Could state have saved Lynnette? By Debbie Cenziper
Another patient dies in mental health care
The girl in the hospital bed looked nothing like Lynnette.
Purple bruises covered her face, arms, chest and legs. Her mouth was swollen. Blood dripped from her nose. She had a rug burn on her shoulder. She was unconscious, and a ventilator helped her breathe.
Donald Morris threw himself across her bed and cried. Ileine Morris whispered, "Mommy's here. Mommy's here."
Twenty-four-year-old Lynnette Martin, who was mentally ill and mildly retarded, had suffered a head injury about eight hours earlier in a Moore County home operated by a company called Preferred Alternatives. Police believe she and her caregiver may have struggled, and Lynnette hit her head on the floor. Her caregiver waited about seven hours before calling an ambulance, police say.
On Dec. 19, Lynnette died after seven weeks in a coma. She is one of the most recent N.C. mental health patients to die under questionable circumstances while in the care of group homes, psychiatric hospitals and other mental health facilities.
Last week, a 15-year-old girl died when staffers restrained her in a Charlotte home for children with mental problems. At least 34 others have died since 1994 from such things as falls, suicides, starvation and choking, The Observer has found. More than a third involved patients' age 35 and younger.
The Morrises and a growing group of supporters are launching a push to change North Carolina's mental health laws, particularly for a group of 2,500 of the state's most vulnerable patients. They are adults like Lynnette, known as Thomas S. clients, who have both developmental disabilities and mental illness.
The Morrises don't know what happened to Lynnette that night, but they fear her bruises and head injury were caused by a beating. Police have charged caregiver Showanda McKoy with felony patient abuse and neglect. She is scheduled to appear in Moore County District Court this week.
Through their attorney, officials from the Fayetteville-based Preferred Alternatives declined to comment on the case.
"We don't know what happened to Lynnette," Donald Morris says. "But we know that whatever happened to her not only killed her, it killed us, too."
Thousands of North Carolinians turn each year to state-run and private mental health facilities for treatment and care. But state and federal regulators do not provide routine oversight and often don't investigate questionable deaths. Sometimes, they don't even know about them. Gov. Jim Hunt and a number of key legislators are now pushing to toughen the laws that protect mental health patients. Among other things, they say North Carolina should begin requiring mental health providers to report deaths to regulators. All questionable deaths should be investigated, they say, and licensing laws for more than 3,300 private mental health facilities need strengthening.
The Morrises say those changes are crucial. But Lynnette's death, they say, should also convince lawmakers to take on similar problems that endanger Thomas S. patients, who often have multiple disabilities. Some are mentally retarded and have frequent hallucinations. Others are violent, have other behavior problems, and suffer from paranoia.
A class-action lawsuit in the early 1980s successfully moved Thomas S. patients from state institutions into group homes and other small facilities. Mental health advocates say the push to serve them outside hospitals was long overdue. State hospitals often didn't provide good care or safe conditions, they say, and the quality of life was poor.
But mental health advocates worry that North Carolina has so far failed to take the next crucial step: Providing oversight and support now that especially vulnerable people have made homes in their communities.
Consider:
The state pays for the care of some Thomas S. clients in one-bed homes operated by nonprofit groups or private companies. But N.C. law doesn't require that the homes be licensed, which means Raleigh regulators are not making site visits or checking staffing levels. Only homes that serve two or more adults must get a license from the state's Division of Facility Services. Lynnette's home wasn't licensed because she was the only client living there.
The 39 local mental health offices throughout the state often don't ensure that Thomas S. caregivers are trained, families say, even though those patients have complex needs. Families also worry about oversight. Though Thomas S. caseworkers have smaller loads than other mental health officials, they are often inexperienced and don't always detect substandard care. And when violations are found, families say, little is done to correct the problems.
Police say Lynnette was slapped and hit in the weeks prior to her death, and have charged a second worker with three counts of assault. Lynnette's family wonders why no one detected problems in the home.
Many communities don't offer enough vocational programs and employment opportunities to Thomas S. clients. Without the involvement of other professionals, mental health officials say, mistreatment is less likely to be detected.
Until two years ago, Thomas S. clients had some of the strictest oversight of any group of mental health patients. State law required Thomas S. caregivers to report all patient deaths to mental health officials. But the state successfully dissolved the class-action lawsuit in 1998, saying proper care is now provided. Now, it's unclear whether that death-reporting law still applies. State officials, though, say the Division of Mental Health still requires caregivers to report deaths.
Raleigh-based attorney Roger Manus says protection is particularly important for Thomas S. clients because they live in small facilities, and often rely on several caregivers for basic needs. Manus is representing Lynnette’s family in a potential lawsuit.
"Until supports are (available) to enable persons with disabilities to become integral members of their communities, with relationships well beyond the paid support staff, we need more effective monitoring, especially in smaller settings, " says Manus, the lead attorney who represented Thomas S. clients in the class-action case.
"Various protections were supposed to be in place. Obviously, they weren't."
A trauma at age 14
In a bedroom painted pink and yellow, Lynnette Martin dreamed of becoming a nurse.
As a child, she swam and played piano, the Morrises say. She threw sleepovers and rarely missed church. She watched medical shows on television, and talked about going to college.
Lynnette was Ileine's sister by adoption. But the Morrises took her in when she was toddler and raised her as their own.
When Lynnette was 14, the Morrises say, a man in an after-school program sexually molested her. She was never the same again.
She wet her pants, rarely slept, told her family she was afraid of getting hurt again.
Diagnosed with post traumatic stress disorder and later with a form of schizophrenia, Lynnette received long-term treatment in hospitals and group homes. In 1995, at age 29, she was classified as a Thomas S. client.
"In a good time, you couldn't have found anyone better to be with," Ileine Morris says. On bad days, though, Lynnette’s eyes would roll back and her arms would flail. She would forget where she was, moan, yell. She said she was constantly afraid of the man who had hurt her.
Last June, mental health officials in Moore County worked with the Morrises to place Lynnette in a home in Aberdeen operated by Preferred Alternatives. The company hired caregivers to help Lynnette with such things as cooking, cleaning and behavior control.
The Morrises say Lynnette hinted that something wasn't right in her new home, but wouldn't give details. Lynnette wanted to move back with her family. So the Morrises were preparing to make an apartment for her in the basement of their home in Troy, about 55 miles east of Charlotte.
But about midnight on Oct. 27, Lynnette suffered a head injury in her Aberdeen home.
"Whether it was intentional or whether it was accidental or what, we don't know at this point, " says Aberdeen Police Chief Charles Campbell. He says he believes there was neglect by the caretaker.
"She was working with her, supervising her," Campbell says.
Lynnette arrived at the hospital unconscious and needed emergency brain surgery. She never woke up.
Not knowing what happened to Lynnette that October night- if she was in pain or calling for help-haunts the Morrises. They suspect Lynnette may have been beaten because of the marks on her body. An emergency room physician, though, wrote on a report that he was told that Lynnette injured herself. The Morrises say Lynnette did not often hurt herself and when she did, staffers were supposed to know how to help calm her.
The police and district attorney investigations continue.
"I want to look (McKoy) in the eye and say 'Please tell me what you did to my daughter,' " Ileine Morris says. "What were the last words that she spoke? Was she calling for her mother and father to come help her?' I just want to know the truth."
McKoy, 22, was arrested in December and posted $20,000 bond. She is now employed by the Department of Correction as a correctional officer trainee. A department official says McKoy will not work with inmates until the martin case is resolved.
McKoy did not return phone calls.
Licensing could add oversight
State licensing might not have saved Lynnette, but the Morrises and some mental health advocates say it would have added an extra layer of oversight.'
If the state's licensing rules are strengthened, and more inspectors are added to make regular inspections and unannounced visits, Thomas S. clients in one-bed homes would be better protected, they say. Though one-bed homes for adults don't need a license, the state requires the licensing of all one-bed homes for children.
Mental health officials say they don't track how many Thomas S. clients live in one-bed facilities. The state pays more than $100,000 a year to care for some Thomas S. clients. Others need much less.
"The law needs to be changed," Ileine Morris says. "Anybody that has an adult in a one-on-one situation like this needs to report to the state."
Mental health official’s counter there was risk involved when Thomas S. patients were moved out of institutions and into their communities. They point out that hundreds of Thomas S. clients are successfully living on their own, with families or in homes run by companies and nonprofit groups.
"(Lynnette's death) is a very, very sad situation, but it is only one person in a number of people who are being successfully integrated," says Ann Eller, with the N.C. Division of Mental Health.
Eller says communities-churches, neighbors or friends-must begin to take responsibility for residents with special needs. The latest mental health research suggests that patients are safer the closer they are to family.
"Although local and state government do their best to provide oversight, there will probably never be enough money and resources to provide the level of oversight needed," she says.
In the meantime, Eller says local mental health offices provide some protection.
But Michael Watson, the director of the mental health program that serves Moore, Montgomery, Hoke, Anson and Richmond counties, said monitoring clients is a challenge.
Four or five case managers divide their time among about 45 Thomas S. clients, he says. The clients are scattered among nursing homes, group homes, supported apartments and their own homes.
"These are often not facilities with a supervisor walking up and down the hall all day long and watching what's going on," he says.
Many of the problems of Thomas S. clients also affect thousands of other patients with mental illness, developmental disabilities and substance abuse problems. If the state doesn't quickly correct them, it risks another lawsuit, says John Tote, executive director of the N.C. Mental Health Association.
"Every day we put ourselves at risk because we don't have the services that we need," he says.
Friends lobby for change
In Montgomery County, Lynnette's friends and relatives have formed a foundation in her honor. They've posted her pictures on the Internet and are beginning to lobby legislators on behalf of the mentally ill.
At night, the Morrises slip in Lynnette's bedroom and pull out her scrapbook, the one with the Betsy Ross report and the Mother's Day card with Lynnette's handprint etched in blue paint.
A carousel figurine the Morrises bought her for Christmas last year still sits on the bureau. Lynnette never got the chance to see it.
"We thought we had caring people to look after her, trustworthy people," Ileine Morris says, "She was the person we loved most in this world."
From 1994 to mid-1999, at least 34 people under the care of N.C. mental health facilities have died suddenly or in circumstances that could raise questions about their care. Two more have died in recent weeks. A majority of the deaths were never investigated by state or federal regulators. In some cases, they didn't know about them.
North Carolina allows individuals with little or no training to open mental health facilities. And once a facility opens, the state offers little oversight. Licenses are often issued without site visits; abuse and neglect complaints sometimes sit untouched for weeks.
Though sporadic investigations have cited dozens of N.C. mental health facilities for failing to train caregivers, state law sets few hiring and training standards. This week in Raleigh, legislators on a joint mental health commission will meet to propose stronger mental health laws.
"Although local and state government do their best to provide oversight, there will probably never be enough money and resources to provide the level of oversight needed." Ann Eller, N.C. Division of Mental Health
Reprinted with permission from The Charlotte Observer of Charlotte, NC, February 12, 2000
