An Uncivilized Neglect of the Mentally Disabled

Civilizations can be judged by how they treat their most helpless members, and California is failing. The state’s care of the severely developmentally disabled, including the profoundly retarded, has declined so precipitously that the federal government has threatened to pull $250 million in federal funding.

It wasn’t always that way. Since the 1950s, California state hospitals had pioneered humane ways of caring for mentally retarded and developmentally disabled citizens. Researchers at Camarillo State Hospital, for instance, have shown that many children suffering from severe autism, dismissed as mentally unreachable, can interact socially and live fulfilling lives if they are cared for by skilled professionals.

Now, with the hospitals mostly emptied and patients sent to cheaper nursing homes and group homes, inspectors found “unsanitary conditions,” “inadequate nutrition” and instances where caretakers had completely lost track of the patients supposedly in their care. The old hospitals were not perfect: Many were large, expensive and far from their patients’ home communities. In the early ‘90s the state dramatically stepped up a program to transfer the disabled to a variety of community locations. The state assigned the job of overseeing the homes to 21 “regional centers” that hire the community homes as subcontractors.

But the state made a fatal mistake. It transferred the patients but failed to transfer the kind of skilled health workers who could adequately supervise their care. With these jobs handed over to unskilled, often minimum-wage workers, severely retarded adults were sometimes deprived of assistance with even eating and clothing themselves.

In the last year, several studies have documented the consequences of the state’s transferring its most vulnerable population into loosely overseen facilities. When the studies first came out, Gov. Pete Wilson should have immediately halted regional center placements, something that the California Medical Assn., Sen. Dianne Feinstein and many patient advocates urged. But the transfers were allowed to continue until now.

Two fundamental reforms are particularly urgent:

* Raise staff credentialing standards. Washington has ordered Sacramento to transfer regional center responsibility from the state’s Department of Developmental Services to its Department of Health Services, which makes sense because medical expertise has been so lacking and the focus has been so sharply on cost reduction. But transferring oversight isn’t enough. The fundamental solution is in requiring higher levels of medical expertise and therapy in both the regional centers and group homes.

* Beef up oversight. Studies in the last year have shown that many community homes fail to provide appropriate care--dentists, for example, who are experienced in aiding patients who can’t make even simple requests. Better monitoring would also ensure that homes at least keep track of their patients and feed and clothe them adequately. The state needs to provide the Department of Health Services adequate funding and the power to punish violators. It should also contract with the University of California to provide regular progress reports.

Gov. Wilson has been quick to use the state’s current budget surplus for tax breaks and useful, politically popular causes like class-size reduction. But this less visible need to protect and nurture the most helpless is urgent. The very measure of California hangs in the balance.