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Dying, intellectually disabled man sent home twice from hospital
The disabled are often treated as second-class citizens, even in hospitals, says Dorothy O’Rourke.
O’Rourke is concerned that may have been the case with a resident of a state-operated group home in Chelmsford. The 51-year-old man, whose name is being withheld, died earlier this month after having been taken twice in two days to Lowell General Hospital and sent away each time, apparently without any significant treatment.
The man had been having difficulty breathing and was sweating profusely when he was taken to the hospital on both February 6 and 7. He died, apparently en route to the hospital, after the group home staff called an ambulance for the third time on the afternoon of February 7.
The cause of death is listed on the death certificate on file in the City of Lowell as acute respiratory failure and aspiration pneumonia, which can indicate choking. A death report form filed with the Disabled Persons Protection Commission, however, states that the man died after experiencing cardiac arrest.
Despite the possible discrepancy in the stated causes of death, the Chief Medical Examiner’s Office declined to do an autopsy, and the man’s remains were cremated. He had lived in the same group home as O’Rourke’s son.
O’Rourke strongly defends the staff of the group home, which is managed by Northeast Residential Services, a division of the Department of Developmental Services. “The staff there are wonderful,” she maintains. “They did all they could for him, including performing CPR. It’s the hospital that kept sending him home. I thought they would have at least kept and monitored him. I don’t understand it.”
O’Rourke has no information about what actually happened in the hospital after the man was taken there on each occasion. But she maintains that many hospitals are ill equipped to deal with intellectually disabled people, particularly those who are non-verbal, as this man was. “I think hospitals tend to ignore the mentally disabled,” she said. “I think they may need a special unit to handle mentally disabled people.”
A spokeswoman for Lowell General said the hospital would have no comment on the case due to privacy issues.
According to sources, the man had been sent to his day program in Lowell on the morning of February 6, and the staff at the day program made the first call to 911 to take him to the hospital. A Lowell Police Department official said a squad car was sent to the day program site at 8:30 a.m. in response to a call about a male having trouble breathing. (A police car was dispatched in addition to an ambulance each time, and the man was accompanied by a staff member to the hospital each time.)
The hospital released the man shortly after his arrival, however, and sent him back home. The following morning, the man reportedly looked exhausted and “out of sorts,” and the group home staff made a decision not to send him to his day program that day. By about 8 a.m., the man was slumped over in his wheelchair and sweating heavily, a source said. A group home staff member called 911 shortly afterward. A Chelmsford Police official said a squad car was dispatched to the residence at 8:30 a.m.
However, once again, the hospital made a decision to send the man back to his home. The DPPC report form on the death states that the man had been observed at the hospital on the morning of February 7 to be sweating profusely, but his vital signs were good when he arrived. According to the report form, the man was sent home with a prescription (the name of which was redacted).
By the time he was back at the group home, he was leaning over the side of his wheelchair and was “sweating terribly,” a source said. After the staff noticed the man’s lips turning blue, they immediately called 911 again. A staff worker couldn’t find a pulse.
The DPPC death report states that shortly after arriving back at the group home, the man began to vomit and then lost consciousness, and that the staff began mouth-to-mouth CPR until the paramedics arrived. According to the Chelmsford Police Department, a squad car arrived at the house at 1:45 p.m. The group home received a call from the hospital later that afternoon that the man had died.
The man was formerly a resident of the Fernald Developmental Center. His case is the third we have heard about in which a former developmental center resident in his 50s died suddenly at a state-operated group home managed by Northeast Residential Services. In this case, however, there doesn’t seem to be any indication that the group home was in any way at fault.
“The staff did a tremendous job,” one source said, echoing O’Rourke’s assessment. “They did exactly what they were trained to do. “They jumped right in and did their best to save his life.”
“We hope the DPPC does a thorough investigation of this case,” said Colleen Lutkevich, Executive Director of COFAR, a statewide, family-supported nonprofit organization that advocates for persons with intellectual disabilities and their families and guardians. “If indeed this hospital was at fault in failing to treat this man adequately, we need to find out why. In particular, we need to know whether his disability played a role in the apparent lack of care he received.”
It’s budget time — time to blame the Fernald families
The Massachusetts human service vendors are at it again — blaming the families of Fernald Developmental Center residents for the state’s budget problems.
In an online email to members this week, Gary Blumenthal, president of the Association of Developmental Disabilities Providers, once again resorts to misleading statements about Fernald’s operating cost in order to stick it to family members and guardians of the 14 remaining residents there.
Here’s what Blumenthal says about the Fernald families in his message, which discusses a $10.2 million supplemental bill filed by the Patrick administration to keep Fernald operating:
While the state is still intent on closing Fernald and three other state institutions, the final closure date is uncertain as the last 14 families attempt to hold out, hoping against reality that they can force the state to reverse it’s closure decision.
Despite the families being offered “equal to or better services” per federal Court Orders, the last Fernald families are using every available delay option available, urged on by anti-closure ideologues who still think they can force the state to leave Fernald open for the lifespan of the remaining 14 individuals.
First of all, through their own volition, these families are exercising their legal right to prevent what they see as the unjust eviction of their loved ones from their long-time home.
Moreover, in at least three of the 14 cases, administrative judges in the Patrick administration itself have ruled that the guardians demonstrated that care would not be better in the new locations proposed by the Department of Developmental Services for those residents.
That’s why these cases have dragged on. The administrative judicial decisions have been taken to state Superior court by both the administration and the 11 guardians who didn’t win their administrative appeals. That is their legal right. But Blumenthal and the ADDP have choosen to castigate the families and unidentified “anti-closure ideologues” for somehow bringing the state to its knees fiscally.
We suppose Blumenthal is referring to COFAR as an anti-closure ideologue. It’s true that we oppose the administration’s planned closures of Fernald and three other state developmental centers, which we believe provide critically needed care to some of the state’s most severely and profoundly intellectually disabled residents. But who are the real ideologues here?
We recognize the importance and need for community-based care for the majority of people with intellectual disabilities in Massachusetts. What we have long argued is that the developmental centers are a necessary part of the continuum of care. It is the ADDP and their state-funded vendor members who are the pro-closure ideologues. They argue that the state should abdicate its responsibility of caring for its most vulnerable citizens and hand the entire business over to them.
In furtherance of this aim, Blumenthal has to bend himself into a pretzel logic-wise, and, as we said, make misleading statements about Fernald’s operating cost. He implies in his message that if Fernald were closed immediately, the $10 million in supplemental funding would somehow be re-invested in the community system of care.
Yet, in the same message, Blumenthal admits what we’ve been saying for years — that the state has “reneged” (his word) on its longtime promise to re-invest funding from the developmental centers into the community system. Thus, Blumenthal knows full well that were Fernald to be closed tomorrow, that $10 million would not be invested in the community. The money, or a good portion of it, would follow the residents themselves to their new locations, wherever they might be. The community system as a whole would not benefit in any way.
Further, as they do every year at budget time, Blumenthal and the ADDP single out Fernald and discuss how the per-resident cost there has “skyrocketed.” It’s true that cost has skyrocketed. But what Blumenthal doesn’t say is that’s what happens when you drastically reduce the population of a care facility. The fixed costs get spread out over a smaller and smaller base of residents.
Despite the photo of an abandoned building at Fernald rising out of the weeds that runs atop his message, Blumenthal erroneously makes it sound as though the remaining residents are living the high life because the cost per resident there has risen. As one of the 14 guardians wrote in an email in response to Blumenthal’s message:
Based on what he (Blumenthal) has to say about the “evil 14”, you’d think we were having a blast, loads of fun and just a grand old time!
Also, just once I’d like to see a picture of one of Fernald “homes” like Malone Park or a cottage, or our beautiful chapel, not a building that hasn’t been occupied for 35 years!
You’d think I be use to this by now, but I guess not.
DDS vendor executives not sharing the pain of their workers
Direct-care workers in the state’s contracted human services system have seen their wages stagnate in recent years, but the executives who run the largely nonprofit contractor agencies that employ those workers do not appear to have been feeling that same pain.
We examined compensation to both CEOs and direct-care workers in a sample of 30 service vendors to the Department of Developmental Services, both large and small, from around the state in Fiscal Years 2008 and 2011. This information is available in Uniform Financial Reports, which are submitted to the state Operational Services Division by the vendors and are posted online by the OSD at www.mass.gov/ufr.
The CEO compensation of our sample increased by an average of 16.6 percent during the four year period while the direct-care salaries decreased by an average of 2.17 percent during that time. (See Vendor Compensation Table.)
Among the 30 vendors, the average CEO compensation in FY 08 was $197,068. It increased to an average of $229,872 in FY 11. In FY 08, the average direct care salary for the sample was $33,508. It decreased to $32,780 in FY 11. In FY 11, direct-care workers were earning an average of 14 percent of what the CEOs of those vendors were earning, down from 17 percent in FY 08.
Among the sample, nine CEOs received compensation increases in the four year period reviewed while the direct care workers employed by those same vendors actually saw their wages cut. In two of those cases, the CEOs received increases exceeding 100 percent.
That many CEOs have taken hefty pay increases and the direct-care workers have gotten little or nothing, or in many cases decreases, raises questions about repeated calls from the vendors to add $28 million to a state budget reserve fund to increase those direct care salaries.
If the Association of Developmental Disabilities Providers and its member vendors are really concerned about their direct-care workers’ pay, why have these companies given raises only to their CEOs? Should the state be called upon to bear the entire burden of raising direct-care wages?
“The vendors appear to have it in their own power to give their direct-care workers increases, but they’ve chosen not to,” said Colleen Lutkevich, COFAR executive director. “Instead, they’re looking to the Legislature.”
If the Legislature does step in to fund the direct-care salary reserve account, it will not be at the urging of Governor Patrick. Despite the ADDP’s appeals, the governor’s budget for the coming fiscal year proposes zero for the reserve fund.
Note: We were not able to use data from one of the vendors, Massachusetts Mentor, Inc. Massachusetts Mentor is a subsidiary of NMH Holdings, Inc., a for-profit corporation that provides residential and other services for intellectually disabled persons in 36 states. NMH Holdings was incorported in Delaware, according to its audited financial statements, though it actually appears to be headquartered in Massachusetts. (NMH Holdings appears to be referred to as The Mentor Network on its national website.)
Massachusetts Mentor’s UFR and other reports filed with the state OSD employ what appears to be an unusual method of listing only partial salaries of top executives. The compensation listed is apparently the amounts of the executives’ salaries that are attributed to Massachusetts. For instance, total compensation for Edward Murphy, CEO of both Mass. Mentor and The (national) Mentor Network, was listed as only $14,830 in FY 10, in a filing with OSD). (The company does not appear to have filed a UFR report in Massachusetts for FY 11.) Murphy is a former commissioner of both Mental Health and Youth Services in Massachusetts.
Greg Torres, chairman of the Board of Directors for both Mass. Mentor and The Mentor Network, earned a total of $2,484 in compensation in FY 10, according to the OSD filing. Torres, a former chief of staff of the Massachusetts Senate Ways and Means Committee, is also currently president of MassINC, the nonprofit civic think tank in Massachusetts that publishes CommonWealth magazine. (CommonWealth frequently advocates for more transparency in governmental finances and operations.)
Also working for Mass. Mentor is Gerald Morrissey, a former commissioner of DDS in Massachusetts. Morrissey’s total compensation as a vice president at Mass. Mentor was listed in the FY 10 OSD filing as $5,113. None of these clearly partial compensation listings could be reliably compared with other CEO and direct-care compensation in Massachusetts.
NMH Holdings earned more than $1 billion in revenues in FY 10, according to filings with OSD, while Massachusetts Mentor took in $3.7 million from DDS and $19.4 million from the Department of Social Services in FY 10, according to its UFR report.
Calls and emails to OSD with questions about Mass. Mentor’s and NMH Holdings’ partial compensation listings for their executives were not returned.
COFAR blog 