Georgia has failed to ensure that developmentally disabled people discharged from state hospitals receive adequate services to remain safe and avoid harm, federal attorneys say in a recent court filing.

The attorneys said that of the approximately 503 people with developmental disabilities discharged from state-run hospitals since 2010, 79 have died.

“The available records indicated many unaddressed medical needs,” said U.S. Department of Justice attorneys in their arguments for improvements in community services for people with developmental disabilities and mental illness.

“While the majority of these persons had complex medical needs that are associated with higher mortality, many of the death reports document poor assessments, care, and oversight across the state,” said federal attorneys Jan. 19 in their filing in federal court.

Some of the deaths were not investigated by the state, said a consultant for the Department of Justice who analyzed state records.

The federal filing, which asks for court intervention, contain new details about problem areas that remain with a 2010 settlement agreement between Georgia and the Justice Department over care for people with mental illness and development disabilities.

Georgia and DOJ remain at an impasse over provisions of the pact, despite U.S. District Court Judge Charles Pannell’s recent push for quicker action to resolve their differences. Earlier this month, after meeting with the two sides, Pannell told them to prepare for a formal hearing in late March.

A spokeswoman for the state Department of Behavioral Health and Developmental Disabilities said Monday that the agency will appear at a court hearing on the matter March 28. “We remain steadfast in our commitment to fulfill the settlement obligations and to support recovery and independence for the people we serve,’’ said the spokeswoman, Angelyn Dionysatus, in an email to GHN.

Previously, Jaime Theriot, an attorney representing Georgia, has argued that the state has fundamental disagreements with the Justice Department over what is required under the settlement.

Theriot has said the state does not dispute the numerical targets on hospital discharges. But she said Georgia does object to what she called a federal “attempt to enforce terms that don’t exist in the settlement agreement.”

Critical report

A September report by independent reviewer Elizabeth Jones described what she determined to be Georgia’s lack of compliance with the agreement.

Georgia, under the landmark pact, agreed to end all admissions of people with developmental disabilities to state psychiatric hospitals. It also promised that patients with developmental disabilities already in those hospitals would be moved to more appropriate settings by July 2015 — the deadline for the agreement’s provisions to be met.

The settlement agreement also sought to improve care for Georgians with mental illness. Georgia agreed to establish community services and housing for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization.

An AJC series in 2007 about deaths of patients in state hospitals helped lead to the settlement.

Both sides have agreed that the state has made tremendous progress in delivering new services to people with serious mental illness. But care for people with developmental disabilities is a source of conflict and disagreement.

“People with complex needs can be served in the community with adequate supports and services…. The state has failed to assemble professionals with expertise who can assess an individual’s needs and connect the individual to services in a timely manner, and the failure to do so has placed persons at risk of serious and preventable harm,’’ DOJ attorneys argue.

Their filing points to one person, referred to by the initials NS, who “was in good health until she choked on a sausage biscuit given to her for breakfast on April 8, 2015. . . . [NS’s] death appeared to have been preventable.”

Even when assessments and recommendations are made, the state has failed to ensure effective corrective actions are implemented, the federal attorneys say.

Federal attorneys, and those representing consumer groups, have pointed out that 14 states have closed state-run facilities for people with developmental disabilities.

“The evidence is very clear that the state needs to be more proactive … to identify and closely monitor the people who are at most risk [of potential harm],” Alison Barkoff of the Bazelon Center for Mental Health Law told GHN on Monday. “We know that people with complex needs can be supported safely in their communities.”

Theriot said in a recent court filing that the state “cannot and will not accept any of [DOJ’s] proposals that are subjective, prescriptive, and divorced from any consideration of available resources — not only financial but also human resources.”

“While [DOJ] may now complain about the ‘quality’ of services in the community or wish for [the state] to operate mini-hospitals throughout the state, that certainly was not contemplated or expressed in the parties’ 2010 settlement agreement and therefore not subject to enforcement in these proceedings.”

Cursory investigations?

The new federal filings include statements from Nancy Ray, who has been hired as a consultant for the Department of Justice.

Ray said she believes “there are fundamental flaws with Georgia’s community service system for individuals with [developmental disabilities] that place these individuals at significant risk of harm.’’

“The most common health-related concerns cited were related to medication problems, including individuals not receiving prescribed medications,’’ Ray said.

“Another common problem was staff’s failure to adequately track and monitor important measures of health status, including the individual’s weight, food and fluid intake, bowel movements, or blood pressure. Tracking and monitoring these measures is critically important to identifying problems for people with complex medical needs.”

Of people who died after a hospital discharge, the state conducted investigations in only 38, or approximately half, of those deaths, Ray said.

“It was notable that in 17 of the 38 investigations, there was at least one concern or deficient practice associated with the death,’’ Ray said. “Most commonly, the investigations cited delays in the individual receiving needed medical interventions.”

The cause of death is listed as unknown for 29 of the 79 individuals.

In addition to the 38 death investigations conducted by the state, there were 19 investigations done by residential provider agencies after people died in their care, Ray said.

“These [provider] investigations were not thorough, and included little more than a timeline of the events in a day or two prior to the individual’s death,” Ray said.

No death investigations were done for 22 of the 79 total deaths, she added.

While services for people with serious mental illnesses have improved, the federal attorneys note that there’s still a major gap in supported housing for these people.

More than 250 of these people with developmental disabilities, meanwhile, remain in state hospitals, said the federal attorneys in the court filing.

The state’s recent court filing said, “The current dispute is not about avoiding contractual obligations to which the parties mutually agreed in 2010.”

Instead, the state argued, the Justice Department has insisted that Georgia “enter into an entirely new agreement that exceeds the language’’ of the original settlement.