Straight Up with Sherri

Sunday, March 27, 2005

Agency Probes Group Homes' Deaths

The case of Terri Schiavo may be the wake-up call we have all needed:

Agency probes group homes' deaths


The deaths of four disabled Floridians are being investigated in light of cost-cutting changes in state nursing care.

A federally funded watchdog group is investigating the recent deaths of four disabled Floridians amid an aggressive campaign by the state to cut millions of dollars from programs that provide medical care for disabled people in community settings.

Two developmentally disabled adults who lived in group homes in Brandon, and two others under the care of The ARC in St. Lucie County, have died since October 2004, a month after the state required the operator of the two Brandon group homes to change the way residents received nursing care.

A woman at one Brandon home developed such a severe infection at the site of her feeding tube that she has been hospitalized in intensive care since Feb. 13.

''We will be looking into these deaths,'' said Sylvia Smith, of the watchdog group, the Advocacy Center for Persons with Disabilities in Tallahassee.

"This is a top priority, and it should be a top priority for the state.''

Said Dr. Cheryl Reed, a Brandon doctor who has treated medically fragile disabled people for about 20 years: "I'm very distressed. I sort of knew this was going to happen.''

Officials at the Agency for Persons with Disabilities have reviewed the four deaths and found no evidence to suggest that statewide cost-cutting measures in any way contributed, said agency spokesman Scottie Howell.

''Our director [Shelly Brantley] has asked the Inspector General to review each of these cases, and we welcome anyone else to do so, as well,'' Howell said.

One of the four deaths also is under active investigation by the Department of Children & Families' adult protective services unit. The mother of a 38-year-old who died Feb. 21 said she told investigators her son may have been neglected.

The man, who is not being identified to protect his privacy, is profoundly retarded and has a history of intestinal problems.

He lived 31 years with his parents, then moved to a group home. He has lived at a home run by The ARC since 2000.

The man's death certificate says he died of a severe intestinal blockage, respiratory failure due to vomiting, and severe infection, his mother told The Herald.

''My heart is broken; he was my little baby,'' said the man's mother, who lives in Fort Pierce. "I want answers. I'm hoping protective services will find the answers I'm looking for.''

NEW HIRE

In 2001, the state hired a private company, Maximus Inc., to look for ways to save money. Under a $5.2 million, three-year contract, renewed in January 2003, Maximus reviews care plans for disabled Floridians who choose to live outside more costly segregated institutions. The clients usually live with family members, in group homes, or even alone with help.

In a recent report to lawmakers, APD officials said they anticipate Maximus will find $24 million in annual savings. The company's actions have been upheld in 97 percent of the appeals to state officials.

Advocates for the disabled insist that the quality of medical care for disabled people in group homes has suffered since Maximus, and the state, in September 2004, began requiring group homes to pay for nursing care from the state's Medicaid Plan. That plan covers rotating nurses, not the more stable nursing care provided under a previous plan for disabled people.

Reed said such patients, who most often have complex medical needs, require constant surveillance by nurses who are trained to recognize often subtle changes.

Following cuts, the two Brandon group homes where clients died, called Overland and Rockwood, were being staffed by rotating ''pool'' nurses who often did not know the group home residents -- and sometimes had no experience treating disabled people with severe medical problems, said Carol Middell, regional director for Spectrum, Inc., which operates the homes.

Developmental disabilities, such as mental retardation, cerebral palsy and autism, often result in a host of serious medical conditions, including seizure disorders, intestinal blockages and feeding and swallowing impairments that are treated with feeding tubes.

''[The patients] can't talk to you, so your clinical skills have to be very well-tuned,'' Reed said. "A nurse who has never worked with a particular client, such as a pool nurse, is not necessarily the best person to come in. They are not looking for the right things.''

UNBLEMISHED PAST

No clients had ever died at either the Rockwood or Overland group homes before this fall, said Middell. The homes have been open since 2000.

''It takes a special kind of nurse to care for these people,'' Reed said.

Should the state have attempted to save money by changing nursing practices? ''Not if you want to keep people alive,'' said Reed.

Among the cases under investigation:

• The Oct. 13, 2004, death of a 19-year-old man from aspiration pneumonia at the Rockwood group home. The condition typically occurs when liquid flows into the lungs of a person with a feeding disorder.

A nursing report obtained by The Herald shows the man had cerebral palsy, severe spasticity that forced his muscles to contract, frequent seizures, skin ulcers or breakdowns, breathing problems and required the administration of oxygen.

"Due to the severity of symptoms and respiratory risk factors, this client requires ongoing 24-hour nursing care, monitoring and intervention, a report by nurse Laurie J. Harlow, then with DCF, stated.

• On Dec. 10. 2004, a 55-year-old woman died after choking on a sandwich at a day training program in St. Lucie County.

INFECTED FEEDING TUBE

• On Feb. 13, a 28-year-old woman at the Overland group home was placed in intensive care after being diagnosed with a severe infection at the base of her feeding tube. The woman remains in intensive care, with a ventilator.

The November 2003 nursing report obtained by The Herald shows the woman, who has mental retardation and cerebral palsy, also had severe medical problems. The woman's feeding tube regularly leaked or became infected, and doctors replaced it frequently, records show.

• The Feb. 21, death of the 38-year-old man who was a client of The ARC of St. Lucie County.

• The March 2 death of a 27-year-old man at the the Overland group home. Both advocates and the APD agree that his nursing care had been changed before he had a seizure Feb. 26. Middell, the group home's director, said the man's total nursing hours had been cut on Dec. 28 by about 53 percent.

Howell, the APD spokesman, says the amount being paid by the state for the man's nursing care was reduced from $11,000 yearly to $8,000. Howell added, however, that the man still was receiving adequate care, because a nurse was present at the man's group home eight hours per day.

''There was a nurse at that group home before and after'' the man's plan was changed, said Howell.

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