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Archive for June, 2011

This is where our money is going

June 24, 2011 4 comments

Inspector General Gregory Sullivan has alleged numerous financial abuses in the state-funded Merrimack Special Education Collaborative, which coordinates special education programs among several school districts in Massachusetts.

Meanwhile, State Auditor Suzanne Bump is investigating whether the case is part of a larger pattern of abuse in the special education system in the state.   And Sullivan’s findings are being reviewed by Attorney General Martha Coakley’s office. 

While as many as three state agencies are now investigating this matter and potentially other special education contracts, it’s clear that state oversight of the special education system in Massachusetts has been lacking.  The system has allowed one man, John Barranco, to allegedly fleece taxpayers of more than $10 million.  The allegations include using a credit card for tens of thousands of dollars in personal items, gifts to a family member, and a no-show job to a lobbyst caught up in the Cognos software scandal involving former House Speaker Sal DiMasi.

We’ve just looked at the federal and state financial filings of the Merrimack Special Education Collaborative and related, nonprofit Merrimack Education Center, both of which Barranco allegedly controlled.   These two organizations are clearly interrelated in a troubling way; and, as in the cases of some other contractors we’ve looked at, state and federal records don’t appear to match up with each other regarding the salaries of Barranco and other executives of the Special Education Collaborative and Education Center. 

For instance, the federal IRS Form 990 for the Merrimack Education Center listed Barranco’s total compensation as $464,411 in FY 2009 and $525,198 in FY 2010. 

However, the state Operational Services Division listed Barranco’s total compensation as $427,909 in FY 2009 and didn’t list any compensation for him in FY 2010 on its Uniform Financial Reports on the Merrimack Special Education Collaborative.   (The OSD does not appear to have a UFR on file for the Education Center.)  Is OSD unaware that Barranco apparently received more than a half million dollars in state-funded compensation  in FY 2010?

According to the Globe, Barranco retired as executive director of the Special Education Collaborative in 2005 and appointed John Fletcher and Donna Goodell in 2007 as co-executive directors.  Both Fletcher and Goodell were listed on OSD’s UFR for the Special Education Collaborative in FY 2009 as making over $200,000 each, and in FY 2010 as making about $150,000 each.  In FY 2009, Barranco, despite his alleged retirement, was still listed on the UFR for the Collaborative as a third executive director.

The UFR and Form 990 reports raise numerous other questions about the financial accounting practices of both the Center and the Collaborative.  For instance, although the OSD uses the UFR to disallow state funds for salaries of vendor executives in excess of $143,900, the 2009 UFR for the Collaborative indicates that no funds were disallowed for the Collaborative in 2009, even though five executives of the Collaborative — including Barranco, Goodell, and Fletcher — were listed as making over the threshold amount that year.

The FY 2009 and 2010 UFRs state that the Collaborative received $24.5 million from “Massachusetts local and quasi-governmental entities” (apparently the 10 member school districts in the Merrimack Valley) in FY 2009 and $15.9 million in FY 2010.  In addition, the Collaborative received over $800,000 each year from the Department of Developmental Services. 

Senate President Therese Murray has promised to introduce legislation to increase oversight of the special education collaboratives.  But these collaboratives are only a part of the vast human services contracting industry in Massachusetts, and their alleged abuses are not unique to special education.  The entire $2.6 billion vendor system needs better oversight.

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Judge rules against Fernald transfer

June 17, 2011 5 comments

A state administrative judge has thrown a new hurdle in the path of the closure of the Fernald Developmental Center, ruling that moving one of the remaining 14 residents out would not be in that resident’s best interest.

In a June 9 decision, Administrative Law Magistrate Kenneth Forton ruled that the resident, identified as Daniel O., would not receive improved services and quality of life if he were moved, as planned, to the Wrentham Developmental Center.

This is the first appeals case to be decided in favor the remaining Fernald residents, whose guardians have appealed the transfers to the state Division of Administrative Law Appeals.  The appeals have already kept Fernald open a year beyond the administration’s planned closure date;  and the administration appears to be projecting that the Center will stay open at least another year as a result of the ongoing litigation.

But before the Association of Developmental Disabilities Providers once again rushes in to blame the guardians of these intellectually disabled residents for the cost of delaying Fernald’s closure, let me pre-emptively make a few points:

1.  As the guardians’ attorney, Stephen Sheehy, has pointed out, the appeals are not intended to keep Fernald open.  They are based on a state law, which says that the state must show that a resident’s services and quality of life will be improved if he or she is to be transferred to another location.

In the case involving Daniel O., the administrative magistrate has concluded that he will not receive improved services or quality of life as a result of the move to Wrentham, at least under the circumstances established by the Department of Developmental Services.  If DDS can demonstrate that the move will be in Daniel O.’s best interest, his guardian will not object to it, Sheehy says.

2.  It is DDS, not the guardians, that is responsible for the cost of keeping Fernald running for the 14 remaining residents while the appeals are pending.  DDS has continually refused to discuss longstanding proposals by the guardians and other advocates for a settlement of the dispute.

For years, we have proposed a “postage stamp” arrangement for Fernald under which new, cost-effective housing would be provided in a reduced section of the campus for the current residents, while the remainder of the campus was developed for other uses.  A compromise based on the postage-stamp idea would end the entire litigation process and allow the state and the Fernald guardians and families to move forward with a cost-effective plan for the future.

Sheehy has stated that DDS remains uninterested in negotiating any type of compromise settlement.  The adminisration has even refused to discuss proposals for saving money during the appeals process by consolidating the remaining residents into one building or location.  Right now the residents are dispersed among several buildings on the campus.

3.  The ADDP has repeatedly inflated the current cost of operating Fernald, stating erroneously that the state is spending as much as $1.3 million per month for the remaining residents there.  In fact, the $1.3 million is an average figure for care throughout the entire current fiscal year, during which there have been as many as 70 residents at Fernald.  The reason for the per-person cost at Fernald has risen is solely due to the mathematical fact that the number of residents left there has steadily declined.  It is a reason to look for more cost-effective ways to operate the Center,  but DDS inexplicably refuses to do.

4.  The ADDP has wrongly stated that  the continued operation of Fernald and the other developmental centers for a small number of people is taking away funding for thousands of people in the community.  This is comparing apples to oranges.  Most of the people in the community system don’t have the high level of needs that the developmental center residents do.  Even if the centers were all closed tomorrow, the state would still have to spend a much larger-than-average amount of money per person to care for those former residents elsewhere.

Think of it this way:  A university with 30,000 students buys 80 helmets for the football team.  The ADDP is effectively arguing that this is unfair — the school should be buying helmets for everyone.  It’s a false argument.  Not everyone in the school needs a helmet; in fact, only a small minority need them.  If the school, out of a misguided sense of fairness, decided not to buy the helmets for the team, it wouldn’t save money in the long run.

A pattern of denigrating Fernald

June 10, 2011 1 comment

Opponents of Intermediate-Facility-Level care in Massachusetts have repeatedly denigrated the Fernald Developmental Center during the past two years as part of a campaign to encourage the shutdowns of that facility and three other state-run developmental centers in Massachusetts for people with severe intellectual disabilities.

Our review shows a pattern in the tactics used by the opponents, which have included repeatedly publicizing inflated figures on Fernald’s per-person cost and falsely characterizing the care at Fernald and other developmental centers as outmoded or obsolete.  The ironic purpose of the campaign has been to close the centers as fast as possible without conducting any meaningful cost studies.

The organizations most directly involved in the campaign against Fernald include the Association of Developmental Disabilities Providers and the Arc of Massachusetts.  Joining them last year was the Governor’s Commission on Mental Retardation, which the Fernald League noted had previously been reconstituted  by the Patrick administration to lobby on behalf of the developmental center closures.

The record appears to show that the efforts to spread misinformation about Fernald have been effective in bottling up cost studies, which would have actually pertained to the three other developmental centers marked for closure.  The misinformation has also been damaging to the reputations of guardians and families of the Fernald residents.

Fernald and five other developmental centers are the only sources in Massachusetts of ICF-level care, which must meet federal standards for staffing and supervision.  The Patrick administration has targeted the Fernald, Monson, Templeton, and Glavin centers for closure, starting with Fernald, by Fiscal Year 2013.  Fernald, which was scheduled to be shut last July, has remained open pending the outcomes of administrative and court appeals filed by the guardians of 14 remaining residents.

For at least the past two years, the ADDP and the Arc have focused during state budget debates in the Legislature on the alleged cost of maintaining Fernald.   Our review shows that during this year’s budget debate in April and May, leaders of those organizations repeatedly made inaccurate claims about Fernald’s per-person cost of operation that were as much as 70 percent higher than the most recent projection by the Department of Developmental Services.

In public statements, the ADDP and the Arc also inaccurately blamed those alleged per-person costs on appeals filed by guardians of their wards’ transfers from Fernald.  The erroneous cost figures were provided to state legislators as the House and Senate were considering budget amendments in April and May that would have required an independent cost study prior to closing the separate Templeton, Monson, and Glavin centers. 
 
 On April 25, ADDP President Gary Blumenthal claimed to the State House News Service that the annual cost per person at Fernald had “nearly quadrupled” to $917,000.  The News Service said the cost was based on documents from DDS.  The News Service account was picked up by The Boston Globe.   However, DDS General Counsel Marianne Meacham told COFAR that to her knowledge DDS has never cited a cost as high as $917,000 per person at Fernald, and that she had no knowledge of any documents listing that amount. 
 
(We called the author of the State House News article to ask for a copy of the alleged DDS documents.  The reporter said he was unable to locate them.)  
 
In a May 25 letter to COFAR, DDS Commissioner Elin Howe stated that DDS had actually projected an annual cost of care of $635,414 per person at Fernald, based on the 14 remaining residents.  Moreover, Howe stated that overall costs at Fernald had dropped during the past year and a half as the residential population has dropped, but that the per-person cost had risen  to the $635,000 amount due to the declining population.  She termed the cost spike “a typical pattern in previous closures.” 

 
That per-person cost spikes occur when facilities are closed was not recognized by the ADDP or the Arc in their accounts of Fernald’s costs.  On April 25, the same day Blumenthal was citing the $917,000 figure to the State House News Service, a letter to legislators, signed by Blumenthal, Leo Sarkissian, president of the Arc of Massachusetts, and about a dozen human service providers, claimed that Fernald was costing “$1.3 million per month for 16 individuals due to administrative appeals.”   That would equate to an annual cost of $975,000 per resident.  Later that same day, as the ADDP/Arc letter had requested, the House leadership rejected an amendment to the House budget bill for the cost study for Templeton, Monson, and Glavin.
 
Whether it was the result of a cost spike due to a declining population or not, the $975,000 figure was wrong.  In her May 25 letter, Howe indicated that the $1.3 million cost at Fernald was an average monthly cost, based on a $15.6 million projection for the full current fiscal year.  At the start of the year, between 50 and 70 residents were still living at Fernald, not 16.  Thus, it would be inaccurate to claim that Fernald was costing $1.3 million per month for only 16 individuals, or that the $1.3 million figure could be annualized, “to understand the high cost of delay and obstruction,” as the ADDP/Arc letter claimed.
 
Nevertheless, a month later, on May 24, the Boston Herald ran a story  that similarly claimed erroneously that $16 million was being spent to care for a remaining 14 residents at Fernald.  That story inaccurately implied that the cost per resident was as high as $1.1 million.  Blumenthal was quoted in the Herald story as terming the cost cited by the Herald  “excessive” and “the cost of delay” in closing Fernald. 
 
A budget amendment requiring the independent cost analysis prior to closing the Monson, Glavin, and Templeton centers was rejected by the Senate leadership two days after the Herald story ran.
 
A similar pattern of unsupported or inaccurate information about Fernald was evident during the legislative budget debate a year previously.  In May 2010,  the ADDP claimed that delaying Fernald’s closure by undertaking a cost study of Fernald and the three other centers marked for closure would cost an additional $13 million a year.   There was no backup or explanation for that number.

That same month, the Governor’s Commission on Intellectual Disability cited a  $1.3 million cost per month at Fernald in calling for rejection of that same cost study.   This number was unsupported as well in the Commission’s letter.

(By the way, the only publication  listed on the Governor’s Commission publications page on its website is the administration’s 2009 developmental center closure plan, which the Commission didn’t even write — the document was written by DDS.)

Meanwhile, as the ADDP and the Governor’s Commission were citing those unsupported cost claims for Fernald in 2010, Sarkissian of the Arc of Massachusetts was claiming erroneously that Fernald and the other developmental centers were providing inferior care to community-based facilities.  In an op-ed article in The Waltham Tribune,  Sarkissian variously termed Fernald and the other developmental centers “decrepit,” “archaic,” “outdated,” “Dickensian,” and “inferior.”

In the op-ed piece, Sarkissian raised issues from the 1960s and earlier about sexual abuse, military experiments, and other issues at Fernald that have not been current for a half century or more.

Last week, I wrote to Blumenthal, asking him to publicly disavow the inflated cost figures for Fernald that he and his organization cited this year.  He declined to do so, saying the cost figures had been provided by DDS.  The question we still can’t answer  is whether DDS itself knowingly publicized inaccurate figures on Fernald’s cost.

It’s about the care model

A disturbing incident involving an attempted rape of a woman by an intellectually disabled resident of a community-based group home last month can teach us all a valuable lesson.

We’ve been in the midst of the wrong debate here about care for people with intellectual disabilities.  We really shouldn’t be having a debate between “community-based” care versus institutional care.  What’s really at issue here is the care model for these people in Massachusetts.

Bear with me for a moment. 

On June 3, The Lowell Sun reported that a resident of a state-run group home in Chelmsford walked out of his residence, went next door and attacked a pregnant woman as she was sitting in her living room with her husband and three-year-old daughter.  The man managed to tear off Amy Hillman’s shirt and jump on top of her before he  was pulled away by Hillman’s husband, James.

The group home resident, Tholda Chhom, and James Hillman ended up in the front yard, where Chhom continued to charge at Hillman before running back to his residence just before police arrived, according to witnesses.  Chhom was later charged with assault and attempted rape, and has been placed in a “more secure state facility,”  according to The Sun.

Meanwhile, the Hillmans and their neighbors have been left asking questions.  Will Chhom be allowed to return to the group home?  Why were the Hillmans previously told that Chhom did not have violent tendencies, even though he frequently used to yell out of his window at passersby?

The Hillmans, in fact, were so concerned about Chhom, prior to the May 8 incident, that they built a stockade fence around their yard.  According to James Hillman, Chhom appeared to be left all day long in his room.  But on the day of the attack on Amy Hillman, the staff at the group home reportedly didn’t even know he had left the group residence.

It would be tempting for us to say that Chhom should never have been in a community-based group home; he should have been in a develpmental center, where, at the very least, it would have been more difficult for him to have gotten out out and to attack a resident in the community.  But that argument may miss the real point here.

What people like Chhom are missing in the community system — even in state-run community residences — is an intensive care model that meets the federal standards set for Intermediate Care Facilities.  ICF-level care, which happens to exist only in the developmental centers in Massachusetts, stipulates that residents receive onsite clinical, medical, and nursing care and full-time supervision.  Not everyone with intellectual disabilities needs this level of care.  Only a small fraction of them do.  But Chhom would appear to be one of them.

That’s why we’re so upset that the Patrick administration is shutting down four of the six remaining developmental centers without replacing the ICF care model available in them.  We don’t want the big old buildings there either.  It’s the ICF care model we want to preserve for those who need it.

We think the current residents of the developmental centers should be able to stay in their current locations in the most cost-effective residential settings, while receiving the same level of care from their familiar staff.  That might well mean they would live in small group homes on the campuses — the “postage-stamp” idea.  Meanwhile, other people in the community, such as Tholda Chhom, who need that level of care, should be able to receive it as well.

But the administration is seeking to eliminate the ICF model and replace it with care under which the ICF standards have been waived.  It’s referred to as community-based care, but it should really be labeled “waiver based” care, because the standards are lower.  Direct-care staffing levels do not have to be as high, clinical and medical personnel can “float” among different homes in geographic regions, and medications can be administered by people with less training.

What does this mean for the safety of neighborhoods around the state where thousands of community-based group homes exist?  What does it mean for people like Tholda Chhom, if there will no longer be an ICF-level facility one day to accept him?  Will he simply be thrown into prison?

Once again, let me be clear.  I’m not trying to make an argument here to preserve the six developmental centers as they exist today, although no doubt we’ll continue to be accused of that. 

Go ahead, call it all community-based care.  Just keep the care model and let the current residents of the developmental centers stay in their current locations with their familiar staff.   And finally, provide the opportunity for ICF-level care for all who need it, such as Tholda Chhom.

What are they afraid of?

June 1, 2011 4 comments

It’s now clear that there will be no independent study of the cost of closing versus maintaining the Templeton, Monson, and Glavin developmental centers for people with profound intellectual disabilities in Massachusetts.

Instead, the Patrick administration will continue on its path of closing these critically important institutions on the basis of its largely unscrutinzed claim that doing so will save money.

We figured the administration and the Association of Developmental Disabilities Providers wouldn’t want an independent assessment of that savings claim.  Now we know the leadership in the House and Senate didn’t want it either.  As a result, it will not happen.

Last week, the Senate leadership scuttled a budget amendment, which would have specified that a study of the cost of closing Monson, Templeton, and Glavin be undertaken by a non-governmental entity selected by the Inspector General. 

This occurred after the House had scuttled a similar amendment, and after the ADDP and The Boston Herald had cited inflated numbers on the cost of operating the Fernald Developmental Center.  (Fernald, by the way, wouldn’t even have been included in the proposed cost study.)

What were the administration and the ADDP, in particular, so afraid of?

I think I can guess.  There is a possibility that the entity selected to undertake the study would have come up with a conclusion that the administration, the ADDP, and the legislative leadership didn’t want to hear, i.e., that there would be little or no savings in closing the three facilities. 

Even if you believe we will save money in closing these institutions, why not verify that with an impartial study?  Because it might delay the closures of these facilities by a few months?

In fact, the administration is on schedule, as far as we know, to close all of these facilities as of Fiscal Year 2013.  Fernald, which was first on the closure list, remains open, not because of any cost studies that have been conducted, but because of administrative appeals filed by the guardians of its remaining residents.

The administration has steadily moved residents out of all four of these developmental centers.  This has caused tremendous displacement and anxiety among hundreds of families and guardians, and is leading us toward a system that no longer meets the same high federal standards of care as do the developmental centers. 

Elderly residents of these centers are being forced to leave homes many have known for practically their whole lives.  The key justification the administration has given for doing all this is saving money.   Yet, we are told we cannot afford to have an impartial review of that savings claim because it might slow down this march of “progress” by a few months.

The fact is that studies in other states have come to conclusions that don’t support the Patrick administration’s claim that closing developmental centers saves money.  (See, for instance: Journal of Mental Retardation cost studies review and Connecticut DDS studies of the cost of closing the Southbury Training School.)  Were an independent study in this state to reach a conclusion similar to those out-of-state studies, it would present a public relations problem, at the very least, for the Patrick administration.

That, it seems to us, is the real reason the administration and the ADDP fought so hard to make sure the independent cost study amendment didn’t see the light of day here in Massachusetts.   Last month, Rep. Brian Dempsey, House Ways and Means chairman, wouldn’t allow the study amendment, which had been sponsored by Rep. Anne Gobi, even to come to a floor vote in the House. 

A staff member for Senator Michael Moore, the sponsor of the independent cost study amendment in the Senate, would only say this week that “(Senate) Ways and Means was not supportive” of the amendment.  As we understand it, Moore was first told he would not be allowed to include language in the measure requiring legislative approval of the study. 

Then Moore was told he would have to knock Templeton and Monson out of the amendment, and restrict the study just to Glavin, which is in Moore’s district.  Moore complied with all of those directives.  But it didn’t help. 

Moore’s watered-down cost study amendment was nevertheless then reportedly bundled with other budget amendments in the Senate’s consolidated “no” pile, meaning it was doomed to be rejected, along with all the other amendments unwanted by the leadership, in a single voice vote on the Senate floor.  You couldn’t have done in this cost study amendment more thoroughly if you tried.

You have to hand it to the administration and the ADDP.  If they don’t want something getting through the legislative process in Massachusetts, it apparently doesn’t get through.  The problem is that doesn’t say much for the democratic process in Massachusetts.