Conflict is boiling over care

The death of a severely retarded man is the latest flashpoint in a battle between families and the state over its developmental centers

By Clea Benson - Bee Capitol Bureau

This story is taken from Sacbee / News
Source: http://www.sacbee.com/101/story/101279.html
Published 12:00 am PST Monday, January 1, 2007
Story appeared in MAIN NEWS section, Page A1

Donald Santiago's mother and sister didn't want the state to move him out of the Agnews Developmental Center in San Jose, the state hospital where he had lived for nearly four decades.

They feared that Santiago, severely mentally retarded since birth, wouldn't get the medical attention he needed in the small group home the state proposed. But state officials said Santiago had a legal right to live in a community setting. They got a court order to move him into Justin's Home in Union City in 2005 over his family's objections.

Santiago, 63, died of pneumonia in a Fremont hospital three weeks ago.

His family says Justin's Home failed to take him to a doctor for almost a week after he fell ill, a charge the home operator disputes.

The death of Donald Santiago -- being investigated by the California Department of Health Services -- is one more flashpoint in a wrenching battle between some parents of Agnews residents and the state, which has been under legal pressure to close its institutions and integrate residents with disabilities into their communities.

Following changes in state law and a U.S. Supreme Court decision requiring community living, the number of people living in developmental centers in California has dropped from a high of more than 13,000 in the 1960s to about 2,900 today. Three developmental centers have been shut down.

Agnews, one of five remaining state centers for people with developmental disabilities, is slated to close in 2008. Only 261 residents remain.

Some family members say they fear the state is hastily moving people into existing community homes that are ill-prepared to care for the severely disabled and don't have medical staff on-site, as Agnews does.

Though they say they have received little encouragement from state officials, some families also want the state to consider building a mixed-use community where severely developmentally disabled people can live in homes near their caregivers and members of the public rather than in scattered houses.

"We're not defending the institutional setting," said Stephen Johnson, head of Keep Our Families Together, an organization representing relatives of Agnews residents. "We're saying we understand that integration is something that needs to happen. But let's do it in a systematic way that keeps professional caregivers involved in the lives of these clients and above all, keeps people safe."

One parent, Michael Biggs of Placerville, says a group home would be inappropriate for his son Stephen, 47, who is severely autistic and prone to outbursts. His son's behavior has kept him out of several group homes, Biggs said.

Biggs said his son can roam the Agnews campus freely.

"If Agnews isn't there, the next best thing would be a mixed-use facility," Biggs said.

Still, some disability rights groups believe the existing community homes are working well.

"There are in fact many, many individuals living in the community with the same levels of disability," said Ellen Goldblatt, an attorney at the nonprofit organization Protection and Advocacy that has sued the state to speed up the process of moving people out of institutions.

"While we think community care always needs to be improved ... we don't believe the community care is inadequate," she said.

The state is buying homes and converting them for use by former Agnews residents. Unlike existing community facilities, owned and operated by private businesses, these homes will be owned by the state and staffed by private contractors.

Eileen Richey, assistant director of the state effort to close Agnews, described the plan as "very innovative."

In the meantime, Richey said, the state has strict standards for moving residents into existing group homes.

"It would only be if the planning team felt that the service providers meet all of the standards ... before a person transitions out of Agnews," she said. "The family is involved and has met the provider."

On rare occasions, when a family objects to the placement, the state will go to court to force the move, "if someone at a developmental center expresses that they want to leave," Richey said.

Donald Santiago had the mental capacity of a 2-year-old and a vocabulary of only a few words, according to his sister, Angie Abrue of Placerville.

But the state argued that Santiago had expressed a desire to leave Agnews in a 2005 court hearing before a Santa Clara Superior Court judge.

Richey said she could not comment on a specific case, citing confidentiality rules. But it is "extremely unusual" that the matter would end up in court, she said.

Abrue said she and her mother objected to moving her brother because of the record of the Justin's Home operators, Pacifico and Thelma Ruiz.

Though Justin's Home had only recently opened, another Union City facility operated by the couple -- Mika's Home -- had been cited numerous times for violating state regulations. Some citations were for failing to provide nursing care.

Recent records show Justin's Home and Mika's Home were cited in October for inadequate access to nursing care.

Pacifico Ruiz, in a telephone interview, said the citations were for minor improvements that had to be made.

"Overall, the general care that we provide is far and beyond" what state regulations require, Ruiz said.

In 2002, health department investigators cited Mika's Home after a complaint that a resident had received emergency treatment only after he insisted on going to a hospital.

"It was fortunate that this client could request to go to the emergency room of his own accord," the report says, "as he required prompt medical attention for pneumonia."

Four years later, on the day before Thanksgiving, Donald Santiago fell ill. Being nonverbal, he couldn't tell anyone, family and friends said.

But aides at Santiago's day program noticed that he wasn't his usual self. They sent him back to his group home and urged the staff there to take him to a doctor, family and friends said.

Six days passed before the staff at Justin's Home took Santiago to see a doctor, even though he was vomiting and refusing his food, according to his sister and family advocates.

Dr. Antonio Uy, a South San Francisco physician who treats developmentally disabled patients from several group homes owned by Ruiz and his family, said he prescribed cough medicine and antibiotics.

In a telephone interview, Uy said there was no indication that Santiago was sick enough to be hospitalized when he saw him.

"His color was good," Uy recalled.

But the next day, at Justin's Home, Santiago collapsed.

He spent the next couple of weeks fighting for his life in the hospital. Finally, his organs failed. He died Dec. 11.

Ruiz said he could not comment specifically on Santiago's case, citing state confidentiality rules. But he did dispute that there had been a six-day delay in getting medical care for Santiago.

State officials said they could not comment while the health department is investigating.

Brian Boxall, president of the Association for the Mentally Retarded at Agnews, a group representing families, said the court system never should have ordered the move in the first place.

"My sense of anger is most focused on the judge, the (district attorney) and the public defender who all orchestrated his placement knowing that his group home operator had these kinds of citations," Boxall said. "In that respect, Donald really was a victim of the system."

Goldblatt, whose organization has assisted others in getting court orders but was not involved in Santiago's case, sees it differently.

"It was our understanding that he got to court because he really wanted to move," she said. "It's tragic that he then died. It's also nice that he got to move after so many years of living in an institution."

Meanwhile, Donald Santiago's family hopes his story helps others.

"I feel that (Donald) would still be alive if he would have stayed in Agnews or he wouldn't have moved into this group home," Abrue said. "It's too late for my brother now, but (not) for the other ones that are going into the homes."

About the writer: The Bee's Clea Benson can be reached at (916) 326-5533 or cbenson@sacbee.com.

Click here to see photos and photo captions that go with the articlehttp://www.sacbee.com/101/story/101279.html

[Photo] Steven Biggs, who is severely autistic, wipes down a state vehicle at Agnews Development Center, a state hospital in San Jose, where he lives and receives care. Sacramento Bee/Brian Baer

[Photo] Donald Santiago, who was mentally retarded, died Dec. 11 of pneumonia. His family fought his transfer from the Agnews center. Special to The Bee/Brian Boxall

[Photo] Steven Biggs spends time in his room Friday at Agnews. He'll be moved to a group home if the state facility closes in 2008 as expected. Sacramento Bee/Brian Baer