Second in a two-part series on Marci Garvin, a 39-year-old woman whose life was inspiring and death marked by misery.
FORT WORTH — In the days before her death in March 2013, Marci Garvin received two visitors.
Mona Patel, a service coordinator with MHMR of Tarrant County, found the severely disabled woman lying on a sofa, reportedly recovering from the flu, during her Feb. 27, 2013 visit.
“She was covered up with a blanket and was lying on a pillow. Her hair covered her ear. I could only see her forehead to her chin of her face,” Patel told investigators. “When I said hello to her she did lift her head up and she went back to sleep.”
A day earlier, service provider employee Bill Eaton had stopped by.
Eaton, a close family friend of the Garvins since 1995, was completing an environmental study for his newest employer, Rock House, a service provider to which Marci was in the process of transferring.
“There was nothing unusual about Marci that day,” Eaton recalled for investigators. “She did not appear dirty. I did not notice any odors. There was a urine smell but it smelt like she needed to be changed.”
Neither Eaton nor Patel expressed concern about the home’s cluttered condition, nor did they notice bedsores, although more than 20 festering sores covering Marci’s emaciated body would be documented in photographs at the hospital 11 days later.
Within two weeks Marci would be dead, her body ravaged by sepsis, pneumonia, acute renal failure and severe dehydration.
An investigation followed and led to indictments of her older sister, Tabby Martinjak, and their father, Mike Garvin, on charges of injury to the disabled. Both remain free on bail. A trial date has not been set.
“Until I saw the death certificate or saw the pictures I had no concerns about the family,” Eaton told investigators. “I had no concerns about her and her health.”
While Marci’s death led to criminal charges, it has also raised questions about how agencies tasked with assisting in and overseeing her care failed to detect warning signs of her demise and intervene.
“It is disgusting, it is awful what she suffered. A couple of her bedsores were to the bone. She was septic. There was no way to save her,” said a social services professional who is familiar with Marci’s case. She is not being identified because she fears for her job.
“Her family should definitely be accountable but people get overwhelmed and they don’t know what to do and they shut down. There are supposed to be unbiased systems in place to prevent this,” the social worker said. “I just think everyone who is accountable should be held accountable because there will not be any effective change unless it’s out in the open.”
Jim Lane, defense attorney for Mike Garvin and Martinjak, said he is eager to find out where the agencies “that were being paid to monitor this” were during Marci’s decline.
“It’s an unbelievable set of facts and tragedy all around,” Lane said. “I think the general public, the legislation, the state agencies are going to have to monitor themselves. Somebody’s going to have to look at what’s available and if, in fact, it’s being delivered.”
A preliminary, several hundred-page report by Adult Protective Services, a copy of which was obtained by the Star-Telegram, revealed troubling findings regarding the oversight of care provided by two service providers — Southern Concepts and Rock House — and by Mental Health and Mental Retardation (MHMR) of Tarrant County.
Southern Concepts had been Marci’s provider since 2008, but her family was in the process of transferring to Rock House in the weeks before her death. Both providers claim that Marci was not their client at the time of her death.
Among the findings:
▪ Employees of the two service providers and MHMR knew that Martinjak was a hoarder whose boxes of possessions and clutter reached from floor to ceiling of the family’s southwest Fort Worth home, but they did little to address it despite the fire and safety risk it posed. Martinjak repeatedly avoided home visits and inspections, yet was allowed to continue her paid role as foster care provider for her sister.
▪ Dianne Salas, a care coordinator with Southern Concepts at the time of Marci’s death, was required to assess Marci’s home yearly but hadn’t been inside the Garvins’ house since 2010. Still, Salas filled out home assessments in 2011 and 2012, stating that the home was safe for Marci.
▪ Marci had not seen her primary care doctor since 2010 despite contrary statements from her sister and had not received a required nursing assessment from her service provider.
The alleged neglect by two service provider employees — Eaton and Salas — was so serious that the state is recommending adding their names to the Employee Misconduct Registry to ensure that they are never again employed in a facility or agency regulated by the Department of Aging and Disability Services. Martinjak and Mike Garvin were added to the same registry in June 2014.
The two employees — both now with Rock House — are appealing. Hearings are scheduled for this month. They did not return messages seeking comment for this report.
Rock House owner J. Brad Allen said Eaton and Salas are working on a restricted capacity until their appeals are concluded.
Citing privacy issues, Southern Concepts owner David Southern declined to discuss Marci or the findings of the Adult Protective Services investigation.
“The death of Marci Garvin was a sad event, however, Southern Concepts was not her HCS provider at that time,” Southern wrote in an email to the Star-Telegram.
Shifting services to home
For years, the severely disabled were often relegated to state-run institutions. But a growing desire of families to keep their loved ones at home or close by in small group homes led to change.
In 1981, federal legislation created a waiver program, known as Home and Community Based Services, or HCS, whereby states could provide home and community-based care under Medicaid for certain people as an alternative to institutional care.
“This program was built at the request of families who said. ‘I don’t want my loved one far away in facilities. I don’t want my loved one across the county in facilities. I want options that allow me to continue to care for my loved one,” said Susan Garnett, CEO of MHMR of Tarrant County.
The Department of Disability and Aging (DADS) contracts with both public and private HCS providers, reimbursing them with Medicaid dollars. As of December, 21,676 clients were receiving HCS services in Texas with more than 72,000 on a waiting or “interest” list.
In Tarrant County, 1,475 people are in the HCS program.
MHMR of Tarrant County is mandated by the state to help HCS clients in Tarrant County understand options and services available to them and monitor the satisfaction and provision of services between the clients and their providers.
Marci was enrolled in the program’s foster care option, allowing her to receive services from her HCS provider while living at home. Her mother, and later Martinjak, were paid for being Marci’s primary caregiver, receiving about $3,000 a month in Medicaid funding at the time of the Marci’s death.
But Marci’s care was supposed to be closely monitored. Under state rules, both the service provider and MHMR staff, as well as inspectors with DADS, were required to have contact with Marci and her caregiver at the home.
Gaining access to the Garvin home, however, proved problematic for many, according to the report from Adult Protective Services.
Several MHMR case coordinators, who were required to see Marci quarterly — but encouraged by MHMR to visit her monthly — told the APS investigator that Martinjak repeatedly avoided or canceled visits, often using the excuse that somebody in the house was sick. As a result, Marci sometimes went months without a visit by MHMR.
Salas, who served as Marci’s direct care supervisor at Southern Concepts from 2009 until just before Marci’s death, told investigators it had been an issue for several years.
“I was required to see her [Marci] once a year,” Salas told investigators in April 2013. “Tabby would give us hell about us getting into the home to see Marci. The last time I saw Marci was 2010. I did pop up over at the house May and June of last year but Tabby would not let me in the home. Tabby was always stalling about letting us in.”
Behind closed doors
When social services staffers did get inside, they were met with a home bursting with clutter and boxes.
To new staff members, Martinjak frequently used the excuse that she had just moved in with her parents and that she was still in the process of unpacking. In reality, she’d lived with them for several years.
To some who had visited before, Martinjak admitted that she was a hoarder and suffered from other mental illnesses. She later told investigators she had been receiving treatment for the hoarding, as well as other mental illness, including bipolar disorder, manic depression, post-traumatic stress disorder and obsessive-compulsive disorder.
Eaton, who was a program manager at Southern Concepts before moving to Rock House in January 2013, told investigators the hoarding had been an issue since he’d met the family in the mid-1990s.
“There had to be access/paths for Marci to get out of the home in her chair from the front to back door,” Eaton told investigators. “I think DADS did tell us there was an issue and she got the house cleaned up and put stuff in storage. She had three storage units at one point.”
In a July 2012 DADS inspection report, the agency said that movement in the house was “significantly limited due to boxes and other objects blocking the walkway.” The inspector also found that the living room windows and walkways were blocked, that Marci’s bedroom smelled of urine, and that there was clutter throughout the home that “posed a trip and fire hazard.”
While Eaton would later assure DADs that he was addressing the issue, the APS report states that the clutter always returned and that Eaton, Southern Concepts and MHMR staff did little or nothing to correct it.
“Service coordinators should have come in and said: ‘We’re having a hard time getting in the home. Every time we’re in there, there’s been hoarding. I think we need to have an intervention here or we need to talk about the appropriateness of this placement,’” said the social services professional familiar with the case.
“But there’s a big belief in that it’s ‘their business,’” she added. “No, it’s not. If the environment is unsafe and if you’re paid by the state to provide these services, it is not a privacy issue at that point. It’s not a privacy issue for someone who doesn’t have a choice in being there.”
Salas told investigators that she believed that Eaton protected the Garvins, helping them get the house ready for state inspections.
“Bill would cover with the family when there were issues. I don’t know that Bill knew that she was being abused or neglected. I think the fact that he had a personal relationship with the family was a reason for him to protect the family,” she told investigators.
Salas, the report alleges, was doing her own covering up.
Though she told investigators she had not been in the Garvin home since 2010, investigators found that she signed off on 2011 and 2012 home assessments stating that Marci’s living environment was typical for the community and “meets her needs in regards to health, safety, comfort and mobility.”
Garnett, of MHMR of Tarrant County, contends that a home’s condition can be a debatable point.
“This program really begins with the notion that all families live the way that those families are most comfortable with,” Garnett said. “… People live the way they live. This program isn’t really intended to say, ‘Aha! I don’t like the way you’re living Remove this person from the home.’”
Privacy issues with family
While the report uncovered issues with the oversight of Marci’s care, it also noted that the Garvin family members chose to keep important information to themselves.
Martinjak had refused to hand over Marci’s medical records, meaning staff had to rely on her word regarding doctor visits and medical issues. She told investigators that her mother would not allow for the release of the records.
Though service providers are required to conduct yearly nursing assessment for clients in the foster care program, Martinjak told investigators that Marci hadn’t been seen by a Southern Concepts nurse since 2008.
“I was never contacted about a nurse contacting me to do an assessment,” Martinjak told investigators. “Southern Concepts could always reach me and if I missed a call I would call back.”
The Adult Protective Services investigator found, however, that attempts had been made.
Progress reports from Southern Concepts indicated that a nurse had contacted Martinjak in September 2012 but that Martinjak refused to schedule an assessment, saying she was getting ready to go out of town and would bring Marci in for an assessment in October. She never did.
On Oct. 16, 2012, the nurse once again called Martinjak to set up a visit, but Martinjak told her she had a sick child in the hospital and would contact the nurse later. In February, another nurse tried to reach Martinjak without success.
Concerns about bedsores
Martinjak told investigators that while she never asked Southern Concepts directly for nursing services for Marci, she insisted that she told Salas, Eaton and two MHMR service coordinators that Marci was experiencing “skin breakdown,” or bedsores.
“I thought since I was telling one on a monthly basis that she was having breakdown they would send someone out,” Martinjak told investigators.
Salas told investigators that Martinjak never mentioned Marci’s bedsores.
Patel and Eaton acknowledged that Martinjak mentioned the bedsores in February 2013, but Martinjack indicated that she was treating the problem under a doctor’s advisement.
“She did not tell me how many wounds she had. I thought the skin breakdown was from her lying down. Usually if you are bedbound, then you do have bedsores,” Patel told investigators.
Eaton said he was planning on getting Marci nursing services on her transfer to Rock House and a sand mattress to help with her skin issues.
Garnett said it is the service provider’s responsibility to ensure that a client is receiving needed medical care. In cases where disabled people cannot communicate themselves, agencies must largely depend on the foster-care provider for reports on how the client is doing, she said.
“The system really was never set up to assume that people would lie about such things,” Garnett said. “The system was set up to honor the family relationships.”
Garnett said MHMR’s service coordinators are prohibited from conducting a physical evaluation of a client, including looking under blankets or clothing for bedsores.
“A service coordinator is not qualified to evaluate a skin condition,” Garnett said. “… We don’t know enough to know what’s a condition. That’s just not a thing we do.”
Garnett said neither MHMR of Tarrant County, nor any of the agency’s employees, were ultimately confirmed to have been neglectful in their care of Marci. She said no changes have taken place in the agency in light of Marci’s case.
“I don’t know that there’s a program rule that could ever completely prevent terrible people from being terrible,” Garnett said.
That Eaton was even inside the Garvin home in the week and a half before Marci’s hospitalization and death came as a surprise to his employer at Rock House.
Allen had previously told the Star-Telegram that none of his employees had set eyes on Marci.
But Eaton told investigators that he had stopped by the house Feb. 26, 2013, to conduct a home environmental study for Rock House.
In a more recent interview, Allen says he was unaware of the late February visit between Eaton and Marci. He said Eaton told him that he had been unable to visit the house because Marci’s family reported she had the flu.
Allen also said Eaton never told him that Marci was living in a hoarder house.
Despite these alleged omissions, Allen confirmed that Eaton remains employed with Rock House.
“Bill has a 30-year history of excellent performance in working with people with developmental disabilities,” Allen said. “We don’t think that one investigation like this, until he has got his due process, would justify jumping to the conclusion that he’s guilty.”
Eaton told investigators that while he was close to the family, he saw no indications that Marci was being neglected.
“I can't begin to tell you what Marci meant to me not only professionally but also personally,” Eaton said. “… I have no way to know if Tabby was overwhelmed. Before I saw the pictures I would have thought that Tabby got her identity from taking care of people. Now I don't know.”
Deanna Boyd, 817-390-7655