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Archive for August, 2011

Once again, we’re waiting for the administration’s cost records

August 30, 2011 1 comment

It has been more than a month since we asked Secretary of Health and Human Services JudyAnn Bigby for public records detailing the costs of specified services in a particular group home program for intellectually disabled persons in Massachusetts.

It has been almost two months since we asked Commissioner of Developmental Services Elin Howe for the budgets of the Templeton, Monson, and Glavin developmental centers.

To date, we’ve received neither set of records.

As we’ve previously noted here, we’ve been attempting to compare the cost of an apparently typical vendor-run group home program with the three developmental centers.  We wanted to see whether the Patrick administration was comparing apples to apples in claiming to the Legislature in the last two fiscal years that closing the Templeton, Monson, and Glavin centers will save tens of millions in state funds.

As we reported,  a group home contract, which we did receive last May from DDS, specified a yearly cost per resident of $104,400.  In its cost savings analysis, the administration compared a very similar residential cost based on group home contracts with an average calculated cost of care at Templeton, Monson, and Glavin.

The potential problem with the administration’s analysis that we found in examining the single group home contract was that it specified budgeted costs for only direct-care, supervisory, and minimal nursing staff.  What about the extensive nursing, medical, clinical, and therapeutic staffing that exists at the developmental centers and to which the residents of DDS group homes are entitled? 

The fact that those additional medical, clinical, and therapeutic costs were not in the group home contract we examined appeared to raise the question whether the administration’s savings analysis was accurate.   One immediate question was: if those additional costs are not paid through DDS contracts, how are they paid?  Secondly, what is the total amount of those community-based costs that the administration may have missed in its analysis?

Once we get the answers to those questions, we can determine for ourselves whether there would be a savings or not in closing the developmental centers.

On July 29, we sent Public Records requests to both Secretary Bigby and Commissioner Howe, asking for copies of any documents detailing funding for medical, nursing, clinical, and therapeutic services for individuals residing in the community-based group home program we had selected for review.  About three weeks prior to that, we had asked DDS for the Templeton, Monson, and Glavin budgets for the same time periods as the group home contract. 

On August 9, I received a letter from the records custodian at EOHHS, stating that the agency was in the process of identifying the records we had requested regarding the group home contract.  Last week, I called the records custodian, and was told EOHHS was still working on our request.  He wasn’t able to tell me when the records would be found.

We’ve appealed to the Public Records Division for the Templeton, Monson, and Glavin budget documents.  We’re close to filing an appeal for the group home contract records.

But one piece of useful information may have emerged here.  The fact that the August 9 response to our request came from EOHHS and not from DDS does appear to confirm that it is not DDS, but some other source at EOHHS, that funds medical, clinical, and therapeutic services in the DDS vendor-run group home system.  We believe that other source of funding is MassHealth. 

In any event, it’s getting clearer and clearer that the administration wasn’t counting all the community-based costs of care it incurs when it told the Legislature there would be major savings in closing the developmental centers.

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Guardians looking for answers in DDS client deaths

August 12, 2011 2 comments

The guardians of two intellectually disabled men in their 50s are grappling with the mystery of why each man died suddenly in the past two months in state-operated group homes in the Department of Developmental Services’ northeast region.

Neither guardian yet wants either their name or the name of their ward to be publicly revealed, but both guardians are trying to find out what happened to their wards.

One of the guardians, who I’ll call Anna,  said her uncle, who was 54, was healthy when he was transferred on July 20 from his long-time home at the Templeton Developmental Center to the group home in Tewksbury.  He died four days later. 

In that case, the Chief Medical Examiner listed the cause of death of Anna’s uncle as a blood clot of unknown origin in his lung.   But Anna, who is a former nurse’s aide, is not convinced that the listed cause of death is correct.  She said the Medical Examiner’s report is inconclusive and the Medical Examiner is still waiting for toxicology results.  

Anna said her uncle had had a blood clot in his leg about a year before the move (deep venous thrombosis), but the problem was cleared up.  Other than that, the only problems he had was a hernia and he was going blind in one eye.  He had worked every day in the dairy barn at Templeton. 

After the thrombosis diagnosis, Anna’s uncle had been on a blood thinner called Coumadin, but he was then taken off that medication at Templeton without Anna’s knowledge or consent, even though she is his guardian.  It’s not clear, though, that that contributed to his death.  There may have been an error involving some other medication that he was taking. 

Anna said the staff from the group home had spent about a week at Templeton with her uncle prior to the move, but she is not sure whether any familiar staff from Templeton accompanied him during the transfer to the new residence.  She said, though, that her uncle had been active after the move and had told her he was happy and excited to be there.  The residence is brand new and is beautiful, she said.  Suddenly, four days later, she got a call that he had died.  She has no idea how that could have happened.

State Senator Stephen Brewer of Barre has asked DDS to investigate the death of Anna’s uncle, and has asked that further transfers to the Tewksbury group home be halted until the investigation is complete.

In the second case, a former Fernald Developmental Center resident swallowed a plastic garbage bag in a group home in Tyngsborough on June 21 and was taken to Lowell General Hospital, where he underwent surgery.  He died approximately two weeks later on July 6.  The cause of death is listed as aspiration pneumonia.  The 50-year-old  man had been living in the group home for about a year.

The man’s sister, who we’ll call Nancy, had been his guardian.  She said she is concerned that the staff at the Tyngsborough group home wasn’t properly supervising her brother, who had a tendency to ingest foreign objects, a condition known as pica.  “Someone wasn’t paying attention,” she said.

Nancy said she would like to push for a bill in the Legislature that would prohibit staff in group homes from holding second jobs.  She heard this was the case in Kevin’s group home, and that there were staff there who weren’t getting enough sleep.

Both of these guardians are dealing with the still fresh grief of the loss of their loved ones.  We offer them and their families our deepest sympathy and our condolences.  We hope they get the answers they are looking for and will continue to try to help them do so.

Second sudden death reported after a transfer to a DDS group home

August 10, 2011 3 comments

We’ve received a report of a second intellectually disabled man who died in the past two months after being transferred to a community-based group home from a state developmental center.

In this second case, the 50-year-old man died suddenly of aspiration pneumonia and a bowel obstruction on July 6, according to the City of Lowell Clerk’s Office, where the death certificate is on file. 

According to sources, the man, who had a history of ingesting foreign objects, died after swallowing a plastic shopping bag in the state-run group home.  He had reportedly lived in the group home for about a year after having lived for most of his life at the Fernald Developmental Center.

We are withholding his name until we can obtain permission to use it from his guardian.

A staff person with the Disabled Persons Protection Commission said the man’s death is under investigation, but would not comment on the cause of death.  

Sources said the staff at the Fernald Center had been aware of the man’s tendency to ingest foreign objects, a condition known as pica, and had watched him closely to prevent him from doing so.  We have received reports that the level of supervision in the group home regarding the man’s pica condition was not as high as it had been at Fernald.

We reported earlier this week about another man who died suddenly of a blood clot in his lung in a group home on July 24, four days after having been transferred there from the Templeton Developmental Center.  Both Fernald and Templeton are among four developmental centers that have been targeted by the Patrick administration for closure.

In both cases, the men had been transferred to state-operated group homes operated by Northeast Residential Services, a division of the Department of Developmental Services.  DDS has refused to discuss or provide any information about these deaths, citing confidentiality and privacy regulations.

We have raised concerns about at least one other incident involving potential lack of supervision in a Northeast Residential Services group home.  In that case, a resident of a Norteast Regional Services home in Chelmsford left the residence unsupervised in May and attempted to rape a pregnant woman who lived next door.

State Senator Stephen Brewer of Barre, whose district includes the Templeton Developmental Center, said in an email to COFAR that he had been made aware of the death of the former Templeton resident and has asked DDS Commissioner Elin Howe to investigate it.  Brewer said he has also asked Howe to halt further transfers to the group home until the investigation is complete.

We think DDS needs to come out from behind its confidentiality veil and take a fresh look at the level of oversight and supervision in its community-based system of care.

DDS client’s death raises new questions about care

August 7, 2011 6 comments

We reported last week that the Patrick administration was refusing to provide any information about — or even confirm — a report that a man in his 50s, who had lived at the Templeton Developmental Center, died four days after being transferred to a community-based group home.

We have since gotten confirmation of  the man’s death from the state’s Chief Medical Examiner’s Office and from a newspaper obituary, and have learned that the cause was a pulmonary embolus, or blood clot in his lung.  We also learned that a contributory cause of his death was a history of deep venous thrombosis, or a blood clot in his arm or leg.

We are withholding the name of the man until we are able to contact his guardian.

Although the initial report we received was that this man had been healthy prior to his transfer out of Templeton,  we now know he had a serious medical condition.  That, however, doesn’t fully explain why he died so suddenly after the transfer.

Given that the Department of Developmental Services is citing privacy and confidentiality grounds to avoid discussing this particular case, we have very little information to go on.   We did receive a report that this man’s familiar staff at Templeton may not have accompanied him to his new residence and may not have been appropriately involved in the transfer process. 

Templeton is one of four developmental centers in the state that have been targeted by the administration for closure by the end of the next fiscal year.  In some cases, as we understand it, DDS has been careful to ensure that familiar staff accompany residents who are transferred from these centers as the administration phases the facilities down.   But it appears DDS may not have uniform policies or procedures on whether familiar staff are made available to accompany transferred residents to their new locations.

Is it likely that this man would have died anyway, had he continued to live at Templeton?  Or did the stress of the move contribute in some way to his death?  Was his death the result of a medication error or a lack of proper medication for his medical condition after his transfer from Templeton?   Was his death the result of any other negligence in his treatment or care?  Was his death due in any way to the fact that familiar staff were not available to him during or after the transfer process?

Moreover, given this man’s medical condition, why were his familiar staff not more involved in his transfer, if it was indeed the case that they were not?  He was presumably treated at Templeton for his thrombosis, possibly with anti-coagulants to prevent blood clots.  There are a number of potential causes of a traveling blood clot that results in a pulmonary embolus, like the one that caused this man’s death.  One cause can be long periods of inactivity or immobility — something which this person’s familiar staff would most probably have known about, but which unfamiliar staff in his new residence might not have known about.  How much communication was there between the two staffs about this person’s medical condition?

Is DDS asking any of these questions?  We don’t know.  We have reported this death to the Disabled Persons Protection Commission in the hope that they will investigate the circumstances surrounding it.

Van crash highlights DDS oversight and protection loopholes

August 4, 2011 3 comments

A van crash this week in Newton, which injured 12 adults with intellectual disabilities, highlights a lack of adequate oversight of the state’s community-based system of care.

The incident, involving a driver for a state subcontracted transportation company, also points to some apparent loopholes in the state’s current Criminal Offender Record Information (CORI) system.

News organizations around the state reported that  Addis Gabriel Woldeguiorguis allegedly drove a passenger van into a parked garbage truck on Monday as he was transporting the special needs adults to a day services program in Newton.  Police said they found a broken crack pipe and a plastic bag containing suspected crack cocaine in the van.  Woldeguiorguis also reportedly told police he had taken two oxycodone pills four hours before the crash for foot pain.

According to The Boston Globe, Woldeguiorguis, who was charged Tuesday with driving under the influence of drugs and with drug possession, has “a traffic history three pages long in New York, with violations dating back to 1980, and a 2005 notation for possession of drugs.”

This seems similar to a situation we reported about in May in which a convicted sex offender in California violated a five-year probation there and fled to Massachusetts where he took a job driving people with intellectual disabilities to day programs.

Both cases appear to result from the fact that Massachusetts requires special needs transportation companies to check drivers’ records only in this state and to administer a CORI background check, which does not identify criminal arrests or convictions in other states.  State agencies are, moreover, not currently authorized to require vendors to make use of the FBI’s national criminal background check system.  Woldeguiorguis’s driving and CORI records did not indicate any problems, according to the Globe, since all of the violations occurred in New York.

There are other potential problems with the current background check system in Massachusetts.  If the potential penalty for a criminal offense does not include incarceration, it does not appear on a CORI record, according to Georgia Critsley, general counsel of the Massachusetts Department of Criminal Justice Information Systems.  Critsley said Massachusetts motor vehicle offenses such as OUI and Operating to Endanger appear on the CORI, whereas civil motor vehicle offenses such as speeding do not.  Further, after reforms were enacted in 2009, CORI regulations appear to exempt existing state and vendor employees, who were not previously subject to CORI checks,  from any additional CORI checks.

These seem like big loopholes when it comes to hiring people to care for and drive DDS clients.  Meanwhile, a bill in the state Legislature, which has been repeatedly filed by Rep. Martin Walsh of Boston and which would authorize the use of national FBI background checks for people hired by DDS and its vendors, has remained in the Judiciary Committee for months.

There may be other loopholes as well.  We asked Howe yesterday whether the CORI background check regulations actually apply to transportation companies that drive clients under subcontracts with either EOHHS brokers or DDS vendors.  We also asked whether DDS has any policies or regulations requiring drug testing for employees of transportation companies, DDS vendors, or other DDS programs. We haven’t yet heard back.

Jennifer Kritz, communications director for the Executive Office of Health and Human Services, told the Globe her department is “conducting a thorough review of the transportation provider’s actions and performance (in the Newton crash), as well as the hiring practices related to this specific driver, in order to determine whether any action is necessary.’’

This reaction by EOHHS seems inadequate.  EOHHS’s review should extend beyond the actions and performance of this particular transportation provider and beyond its hiring practices related to this specific driver.  EOHHS should be looking at this point at all of the state’s background check policies and regulations, and whether all of the clients in its agencies are protected from persons unsuited to be caring for and driving them.

DDS won’t give out information on reported death

August 2, 2011 1 comment

Late last month, we received a report that a healthy, 55-year-old man had been transferred from his home at the Templeton Developmental Center and subsequently died four days later at a community-based group home.

The death reportedly occurred around July 24.

As an organization that advocates on behalf of persons with intellectual disabilities and their families and guardians, COFAR has an interest in getting to the bottom of reports such as this.

Is the report, in fact, true?  If so, why would a healthy man die four days after being transferred from one Department of Developmental Services location to another?  The answers to these questions could help us better understand the state of care available to all DDS clients.

We posed those questions regarding this reported death in an email on July 27 to DDS Commissioner Elin Howe.  In response, we received a message on July 29 from DDS General Counsel Marianne Meacham, which provided no answers and stated that personal and medical information is exempt from disclosure under the state’s Public Records Law.  Meacham also cited a provision in DDS’s enabling statute, stating that records of admission and treatment to DDS facilities shall be kept private.

For reasons I’ll get into below, we intend to appeal this denial of information to the state’s Public Records Division.  But first, I’d note that DDS’s reaction to our query appears unfortunately to be part of a longstanding pattern on the part of the department of secrecy concerning deaths of persons in its care.

For years, our member organization, the Advocacy Network, has tried without success to obtain notification from DDS of the deaths of former residents of the Belchertown State School and other facilities in order to arrange to pay proper respects to those people.  In one case, the Network learned that the cremated ashes of a resident of a vendor-based group home in the Pioneer Valley had sat disregarded on a shelf in the provider’s business office for two years.   

In their Spring 2009 newsletter, the Advocacy Network stated that DDS cited confidentiality and privacy regulations as reasons for not providing notifications of the deaths of DDS residents even when obituaries had been published in newspapers.

Edward Orzechowski, editor of The Advocacy Network News, quotes Donald Vitkus, a former resident of the Belchertown State School as saying, “‘No one ever died at Belchertown. People just were never seen or talked about again.'”  Although that apparently was the case at this former state facility in the 1950s, one wonders if that situation still prevails in the DDS system.

To be fair, deaths at the Wrentham Developmental Center appears to be handled much differently.  COFAR Executive Director Colleen Lutkevich notes that when Wrentham residents die, residents’ guardians are notified and wakes and funerals are held, which are attended by residents, staff, families and friends. 

In refusing to provide any informaton about the reported death of the former Templeton Development Center resident, Meacham appears to have cited an exemption to the Public Records Law [M.G.L. Chapter 4 Section 7(26)] that concerns “medical files or information…(and)  any other materials or data relating to a specifically named individual, the disclosure of which may constitute an unwarranted invasion of personal privacy.”  She also cited DDS’s enabling statute ( M.G.L. Chapter 123B, Section 17), which states that records of admission and treatment to DDS facilities shall be kept private.

We intend to appeal this denial of information because we were not asking for medical files or medical information or for records of admission or treatment.  Instead, we are seeking information about the circumstances under which a client in the DDS system died.  Secondly, case law, as we understand it, holds that personal privacy rights end when a person dies.

Not only do we and our member families have an interest in learning about deaths of persons in DDS care, the general public has a legitmate interest in knowing about this as well.   What if there was negligence or even foul play involved?  DDS has to start using common sense and stop hiding behind false confidentiality and privacy claims in these cases.