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Island siblings seek answers in brother’s group-home death

Two years after 65-year-old Darby Britton died after a fall at a group home for people with developmental disabilities, his siblings are still searching for answers in the troubling case.
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Gerry Britton, left, and his sister, Bonnie Newman, say they are still waiting to hear from the association that ran the Mission group home where their brother, Darby Britton, died two years ago.

Two years after 65-year-old Darby Britton died after a fall at a group home for people with developmental disabilities, his siblings are still searching for answers in the troubling case.

Investigations have been opened and closed, findings have been shared among the various agencies, but Gerry Britton says he and his sister, Bonnie Newman, have been kept in the dark.

“I just feel they have shunned us since the day he died,” he said.

Born with cerebral palsy, spastic quadriplegia and a seizure disorder, Darby William Britton spent much of his life in institutions — Woodlands, Tranquille, Glendale — before moving into a community home in Mission for the last 20 years of his life.

During that time, his family says he received excellent care in a group home run by the Mission Association for Community Living.

“It’s the best thing that ever happened to Darby,” Gerry Britton said.

But on the evening of May 26, 2011, something went terribly wrong.

A B.C. Coroners’ report, a licensing investigation, a government review and other documents obtained by the family and the Times Colonist indicate that shortly after 9 p.m. that night, Darby was placed on his side in bed and left alone to allow privacy during his bowel routine.

“As per procedure, all four side rails on the his bed were placed in an upright position,” the coroner’s report says.

When a nurse checked on him a few minutes later, one of the side rails was down and Darby was face down on the floor, bleeding profusely, the reports say. His nose was broken and he had stopped breathing.

The coroner’s report says Darby resumed breathing about 30 seconds after being found. He was taken to hospital, where he developed pneumonia and died four days later.

Gerry Britton, who lives in Bowser spent those final days with his brother at the Mission Memorial Hospital and recalls the anguish of staff members from the group home.

“They were just devastated,” he said.

“Each one of them said to me, ‘Gerry, something’s not right here.’ ”

The subsequent investigations concluded that a side rail on Darby’s bed malfunctioned.

Staff had reported problems with the rail two days before the fall. One staff member recorded that the rail “doesn’t always stay locked,” according to an investigation report by the Fraser Health Authority’s community care facilities licensing branch.

A manager notified an equipment maintenance contractor by email, but the bed remained in service, the coroner’s report says.

After Darby’s death, a repairman determined that two broken bolts had prevented the side rail from locking into place.

The coroner ruled the death an accident and licensing officials ultimately concluded Darby’s caregivers failed to ensure his health and safety.

“While it is believed that there was not any intentional mismanagement by staff and/or manager, I am of the opinion that the fall which occurred on May 26, 2011, was preventable,” wrote licensing officer Irene May.

She also concluded there was a delay in calling for an ambulance after Darby’s fall, although the Mission Association for Community Living disputed that finding.

Darby’s siblings say they only learned of the investigative findings from the coroner’s report and by filing freedom of information requests; they have yet to hear anything official from the association or Community Living B.C., the government agency that oversees services to adults with developmental disabilities.

The silence has fuelled the family’s frustrations and furthered their suspicion that the full story of Darby’s death has yet to be told.

Newman, who lives in Victoria, disputes that her brother could have rolled out of bed — even if the bed rail malfunctioned. She says Darby had limited mobility and was lying on the one arm that he was able to use.

“It is absolutely impossible for him to throw himself out of bed,” she said.

Gerry Britton said his brother was aware of any risks to his safety and would have hollered for help if he was in danger of falling. He also questions why Darby’s longtime nurse, who lived nearby, was not alerted immediately after the incident.

Community Living B.C. ordered an external investigation into Darby’s death and other issues at the Mission association, including a death in May 2008 when a group home resident died from an accidental morphine overdose. The employee in that case was fired for negligence, the external review said.

The review concluded that Darby’s death was unforeseen by agency staff, that “the program manager acted promptly to test the bed rail and report it for repair, and that there was no intentional disregard for the individual’s safety.”

The review did note a strained relationship with Darby’s family after the incident, marked by “lack of communication amid potential legal action.”

Gerry Britton and Bonnie Newman say they never wanted money, just answers and an apology. They describe the people who worked in the home as “angels,” and say that made the association’s silence after Darby’s death all the more disappointing.

“I had a lot of respect for them until the day nobody said anything,” Gerry Britton said.

“Had they have come to us and said, ‘Look, this is a really bad thing that has happened and we’re dreadfully sorry,’ that would have done 90 per cent of it right there.

“We understand that, because anybody can make mistakes. … It’s a tough job they’ve got over there. It’s not easy, and whoever put Darby in that bed has got to feel really, really bad.”

On that point, Dawn Hein, acting executive director of the Mission Association for Community Living, agrees. She says Darby’s death was traumatic for the entire organization.

“Darby was a wonderful man and he was very loved and we’re sorry for the loss his family has suffered, but also, as an association and as individuals who cared really deeply for him, we share their grief and we continue to experience grief following his death,” she said.

Hein said she was disappointed to learn about the family’s frustrations, because she believes the association was forthcoming with them and shared all the facts at the time of the incident.

“The subsequent reports confirmed the facts that we shared,” she said.

The reports show the association has taken a number of steps to prevent similar incidents, including creating a new policy that requires the immediate removal of faulty or hazardous equipment until it is repaired or replaced.

Hein said the association also completed a comprehensive inventory of equipment, set up a maintenance schedule, and hired companies to carry out inspections and repairs. In addition, staff have undergone training in how to spot, report and mitigate potential hazards.

“We’re just so committed to making sure this type of accident doesn’t happen again,” she said.

In response to the Times Colonist’s inquiries about the case, Community Living B.C. said it plans to reach out to Darby’s family to arrange a meeting.

Communications director David Hurford said CLBC believes that the multiple investigations uncovered the truth of what happened to Darby. But he said the family should be given every opportunity to ask any questions they have and share additional information.

“We take the case very seriously,” he said. “We’re very sorry for what has taken place in this case and sorry for their loss.”

Hurford said a letter went out to the family earlier this week. “We hope they’ll take us up on that.”

lkines@timescolonist.com