayor Anthony A. Williams, who has ordered the police, human services and health departments to investigate the death.
The U.S. Justice Department is investigating the District's government-funded facilities for the retarded after The Washington Post in March found 350 documented cases of abuse, neglect and profiteering in the 150 group homes for the retarded.
The company that managed Dutch's group home, D.C. Health Care Inc., had few problems compared with other facilities in the city's troubled care system for the mentally retarded, D.C. officials said yesterday. But according to records obtained by The Post, the home was cited by the city's Medicaid office during the last five years for treating Dutch too strictly and for inappropriately removing funds from his Medicaid-funded account.
Officials at D.C. Health Care promised yesterday to institute new procedures to make sure drivers and the escorts who accompany clients to day programs check to see that everyone has entered the facility.
Elizabeth A. Abramowitz, president of PSI Associates Inc., the day program that Dutch was supposed to attend Friday, said the school usually doesn't get concerned when some clients don't show up.
"We assumed you can be out for a day," she said, adding that 10 to 30 percent of the program's 550 clients are absent on any given day, usually because of medical appointments. "We've revised it so that from now on, the first day you're out, we call" to check.
Day programs like PSI have traditionally set their own policies about what to do when a client doesn't show up. City officials say a new Medicaid directive will advise them to inquire immediately when a client fails to arrive for treatment.
Abramowitz said Dutch attended the day program off and on for 15 years, focusing on developing communications and basic daily living skills.
"Think of someone intellectually between 18 months and 1 year old," she said. "Those are the cognitive tasks you're working on."
Care providers said in interviews that a driver and an escort, both employees of the group home, drove Dutch and six other residents to the day program, housed in a two-story brick building across from the Washington Navy Yard in Southeast Washington. An eighth person was aboard to be dropped off later at another facility.
The 15-passenger, burgundy-and-silver van was late because several of Dutch's fellow residents had medical appointments that morning, said Hyacinth Salmon, the activities coordinator who worked with Dutch every day. When it finally pulled up at 11:30 a.m. Friday, the driver and escort were supposed to help seven people, including Dutch, off the van.
However, a commotion started when one of the passengers became hyperactive and started running away, according to Gracy Stephen, co-owner of D.C. Health Care. When the confusion subsided, the others had entered the building, and the driver thought they were all accounted for, Stephen said.
However, Abramowitz said that according to the day program's sign-in book, which contains an individual sheet for each participant the escort is supposed to sign in, no one signed in for Dutch. Assuming he had gone to a medical appointment, staff members wrote "ABSENT."
The van's driver dropped off the eighth passenger, then drove the van back to the home--with Dutch curled up in the back.
"You should put the blame where the blame is due . . . the two [employees] on the van," said Mary Dutch, the deceased man's mother.
A different van returned to the day program when the session ended at 3:30 p.m. Only when that van returned was Patrick Dutch's absence noticed, said Vanessa Hill, the home's program manager. "I said he had no medical appointment," she said. "That's all they needed me to say. That was around 4:50."
Staff employees immediately jumped into the original van or into their own cars and drove to Southeast Washington, thinking that Dutch had wandered off the day program's grounds.
At a wooded area at 12th and M streets SE, "the driver of the van, at that point, just decided to come out and look in the van, open all the doors," Hill said. "That's when [Dutch] was discovered."
Inspectors from the health department's Medicaid office visited Dutch annually from 1993 to 1997, describing his health as stable. But in 1994, they criticized the home for disciplining Dutch, who had a habit of spitting, with a behavior plan that only a hearing person could understand. Two years later, they said the home hadn't monitored his nutrition or gotten him dental care. And in 1996 and 1997, they said it improperly took money from Dutch's personal account, including charging him for items for which the home was reimbursed.
Stephen said that the citation for misuse of funds was due to a minor accounting error and that the program manager who made the error was later dismissed.
The company also fired a staff member at another home after health officials concluded the employee had beaten a retarded man.
Jearline F. Williams, the city's director of human services, said D.C. Health Care has been "one of the better providers" among group homes.
"My heart goes out to the family in this case," she said. "We want to know what went wrong. This is not acceptable."
Staff writers Michael H. Cottman and Sari Horwitz contributed to this report.