Care Facility Fined Over Slaying

Regulators have fined a state developmental center in Pomona $25,000 for failing to protect a 31-year-old mentally retarded man who was slain there last August.

The California Department of Health Services said Wednesday that it had issued an AA citation against Lanterman Developmental Center in the death of Mark Orchen. The AA is the most serious possible citation under state law.

In the early morning of Aug. 7, 2002, Lanterman staff found Orchen unconscious in his room and in respiratory distress, according to state documents. Attempts to resuscitate him failed.

An autopsy by the Los Angeles County coroner’s office determined that Orchen died of internal bleeding caused by blunt-force trauma to the abdomen. The perpetrator is unknown, according to the health department.

Inspectors found that Lanterman failed to protect Orchen from multiple injuries during his five-month stay and then didn’t investigate them properly afterward.

Between March and August 2002, Orchen was hurt more than a dozen times -- sustaining cuts, bites, bruises and broken fingers. Some of the injuries resulted from his own aggressive behavior and retaliation from peers; others were unexplained, according to the state.

State inspectors also faulted Lanterman for failing to follow its own staff’s May 2002 recommendation that Orchen be transferred to another unit where he could receive better care and protection.

“They had meetings, they talked about what they wanted to do and then they just didn’t do it,” said Paul Hendricks of the state Department of Health Services.

“There was some negligence on their part.”

Lanterman officials said they do not plan to appeal the $25,000 penalty.

“We’re devastated by this tragedy, and our hearts and prayers go out to the family,” said Lanterman’s interim Executive Director Sherry Kohler. “Nothing like this has ever happened before.”

She said Orchen was not moved to another unit because his parents objected. Since his death, Kohler said, Lanterman officials have evaluated the level of supervision given to all clients and made changes, when needed, to ensure that they are protected.

One resident, identified by police as a possible suspect, was placed on continuous supervision overnight for six months, although staff members reported nothing untoward. Supervisors also have conducted random spot checks in Orchen’s unit to monitor the clients and staff members there.

Orchen’s father, Melvin, said through his attorney, Randall Walton of San Diego, that the fine is justified.

“Unfortunately, it will not bring our loving son back from his untimely and wrongful death,” he said.

The Orchens filed suit last week against Lanterman and one of its staff members in Los Angeles Superior Court, alleging negligence, battery and wrongful death.

Lanterman, which opened in 1927, houses about 640 residents with developmental disabilities, including mental retardation and brain damage. It sits on a 302-acre campus in Pomona.

Because Lanterman deals with clients who are difficult to manage, Hendricks said, fights and outbursts sometimes occur. “As they’ve depopulated the state hospitals, only the tougher clients have stayed behind,” he said. But he said this incident was “very serious” and should not have occurred.