Deaths of Mentally Retarded Children Raise Questions About Hospital : Health care: State inspectors find myriad problems at the Loma Linda facility. But officials allow it to continue operating.

The recent deaths of six mentally retarded children within six weeks at an extended-care hospital raise questions of whether these fragile youngsters were victims of illness or incompetence.

The cluster of deaths at Mountain View Child Care Center in this San Bernardino County town is the second time this year that severely disabled youths died under questionable circumstances in a state-licensed health facility.

A state inspection after the Mountain View deaths, which occurred in March and April, turned up a veritable handbook of horrors, from poorly trained staff to a record-keeping system so shoddy an apparent attempted murder was never followed up.

But the state Department of Health Services allowed Mountain View to keep its license and continue to accept children with severe mental and physical disabilities.

Inspectors said the most they could do was assess a $37,000 fine and order the facility to clean up its act.

“This facility is taking clients that normally other facilities wouldn’t take,” said Roger Robinson, a supervisor for state inspectors. “My problem is I could close this place. But if I did, where then are we going to put these babies?”

Health officials and advocates for disabled people say the Mountain View case illustrates the complicated problems in a mental health system that is failing to protect the state’s most delicate residents.

But assessing clear blame is not easy. A lack of money, bureaucratic confusion, lax laws, a shortage of facilities and the inherent difficulties in caring for severely disabled clients all contribute to the problem, advocates say.

“The system is not coordinated and integrated, and you don’t see people having a shared mission and direction in terms of the clients,” said Colette Hughes of Protection and Advocacy Inc., a nonprofit agency that monitors the treatment of the mentally disabled.

In the Central California community of Gilroy, three mentally disabled children died between Jan. 6 and 22 after they were transferred to a convalescent home from a facility that had its license revoked.

In both that case and the one in Mountain View, state health officials said their options for responding to the deaths were limited because in such situations it is often unclear whether the children died as a result of negligence or whether fate had run its course.

“I don’t mean to downplay the fact that these clients died and there was negligence involved, but there is a certain amount of risk involved in operating one of these facilities,” said Paul H. Keller, chief of the southern field operations branch of the state Health Department.

The Mountain View deaths serve as a good case study.

A neatly kept complex of gray stucco buildings between a freeway and the railroad tracks 60 miles east of Los Angeles, Mountain View is often the last stop for children with severe disabilities.

The clients suffer both physical and mental problems, making them among the most difficult to care for. Many eat and breathe through tubes inserted in their bodies. They require help to sit up, bathe and go to the bathroom.

Because of their fragile health, they are extremely susceptible to viral and bacterial infections. It is common for them to die of pneumonia and other ailments even under the best of care.

Often, such children are abandoned by desperate parents unable to cope with the demands and expense of rearing them. Some are abused at home. As a result, they end up in the state mental health system.

Usually, they are cared for in private houses, licensed to handle half a dozen clients in an environment that offers homelike surroundings but limited medical care. Larger facilities balk, saying the state’s $90-a-day reimbursement does not cover the costs of high-level care.

The state this year started referring children to Mountain View, a for-profit facility closer to a convalescent hospital for the elderly than a private home for the mentally disabled.

Mountain View co-owners Don Nydam and brother-in-law Jim Hooyenga said they spent $1.8 million to convert the center from one caring for clients with lesser needs to a more acute-style facility.

But state inspectors and former Mountain View employees said the more demanding clients started arriving before the center was ready to take them.

Between March 1 and April 14, six clients died, including boys ages 2 and 6 whose breathing tubes fell out. For one of the deaths, the center was fined the maximum under law: $25,000.

“By their bungling, death did result,” said Robinson, the state inspector supervisor. “They just kind of ignored the kid and let him choke to death.”

Mountain View plans to appeal the penalty at an administrative hearing, officials said.

“The facility strongly disagrees that a client developing pneumonia or dying from respiratory arrest is evidence of failure to provide appropriate nursing services,” the center said in its written response to the state findings.

For other deficiencies, the center said it was changing its policies and improving staff training.

Nydam said the center has an excellent reputation and provides “the kind of care that has always been considered to be outstanding.”

And, in fact, until this year, the center did have a good track record. Its April, 1992, inspection revealed only six deficiencies that were relatively minor and easy to correct.

The April, 1993, inspection was another story.

According to a 67-page report, the center had hired newly graduated registered nurses and licensed vocational nurses without any experience in working with developmentally disabled clients, or even children.

At one point, the facility had 38 patients--many with throat and stomach tubes--with only one registered nurse and one licensed vocational nurse on duty, a former worker said.

“I just saw a nightmare coming,” said the worker, who spoke on condition of anonymity. “I thought there is liability here. There is going to be problems.”

When inspectors asked staff members working with infants what they, the staff members, were supposed to be doing, they gave such responses as, “I am new here” or “I’m just waiting until the other person comes back,” the report said.

Meanwhile, clients were left in isolation for no apparent reason, allowed to do things that were not part of their mental health programs and in some cases just ignored, inspectors found.

“On three separate occasions clients . . . were observed placed in front of the TV with a lot of static and with no picture,” the report said. “The clients were just there. There was no stimulation or talking to the clients by the staff.”

The problems created a dangerous environment, the report said.

During the inspection, one client vomited but the staff did nothing to help the client until the problem was pointed out by an inspector.

At another point, when aides were asked what they would do if clients stopped breathing, they said they would find a nurse and failed to say they would give first aid, the report said.

In the most severe case, a client identified only as No. 52 was trying to get phlegm out of his throat, but a staff member declined to intervene, saying, “He didn’t need suctioning, he can bring it up on his own.”

Five days later, the client died from respiratory distress when the tube in his throat fell out, the report said.

Record-keeping also was lax, inspectors said. In one instance, a nurse recorded that a client’s father on March 7 apparently tried to kill his child by squeezing the child’s breathing tube.

But there was no documentation to indicate the center did anything about it, the report said.

“No follow-up or protection was addressed . . . by the facility,” the report said.