Families fight for facility to stay open

Central Virginia Training Center

For two decades, Taylor Bryant, 24, spent most of his time a few feet away from his twin brother, Tyler, at Central Virginia Training Center in Madison Heights.

For the past 10 months, the bed next to his has remained empty.

The Bryant twins, who were born with severe intellectual and physical disabilities, spent almost all their lives at CVTC until Jan. 17 of last year, when they were transferred to Hiram W. Davis Medical Center in Petersburg by the Virginia Department of Behavioral Health and Developmental Services. The move came as Virginia prepares to close the state-run facility that cares for those with intellectual and physical disabilities by 2020 as part of a 2012 agreement with the U.S. Department of Justice.

Barely two months after the brothers' transfer at the objection of their mother, Martha Bryant, Tyler Bryant died of respiratory failure March 18 at Chippenham Hospital in Richmond.

As CVTC consolidated and headed for closure, Martha Bryant and other family members of residents became increasingly worried the level of care in the community or in another state facility would not meet the specialized and complex medical needs of their loved ones. In order to fight the closure, Martha Bryant and a small group of other families filed a request for injunctive relief in August 2017 to slow the shuttering of the training center.

Although this court filing did not stop DBHDS from transferring the Bryant twins to Petersburg after the state decided to close CVTC's skilled nursing unit because of staffing shortages, the court fight to stop the transfers continues.

The injunction requests the state stop "badgering" family members of CVTC residents to move their loved ones out of the facility, cease "forcibly transferring" any more residents out of any training centers and only transfer residents if there is an "accurate certification" the proposed placement location has comparable care and safety.

Other requests include the transfer of the specific residents named in the injunction who were moved to Hiram Davis to a training center that provides comparable care to CVTC's nursing facility and also for the state to disclose all of the options available to CVTC residents, which includes being able to remain in a training center.

Appearing in U.S. District Court alongside other family members of residents Nov. 6, Martha Bryant and other members of the CVTC family and friends group spoke about their experiences and concerns about the level of care at Hiram Davis and the lack of options for severely disabled patients in community group homes. Bryant said a ruling on the injunction request is expected in the coming weeks.

Bryant, who frequently travels back and forth between her Amherst County home and Petersburg since her sons were transferred, has been troubled both by the high turnover of physicians who have treated her sons and the lack of communication between nurses, doctors and family members at Hiram Davis.

"I think there are some good people at Hiram Davis," Martha Bryant said. "I've seen some caring people there, but it's not consistent. Whether it's physician turnover or Taylor being isolated, it's not the same care as CVTC."

Tyler Bryant's death sparked calls for an investigation into the decision to transfer residents from the Madison Heights training center to another state facility from members of the Virginia legislature. Led by long time CVTC advocate Sen. Steve Newman, R-Bedford County, the effort resulted in a Department of Justice inquiry into the medical care at Hiram Davis.

Since the closure of CVTC's skilled nursing unit in January 2017, three residents transferred from CVTC to Hiram Davis have died, according to DBHDS spokesperson Heidi Dix. This includes Tyler Bryant.

At the request of DOJ, officials from the Center for Developmental Disabilities Evaluation and Research at the University of Massachusetts Medical School conducted a review of Hiram Davis and its medical care for seven individuals -including the Bryant twins - who were transferred from CVTC, including those three who had died between June 2015 andmid-2017.

DBHDS spokesperson Maria Reppas said in the same time frame, 11 residents in the CVTC skilled nursing unit died.

According to the June 2017 report, investigators visiting Hiram Davis found "fragmented practices surrounding communication and documentation between team members," which affected decision making; medical records and care plans had "frequent" errors; and services provided by external vendors had "repeated compliance and quality issues," particularly in the areas of fire safety and food handling.

Newman, who has been highly critical of the decision to close CVTC, is concerned about the trend to move more of the state's training center residents into community group homes because he believes that living arrangement is not appropriate for all of the residents in the commonwealth's care.

"I'm a very conservative legislator but one that believes that God has told us to take care of people who cannot take care of themselves," Newman said in a phone interview this month. "I believe the people at CVTC fit that description exactly. As I have watched the commonwealth and the DOJ push to have more of these severely disabled individuals in a home environment, I have been very concerned that will happen at the peril of their health."

According to DBHDS, since July 2011, 29 of the 208 residents of CVTC that have been transferred to community group homes have died.

Martha Bryant said her sons struggled to adjust to the environment of Hiram Davis, which houses a different population of patients than CVTC and requires a more secure environment.

"Every time I go to Hiram Davis, I'm reminded of how it's not like a training center," she said. "When we arrived [for a visit in December], the elevator was unlocked, but around noon, it locked, like you're in a psychiatric facility. I had to go to the bathroom in the afternoon, and I was told to take the stairs and beat on the door when I came back up. I was never locked in like at a psychiatric facility at the training center."

Although family members of residents still living at the Madison Heights training center who do not require skilled nursing care have not been forcibly transferred from the facility, CVTC friends and family group president Mike Milnor said they have been under "constant" pressure by DBHDS to move to a community group home.

Milnor's sister is severely autistic and has lived at CVTC since 1971. Despite the number of residents at CVTC dwindling from 426 in March 2010 to 113 patients last week, he remains steadfast that she stay at the facility because of the consistency of care as well as the lack of comparable care in the community.

"We're going to fight for Angie, but for the severely autistic and severely mentally handicapped, there's basically no place for them in the community," he said. "Any homes we've looked at, they've said she's too much."

When asked about concerns that community resources are not equipped to handle high-needs patients, Reppas said the state agency is in the process of "expanding both capacity and expertise" in the community and is releasing more requests for proposals soon to expand group home offerings across the state.

Milnor also is concerned about the lack of consistency in care from group home to group home, as well as the lack of resources to respond to negative behaviors in residents. Citing his career in law enforcement and current role as the Altavista police chief, he said law enforcement often is called to deal with incidents at group homes, which he feels is inappropriate.

"These individuals do not belong in police custody when they act out, but a lot of the group homes call the police, so they will be taking them into custody," Milnor said. "It's throwing the mental health system onto the law enforcement and legal system. It's putting the most vulnerable population that the state has at risk."

House of Representatives Judiciary Committee Chairman Rep. Bob Goodlatte, R-6th District, also has stepped into the fight over closing the training centers. He blames the Department of Justice under former President Barack Obama for pushing too many intellectually and physically disabled residents out of institutions and into the community.

"The [Judicial Committee] continues to hear concerns from many of the family members and legal guardians who have been forced to move their loved ones into settings that don't provide the level of assistance and care that they are receiving at their present facility," Goodlatte said in a Dec. 6, 2017, letter to Attorney General Jeff Sessions.

Of the residents who wish to be transferred to another state facility instead of a group home, the only option currently for skilled nursing care is Hiram Davis.

South eastern Virginia Training Center in Chesapeake, which is scheduled to remain open, has a capacity of 75 residents. According to Reppas, DBHDS anticipates 15 to 20 beds will be available at that facility by the time CVTC closes in 2020. SEVTC will not have any skilled nursing care.

Martha Bryant spent much of Christmas season worrying about Taylor Bryant, who has contended with several bouts of illness in recent weeks.

Although this was the first Christmas season without Tyler Bryant, she still hung their two matching star ornaments on her small Christmas tree at home.

"The holidays have been full of worry," she said. "I'm grateful he didn't have to go to the hospital, but he's got an infection and fever, and I'm this far away. I keep walking around the house withmy two phones in my pocket in case the doctor calls."