BY KEN LITTLE
A resident of a state-run community home in Greene County found dead three months ago died of "a sudden cardiac death" likely brought on by chronic heart conditions and not by the excessively hot temperature in his room, according to results of an autopsy made available this week by the state Department of Intellectual & Developmental Disabilities (DIDD).
The autopsy report is one of the final components of investigations that started following the Dec. 2. 2012, death of 47-year-old Ronnie Derrick, who lived in a community home at 2105 Susong Drive.
The DIDD investigation is complete.
A summary of that investigation made public earlier this month "does not indicate that the death was a result of abuse or neglect by the staff."
"The currently available evidence in this case does not indicate that the death was a result of abuse or neglect by the staff at the East Tennessee Community Home," the DIDD report states.
A separate inquiry by the Tennessee Bureau of Investigation (TBI) is not complete.
"TBI's case into his death is still open at this time. We are waiting for the results of some additional testing on evidence in the case for it to be completed," TBI spokeswoman Kristin Helm said Thursday in an email response to questions by The Greeneville Sun.
DIDD Commissioner James M. Henry said this week that the finding of his agency's investigation that there was no foul play in connection with Derrick's death is supported by the autopsy results.
"It's a natural cause of death. It had to do with a cardiac-related thing with Mr. Derrick," Henry said.
Dr. Tom Cheetham, DIDD director of health services, concurs.
"The conclusion is, the death is not heat-related," DIDD spokeswoman Missy Marshall said this week in an interview after speaking with Cheetham.
Derrick was found deceased in his bed by a staff member in the community home in the Camp Creek community at 6:05 a.m. on Dec. 2, a Sunday morning.
The DIDD report summary said that Derrick's condition was "normal and routine" the night before his death and at bedtime.
An autopsy was conducted on Dec. 2 at the William L. Jenkins Forensic Center at the Quillen College of Medicine, East Tennessee State University.
The purpose of a narrative summary of the autopsy "is to provide a certified opinion to the county medical examiner and district attorney general," according to a summary signed by Dr. Dawn R. Lajoie.
"Foul play is not suspected in his death," the summary said.
"(Derrick) had a medical history of autism and was considered fairly 'high functioning' in that he was capable of expressing discomfort, although not via specific verbalization," the summary said.
Derrick was able to take care of "his own basic physical needs," the summary added.
His medical history includes hypertension and high blood cholesterol.
The night before his death, Derrick was described as being in a "good mood" and expressed no discomfort, the summary said.
"On the night of his death, a malfunction of the heating system at the home resulted in a significantly increased temperature within [Derrick's] room.
"When he was discovered deceased, it was noted that he had removed articles of clothing and cast them off the bed, potentially as a response to increasing room temperature," the summary said.
A core temperature of Derrick's body was not taken at the scene, the summary noted.
"The room temperature upon initial entry was estimated to be over 100 degrees; however, the actual temperature of the room was not measured at that time," the summary said.
Derrick was reportedly not confined to his room "and was free to leave the room of his own volition," according to the summary.
"Therefore, the question as to why the decedent did not leave his room when the temperature had increased to an extreme is raised, since he was capable of notifying others of discomfort and taking care of his own basic physical needs," it said.
BED CHECKS DONE
Visual bed checks on Derrick were conducted hourly, the DIDD investigation report stated.
"This person preferred to not be disturbed throughout the night so bed checks were done visually with staff not physically entering his room," it said.
But the DIDD report also said that one staff member on duty at the home "admitted to leaving his shift an hour and 10 minutes early without authorization."
"It does not appear that this contributed in any way to the person's death, as the home exceeded ICF [Intermediate Care Facilities] and DIDD staffing requirements," the report said.
Derrick had various cardiac medical conditions, including "an enlarged and thickened heart" and narrowing of the blood vessels that supply the heart with blood, the autopsy summary said.
He had "superficial burns" over part of his body and by the time he was found dead, the process of decomposition had already started, "likely accelerated by heat exposure," the summary said.
"It is not possible to determine with certainty whether thermal injury to the skin is incurred [before death] or postmortem," the summary said.
Derrick's risk of "sudden unexpected cardiac death" was significantly increased due to the "severity" of his cardiovascular disease, the summary said.
"Given the investigative findings that the decedent did not exit the room as the temperature increased, although he was capable of doing so and was known to express discomfort to staff as necessary; and the negative toxicological examination in this case, indicating he was in no way intoxicated or chemically impaired, it is considered most probable that [Derrick] suffered a sudden cardiac death rather than death by hyperthermia," the summary said.
Hyperthermia is greatly increased body temperature.
"The manner of death is natural," according to the autopsy summary.
VISUAL CHECKS DONE
Because Derrick preferred that his room not be entered, a visual check on his condition was done as a matter of routine.
"We did a visual check. That's why we couldn't detect that his room was hot," Henry said.
There are 13 community homes operating in Greene County, and three more are under construction.
Each one houses four residents and is an ICF designed for intellectually disabled clients. Most of the residents have other health-related issues.
Marshall said in February that "at this point in time, no policies have been changed" in connection with Derrick's death.
Physical checks, as opposed to visual checks, on all home residents are one policy option, she said.
Henry said in February that one person was placed on administrative leave as a result of Derrick's death.
RESIDENTS BACK IN HOME
The three other men living in the group home returned there on Jan. 3. East Tennessee Community Homes (ETCH) will likely move a new resident into Derrick's room this month, DIDD spokesman Jeffrey Goodwin said.
"The men and their support staff have returned to their normal routines with no concerns noted," Marshall said. "The gentlemen were very pleased to get back into their home and daily routines."
The heating/cooling systems in the Susong Drive community home where Derrick lived, and seven others built in Greene County about the same time, were all inspected, Marshall said.
"The HVAC systems in all eight homes were inspected by an independent heat and air company as a safety precaution. Problems were found in four homes, but corrective actions have been taken," she said.
"ETCH continues to measure room temperatures every 15 minutes when the [Susong Drive] home is occupied."
Goodwin said ETCH will replace the thermostats and thermostat sensors as a safety precaution in the eight community homes.
"Once all thermostats and thermostat sensors are replaced, we will decrease the frequency between temperature checks. Any reported temperature spikes above 80 degrees are assessed promptly by maintenance professionals," he said.
Henry said in December that the safety of community home residents is an ongoing priority.
"We spend all of our careers trying to take care of these people, and we didn't want any harm to befall them," he said.