Sylvester Williams, 64, died late last year in a small unlicensed nursing home in Northwest Washington. The man, who was 5 feet 7 inches tall, weighed 96 pounds when District police found him in what one officer said was a "dirty and filthy" bed.
Williams died because he was not getting the insulin he needed to treat his diabetic condition, according to the District's chief medical examiner. Williams' chronic diabetes left him in a state of "severe dehydration and malnutrition," the medical examiner said.
District homicide detectives are investigating the man's death, and the D.C. Corporation Counsel's office, the city government's lawyers, plans to obtain a search warrant for the nursing home at 4903 Illinois Ave. NW.
There are approximately 450 similar nursing homes in the city that are operating without licenses, according to Robert Sauls, director of licensing for such homes for the D.C. Department of Human Resources.
Sauls said his office lacks the staff needed to enforce a 1977 law that requires inspection and licenses for all homes in which one or more persons are cared for by someone other than a relative. Such homes are known as community residential facilities.
"I had no staff for the community residential facilities," Sauls said. He said his eight-member staff spends its time keeping up with licensing requirements for the city's 500 day-care centers, seven adoption agencies and 17 group homes for adults in need of supervision.
As a result, small nursing homes for the elderly, such as the one on Illinois Avenue, are only inspected when a complaint is received by city officials, Sauls said.
Concerning Sylvester Williams' death on Dec. 2, chief medical examiner James Luke said "his diabetes was completely out of control. The number of units of insulin purchased in the recent past would not have covered his requirements."
"The extent of his dehydration... It's not just straightforward natural causes. There is an element of care question (whethere) a proper standard of medical care had been given," Luke said.
"He needed something he didn't receive," the chief medical examiner said.
The home's operator, Lucille Johnson, said that Williams, who lived at the home for two years, had been well cared for and was not suffering from malnutrition. When a reporter who visited the Illinois Avenue home attempted to question her her further. Johnson declined additional comment on Williams' death.
Johnson maintained that she does not need a license to operate the home because, she contended, she is caring for persons related to her. Williams' aunt, Ella Anthony, said in a telephone interview, however, that her nephew was not related to Johnson.
City officials said that Johnson's home must be licensed.
"It you have elderly people who are ambulatory (self-sufficient) and receiving some assistance (such as preparation of meals), they (the homes) are a community residential facility" and must be licensed, Sauls said.
Officials from the Department of Human Resources and the Environmental Health Administration inspected the Illinois Avenue home last June after they received complaints of unsanitary conditions, Sauls said.
According to a health report that followed the inspection, mattresses were soiled with "blood stains and urine stains," there was evidence of roaches and rodents in the home and the kitchen walls were dirty, said Dr. Bailus Walker, chief of the environmental health administration.
At the time of that inspection, there were two blind women and two men in the home, according to a DHR report.
When officials returned to the home for a reinspection on July 18, Johnson refused to let them inside the building, licensing director Sauls said.
Johnson acknowledged that she refused to allow the inspectors to enter the building -- contending that her home does not need to be licensed.
"You can have three people without any license or anything. There's no reason for them to come in," she told a reporter.
The home has remained uninspected although the city's Office on Aging asked the Department of Human Resources and the Environmental Health Administration to investigate a February complaint that beds in the home were soiled and that residents were "hungry" and "abused."
When city officials went to the home on Feb. 23, Johnson again refused to let them in, Sauls said.
According to Dr. Luke, the chief medical examiner, three other elderly residents have died at the home since last May. Two were heart attack victims and the third, a cancer victim, died of pneumonia, Luke said.
Ella Anthony, 68, Williams' aunt, said that Johnson called her at 7 a.m. or the morning of Dec. 2 to tell her of the nephew's death.
Five hours later, police sources said, they received a report of Williams' death and removed his body from the home.