Between 1993 and 1995, 1,878 persons transferred from California institutions into the community. By early 1996, 45 had died—significantly more than expected (Strauss, Shavelle, Baumeister, and Anderson, 1998). We report here on the death certificates for this group, using a comparison group of 45 certificates for institutional residents. Thirty-two of the community deaths versus 10 of the institution deaths were “sudden” or “subacute.” All of the institution deaths versus 79% of the community deaths were reported to the coroner, and 55% of the institutional deaths were followed by autopsy compared to 33% in the community. Six deaths were due to perforated bowels, 5 of which were in individuals residing in the community.

The provision of data from the California Departments of Developmental Services and Health Services is gratefully acknowledged. We thank the editor of Mental Retardation, the reviewers of an earlier draft, and Stephen Ashwal for helpful suggestions. We thank James White and Linda Andress for assistance with obtaining death certificates and other data for this study. The research was supported in part by grants to the University of California, Riverside from the National Institutes of Health (Grant No. HD21056) and from the California Association of Psychiatric Technicians and allied groups.

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