By Debra Jasper and Spencer Hunt
Photos by Michael E. Keating
The Cincinnati Enquirer
In Dayton, a mentally retarded woman is so severely dehydrated she curls up on an old couch and dies of thirst.
In Cincinnati, a mentally retarded man having a seizure dies after a caregiver hangs up on a 911 operator offering help.
In Columbus, a mentally retarded man on a dairy-free diet chokes to death on a "golf ball-sized wad" of bread and cheese.
Whether by neglect, incompetence or accident, these are three of at least 12 people who died in questionable circumstances inside a state system that's supposed to protect them.
Instead of keeping people healthy and safe, Ohio's mental retardation system is so chaotic it routinely fails to prevent deaths, correct problems or enforce minimum standards of care, The Cincinnati Enquirer has found.
For every person who dies unexpectedly, hundreds more are abused, cursed at or stolen from. Many people get inept medical care. Others, robbed of dignity, sit for hours in their own urine and excrement or spend days with nothing to do.
In some of the worst homes, supervision is so careless that people with eating disorders have swallowed everything from a double-A battery to dirty diapers left out by staff. Agencies at times don't even watch over sex offenders or other dangerous mentally retarded people.
A computer analysis of inspection records since 1998 and hundreds of interviews with the mentally retarded, their families and officials reveal problems at all levels of the system - from government-funded, at-home care and day programs to group homes and institutions.
Among findings of the Enquirer's investigation:
"I see it all the time, inadequately trained staff, people who don't know how to manage behavior. Broken bones are common, so is dehydration. There's not even enough staff to make sure people who can't express their thirst are getting enough water," says Marti Estep, program director of Advocacy and Protective Services Inc., a state-funded agency that provides guardians to 3,400 Ohioans.
- Deaths from all causes jumped 78 percent in the past four years, to 747 in 2001. The 12 questionable deaths identified by the Enquirer just hint at a bigger picture: One state medical director says he sees 80 to 120 avoidable deaths a year - more than one of every seven deaths in the system.
- Reports of abuse, neglect, accidents, hospitalizations and injuries quadrupled since 1998, to more than 14,000 in 2001. Details of abuse, and whether anything is done about it, are kept secret by state law.
- Conditions were so bad in the past three years that the state threatened to cut off all funding to 65 of Ohio's 400 institutions and nursing homes for the mentally retarded. None of the threats was carried out, and the institutions collected $263 million in tax dollars.
- In some counties, a single social worker oversees as many as 125 people at a time, even though the state says workers should watch over no more than 30. Half of all caregivers, who work directly with the mentally retarded and earn some of the lowest hourly wages in Ohio, quit the system each year.
"It's like I'm seeing a world through dark glasses."
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