COSTA MESA – The details of deadly neglect and abuse at Fairview Developmental Center will not sway Maggie Flavia.
To her, the hospital for people with developmental and intellectual disabilities is filled with doting staff who keep her 58-year-old son clean and groomed. He goes to music therapy and spends time outside in the sunshine with his foster grandparent.
Fairview has been his home for 30 years.
Flavia’s view of Fairview contrasts sharply with the image painted by dozens of citation reports from the California Department of Public Health, released this month by the Center for Investigative Reporting.
The reports, which track incidents from 2002 to 2011, detail a 16-year-old girl’s killing by a fellow resident, as well as cases of sexual abuse, escapes and falls.
They also reveal that state regulators blamed Fairview for the death of six residents during that period, including a young a man with a history of seizures who drowned in a bathtub while left unsupervised.
Those reports are fueling calls by some disability-rights advocates and at least two state lawmakers for Fairview to be closed. Some also cite Fairview’s high cost of operation – $500,000 a year, on average, for each patient.
Fairview officials declined comment for this story.
But calls to shutter Fairview are strongly opposed by some of the families connected to the developmental center.
“If one of my sons choked or drowned, I’d feel terrible,” said Flavia, of Huntington Beach.
“But it’s an impossible situation.”
For the six deaths for which Fairview was deemed directly responsible, plus two others for which Fairview was deemed partly responsible, the state fined Fairview $232,500.
But there’s a lot more money on the line.
Fairview is at risk of losing $32 million in Medicaid funding this year if it does not fix violations that regulators uncovered two years ago.
During a visit in the summer of 2013, regulators found chronic failures in patient care.
They also found some residents were not given personal freedoms: They were not allowed to make their own sandwiches or do their own laundry when they were capable of doing so. There were not enough staff to take residents outside when they asked, state records show. Right now, there are about 1,500 psychiatric technicians, administrators, nurses and others on staff to care for 281 residents.
Additionally, regulators determined that the independent state-run police force that serves California’s four developmental centers, the Office of Protective Services, has not always following procedures to investigate residents’ allegations of abuse.
COSTA MESA OPENING
The state’s first institution for developmentally disabled adults, the Insane Asylum of the State of California, opened in 1853 in Stockton.
Over the next century, the state opened several similar institutions, offering an often grim life for people with mental disabilities who couldn’t take care of themselves or whose families couldn’t care for them. People with everything from severe autism and epilepsy to cerebral palsy and severe brain trauma have lived and died in developmental centers.
The state opened Fairview Developmental Center in 1959 in Costa Mesa; the 2,622-bed hospital abutted the city’s golf course. By the late 1960s Fairview was one of eight developmental centers in California, with a systemwide population of 13,400.
Demand was so high at some centers there was a waiting list to get in.
But as demand peaked, in 1969, the state passed the Lanterman Act. The law said people with developmental disabilities had the right to choose where and with whom to live, and to pick the types of services they want and need.
It also said they had the right to those things near their home, with people from their community. Those changes essentially jump-started the demise of so-called mental hospitals.
“It basically said people have to be in the least restrictive setting,” said Larry Landauer, executive director of the Regional Center of Orange County, which helps people with developmental disabilities find resources and housing.
“So the big question is, ‘Why are there even institutions then?’ They were the only games in town.”
THOSE WHO REMAIN
That’s not true anymore.
Today, more people with developmental disabilities live in group homes and smaller facilities, where the level of care ranges from providing meals to round-the-clock nursing and specialized medical care.
Group homes are licensed by different state agencies depending on the extent of care. These homes and facilities are less expensive to operate – from about $75,000 to $300,000 annually per resident – and tend to look more like houses; they are often in residential neighborhoods.
Every year, about 200 residents statewide move out of bigger developmental centers, like Fairview, and into smaller group homes. There are about 415 group homes and residential facilities in Orange County, housing about 2,421 residents, according to the regional center.
Four developmental centers have closed in California since the late 1990s, and a moratorium was placed on almost all new admissions in 2012. The four remaining developmental centers house a combined 1,115 residents, many needing the highest levels of care and services.
The Legislative Analyst’s Office has recommended that Fairview be closed too. There are also two bills, one in the state Senate and one in the Assembly, calling for Fairview to be shut down.
Given the high cost and plummeting population, there’s no question that Fairview eventually will close, said Landauer, of the regional center.
“It’s going to close,” he said. “Some families don’t want to hear that. The staff don’t want to hear it.”
PETE’S STORY
Pete Flavia is among the 281 residents of Fairview. It’s where he has spent much of his adult life.
At age 14, after a bout of viral encephalitis, he was left quadriplegic and with the mental capacity of a 6-month-old, according to his mother, Maggie Flavia, 82. He is unable to walk, speak, feed or dress himself.
Maggie took care of Pete for about four years while raising three younger sons.
“I thought he ought to be home. You don’t desert your family,” she said. “But it had a down side, because my husband and the other three boys missed out on a lot of my attention. It was like taking care of a 6-month-old baby. I was housebound big time. I was definitely a stay-at-home mom. But I’m glad I did it.”
Pete Flavia moved into Fairview as a young man in 1985. His brother Kevin Flavia’s first impression of Fairview was that it was bright and engaging.
“It didn’t seem like (residents) were on mind-altering drugs or being tied down. It seemed like a much more positive place for a person who was disabled to live,” he said.
That impression never changed.
“I’ve always felt that way,” Kevin Flavia said. “It’s not a perfect world. If we had unlimited (income), that would be a different story. But we’re talking about a public institution.”
Before he was on a feeding tube, Pete Flavia would allow only certain people to feed him, his mother said. Once, when he was particularly sick, one of his favorite Fairview employees drove to the hospital every day to get him to eat, she said.
“He put Pete’s wheelchair in his pickup truck, and every afternoon he went down there and fed Pete,” she said. “I’ll never forget that.
PREPPING THE BEDS
The Flavias are not convinced, but Landauer said the care Pete Flavia gets now at Fairview can be replicated elsewhere.
If and when Fairview does close, he added, it will take a couple of years to develop enough appropriate homes and facilities for the residents. The regional center expects about 80 of the 281 people now living at Fairview would land somewhere in Orange County.
“You have to really be gentle on the transition from an incredibly structured and locked facility into the community, with all the commotion and all the freedoms,” Landauer said.
Other advocates say it’s tough to know where people with developmental disabilities will be safer.
Leslie Morrison, an attorney who heads the investigation unit at the state department of disability rights, says it’s harder to track abuse and neglect in group homes than it is inside developmental centers.
“Certainly, there have been many questions about the quality of investigations that (state investigators have) conducted,” Morrison said. “The good news is that they’re accustomed to speaking with people with developmental disabilities. And they’ll respond to some of the things that police wouldn’t respond to, like someone kicking a resident.
“A cop in a community may not come out and investigate that,” Morrison said.
Still, she said, it’s unclear what will be best for patients.
“We don’t know what’s happening in the community places the way we know what’s happening in developmental centers.”
Contact the writer: jchandler@ocregister.com and @jennakchandler on Twitter
