Failing Marci: A disabled woman’s story of triumph and tragedy

First in a two-part series on Marci Garvin, a 39-year-old woman whose life was inspiring and whose death was marked by misery.

Marci Garvin was long lauded as a shining example of what the severely disabled could achieve.

Born with numerous disabilities, including cerebral palsy, Marci was deaf, mostly blind and unable to talk. But her family had insisted she would not be locked away at a state hospital or adult day-care centers. Instead, she attended Fort Worth public schools for 16 years. She took outings to restaurants and movies, sometimes the library. She went shopping.

And she worked part time for almost 12 years, stapling and shredding papers for the Star-Telegram.

She was one of a handful of people with severe or significant disabilities nationwide to find employment in the late 1990s, according to Michael Callahan, president of Marc Gold & Associates, a consulting company that trains agencies, systems and families in working with the significantly disabled.

“It was of national significance,” Callahan said. “We know that we need to be focusing on people with the extent of Marci’s disability, but nationally it is extremely rare.”

“… The role she played and the role that her experience played, she was the place holder for that group of people that everybody would just say, ‘Surely you don’t mean her,’” Callahan said. “Well, yeah, we do. You can’t have much more significant of a disability and live than Marci did.”

When Marci died in the spring of 2013, however, the 39-year-old’s final months painted a far different picture. When she was hospitalized on March 9, 2013 — two days before her death — nurses counted more than 20 major bedsores. Marci was covered in urine, feces and bugs. She weighed 50 to 60 pounds, almost half her normal weight.

Adult Protective Services and the inspector general’s office launched investigations, and ultimately Marci’s father, Mike Garvin, and older sister, Tabby Martinjak, were indicted on charges of injury to the disabled. Their cases are pending.

Because Mike Garvin, 70, used to work for the county, the Tarrant County district attorney’s office recused itself from the case, and a special prosecutor, Michael Jarrett from McLennan County, was appointed.

“Marci’s death was tragic, unnecessary and preventable,” Jarrett previously told the Star-Telegram. “I look forward to speaking on her behalf and ensuring that those responsible are held accountable.”

But the investigation indicates that others may have failed Marci, too.

Enrolled in Home and Community Based Services, a Medicaid-funded program, Marci had been receiving help from private service providers and MHMR of Tarrant County.

But even with their assistance and oversight, Marci spent her last years under the primary care of an increasingly overwhelmed sister battling her own mental illness while also caring for a special-needs daughter and an ailing mother, according to a preliminary APS report, a copy of which was obtained by the Star-Telegram.

“I think the facts will show that she had three sad situations happening all at the same time,” said attorney Jim Lane, who is defending Martinjak, 46, and her father. “Any one of three would overwhelm most people.”

Martinjak and Mike Garvin’s failure to properly care for Marci, coupled with a series of missteps and instances of inattention by service providers, contributed to Marci’s demise, according to the report.

“I was shocked when I thought there might be some consideration that things weren’t as they should have been,” Callahan said after learning that neglect may have led to Marci’s death. “It’s just heartbreaking if that happened.”

An iconic life story

From the outside, the Garvins seemed the least likely to be the focus of an investigation dealing with the neglect of Marci.

Marci’s father, Mike Garvin, worked for 23 years as a Fort Worth police officer, then for 22 years as an investigator with the DA’s office before retiring in August 2013.

Marci’s mother, now deceased, was a well-respected advocate for the disabled who worked for years as a family representative for MHMR of Tarrant County and chaired the Family Support Council of Tarrant County.

The family insisted that Marci be provided opportunities to succeed.

Marci attended schools in the Fort Worth district, enrolling in first grade at Bluebonnet Elementary in 1979. She would later attend Alice Carlson Elementary, Jo Kelly School and the Transition Center, where disabled students received employment training.

At a support group in 1997, Elaine Garvin had inspired other parents of disabled children with stories of Marci’s upbringing and mainstreaming in the community.

Elaine Garvin told attendees how she did everything for her daughter until Marci was 7 and she realized that her little girl could not only communicate with body motions but also make choices for herself. When she found something pleasing, Marci’s body, often in motion, became still and attentive.

From then on, Elaine Garvin told the group, she looked for ways that her daughter could explore a sense of independence.

“It’s almost like God chose these people to care for these children,” one mother told a Star-Telegram reporter in May 1997 after hearing Elaine Garvin share her story.

Callahan was also impressed with Elaine Garvin.

He met Marci and her family through Bill Eaton, who began developing a relationship with the Garvins in 1995 while he worked for MHMR. The Garvins were fond of Eaton and followed him to different service providers every time he got a new job.

Eaton had asked Callahan for help in finding employment for Marci.

Matt Byars, director of human resources for the Star-Telegram, said Marci proved a good fit and helped with basic clerical work like shredding papers.

“That would get stacked up and need to be dealt with,” Byars said. “When Marci came along, we figured out a way she could help us with that.”

So inspirational was Marci’s employment that it would later be featured in the employee magazine for Knight Ridder, the Star-Telegram’s parent company at the time.

“For someone that had her health and physical issues, it was gratifying for someone like that to be productive,” Byars said.

Focused on Marci

Callahan visited Marci’s home a couple of times and even worked with her family to expand her community activities. He lost contact with the Garvins around 2001.

“That’s what I remember is just Elaine’s total focus on Marci’s well-being,” he said.

Callahan said Martinjak was at times called on to help support her younger sister in community outings.

“Elaine knew that Marci responded when being bathed,” Callahan recalled. “She responded to certain fragrances in a way that indicated it really made a difference to Marci.”

Martinjak would take her younger sister to Bath & Body Works and ask employees to allow Marci to choose which fragrance of bath oil or shampoo she wanted.

“It was pretty dramatic stuff because usually salespeople don’t routinely interact with folks with Marci’s level of disability, but yet they did and Tabby was part of that,” Callahan said. “And then we expanded that to her picking up her drug medication and depositing her paycheck at local banks.”

So impressed with the life Marci led, Callahan said he still shares her story when training others, calling it one of those iconic cases “that help people understand that what they thought was not possible is indeed possible.”

Now Callahan is among those wondering about Marci’s end-of-life experience.

Marci’s final days

In her 911 call on the evening of March 9, 2013, Martinjak told dispatchers that she needed an ambulance and believed that her sister was “nearing the end stages of life.”

“I have a sister. She is about to be 40. She is multi-handicapped, cerebral palsy her whole life,” Martinjak told dispatchers. “The last couple of days, she started not really wanting to eat anything. …

“I think she’s ending her life. I think she’s coming to the end stages. We were told she wouldn’t make it to 20,” Martinjak said, her voice starting to break. “We got her to 40.”

When paramedics arrived, a firefighter already on the scene warned them that it was a “hoarder house.”

Inside, a paramedic noted, trash and boxes were stacked floor to ceiling “as far as I could see.”

Marci’s room was so cluttered that paramedics didn’t have room to examine her. They lifted her using her bedding, then carried her outside to a waiting stretcher.

There, paramedics took in the multiple wounds covering Marci’s body. Her hair was filthy. She stunk of urine and feces. Her diaper appeared not to have been changed for weeks, according to the report.

The nurses who treated Marci at Texas Health Harris Methodist Hospital Fort Worth were horrified.

Sonya Owens, Marci’s bedside nurse, would later describe for investigators how the stench of rotting flesh from her undressed sores trumped the smell from the layers of feces matted into Marci’s hair and skin folds.

Marci’s skin was red, raw and inflamed. The egg crate bedding that paramedics had used to carry her from the home contained roach parts and eggs. And part of her left ear was missing, with Owens speculating to investigators that “it had probably fallen off.”

Martinjak, Owens would tell investigators, was reluctant to provide her name and contact information for the family. Martinjak initially told staffers that she wanted everything done to save her sister, but the family later decided to put a do-not-resuscitate order in place.

Two days later, Adult Protective Services began its investigation.

By that night’s end, Marci was dead.

For several doctors and nurses who treated Marci or later reviewed the medical records and photographs of her sores, Marci’s condition painted an obvious picture of neglect.

“There is no explanation for her having that many wounds. They let her die. They murdered her,” Rebecca Musser, a registered nurse with Southern Concepts, told investigators. For five years, the HCS service provider was responsible for offering individualized services and support to Marci as she lived with her family.

“I would say that it [was] six months to a year of pure misery,” Musser said.

A demanding home life

Ten days after her sister’s death, Martinjak met with investigators from APS and the inspector general’s office for the first of two interviews.

In her statements, copies of which were included in the APS report obtained by the Star-Telegram, Martinjak described a demanding home life in which she shouldered the responsibility of caring for Marci, her ailing mother and her adult daughter, who has Down syndrome and other medical issues.

Elaine Garvin, she told investigators, took on a more limited role in caring for Marci after suffering two hearts attacks in 2000.

By 2008, Elaine Garvin’s ability to help care for her daughter had practically ceased as her health problems worsened.

“My dad would do the night stuff and I would do the day stuff. It started waning. My dad Mike is 69,” Martinjak said. “I started taking on a full-time role in late 2009.”

Her daily routine, Martinjak told investigators, was to dress, feed and medicate Marci. She would then turn her attention to helping her daughter and her mother, who had been diagnosed with the early stages of dementia and had congestive heart and kidney function failure.

Sometimes her father or husband, from whom she had occasionally separated, would help.

Mike Garvin, still employed full time by the DA’s office at the time of his daughter’s death, told investigators that “we all helped with the feeding, bathing and caring for Marci until just recently.”

Martinjak told investigators that she began noticing bedsores in November 2012 and tried to treat them herself.

When they persisted, she claimed, she repeatedly contacted the office of Marci’s primary physician but could not get an immediate appointment and was told by staff to put cream on the sores.

She acknowledged that she never requested help from a Southern Concepts nurse but insisted that she had told others, including Eaton, about her sister’s bedsores.

She said Eaton told her that he’d look into ordering a sand bed and getting Marci a nursing assessment once she was transferred to Rock House, another HCS service provider for which he had begun working.

“Some of the bedsores were bad. I did not think to take Marci to the ER for her bedsores since they got better. I would say in the last couple of weeks [before Marci’s death] they got worse,” Martinjak told the investigator on March 21, 2013. “… In hindsight, I should have taken her to the doctor.”

She said she noticed a foul smell the week before Marci’s hospitalization but was unclear about its source.

“I was doing the best I could do,” Martinjak told the investigator. “I was not getting help from anyone else. If I could do it over again, I would. I would have been a bitch to get what I needed.”

Mike Garvin agreed in his interview that his daughter had her “hands full” but told investigators that he didn’t know whether his daughter ever sought help from the agencies working with Marci.

Mike Garvin told investigators that he couldn’t recall when he noticed Marci’s weight loss but that he never noticed any odors or a lack of urine when he helped change Marci’s diapers.

“I recall looking at her [Marci] on Friday,” Mike Garvin said, referring to the day before Martinjak called 911. “I think it was Friday that Tabby told me that Marci was refusing to drink and that the sores were getting worse. The next day, Tabby told me that she thought we needed to call the ambulance.”

“Marci was deaf, blind and multi-handicapped, and she had lived a good life and we were not expecting her to go,” Mike Garvin said. “We did not think she was about to pass. When she left for the hospital, I was expecting to bring her home.”

Credibility questioned

The APS investigator concluded in her preliminary report that the statements by Martinjak and her father were not credible.

Telephone and appointment records from the office of Marci’s primary physician showed that Martinjak had called only once in 2013 — the day before Marci’s hospitalization — and that she’d never mentioned bedsores.

Instead, she told staffers that she was taking Marci to the emergency room because her sister had “voided all over herself, was very pale and had lost weight,” the report says.

In fact, the investigator found, Marci had not seen her doctor for years despite contrary statements by Martinjak and her mother. The doctor’s records showed that four appointments had been set for Marci since September 2010 but that the family had shown up only for the first one.

In a May follow-up interview with investigators, Martinjak said that all decisions about Marci’s care went through her parents and that going to the doctor was “a process.”

“I would have to take my mom, my sister and my daughter all loaded up in the van. I was overwhelmed,” she told investigators.

Martinjak also acknowledged having to reschedule appointments and skipping some annual examinations.

“I did make a mistake in not taking her to the doctor,” Martinjak said. “… It was really a scheduling issue. Mother was under an assumption that since Marci was not sick, then why go.”

The investigator concluded that, before her death, Elaine Garvin was likely unaware of Marci’s condition because of her own medical issues and mental decline.

But Mike Garvin, she noted in her report, “was aware that Ms. Marci Garvin had bedsores for several months and did nothing to get them treated.”

She also found that Mike Garvin failed to ensure that Marci was in a safe environment because he allowed Martinjak’s hoarding to continue, including in Marci’s bedroom.

As an additional “competent adult in the home,” the investigator said, Mike Garvin served as a secondary “caregiver” and was thus as responsible as Martinjak to seek treatment for Marci.

This story was originally published February 27, 2015 at 3:22 PM with the headline "Failing Marci: A disabled woman’s story of triumph and tragedy."