Archive

Author Archive

Lawsuit filed after Suffolk DA apparently declines to bring criminal charges in alleged rape of a woman with an intellectual disability

March 7, 2022 4 comments

Although the Department of Developmental Services (DDS) substantiated a sexual abuse charge in 2018 against the supervisor of a day program for allegedly raping a client of the program, the Suffolk County District Attorney’s Office has apparently not brought criminal charges against the supervisor.

The case has resulted in a lawsuit brought by the victim’s mother against the supervisor and the day program provider, Work, Inc.

The case offers insights into why sexual abuse of disabled individuals happens so often in day and residential programs and why it is so difficult for victims of the crimes to obtain justice.

The lawsuit states that on September 5, 2018, a supervisor at the Dorchester-based day program allegedly “coerced and intimidated (the victim) to follow him into a separate room on the premises. He then physically forced her into the bathroom and raped her.”

The Boston Globe reported last month that DDS investigated and substantiated the sexual abuse allegation against the supervisor, based primarily on a medical examination that revealed physical evidence of rape.

According to the lawsuit, the victim, who is deaf, was unable, due to her disability, to call out for help during the alleged assault. The following day, September 6, the victim disclosed to a staff member at WORK, Inc. that she had been sexually assaulted by the supervisor, the complaint stated.

Both the Globe and an attorney for the victim stated, however, that no criminal charges have been brought against the supervisor.

John Martin, an attorney representing the victim, said that the alleged assailant’s employment was terminated after the complaint was substantiated by DDS. He said, however, that no disciplinary action was taken against the assailant’s supervisors or the program manager.

COFAR has asked the Suffolk County District Attorney’s Office why criminal charges have not been filed in the case. Thus far, the office has not responded.

“We do not know why they (the Suffolk County DA) did not prosecute or arrest the assailant,” Martin told COFAR. “The fact that he was not arrested is unfathomable to me.”

The name of the victim is being withheld. The supervisor is referred to in the lawsuit as “John Doe.” The lawsuit is seeking $1 million in damages.

Lawsuit reveals problems with safety of DDS system

The lawsuit alleges several lapses or omissions  in Work, Inc.’s safety procedures in its day program. Among them are that Work, Inc. “failed to maintain proper policies and procedures to protect (clients’) safety… failed to properly supervise and monitor their staff and their (clients) while on the premises, and … failed to maintain any type of surveillance on certain areas of the premises.”

The complaint specifically alleges that Work, Inc. had no security measures in place in separate parts of the facility, such as surveillance cameras, and had no policies regarding monitoring or safety checks on clients when they “stepped away from the main area where the program was conducted.”

Also, Work, Inc. didn’t have any formal policies or procedures “regarding instructors and staff being alone with disabled clients in the program,” and didn’t have any policies in place “specific to female disabled (clients).”

According to the lawsuit, Work, Inc. was also negligent in waiting several hours after the victim disclosed to a staff member that she had been sexually assaulted by the supervisor before sending her to the South Shore Hospital ER to undergo a Sexual Assault Nurse Exam (SANE).

And Work, Inc. failed to send a sign language interpreter with the victim to the hospital. No interpreters were available at the hospital either, so the victim was forced to wait until the next day to undergo the exam, the complaint stated.

In addition, the complaint alleges that Work, Inc. “failed to exercise reasonable care in hiring, training, and supervising (the supervisor),” who the complaint alleged was “unfit and/or incompetent to perform the work for which he was hired.”

We are concerned that Work, Inc. is not alone in failing to maintain proper policies and procedures to protect clients in both day and residential programs. Some of these measures can be costly, and it has become apparent that many corporate providers that dominate the DDS system are more focused on keeping their costs down rather than keeping clients safe. (See here and here.)

Case was referred to the Suffolk County DA, which apparently has not brought charges

It is our understanding that under state regulations, this incident should have been reported to the Disabled Persons Protection Commission (DPPC). Also, under DPPC regulations, the DPPC should have referred it to the Suffolk County District Attorney for a crminal investigation. I first checked February 23 with the DA’s office, and was told there was no record of the case having been referred to them.

Martin contended, however, that he has emails indicating that the rape allegation had been referred to the Suffolk County DA, which” allegedly conducted an investigation, including an interview of the assailant.”

On March 1, after talking with Martin, I called the DA’s office back and reached a supervisor who said she would  ask the DA’s High Risk Crimes Unit about the matter. She said it is possible that the DA’s office concluded that there was not enough evidence to bring charges, but that she didn’t know if that was the case here.

The supervisor also said that since we are not directly involved in the case, she might not be able to give me any information about it, but that she would get back either way. To date, we have not heard back.

It is hard for us to believe that the DA would not have sufficient evidence to bring charges in a case like this in which the victim had not only reported the assault and identified the alleged assailant, but DDS had substantiated her allegation.

Alleged assailant’s name will apparently not go into Nicky’s Law registry

Given that DDS substantiated the alleged rape in 2018, it does not appear that the alleged assailant’s name would be placed in a new state registry of names of substantiated abusers of persons with developmental disabilities in Massachusetts.

Under Nicky’s Law, persons whose names are placed in the registry are banned from further employment in DDS-funded facilities. Nicky’s Law, however, went into effect in July 2021.

In this case, it would appear the Work, Inc. supervisor, whose alleged assault was substantiated in 2018, could be continuing to work in another day or residential program in the system.

Criminal charges are rare in assaults of people with developmental disabilities

If the Suffolk County DA is reluctant to bring charges in a sexual assault case involving a developmentally disabled victim, the office would not be alone. Prosecutions of assaults against disabled persons are apparently rare.

Perpetrators, in fact, are aware that women, in particular, with developmental disabilities ”are less likely to be believed by police, judges and juries” when they say they have been sexually assaulted, according to researchers at the University of British Columbia.

The researchers, Janine Benedet and Isabel Grant, noted that experts in criminal court proceedings often portray  women with developmental disabilities as “having childlike levels of intelligence” in order to undermine their credibility  as witnesses “in ways that would be impermissible for other women.”

In addition, the researchers contend that while women with developmental disabilities are often “infantilized,” their  ”vulnerability disappears” when considering whether they actually gave consent,  and instead they are “portrayed as desperate for male attention or as overly friendly.” (Links in the orignal.)

Martin said, in fact, that recent correspondence from Work, Inc.’s defense counsel suggests they are intending to pursue a “blame the victim defense” and have instructed him to “preserve all evidence of the ‘relationship’ between our client and her rapist.”

This would be a particularly disturbing legal strategy by Work, Inc., in our view.  We don’t understand how it is possible that someone could argue that a sexual relationship between a developmentally disabled client of a day program and a supervisor of that program could be consensual.

In discussing when an individual can be considered to have given sexual consent,  Alexander A. Boni-Saenz  wrote in Psychiatric Times that the individual “must be willing to express volition, have the ability to control one’s choices, and not be overly susceptible to outside influence.”

DDS reportedly discounts second alleged assault of victim by another staff

Martin said that the victim in this case was recently assaulted again at the same Work, Inc. facility when an employee “flirted with her and slapped her on the buttocks.” He said DDS has opened another investigation, but that their opening letter “included some very disappointing and alarming language that indicates they are treating the complaint with a great deal of skepticism.”

Specifically, Martin said, the DDS investigator “took pains to point out that the assault was not witnessed by other employees, a fact that should be irrelevant given that no one witnessed an anal rape that was medically confirmed.”

Charitable Immunity cap

Adding to the difficulties that developmentally disabled victims, such the victim in this case, face in seeking justice is a state law limiting legal liability for nonprofit organizations in Massachusetts in abuse and neglect cases.

Under the the Charitable Immunity Law (M.G.L. c. 231, s. 85K), any damages assessed against Work, Inc. would apparently have to be whittled down to $20,000. We are advocating on Beacon Hill for ending or changing the law to eliminate the $20,000 cap.

Martin maintained that,“ There are ways around the cap and we intend to pursue all of them in this case.”

It is likely, however, that the Charitable Immunity Law will present one more difficulty in a long series of difficulties that the victim and her family in this case will face in order to realize a measure of redress for what happened to her more than three years ago.

DPPC rescinds abuse charge against mother who gave her son prescribed Tylenol and cough syrup

February 28, 2022 9 comments

In what appears to be a rare reversal, the state has rescinded an abuse charge against Christine Davidson for giving her son John an “undetermined” amount of cough syrup and Tylenol last June.

Robert A. Reed, an assistant general counsel with the Disabled Persons Protection Commission (DPPC), stated in a February 17 letter that he was changing the agency’s conclusion regarding the abuse allegation against Christine from “substantiated” to “unsubstantiated.” The letter was addressed to Thomas Frain, an attorney who is representing Christine and who is also COFAR’s president.

Reed’s letter stated that his decision was the final decision of the DPPC, which is a state agency that is charged with investigating abuse and neglect of adults under 60 with disabilities.

“I’m so relieved,” Christine told us. “I’m so glad they understand that I love my son and have never done anything to harm him. The truth has finally won out.”

Christine and John Davidson

Frain had filed an appeal of the original abuse charge with the DPPC in November. COFAR has maintained that the Tylenol and cough syrup with codeine that Christine provided her son had been prescribed by his primary care doctor, and that there was no evidence presented by the DPPC that she did not follow the prescriptions.

In accusing Christine in October of abuse, the DPPC alleged that in addition to giving him an “undetermined amount of cough syrup and Tylenol,” she had failed to provide him with prescribed breathing therapy support “causing (John) to lose consciousness” while he was home with her on the morning of June 21. The prescribed therapy was the use of a Bi-PAP breathing assistance machine at night.

Christine maintains that the Bi-PAP machine was not delivered to her until June 22, the day after John’s episode of low oxygen or hypoxemia. She also said she did not receive necessary training in how to use the machine.

Christine was unable to wake John up on the morning of June 21, while he was home for a weekend visit, and called 911. John was brought to the Newton Wellesley Hospital ER. He quickly recovered after being given oxygen.

Reed’s February 17 decision acknowledged that an October DPPC report, wich had substantiated the abuse charge, had based its conclusions on an uncertain opinion about the cause of John’s hypoxemia rather than on conclusive evidence of the cause.

Reed further acknowledged that the DPPC had blamed what it alleged to be excessive Tylenol use and the lack of use of breathing machine solely on Christine, when in fact Tylenol had also been given to John in the group home. Reed further noted that the breathing machine had apparently not been used in the group home either.

“Given these unresolved factual disputes which bear directly on the causation analysis of (John’s) injury, including the confusion about the type and use of (John’s) prescribed and unprescribed cough medicines … I do not find that the conclusions of the Report were supported by the weight of the evidence,” Reed’s decision stated. “As such, I amend the Report to unsubstantiated.”

In the wake of the original abuse charge, John has been subject to a prohibition on visits home to his mother. Earlier this month, two medical specialsists stated that John has been declining physically in his group home where he is currently receiving no physical therapy and few, if any, other activities.

The group home is run by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS).

Final DPPC decision said cause was uncertain

As we reported in January, doctors at Newton Wellesley Hospital, who were interviewed by DPPC, did not appear to have provided the investigator with a conclusive cause of John’s episode of hypoxemia on June 21.

One Newton Wellesley hospital official told the DPPC investigator that Christine’s son had an enlarged liver, which was likely caused by a drug toxicity. The official said, however, that John’s Tylenol levels were not elevated when he was examined at the hospital. Nevertheless, the hospital official said that toxicity in John’s liver could be due to small amounts of Tyleol built up over time.

Christine maintained, however, that since her son had only been with her over the weekend of June 18 to June 21, when he was hospitalized, she believed it was possible that any toxicity buildup in his liver from Tylenol use could have happened previously at the group home. The DPPC report did not mention that possibility.

In his February 17 decision overturning the abuse charge, Reed appeared to accept Christine’s argument. He noted that the Newton Wellesley Hospital official, who he identified as John’s treating physician, “did not wholeheartedly endorse (the) theory” that Tylenol use was the cause of John’s liver enlargement.

Reed added that:

Even if (the hospital physician’s) couched opinion about the cause of (John’s) enlarged liver is accepted, it begs the question of why (Christine) would be more accountable for a long-term overdosing of (John’s) acetaminophen (Tylenol) —when (John) spent limited time under her care.

Decision stated that Bi-PAP machine not used in group home either

Even though the DPPC’s October report had accused Christine of failing to use the prescribed Bi-PAP machine on John, the report acknowledged that it appeared the group home staff rarely if ever used the machne either.

In his final decision, Reed stated that John’s attending doctor at Newton Wellesley Hospital had “partially attributed (John’s) unresponsive state to the failure to use (John’s) Bi-PAP, and again assigned this omission to (Christine), when there were conflicting accounts from medical professionals about the use of this device generally.”

Like Christine, we are relieved that the DPPC recognized that it’s standard for substantiating abuse based on the proponderance of the evidence was not met in this case. We hope, among other things, that this case prompts DPPC to reassess its investigative policies and practices. All too often, both DPPC and DDS do not appear to reach the right decisions in these cases. (See examples of that here, here, here, and here.)

Two medical specialists say physical therapy needed for man allegedly isolated in group home

February 17, 2022 5 comments

John Davidson, a man with an intellectual disability, is declining physically in his group home and has not received needed physical therapy there after an extended stay last year at Tewksbury State Hospital, according to two medical specialists.

One of the physicians, Adam Harris, a specialist in spinal disorders at New England Baptist Hospital, on Wednesday (February 16) recommended an eight-week regimen of physical therapy for John at Spaulding Wellesley rehabilitation center.

In a summary of an examination of John on Wednesday, Dr. Harris wrote that John had “deconditioned” after his stay at Tewksbury. Harris’s summary stated that following that hospitalization, John was “never transferred to outpatient therapy.”

A second specialist, Steven Cohen, a gastroenterologist with Beth Israel Deaconess Medical Center, wrote in a medical progress note, dated February 3, that John was declining physically due to a lack of physical therapy and other stimulative activities.

John has been confined to a wheelchair following the stay at Tewksbury, which reportedly stemmed from a broken leg that he suffered from a fall outside his group home in 2019.

The two medical assessments corroborate a contention by John’s mother, Christine Davidson, that John has not been provided with stimulative activities at the residence, which is operated by WCI, Inc., a corporate provider to the Department of Developmental Services (DDS). She said he was not receiving physical therapy and has had no functioning day program. She also said he is depressed and wants to be allowed to visit her at her home.

Cohen also wrote in the progress note that he believes John should be living with his mother rather than in the group home.

“Overall, I’m very concerned about prognosis due to poor conditioning,” Cohen’s progress note stated. “Aggressive PT is best hope. Would be best served if living with his mother whose excellent care I have witnessed for over 20 years.”

Cohen added that, “John is terribly deconditioned and needs PT and aquatherapy.”

Cohen also stated that John was “clearly deteriorating” in terms of his mobility, and was “too weak” to be safely examined on a table in Cohen’s office.  He further wrote that John was “upset over not being home.”

Breathing mask unhygienic

In addition to his concerns over John’s physical condition, Cohen stated in his February 3 progress note that a breathing mask that is apparently being used on John at the group home to treat sleep apnea was “apparently not hygienic.”  Christine sent us the photographs below that her partner, Carmine Tocco, took on February 2 of John’s breathing mask, which is attached to a Bi-PAP machine at the WCI residence.

Christine Davidson said she has spoken to the group home staff about the breathing mask and about what she said were other poor hygienic conditions in the residence.

Photographs taken February 2 of a reportedly dirty breathing mask apparently being used on John in his group home.

Questionable abuse charge appealed

In a recent blog post, we reported that we have raised numerous questions about the accuracy of a report written by the Disabled Persons Protection Commission (DPPC), which concluded last October that Christine abused John after she gave him an “undetermined” amount of cough syrup and Tylenol last June. Since then, John has been subject to a prohibition on visits home.

Christine’s attorney, Thomas Frain, who is also COFAR’s president, filed an appeal with DPPC of the abuse finding. The appeal notes that the cough syrup and Tylenol that Christine provided her son had been prescribed by his primary care doctor, and that there was no evidence presented by the DPPC that Christine did not follow the prescriptions.

Christine is a co-guardian of her son. The other co-guardian, George Papastrat, is Christine’s nephew and lives in North Carolina. Under the co-guardianship agreement, Papastrat has the authority to make medical and other decisions about John’s care. Papastrat has not responded to emails I have sent him raising concerns about John’s care.

Numerous medical issues

John has Down Syndrome, “multiple gastrointestinal issues,” Celiac disease, obesity, severe osteoporosis, and several other medical conditions. He is also continuing to experience pain from the leg fracture in 2019.

In addition to the lack of physical therapy, Cohen said John was not being taken out of the residence for aquatherapy, an activity he previously enjoyed.

DPPC placed blame on mother regarding breathing mask

In accusing Christine in October of abuse, the DPPC alleged that in addition to giving him an “undetermined amount of cough syrup and Tylenol,” she had failed to provide prescribed breathing therapy support “causing (John) to lose consciousness” in the morning of June 21. The prescribed therapy was the use of the breathing mask and Bi-PAP breathing assistance machine at night.

Christine was unable to wake John up in the morning of June 21, and called 911. John was brought to the Newton Wellesley Hospital ER. He quickly recovered after being given oxygen.

Christine maintains that the Bi-PAP machine and mask were not delivered to her until June 22, the day after John’s episode of hypoxemia or low oxygen level. She also said she did not receive necessary training in how to use the machine. When she inquired of a group home staff member about receiving training, she said she was told there would be no opportunity for that.

Christine said the breathing machine was later removed from her home by a group home staff member, and that she later saw the machine’s breathing mask on the floor of John’s room and noticed that it looked dirty. She said when she brought that to the attention of the staff, they did not respond to her.

Following the DPPC’s decsion to level the abuse charge against Christine, DDS issued an “action plan” in October that recommended sharply curtailing contact between Christine and John. The DDS action plan also stated that the Bi-PAP machine “should be operated by trained residential staff.”

Attempts to contact DDS commissioner and other officials

On February 14, I sent an email to DDS Commissioner Jane Ryder, asking whether she would inform either us or Christine of what measures, if any, DDS may be taking to address the concerns raised by Dr. Cohen and Christine about John’s care.

I sent a similar email the same day to Nancy Silver Hargreaves, president and CEO of WCI. To date, I haven’t received a response from either Ryder or Hargreaves.

On January 10, I wrote to Gail Gillespie, DDS Metro Region director, and Joan Thompson, DDS area director, about John’s situation. I have not received a response from Gillespie.

On January 11, Thompson responded with a two-sentence email stating that I would need written authorization from both co-guardians in order for her to release any information about the matter.

As we have previously stated, we think DDS should conduct an investigation of the conditions under which John is living, and should take immediate steps to provide him with physical therapy and other activities – particularly those activities recommended by Drs. Cohen and Harris.

We have also urged DDS to take both John’s and Christine’s often-stated wishes into account and begin by arranging for visits home for John. We concur with the assessment that the best hope for John is to return home to live with his mother.

Judi Lydon-Ruby receives the Manuel Carballo Award for public service

February 14, 2022 4 comments

By Joe Corrigan

COFAR would like to congratulate Judi Lydon-Ruby, recipient of the Manuel Carballo Governor’s Award for Excellence in Public Service.

Judi is director of the Wrentham Developmental Center (WDC). She has had a long history with WDC, starting at the age of 16 in their kitchen until becoming director in 2018.

Roughly two years ago, we all woke up to learn of a growing pandemic the likes of which haven’t been seen in 100+ years. Most of us began to take precautions in our own immediate families by masking, distancing, etc.

Judi Lydon-Ruby

Now imagine also having responsibility for an additional approximately 1,000 staff and nearly 200 very vulnerable residents with intellectual and other developmental disabilities (I/DD) and medical frailties in a campus setting. This describes the daunting task Judi was facing.

Beyond creating difficulties for staff in continuing to provide great everyday care for the residents, the pandemic created challenges that nobody was prepared for.

Throughout the pandemic, Judi has adapted to the challenges requiring masking, distancing, quarantining, isolation, testing, innoculations, vaccination mandates, resource balancing, hiring and training for infectious disease and more. She created a plan where there was none and no doubt helped people survive.

Given all that and more, the WDC Board of Trustees, along with support from the Wrentham Families Association, nominated Judi for the Manuel Carballo Governor’s Award in September 2021. The nomination was well received by the administration, and on January 10, 2022, Judi received the award.

Congratulations to Judi and her staff for a continuing job well done.

(Joe Corrigan is a COFAR Board member. His sister Patricia is a resident at WDC.)

We need a $25-per-hour minimum wage for direct care workers in the DDS system

February 9, 2022 4 comments

We think it’s time for a meaningful boost in the minimum wage paid to direct-care workers in the Department of Developmental Services (DDS) system, particularly for those caregivers who are employed by corporate providers to DDS.

We’re suggesting a minimum wage rate for direct care workers of $25 per hour. Right now, the average hourly rate for these workers appears to be $16 or possibly even less. The situation is contributing to staffing shortages throughout the system and a resulting decline in the quality of care in group homes.

We think increasing the minimum wage to $25 is affordable, given that the state has a large projected budget surplus this year. Also, Gov. Baker is proposing a tax cut on capital gains and on inherited estates. We think that money could be used instead to boost direct care worker wages, which are unconscionably low.

At least some of the funding needed for a $25 minimum wage could potentially come from the providers themselves.

In 2019, Sate Auditor Suzanne Bump recognized that at least some of the continually increasing state funding to human services providers could be used to boost direct-care wages, but said that was not happening.

In her 2019 audit , Bump found that the average hourly direct-care wage was $11.92 in Fiscal 2010, and that it had risen only to $14.76 as of Fiscal 2017. That was an increase of only 24% over that eight-year period, an amount that only barely exceeded the yearly inflation rate.

According to Bump’s audit, the increased state funding to the providers provided them with a 237% increase in surplus operating revenues (total operating revenues over total operating expenses) during that same eight-year period.

Residential DDS provider revenues have grown to more than $1.4 billion

DDS corporate residential providers would receive $1.44 billion under Governor Baker’s  proposed state budget for Fiscal Year 2023, which begins in July. If that amount is approved by the Legislature, the provider group homes will have gotten an increase of $563 million, or 64%, since FY 2012, when adjusted for inflation.

That increase doesn’t even appear to include appropriations to a reserve fund (line item 1599-6903) intended to further boost contractual payments by the state to the residential providers. Baker’s Fiscal 2023 budget would increase the size of the provider reserve fund from $79 million to $230 million in the coming fiscal year.

On Jan. 31, I asked the staff of the Legislature’s Children, Families, and Persons with Disabilities Committee whether Senator Adam Gomez or Representative Michael Finn, the committee co-chairs, might comment on a $25 minimum wage for direct care workers. To date, I haven’t received an answer.

Pending bill would eliminate a disparity between state and provider wages

On February 8, I called and emailed Senator Cindy Friedman, Senate Chair of the Health Care Financing Committee, for comment on our proposal.

Friedman has proposed a bill (S.105), which would eliminate a “disparity” in wages between direct care workers working for human service providers and those working in state agencies over a five-year period. The amount of that disparity has apparently only been “guesstimated,” however, and the guesstimate is that the disparity is roughly 20%.

That guesstimate came from a staff member of the Children and Families Committee. If the guesstimate is correct, it appears that even after five years, Friedman’s bill would raise the wage of a worker making $16 an hour to roughly only $19 – a level nowhere near $25.

I haven’t yet heard back from Senator Friedman or her staff.

Friedman’s bill and a companion House bill (H.237) apply to caregivers working in residences overseen by the Executive Offices of Health and Human Services and Elder Affairs, and the Department of Housing and Community Development. The bills would require that the disparity be reduced to 50% as of July 2023, and to zero by July 2027.

Average pay is about $16 per hour

Data on the average wage earned by direct care workers in the DDS system is not easy to find. The federal Bureau of Labor Statistics lists an average hourly wage for “personal care aides” in Massachusetts of $16.29.

Personal care aides, according to the BLS, include workers in both group homes and private homes, and include persons who care for individuals with all types of disabilities, not just intellectual or developmental disabilities.

The BLS does publish data on personal care aides in residential facilities for persons with intellectual and developmental disabilities; but that data is for workers throughout the country, not just in Massachusetts. The average hourly wage in that catetory is $13.49.

Wage disparity amount has not been officially projected

The BLS wage data also do not differentiate between caregivers in state-run versus provider-run facilities.

The amount or amounts of the wage disparity are not specified in Senator Friedman’s legislation either. Her bill requires the agencies involved to provide a report to the Legislature as of next July 1 listing the disparity amount. The agencies must also project the amount of the appropriation needed to achieve those disparity reductions.

No one in a hurry to pass legislation to raise wages

Despite their potentially modest impact, S. 105 and H.237 have failed to make much headway over the past year in the Legislature. Friendman’s bill was referred to the Children and Families Committee in March 2021. It was reported favorably by the committee and sent to the House and Senate Ways and Means Committee only this week (February 7.)

In 2018, Governor Baker did sign legislation to raise the minimum wage of direct-care and other workers to $15 an hour; but it won’t reach that amount until 2023.

Some federal funding to raise wages is due to be distributed next month

Gov. Baker signed legislation in December that would target hundreds of millions of federal economic stimulus dollars for human services workforce retention and recruitment as part of a $4 billion federal and state spending package. But it doesn’t appear that that money would provide for a permanent increase in direct care wages.

Some of the federal money will finally be distributed in the form of $500 checks to an estimated 500,000 low-income, direct-care workers starting in March, the State House News Service reported Tuesday (February 8).

But even when the full amount of the American Rescue Plan Act money is finally distributed, the legislation signed by Baker would set a ceiling of $2,000 on the total amount of funding per worker. A one-time payment of $2,000 will not substitute for a higher minimum wage.

Even so, Shannon Guenette, the executive director of Almadan, Inc., a DDS provider in western Massachusetts, first told us in August 2021 that her agency and other DDS providers throughout the state desperately needed the additional federal funding to retain workers in light of a worsening shortage of direct-care and clinical staff.

But Guenette said on February 1 that her agency’s wage rates would need to be at least $20 to $25 per hour “to hire the staff we need and compete with gas stations and fast-food restaurants. Many of our employees are really struggling with higher rents, higher grocery bills, higher utility costs, and increasing transportation costs,”  she said.

More funding eyed for DDS state-operated group homes in governor’s budget, but less for ICFs and day programs

January 27, 2022 3 comments

State-operated group homes would receive an increase in funding in the coming fiscal year roughly equal to the inflation rate, according to Governor Charlie Baker’s proposed Fiscal Year 2023 budget, which was released Wednesday (January 26).

Overall, the budget contains mixed news for Department of Developmental Services (DDS) line items. The new fiscal year starts July 1.

While the state-operated group homes would get a much needed 6.17% increase in funding, the numbers don’t look as good under the governor’s budget for the developmental centers, community-based day programs, autism services, and transportation programs.

According to the governor’s proposal, state-operated group homes would receive $256 million in Fiscal 2023. That would amount to an increase of $14.8 million from the current-year appropriation. That is an increase roughly equal to the current inflation rate for New England. We are urging a minimum increase in state-run programs at least equal to the inflation rate.

Still, even with that increase, the state-operated residences would have a long way to go to catch up to the percentage increases in funding for provider-run group homes over the past decade.

Developmental centers, day programs, and transportation continue to see cuts

The Wrentham and Hogan Developmental Centers line item would receive $109.1 million under the governor’s Fiscal 2023 budget. That would amount to an increase of $5.4 million, or 5.2%. That is less than the minimum $6.3 million increase needed to keep pace with inflation.

The developmental center or Intermediate Care Facility (ICF) line item has, moreover, been cut by $68.4 million, or 39%, over the past decade, when adjusted for inflation.

Community-based Day and Work Programs would receive $227.4 million in Fiscal 2023. That would amount to a cut of $7.6 million, or 3.6%. We are urging a minimum increase of at least $13.4 million in that account to keep it even with inflation. The account provides funding for job skills training and other activities to help clients make the transition to the mainstream workforce. 

A DDS “Progress Report” last year showed a drop in total “integrated employment” of DDS clients in Massachusetts from a high in October 2019. The Progress Report indicated that the numbers of clients being placed in DDS day programs, where few meaningful work activities are available, has exceeded the numbers entering integrated employment in recent years.

Transportation funding would be cut for the second year in a row under the governor’s proposal for Fiscal 2023. The line item would receive $24.8 million in funding, which amounts to a $7 million, or 22%, cut from the current fiscal year.

The Autism Omnibus line item, which provides services and supports for people with autism and related disabilities, would also be cut. That line item would receive $36.6 million in Fiscal 2023, down $4 million, or 10%, from the current fiscal year appropriation.

Some line items would get increases

The DDS corporate residential providers would receive $1.44 billion under the governor’s budget plan. That would amount to an increase of $34 million or 2.4% from current year. While the increase would be less than the rate of inflation, the provider group homes will have gotten an increase of $563 million, or 64%, since FY 2012, when adjusted for inflation.

In contrast, funding for the state-operated group homes has been increased by about half that percentage over the past decade.

In addition, Baker has proposed a major increase in a reserve fund (1599-6903) intended to boost contractual payments by the state to the residential providers. His Fiscal 2023 budget would increase the size of the residential provider fund from $79 million to $230 million in the coming fiscal year.

The Turning 22 line item would also get a major increase under the governor’s budget plan. The line item would receive $84 million in Fiscal 2023. That would require a $59.5 million, or 242%, increase in funding from the current-year appropriation.

Respite and Family Supports would be increased by $5.2 million, or 6%, to $90.6 million.

The DDS administration line item would receive $87.8 million in Fiscal 2023, a 6.4% increase. The administrative line item includes funding for DDS service coordinators, a key departmental function.

Reasons for our funding increase requests

Flat or declining funding levels for state-run residential programs appears to be connected with an apparent policy by the administration not to offer those settings as options for people seeking residential placements.

Documents provided by DDS last September confirm that the census in the state-operated group homes has been declining since Fiscal Year 2015. We previously received information from DDS showing a decline in the census and virtually zero admissions in 2019 and 2020 to the Wrentham and Hogan Centers.

In turn, funding for these facilities has dropped or has remained flat for years. 

Unless families have the money for a lawyer or are politically connected, most people waiting for residential placements are never informed that state-operated group homes or developmental centers exist. Yet, as COFAR has reported, the federal Medicaid law requires that individuals and their families and guardians be informed of all the “feasible alternatives” for placement.

State-operated group homes and the Hogan and Wrentham centers are the backbone of the DDS system because they care humanely and efficiently for even the most profoundly intellectually disabled and medically involved people. They also provide jobs.

These decreases in funding and the census in state-run residential facilities have been ongoing while funding under the DDS corporate residential line item (5920-2000) has skyrocketed over the past decade to over $1.4 billion, an amount that dwarfs the funding for state-operated group homes and the two remaining developmental centers in Massachusetts.

In a survey we conducted in 2015we found that more than 600 executives employed by corporate human service providers in Massachusetts received some $100 million per year in salaries and other compensation. As just one example, the FY 2020 IRS filing by the Edinburgh Center, a DDS corporate provider, listed eight executives as each making over $100,000 that year, while the CEO received more than $230,000 in compensation.

Baker’s proposal to increase funding next year to the state-operated group homes, at least at the rate of inflation, is a positive step, albeit a minimal one. We hope over the next six months to see a turnaround in the declining funding trend for the developmental centers and day programs as well.

Mother, who was charged with abuse after giving son Tylenol and cough syrup, says he is being neglected and isolated in his group home

January 19, 2022 10 comments

Christine Davidson, who has been charged by the state with abuse after she gave her son prescribed cough syrup and Tylenol, says the real problems her son is facing include isolation and neglect in his group home.

We have joined Christine in expressing concern to the Department of Developmental Services (DDS) about conditions in the residence and a ban on home visits from her son John.

John Davidson is a resident of a group home in Waltham, which is run by WCI, Inc., a corporate provider to DDS. Christine contends that the conditions under which John is now living violate a number of DDS regulations referred to as “standards to promote dignity” (115 CMR 5 et seq.).

Christine is a co-guardian of her son. The other co-guardian, George Papastrat, is Christine’s nephew and lives in North Carolina.

Christine wants to take John back home with her, and John has repeatedly said he wants to come home. That is not being permitted, however. She said John is effectively being confined in his group home with virtually no activities.

As we noted in a recent blog post, we have raised numerous questions about the accuracy of a report written by the Disabled Persons Protection Commission (DPPC), which concluded that Christine abused her son after she gave him an “undetermined” amount of cough syrup and Tylenol last June. Since then, John has been subject to a prohibition on visits home based on the abuse finding.

Christine’s attorney, Thomas Frain, who is also COFAR’s president, has filed an appeal with DPPC of the abuse finding.

Last November, I emailed George Papastrat, John’s other co-guardian, with an explanation of our concerns about the DPPC investigation and its apparent bias against Christine. I have not recieved a reply to my message.

Only person left in the home during the day

Christine said she visited John in his group home yesterday (January 18), and found him sitting alone in the kitchen. She said the other three residents currently living in the home are being taken to day programs.

John no longer has a functioning day program, according to Christine. An Individual Support Plan (ISP) states that he lost his previous day program activities at Jewish Family Chai Works in Waltham in March 2020 because of COVID restrictions.

The ISP states that when the day program reopened on a limited basis in August 2020, John was not alowed to return to it. The ISP does not specify the reason he was not allowed to return.

Christine also said John’s physical therapy services, which he received after fracturing his leg outside his group home in 2019, have been discontinued. Yet, she said, he is still in need of those services.

Personal hygiene allegedly neglected

Christine said she often finds John’s bedroom and the bathroom in the group home to be dirty, and John is frequently unshaven and dirty when she visits him. She provided photographs of his bed, which show several damp spots that she said are urine.

She also sent a photo of what appears to be soiled toilet paper in a waste can in the bathroom. She said the toilet paper contained fecal matter.

Christine filed a complaint with DPPC on December 7 after finding Jonn sitting alone and naked on the floor of his bedroom, apparently after he slid off his wheelchair while under the care of a staff member. The complaint has been referred to the DDS area office for an administrative review, according to a letter sent by DDS to Christine on December 8.

As noted below, many of the conditions Christine described would appear to violate DDS “standards to promote dignity,” including the “opportunity to undergo typical developmental experiences.”

Christine said she believes John is declining physically and mentally in the group home and is severely depressed. “I don’t know if he’ll ever be the same person he was — energetic and engaging,” she said.

DDS doesn’t respond to concerns

On January 10, I sent an email to Joan Thompson, DDS area director, calling her attention to the apparent violations and asking that the Department investigate them.

Thompson responded the following day with a two-sentence email that did not appear to relate to my request. Thompson’s email stated the following:

After review of your request, you would need written authorization from both (co)guardians to release any information.  Without the written authorization, you do not have the authority to make such a request.

Thompson’s message wasn’t signed.

I reiterated my request in a second email on January 12 and copied Gail Gillespie, the DDS director for the Boston Metro Region. I haven’t received a response to that message from either Thompson or Gillespie.

Apparent violations of DDS regulations in group home

Christine said that after his hospitalization, John was kept for months at Tewksbury State Hospital, ostensibly for treatment of a leg injury from a fall outside his group home in 2019. But she said his leg actually got worse at Tewksbury, yet he was discharged to his group home where he now needs a wheelchair.

She said the group home staff does not appear to be encouraging John to get exercise. She added that John wants to get out of his wheelchair, but the staff are not encouraging him to do so or helping him.

When John was discharged from Tewksbury in November, the group home staff was supposed to develop a chart listing weekly activities for him. But Christine said no such chart has been developed for him.

We are concerned that this overall situation may violate a number of DDS standards to promote human dignity, including a number of the “general principles,” which state that services are supposed to be provided in a manner that promotes:

  • The opportunity to undergo typical developmental experiences, provided that the person’s safety and well-being are not unreasonably jeopardized,
  • The opportunity to engage in activities and styles of living which encourage and maintain the integration of the person in the community through individualized social and physical environments, and
  • Opportunities for daily recreational activity and physical exercise, as appropriate to the age and interests of the individual.

The apparent confinement in the group home against John’s stated wishes appears to violate additional DDS standards and other rights that are intended to promote or include:

  • Self-determination to the person’s fullest capacity,
  • Least restrictive care, and
  • The right to be visited and to visit others under circumstances that are conducive to friendships and relationships.

ISP specified activities 

John’s Individual Support Plans (ISPs) in both 2019 and 2020 discussed his enthusiasm for his day program at Chai Works. As noted, he lost that program in 2020.

John’s 2020 ISP stated that while at the day program, which he had attended since 2012, he participated in numerous activities including dance, yoga, and martial arts. He was also taken on community outings.

The 2020 ISP stated that after the day program was initially shut down in March 2020, John was able to participate in online groups connected with the program a couple of days a week for an hour or two at a time. Accoring to the ISP, John needed help logging in to the online sessions.

Christine said she was told at both Tewksbury State Hospital and at the group home that they were too short-staffed to help him log into the day program sessions. As a result, John has not been able to participate in his day program, even online, for at least the past six months, she said.

Additional conditions in group home

Christine also said that in addition to the problems with cleanliness in the home, she discovered that other residents’ laundry is repeatedly put in John’s dresser drawers even though all of his clothing is labeled.

The overall situation appears to violate the principle specifying “freedom from discomfort, distress, and deprivation which arise from an unresponsive and inhumane environment.” There also appears to be a violation of John’s additional right to “individual storage space for personal use.”

Further, according to Christine, John’s cell phones have repeatedly gone missing, first at Tewksbury and later at the group home. As a result, he is unable to make or receive calls directly from Christine or anyone else.

Christine said she has also been told not to call the group home after 6 p.m. All of that appears to violate the right of individuals to have “reasonable access to a telephone and opportunities to make and receive confidential calls…”

John’s 2020 ISP and an August 2020 staff memo noted that John liked to talk to his mother on the phone, so much so that a protocol was established to end the calls at 10 p.m.

DDS needs to change course

In my January 10 email to DDS Area Director Thompson, I requested that DDS revisit and reverse the prohibition placed on John’s visits home. As noted, I have not received a response to that email.

We are also requesting that the area office expand its review of Christine’s complaint in December after she found her son on the floor of his room. We are urging the Department to examine the overall conditions under which John is currently living and the potential violations of the Department’s regulatory standards.

Large increase in COVID among residents in DDS provider-run group homes, but not in state-operated homes

January 11, 2022 4 comments

The latest state report on COVID testing in facilities funded by the Department of Developmental Services (DDS) shows what appears to be a major increase in residents testing positive for the virus in corporate provider-run group homes.

However, there appears to have been little or no increase in COVID among residents of the smaller network of DDS state-run group homes.

According to the state data, the number of residents testing positive in DDS provider-run group homes jumped from 34 to 146 in the period from November 30 to December 28.

In the DDS state-operated group home system, the number of residents testing positive rose only from 9 to 10 in that time frame. We think this difference may reflect the fact that staff in state-run facilities are required to be vaccinated, whereas there is no similar vaccination requirement for staff in provider-run residences.

Staff testing positive in state-run group homes did rise from 20 to 66, according to the latest report. But there is no information available on the number of staff that have tested positive in provider-run group homes. For some reason, that number is not reported.

At the DDS-run Wrentham Developmental Center, the number of residents testing positive rose from zero to five or less. (Numbers under 5 are not specified.)

Staff testing positive at the Wrentham Center rose from three to 24. But that hike in positive staff does not appear to have been mirrored by a large increase in residents testing positive there. Also, as one family member of a Wrentham Center resident said, most of the staff testing positive there are either asymptomatic or have mild symptoms, apparently due to the required vaccinations.

At the Hogan Regional Center, zero residents have tested positive since January of last year. Five staff tested positive at Hogan as of December 28. Prior to that date, no staff had tested positive there since last April.

Despite the increases in residents testing positive in DDS provider homes, deaths among residents have not risen in either the provider-run or state-run networks. In the month prior to December 28, less than five residents died in the state-run and provider-run group homes. (Numbers of deaths are not reported separately for each network.)

There were zero deaths of residents at Hogan or Wrentham in the month prior to December 28. Data on deaths among staff in DDS facilities, whether state-run or provider-run, are not reported. Also, testing results are only now reported monthly, which makes analyses of trends difficult.

Vaccinations of all staff urged

Rick Glassman, director of advocacy for the Disability Law Center, was quoted by WBUR last week as saying that regardless of staffing shortages facing some DDS group homes, vaccines should be mandated for all group home workers, and there should be more frequent testing of both residents and workers.

“It is to the state’s credit that they require vaccines in nursing homes,” Glassman said, according to WBUR. “But people with intellectual and developmental disabilities are equally, and sometimes more, vulnerable.”

Inconsistencies in vaccination policies

We have similarly called for a requirement that staff in provider-run residences be vaccinated. The difference in vaccination requirements for state and provider staff has resulted in major inconsistencies in the state’s response to the virus.

For instance, Nicole Coughlin, a DDS service coordinator, was suspended without pay on December 27, according to a Mass Live report, and threatened with termination because she had not received a second Moderna shot by the October 17 vaccination deadline set by Governor Baker for state employeees. Coughlin’s first vaccine shot last February prompted a severe allergic reaction that accelerated her heart rate and made it difficult to breathe.

According to the report by Mass Live, the Baker administration denied Coughlin a medical exemption even though three medical specialists, including her doctor, recommended that she not receive a second Moderna shot. One specialist said a second shot could be fatal to her.

It makes no sense that some DDS employees are facing a vaccination requirement that apparently allows for virtually no exceptions, while a much larger group of employees in the same field face no requirement at all.

It has been fortunate that the uptick in residents testing positive in the DDS system has so far not resulted in more deaths among those residents. But there is much to be concerned about regarding the increase in COVID cases, and little information on which to evaluate those concerns.

Even though the death rate hasn’t gone up, has the rise in residents testing positive in the provider-run group homes resulted in a higher hospitalization rate or in potentially long-term health complications among those residents? Since no data are reported on hospitalizations or health impacts, we don’t know the answer to those questions.

Questions surround state’s abuse finding against mother who gave her son prescribed cough syrup and Tylenol

January 3, 2022 29 comments

Christine Davidson is known by her family and friends to be devoted to her 45-year-old son John, who has an intellectual disability and numerous medical issues.

“Christine is a dedicated mother who has steadfastly kept John as her number one priority,” Pat Diianni, a friend who has known Christine for nearly 40 years, wrote in a letter of support for her last year.

Pat said Christine has consistently worked over the years to ensure the best possible care for her son in the Department of Developmental Services (DDS) system.

Christine herself says John is “the focus of my life. Everyone knows that I’d go to any lengths for him.” By all accounts, John loves her equally, and has told his caregivers that he wants to be home with his mother.

Christine and John Davidson

State alleges abuse by mother and restricts contact with son

But the state Disabled Persons Protection Commission (DPPC) and DDS concluded in October that Christine abused John because she “more likely than not gave (him) an undetermined amount” of Tylenol and cough syrup with codeine while he was home with her for a weekend visit last June.

In a 20-page report, a DPPC investigator concluded that Christine also failed to provide prescribed breathing therapy support “causing (John) to lose consciousness” in the morning of June 21. The prescribed therapy was the use of a Bi-PAP breathing assistance machine at night.

Christine was unable to wake John up in the morning of June 21, and called 911. John was brought to the Newton Wellesley Hospital ER. He quickly recovered after being given oxygen.

The DPPC is a state agency that is charged with investigating abuse and neglect of adults under 60 with disabilities.

Following the DPPC investigation, DDS issued an “action plan” that recommended sharply curtailing contact between Christine and John. All visits to Christine’s home have been suspended, and all of Christine’s visits to the group home have to be scheduled and supervised, despite the fact that Christine is John’s co-guardian. John was not even allowed to go home to visit Christine at Christmas.

Questions about accuracy and completeness of DPPC report

But following a review of the DPPC report and related documents, and an interview of Christine,  COFAR is questioning the completeness and accuracy of DPPC’s investigation of the incident leading to John’s hospitalization.

Most importantly, both the cough syrup and Tylenol medications had been prescribed by John’s primary care doctor, according to Christine and to medical records, and Christine maintains that she has always followed the prescriptions.

There was no evidence presented in the DPPC report that Christine did not follow the prescribed doses in administering each medication to her son.

As for the failure to use the Bi-PAP machine, Christine says that such a machine wasn’t delivered to her house until June 22, the day after John’s episode of hypoxemia or low oxygen level. She also said she did not receive necessary training in how to use the machine. When she inquired of a group home staff member about receiving training, she said she was told there would be no opportunity for her to do that.

Christine said the machine was later removed from her home by a group home staff, and that she later saw the machine’s breathing mask on the floor of John’s room, dirty and apparently unused. She said when she brought that to the attention of the staff, they did not respond to her.

Christine’s son’s group home is run by WCI, a DDS provider.

Christine, who cooperated with the DPPC investigation, told the investigator she gave her son prescribed cough syrup over that weekend because he had a history of a chronic cough and “has a tendency to cough so much he can’t breathe.” She said she gave him Tylenol as prescribed for arthritis pain.

Following his hospitalization in June, John was admitted in early August to Tewksbury State Hospital due to continuing leg pain stemming from a fracture caused by a 2019 fall outside his group home. He was kept for months at Tewksbury State for unclear reasons, and was discharged back to his group home only at the end of November.

Since August, Christine and her partner, Carmine Tocco, have wanted John discharged home to them. John also strongly expressed his desire to the DPPC investigator to go home to his mother.

Christine and Carmine said they believe that Tewksbury State Hospital was not an appropriate setting for John, and said they have seen signs that he was neglected there and in his group home, and has suffered physical and emotional abuse.

In the 40 years of John’s life prior to his admission to the WCI group home in 2017, he had lived at home with his mother.

Mother lost sole guardianship last year

Christine said DDS petitioned in probate court in May of 2020 to remove her as her son’s sole guardian after she got into a dispute with the Department over the placement of her son in a new group home.

Christine engaged Tom Frain, who is also COFAR’s president, as her attorney, and was ultimately restored to full guardianship. Her nephew, George Papastrat, who lives in North Carolina, was later appointed as co-guardian, with the medical and residential decision making powers.

We are concerned that DDS and DPPC appear to be setting the stage to remove Christine as co-guardian. Frain assisted Christine in appealing the DPPC abuse finding.

Friends, colleagues, and family cite mother’s devotion to her son

Amelia Lawless, Christine’s sister, stated in a letter of support for Christine in June 2020, during her fight to regain her guardianship, that, “(John) and his mother are a real team – they cry, laugh, and work well together. You might say that they complete each other.”

That same month, Rachel Geller, a former behavioral specialist in the Waltham Public School District, noted in a letter that Christine had worked in the school district as a special education teacher, and described her as “enthusiastic, kind, and loving…There are many wonderful teachers. Ms. Davidson stood out,” Geller stated.

Geller added that, “I have found Ms. Davidson to be sincere, hard-working, diligent, and of high moral and ethical standards.”

Father Fred Mannara, who was Christine’s parish priest for 57 years, wrote that, “John has a person in his life, his mother, who knows him and shares his history and loves him dearly. John knows that he belongs.”

Denise Cerrati, another friend of Christine’s for more than 40 years, wrote that, “John is the remarkable, resilient young man he is because of his mother’s care and undying attention to his needs… It would be a great injustice to restrict John’s life in such a way as to not allow him to draw on the strength and love he has always known.”

Milestones in advocacy for John

A former Special Education teacher in the Waltham school system, Christine enrolled John in an Early Intervention program at the Shriver Center prior to preschool, and later enrolled him at the LABB Educational Collaborative from which he graduated in 1998.

Christine found a speech therapist and reading tutor for John when he was an adolescent. She arranged for swimming lessons for him and watched him win two gold medals in an 800-meter swimming event at the Special Olympics International Games in 1991.

Christine encouraged John’s love for dance; and John performed for several years at a local dance studio.

In addition, Christine arranged for John to work at Brandeis University in a paid job in maintenance that lasted for 13 years.  And she found a volunteer position for John with Chai Works in Waltham, a program for persons with developmental disabilities. “He was very proud of that job,” she said. “He never missed a day.”

John also helped Christine in campaigning for Joe Kennedy II in his run for Congress in her Waltham district in the late 1980s.

In 2009, Christine began working with a priest to arrange for a special dispensation to have John receive the sacrament of confirmation as an adult. He was confirmed in 2014.

Christine was also a frequent speaker at family events organized by the Greater Waltham Arc. The Arc sponsored the Brandeis job that John held, starting in 1998. When that job lost funding at Brandeis, Christine contacted Waltham city officials who were able to find the funding needed to keep the job going.

No conclusive cause determined for hypoxemia

Doctors at Newton Wellesley Hospital who were interviewed by DPPC did not appear to have provided the investigator with a conclusive cause of John’s episode of hypoxemia on June 21.  One doctor stated that John may actually have been aspirating when he was brought to the hospital, meaning he was actually choking on something.

We have seen a number of cases in which individuals have aspirated or choked on ingested objects for a period of a week or more before being taken to a hospital. Christine said she thinks it is possible that her son was aspirating on something he had ingested while at his group home before his visit home to her.

While the DPPC concluded that John’s hypoxemia was more likely than not caused by a combination of Tylenol, cough syrup, and lack of a Bi-PAP machine, the report specifically concluded that the amount of the two medications given to John was “undetermined.”

In an appeal filed with the DPPC on November 29 of the agency’s abuse finding, Attorney Frain stated that it is Christine’s position that “the preponderance of evidence does not support the conclusons reached by the investigation report.”

Questions about enlarged liver

One Newton Wellesley hospital official told the DPPC investigator that Christine’s son had an enlarged liver, which was likely caused by a drug toxicity. The official said, however, that John’s Tylenol levels were not elevated when he was examined at the hospital.

Nevertheless, the hospital official said that toxicity in John’s liver could be due to small amounts of Tyleol built up over time. The official stated, “I have every suspicion that (John) took too much Tylenol, but I wouldn’t go to court to testify on that.”

But given that Christine’s son had only been with her over the weekend of June 18 to June 21, when he was hospitalized, Christine said she thinks it is possible that any toxicity buildup in his liver from Tylenol use could have happened previously at the group home. The DPPC report did not mention that possibility.

Witness confirms John had chronic cough

An official from Brigham and Women’s Hospital confirmed to the DPPC investigator that John had had “a chronic intermittent cough for many years.” The hospital official also said that John’s “cough syrup prescription had not raised many concerns prior to latest hospitalization.” Christine said she knows of no concerns that were ever raised about it.

Charge that Christine didn’t know dosages lacks specifics

Much of the case for the DPPC’s abuse charge appears to rest on accounts by the unnamed Newton Wellesley Hospital personnel that Christine couldn’t remember the dosages of the cough syrup and Tylenol that she had given John.

But even if that were the case, Christine maintains it would not prove that she had given her son too much of those medications. She told the DPPC investigator that she has always followed the doctor’s prescriptions regarding medication that she has given her son.

Christine said that she volunteered information to the EMTs who answered her 911 call about the medications John was taking, and gave them a list of all of his medications. She said that she has been giving John his medications throughout his life, and has always followed the written prescriptions.

John’s cough syrup and Tylenol had been prescribed

John’s cough syrup and Tylenol had, in fact, been prescribed for him, according to medical records examined by COFAR.

Those medical records were apparently not reviewed by the DPPC investigator who indicated in the report that the only medical records reviewed were Newton Wellesley Hospital records and John’s Individual Support Plan. [DPPC regulations (Section 1(k) of 118 CMR 5.02) require “the review and obtaining of copies of all documents which are not plainly irrelevant to the matter under investigation.” (My emphasis.)]

According to the records reviewed by COFAR, Tylenol and Tussionex cough syrup containing Hydrocodone were prescribed for John going back as far as January 2020.

Frain stated in his appeal that the cough syrup with Hydrocodone had been prescribed for the past 15 years, and had been administered by Christine to John since that time without incident.

Frain also noted that the DPPC report did not make clear that there were actually two prescriptions for the cough syrup for John. One — Mucinex DM Max Strength — was used by the group home, and the other — Tussionex with Hydrocodone — was used by Christine.

Frain said the reason for the separate prescriptions was that no cough syrup with a narcotic could be safely stored or administered in the group home. But that confusion was used by the DPPC report, Frain said, “to insinuate that there was wrongdoing on Ms. (Christine) Davidson’s part.”

Bi-PAP machine was not used by the group home

The DPPC report stated that the Bi-PAP machine had been prescribed for John to use at night to help him breathe. John had been diagnosed with severe apnea, according to the report.

As noted, Christine said the Bi-PAP machine was not delivered to her home until after John’s hospitalization, and that the group home later removed it.

The report did note that while it appeared the group home did have a B-PAP machine for John, the staff rarely if ever used it. The Brigham and Woman’s Hospital official told the investigator that:

I’m not sure you can blame this (failure to use the Bi-PAP machine on (Christine). Some sleep doctor must have prescribed it years ago. (John’s) usage has been spotty forever…I don’t think the group home even used it…

John could not be awakened previously

In his appeal of the DPPC report, Frain noted that in two previous incidents in the months prior to June 21, John was found non-responsive. In those incidents, on February 17 and during the “April/May time frame,” John was in the care either of his group home or a medical provider. Yet no report of abuse was filed with DPPC or DDS.

In the February case, medical staff at the Mass General Infusion Center in Waltham noted in on a medical form that John was “very sleepy in infusion…Quite lethargic.”

The DPPC report did not mention either of those previous incidents, either or both of which Christine believes could have a bearing on the cause of the incident in June.

No reaction to Narcan

According to the DPPC report, when EMTs arrived at Christine’s home on June 21, after Christine found John unresponsive, they administered Narcan “without effect.” Narcan is a medication used to counteract decreased breathing in an opioid overdose.

The report didn’t discuss whether John’s lack of reaction to Narcan might rule out the cough syrup as a cause of his hypoxemia. Narcan will not have an effect if there is no opioid in a person’s system.

Disputed statements about leg injury and air mattress

Also in the DPPC report is a statement by John’s DDS service coordinator that John had previously broken his leg while in Christine’s care.

The report, however, stated that in a follow-up interview to “clarify” that charge, the service coordinator acknowledged that Christine’s son had broken his leg in December 2019 when he slipped and fell outside his group home after direct care staff failed to greet John as he arrived with a transportation provider. It is undisputed that John was in WCI’s care at the time, and not under his mother’s care.

The report further stated that the incident in which Christine’s son broke his leg was not reported to DPPC because “the incident was witnessed and no one appeared at fault.” The investigator didn’t question that apparent breach of DPPC’s reporting statute and regulations.

According to the report, John refractured his leg in February 2020, possibly while at Christine’s home. However, the report stated it could not be determined whether that second fracture was due to a fall or to failed hardware in his leg stemming from the repair of the first facture.

Christine and Carmine also dispute an apparently second-hand claim in the report, apparently by the service coordinator, that in February 2020, an unidentified person had seen John sitting on a deflated air mattress on the floor in her home. Christine and Carmine said that not only does her son have an upstairs bedroom with a bed in it, but they put a second bed into a downstairs bedroom for him because he was having trouble walking.

Christine said she has never had an air mattress in her home. Carmine sent us the photo below of Christine’s son’s downstairs bed.

John Davidson’s downstairs bed in Christine’s home. John’s DDS service coordinator implied to the DPPC that John had been forced to sleep on an air mattress.

The investigator acknowledged in her report that she had not visited Christine’s home, citing COVID restrictions.

DPPC report relied on negative speculation about personality

In addition to accounts from the unidentified Newton Wellesley Hospital personnel, assertions about Christine’s temperament were included in the report from John’s DDS service coordinator, a DDS program monitor, and a DDS area office nurse. Only one staff member of his group home was interviewed, and that interview does not appear to have been about Christine’s alleged behavior toward the group home staff.

The service coordinator, for instance, described Christine in the report as “crafty and manipulative.” No example of that is given.

COFAR has in the past found that in investigating allegations of abuse, DPPC and DDS have discounted information provided by family members of clients. In some cases, the agencies have made negative assertions or taken punitive or even retaliatory actions against family members seen as meddlesome or too aggressive in their advocacy for their loved ones. (See here, here, herehere, here, here, here, here, here, and here.)

Assessed as frail and elderly

At least one of the Newton Wellesley Hospital personnel and Christine’s service coordinator described Christine to the DPPC investigator as “frail,” while the service coordinator also described her as “in her mid-70s and elderly.” The Newton Wellesley Hospital official also said Christine was using a wheelchair in the hospital.

Christine responded to us that she used a wheelchair temporarily in the hospital because she was recovering from back surgery at the time. She said she no longer uses a wheelchair. She added that she resents being characterized as frail, in particular. “It’s like calling someone fat or too skinny,” she said. “They don’t want me in the picture. They don’t want my involvement in John’s medical care.”

Staff actually rude to Christine

In her own contemporaneous handwritten notes, Christine wrote that on July 29, staff in John’s group home were “ rude” to her, and that one had “abruptly snatched snack from my hand.” She said she had brought the snack of yogurt and lemonade to give to John. She also wrote that the staff were giving him “no choice in (TV) channels.”

On July 30, she wrote that, “John’s bed, blanket, and pillow soaked with urine.”

In early August, she wrote in her notes that, “I would be remiss not to speak up for him — elderly and disabled have no voice.”

Christine praised staff member in notes

Despite the negative assessments of Christine’s relationship with the group home staff, her written notes from July 8, 2019, include praise for a staff member named Mohammed. In her notes, she stated after Mohammed’s name: “Humor attention to detail, kindness empathy, helped John shave.” Christine said Mohammed left the group home more than a year ago.

Visits with mother considered a negative

The DDS program monitor indicated to the DPPC investigator that both DDS and the provider thought Christine was visiting her son in his group home and taking him home for visits too often. “Weekend visits would turn into weeks,” the DDS official said. “(John) couldn’t gain a foothold in the group home.”

“We have been walking a fine line and have done everything we can do,” the DDS official said. (Christine) will always find a reason to bring (John) home.”

The DPPC report, however, includes no reasoning or discussion as to why frequent visits and contact with John’s mother would necessarily be bad for him. DDS regulations, in fact, support “least restrictive care” options, meaning options that honor the wishes of clients to interact with family, friends, and the greater community.

DDS regulations (115 CMR 5 et seq.) also state that “Arrangements shall be made for private visitation (of DDS clients) to the maximum extent possible.”

Report acknowledges son’s wish to return home

The service coordinator stated to the DPPC investigator that Christine and her “family attorney (Frain) have lost sight of (Christine’s  son’s) individual rights.”

Ironically, the DPPC investigator stated that when she interviewed John, he expressed a strong desire to go home from Tewksbury State Hospital to his mother. There was no discussion in the report about taking his wish into account.

Lack of contact, communication

Christine maintains that while John was at Tewksbury State Hospital, her contact with him was sharply constrained for unclear reasons. While she was allowed to visit him there, she said the visits were supervised and she was not allowed to ask him or the staff questions.

She also said John’s cell phone went missing almost immediately after his admission to Tewksbury, and she was unable to call him. She said the DPPC investigator never asked her about that situation.

Neglect alleged at Tewksbury Hospital

Christine and Carmine said that when they initially visited John at Tewksbury, he was wearing diapers with feces in them and hadn’t been shaved for at least a week. Also his glasses and cell phone were missing. They said he appeared at times to be drugged there, and his leg pain was continuing.

Christine believes John regressed regressed mentally and was depressed at Tewsksbury and is continuing to decline mentally and physically at his group home. She said he is now in a wheelchair and is incontinent. Prior to his hospitalization, she said, he was continent and able to walk with a cane.

DPPC should reverse abuse finding

We hope the DPPC reconsiders its finding of abuse against Christine for all of the reasons discussed above. We also hope that DDS reconsiders its restrictions imposed on contact between Christine and her son.  It appears to be very important to John – and witnesses have attested to this – that he be afforded the contact he desires with his mother.

We also think both DDS and DPPC should investigate the care and conditions under which John was kept at Tewksbury State Hospital. A similar investigation should be undertaken at the WCI group home.

Christine and Carmine believe that with adequate assistance from DDS and caregivers, they can care for John at home. “He will receive the love, care, and stimulation he needs that only we can provide if he is allowed to come back home,” Christine said. “Right now, I’m very concerned that he is progressing into a state of despair, which is the last stage of depression.”

We hope DDS seriously considers the option of returning John home to Christine.

DDS corporate providers and their allies once again attack the former Fernald Center with a selective account of its history

December 21, 2021 4 comments

Yet again, the former Fernald Developmental Center in Waltham is being targeted politically by corporate human services providers that are selectively focusing on the Center’s dark history prior to the 1980s.

Fernald may have been closed for the past seven years, but it is still proving to be as potent a target as ever for proponents of the privatization of care in the Department of Developmental Services (DDS) system.

As was the case last year, the Arc of Massachusetts and other provider-based groups have signed a petition and letter to Waltham Mayor Jeanette McCarthy, protesting an annual holiday light show currently underway on the Fernald campus.

This year, the providers have been joined by the Mental Health Legal Advisors Committee (MHLAC), a legal advocacy entity located within the state Supreme Judicial Court.

Philip Kassel (no relation to this blog post writer), executive director of the MHLAC, wrote a letter on December 10 to a legislative commission on the status of persons with disabilities in which Kassel joined in the criticism of the light show as “disturbing and inappropriate.” Kassel described Fernald as as a place of “horrors” and “virulent dehumanization.”

Kassel’s letter further stated:

…residents with disabilities (at Fernald) were subjected to “scientific” experiments and other forms of physical and psychological abuse. Walter Fernald himself was a proponent of eugenics and forced sterilizations, which occurred at the institution. Students were fed radioactive oatmeal by esteemed Harvard and MIT professors in what they called research. And innocents were imprisoned in squalid conditions for much of their unhappy lives.

These things either occurred or were true of Fernald prior to the 1980s. But, as I stated in an emailed response to Kassel on December 16, significant changes were brought about at Fernald and in other institutions for persons with developmental disabilities from the 1980s onward. Those changes occurred as a result of class action litigation in the 1970s, which was overseen by the late U.S. District Court Judge Joseph L. Tauro.

Judge Tauro enabled the creation of a new model of care in both the institutions and the community system in Massachusetts that required the investment of hundreds of millions of dollars.  After years of improvements, Tauro concluded in 1993 that this state now had “a system of care and habilitation that is probably second to none anywhere in the world.”

There is no mention in Kassel’s letter of Judge Tauro or of the changes he oversaw at Fernald and at other institutions for persons with developmental disabilities. There is similarly no mention of Tauro or those changes in the petition or letter to Mayor McCarthy.

I also noted in my message to Kassel that the experiments at Fernald on children that he referred to took place between 1946 and 1953. It is, of course, necessary to know and understand that awful period in the history of institutional care of the developmentally disabled in this country.

But, as I stated to Kassel, “focusing public attention solely on the history of Fernald from the 1940s through the 1960s, and even before that, overlooks the full history of Fernald.”

That selective focus, I noted, also overlooks the human price paid for deinstitutionalization from the 1980s onward of both persons with developmental disabilities and mental illness. That is because such a selective focus diverts discussion and inquiry from events that happened subsequent to the 1980s and from current matters affecting people with disabilities.

That is an erasure of history, I said in my message, and its effect has been the facilitation of the ongoing and unchecked privatization of care in the DDS system, in particular.

In a response to my message, Kassel said he disagreed that the reforms at Fernald from the 1908s onward should necessarily be considered in discussing “the sordid history” of the institution.

Kassel said he also disagrees with our assessment of the history of deinstitutionalization. “If there are failures (with  deinstitutionalization),” he stated, “they may be attributed to inadequate efforts to replace places like Fernald with community-based alternatives.”

In a response to Kassel’s response, I said we agree that the efforts to replace Fernald and other institutions with community-based alternatives have been inadequate. I noted that in testimony in 2018 to a legislative committee, Nancy Alterio, executive director of the Massachusetts Disabled Persons Protection Commission (DPPC), stated that abuse and neglect of persons in the DDS system had increased 30 percent in the previous five years, and had reached epidemic proportions.

Alterio’s testimony came long after the state had begun to rely primarily on privatized, community-based group homes for residential care of persons with developmental disabilities, and long after the state had phased out and closed all but two state-run developmental centers comparable to Fernald.

So, in our view, I said, deinstitutionalization of people with developmental disabilities has been far from a success. And that failure hasn’t been due to a lack of funding. DDS’s corporate provider-run group home line item in the state budget (5920-2000) is now well over $1.3 billion — an amount that is 90 percent higher than what it was a decade earlier.

I added in my second response to Kassel that rather than investing that increased funding over the years in adequate wages and training of direct-care workers in the community-based system, the providers have enriched their own executives. In a survey we conducted in 2015, we found that more than 600 executives of providers in the DDS system in the state were receiving some $100 million a year in salaries and other compensation.

In fact, decades after closures have occurred of a significant portion of the institutional system for people with developmental disabilities around the country, it is now in community-based group home settings that abuse, neglect, and warehouse-like conditions appear to have become a problem of epidemic proportions. (See these multi-part exposes starting in 2011 by The New York Times, in 2013 by The Hartford Courant, and in 2016 by The Chicago Tribune.)

Our concerns remain over proposed commission on history of Fernald and other state facilities

Meanwhile, as the debate continues over the Fernald light show, legislation is pending in the Legislature that would establish a state commission (S.1257and H. 2090) to study the history of Fernald and other similar institutions. We are seeking changes in the language of the bill to ensure that the commission tells the accurate and complete story of those places.

I said to Kassel that we assume that the Mental Health Legal Advisors Committee supports this legislation, and we would hope the organization similarly desires that the story of Fernald be told accurately and completely.

In our view, the effort to revoke the permit for the light show at Fernald simply serves the purpose of those who have a vested interest in overlooking Fernald’s complete history.

%d bloggers like this: