Another review has found troubling conditions at the Rosewood Center for developmentally disabled residents, leading a state agency to reimpose a ban on admitting new patients and requiring a part-time independent monitor to help protect current residents at the Owings Mills site.
"We really felt there had to be a continued presence given what we've found and the history," said Wendy A. Kronmiller, director of the Office of Health Care Quality, part of the state Department of Health and Mental Hygiene.
The 160-page document, made public yesterday, details problems at the 300-acre Baltimore County campus, such as staff members' inability to control aggressive residents, signs of residents repeatedly choking on food and missed feedings of intubated residents and missed mealtimes for others.
This is the third time the state has banned new admissions to Rosewood. If the center does not meet federal standards -- it's now failing seven of eight criteria -- Rosewood would lose its federal funding by July.
Among problems found during a review last month were small, loose objects such as a razor blade, batteries, screws and other items outside cottages that house residents who put inedible items in their mouths.
Staff members did not take steps to protect other employees or residents from a client with a history of violent behavior. Also, a family was not informed of injuries after a resident suffered broken ribs from the Heimlich maneuver after choking on food.
And nine of 14 patients who receive nutrition through tubes did not receive adequate feedings nor were they administered at the scheduled times.
"This confirms concerns about the quality of people's lives and their safety," Kronmiller said. Advocates for the developmentally disabled who favor closing institutions such as Rosewood were shocked by the extent of the problems.
"How many times does it have to be this bad?" said Teri Sparks, a client advocate for the Maryland Disability Law Center. "The most disheartening thing is that nothing happened last time [a ban was put in place]. We really thought the governor was going to step up."
Problems at Rosewood, founded in 1888 as the Asylum and Training School for the Feeble Minded of the State of Maryland, have been in the spotlight this year. In January, the Health Department banned new admissions after state investigators found instances where staff members failed to protect residents from harm.
The General Assembly took up the issue in March, holding a hearing in which disabled adults and advocates urged the state to close Rosewood. Others defended the center, saying that it had improved and that it offered care unavailable elsewhere.
The state then passed a law that would require the Health Department to develop a plan for Rosewood, review each patient's situation and develop a cost analysis and timetable for moving the patient to another site or into the community.
Sparks wasn't sure that the new requirement of an outside monitor would bring much improvement. The monitor would be at Rosewood 25 hours a week, starting in October.
"I'm encouraged that they're going to give it some more attention, but you just feel more drastic measures are needed," Sparks said. "Even if some of these problems were resolved, it's still keeping people institutionalized that don't need to be institutionalized."
Glenn M. Brown, whose profoundly retarded daughter Jean has lived at Rosewood for 42 years, said he was happy with her care there.
Brown felt the problems arose because there aren't enough staff members to care for clients referred to Rosewood by the judicial system -- nor are employees adequately trained for the significant challenges these residents present.
But only about 40 to 45 residents are court-assigned, compared with about 130 developmentally disabled people, Brown said.
He said he would object to an outside monitor if he or she opposed the role of institutions.
Kronmiller said the monitor would be someone who was open to the idea.
"It's an embarrassment that an independent monitor needs to be sent into a state facility," especially because of Maryland's status as the richest state in the nation, said Brian Cox of the Maryland Developmental Disabilities Council.
"This is how we treat some of its most vulnerable citizens," he said. "There's really no excuse for it."