District officials have revised policies for transporting mentally retarded clients who live in group homes that have city contracts. The change comes after an incident in July in which a severely retarded man died of heatstroke after being left in the back seat of a group home's van.
The Mental Retardation and Developmental Disabilities Administration (MRDDA), a branch of the D.C. Department of Human Services that is responsible for the District's mentally retarded wards, prepared a policy that would require group homes to provide a list of which clients are supposed to be in a van, and an explanation if they are not present once the van has been unloaded.
The move follows the heatstroke death of Patrick Dutch, 41, who was left unnoticed for more than five hours on July 9 in a van that was supposed to take him from his Quincy Place NW group home to a day program in Southeast Washington.
Workers from the group home mistakenly believed that Dutch, who could not hear or speak, had been dropped off at PSI Associates Inc., the District's largest day program for the retarded.
Shortly after Dutch's death, the Medical Assistance Administration, a branch of the D.C. health department that contracts with the Medicaid-funded group homes, reminded transportation providers to check that all passengers have boarded and departed and to make water and first-aid supplies available on the vans.
Advocates and care providers for retarded people say that the proposed guidelines do not go far enough and that the city has done little to address important problems involving care for the retarded, including a lack of oversight and inadequate funding.
The new policy does not require a day program to contact the group home immediately if a client hasn't arrived, said Kelly Bagby, managing attorney at University Legal Services Inc. Legal Services represents the mentally retarded patients who had lived at Forest Haven, the District's asylum in Laurel for the retarded, until it closed in 1991. Dutch was part of that group.
"It's an improvement, but it's certainly not going to remedy the problem," Bagby said. "We have to have a clear line of transfer of responsibility for these individuals."
Adrienne Buckner, acting administrator of MRDDA, said that under the new policy, a person at the day program has to sign a document indicating that everyone on the list to be transported there has arrived. Buckner said that if that had been the policy when Dutch was left in the van, it would have "sounded an alarm" with the day program that his name was on the list to be delivered to the facility and he had not arrived.
Bagby recently sent two staff members to observe the arrival and transfer of clients at the PSI day program. In a subsequent letter to city officials, she said that "a general air of chaos throughout the morning drop-off period was observed."
Clients were unloaded in dangerous areas and in risk of being hit by traffic, were seen not wearing seat belts and were unloaded onto "unsteady or poorly positioned step stools or milk crates," according to the letter.
The observers also saw clients left unattended in vans and verbally abused by staff members for being slow. One person was seen being pushed in the head. The wheelchair of another was tipped back low enough to pass under a chain gate, rather than waiting for the chain's padlock to be released, the observers found.
"This isn't anything fantastic that my staff did, they just sat out there for two hours and this is what they witnessed," Bagby said. "I think if MRDDA did this periodically, they would uncover the same thing. That's what's distressing."
In addition, transportation operators say that inadequate funding means that they are not always able to hire qualified staff.
The Medical Assistance Administration, the city's Medicaid office, does not pay operators on time, according to Bessie L. Epps, president of the D.C. Wheelchair Carriers Association, which includes 30 companies that transport wheelchair-bound District wards, including mentally retarded clients.
"If you want quality service for the wards of the city, you have to at least pay for it," said Epps, who operates a van that takes clients from a Southeast group home to the PSI day program. "Some of the companies can't stay in business. They hire all these people and then don't have work for them. It's going to catch up one of these days. More people are going to get hurt, more clients are going to get bad service."
Paul Offner, the District's Medicaid director until he left at the end of October for a position at Georgetown University, said he was "flabbergasted" by Epps's comments.
"My staff met with the leadership of that association and that issue didn't even come up," he said. "I [did] not have any call or any letter from any transportation provider in the District of Columbia saying that they were having troubles with late payments."