Kentucky advocates say state should better review deaths of disabled people in institutions

From the Lexington Herald-Leader in Ky.:

FRANKFORT, Ky. — Kentucky needs to increase the number of autopsies and death reviews done for the mentally disabled and mentally ill, a leading advocate said Dec. 15.

Marsha Hockensmith, director of Protection and Advocacy, told the Interim Committee on Health and Welfare the state currently reviews deaths of the mentally disabled and mentally ill in state-run facilities and can review deaths of disabled people in some community-based settings. Protection and Advocacy is a state agency that advocates for the disabled.

However, more needs to be done to ensure those who receive services in community-based settings are not dying as a result of abuse, neglect or other preventable diseases, Hockensmith said.

Problems were uncovered in other states where autopsies were performed on people with disabilities, she said. For example, a Michigan woman with an intellectual disability died from a dental abscess that led to a brain infection because surgery on the infection was delayed, Hockensmith said.

Hockensmith said she recently was notified about the death of a 37-year-old man who was released from a psychiatric hospital to a personal care home, a less restrictive form of nursing care than a nursing home. It's not clear what happened to him, but given the man's age, its a death that needs to be investigated, Hockensmith said.

Broadening the review of deaths of the mentally ill and mentally handicapped should begin with looking at requiring autopsies in unexplained or unexpected deaths of those who have a state guardian, she said. So far in 2010, 252 clients of state guardianship have died.

State guardians are appointed to oversee a disabled person's care if no family member is able to do so. Many of those deaths were natural or were people who did not die unexpectedly.

"You're not looking at a huge, huge number," Hockensmith said of the autopsies.

Stephen Hall, the commissioner for the Department for Behavioral Health, Developmental and Intellectual Disabilities, said the Cabinet for Health and Family Service's mortality review expanded to include people who receive state services in the community in 2007. That change was prompted by a series of stories in the Lexington Herald-Leader, which showed that deaths in community-run programs for the disabled were not investigated.

Hall said the cabinet agrees with Hockensmith that more needs to be done to protect those who receive state services. However, the cabinet has run into problems receiving information from private providers on deaths in the community.

"It's significantly more difficult to get information in those cases," Hall said.

Rep. Darryl Owens, D-Louisville, questioned if there were costs associated with autopsies and who would pay for those autopsies. Hockensmith said there has been some disagreement on whether the county government or the state would pay for the autopsies.

Hockensmith said after Wednesday's meeting she plans to investigate the issue further to determine if money would have to be appropriated by the legislature and what, if any, legislation is needed to change existing law so more deaths could be reviewed and examined.