Archive
DDS client’s death raises new questions about care
We reported last week that the Patrick administration was refusing to provide any information about — or even confirm — a report that a man in his 50s, who had lived at the Templeton Developmental Center, died four days after being transferred to a community-based group home.
We have since gotten confirmation of the man’s death from the state’s Chief Medical Examiner’s Office and from a newspaper obituary, and have learned that the cause was a pulmonary embolus, or blood clot in his lung. We also learned that a contributory cause of his death was a history of deep venous thrombosis, or a blood clot in his arm or leg.
We are withholding the name of the man until we are able to contact his guardian.
Although the initial report we received was that this man had been healthy prior to his transfer out of Templeton, we now know he had a serious medical condition. That, however, doesn’t fully explain why he died so suddenly after the transfer.
Given that the Department of Developmental Services is citing privacy and confidentiality grounds to avoid discussing this particular case, we have very little information to go on. We did receive a report that this man’s familiar staff at Templeton may not have accompanied him to his new residence and may not have been appropriately involved in the transfer process.
Templeton is one of four developmental centers in the state that have been targeted by the administration for closure by the end of the next fiscal year. In some cases, as we understand it, DDS has been careful to ensure that familiar staff accompany residents who are transferred from these centers as the administration phases the facilities down. But it appears DDS may not have uniform policies or procedures on whether familiar staff are made available to accompany transferred residents to their new locations.
Is it likely that this man would have died anyway, had he continued to live at Templeton? Or did the stress of the move contribute in some way to his death? Was his death the result of a medication error or a lack of proper medication for his medical condition after his transfer from Templeton? Was his death the result of any other negligence in his treatment or care? Was his death due in any way to the fact that familiar staff were not available to him during or after the transfer process?
Moreover, given this man’s medical condition, why were his familiar staff not more involved in his transfer, if it was indeed the case that they were not? He was presumably treated at Templeton for his thrombosis, possibly with anti-coagulants to prevent blood clots. There are a number of potential causes of a traveling blood clot that results in a pulmonary embolus, like the one that caused this man’s death. One cause can be long periods of inactivity or immobility — something which this person’s familiar staff would most probably have known about, but which unfamiliar staff in his new residence might not have known about. How much communication was there between the two staffs about this person’s medical condition?
Is DDS asking any of these questions? We don’t know. We have reported this death to the Disabled Persons Protection Commission in the hope that they will investigate the circumstances surrounding it.
Van crash highlights DDS oversight and protection loopholes
A van crash this week in Newton, which injured 12 adults with intellectual disabilities, highlights a lack of adequate oversight of the state’s community-based system of care.
The incident, involving a driver for a state subcontracted transportation company, also points to some apparent loopholes in the state’s current Criminal Offender Record Information (CORI) system.
News organizations around the state reported that Addis Gabriel Woldeguiorguis allegedly drove a passenger van into a parked garbage truck on Monday as he was transporting the special needs adults to a day services program in Newton. Police said they found a broken crack pipe and a plastic bag containing suspected crack cocaine in the van. Woldeguiorguis also reportedly told police he had taken two oxycodone pills four hours before the crash for foot pain.
According to The Boston Globe, Woldeguiorguis, who was charged Tuesday with driving under the influence of drugs and with drug possession, has “a traffic history three pages long in New York, with violations dating back to 1980, and a 2005 notation for possession of drugs.”
This seems similar to a situation we reported about in May in which a convicted sex offender in California violated a five-year probation there and fled to Massachusetts where he took a job driving people with intellectual disabilities to day programs.
Both cases appear to result from the fact that Massachusetts requires special needs transportation companies to check drivers’ records only in this state and to administer a CORI background check, which does not identify criminal arrests or convictions in other states. State agencies are, moreover, not currently authorized to require vendors to make use of the FBI’s national criminal background check system. Woldeguiorguis’s driving and CORI records did not indicate any problems, according to the Globe, since all of the violations occurred in New York.
There are other potential problems with the current background check system in Massachusetts. If the potential penalty for a criminal offense does not include incarceration, it does not appear on a CORI record, according to Georgia Critsley, general counsel of the Massachusetts Department of Criminal Justice Information Systems. Critsley said Massachusetts motor vehicle offenses such as OUI and Operating to Endanger appear on the CORI, whereas civil motor vehicle offenses such as speeding do not. Further, after reforms were enacted in 2009, CORI regulations appear to exempt existing state and vendor employees, who were not previously subject to CORI checks, from any additional CORI checks.
These seem like big loopholes when it comes to hiring people to care for and drive DDS clients. Meanwhile, a bill in the state Legislature, which has been repeatedly filed by Rep. Martin Walsh of Boston and which would authorize the use of national FBI background checks for people hired by DDS and its vendors, has remained in the Judiciary Committee for months.
There may be other loopholes as well. We asked Howe yesterday whether the CORI background check regulations actually apply to transportation companies that drive clients under subcontracts with either EOHHS brokers or DDS vendors. We also asked whether DDS has any policies or regulations requiring drug testing for employees of transportation companies, DDS vendors, or other DDS programs. We haven’t yet heard back.
Jennifer Kritz, communications director for the Executive Office of Health and Human Services, told the Globe her department is “conducting a thorough review of the transportation provider’s actions and performance (in the Newton crash), as well as the hiring practices related to this specific driver, in order to determine whether any action is necessary.’’
This reaction by EOHHS seems inadequate. EOHHS’s review should extend beyond the actions and performance of this particular transportation provider and beyond its hiring practices related to this specific driver. EOHHS should be looking at this point at all of the state’s background check policies and regulations, and whether all of the clients in its agencies are protected from persons unsuited to be caring for and driving them.
DDS won’t give out information on reported death
Late last month, we received a report that a healthy, 55-year-old man had been transferred from his home at the Templeton Developmental Center and subsequently died four days later at a community-based group home.
The death reportedly occurred around July 24.
As an organization that advocates on behalf of persons with intellectual disabilities and their families and guardians, COFAR has an interest in getting to the bottom of reports such as this.
Is the report, in fact, true? If so, why would a healthy man die four days after being transferred from one Department of Developmental Services location to another? The answers to these questions could help us better understand the state of care available to all DDS clients.
We posed those questions regarding this reported death in an email on July 27 to DDS Commissioner Elin Howe. In response, we received a message on July 29 from DDS General Counsel Marianne Meacham, which provided no answers and stated that personal and medical information is exempt from disclosure under the state’s Public Records Law. Meacham also cited a provision in DDS’s enabling statute, stating that records of admission and treatment to DDS facilities shall be kept private.
For reasons I’ll get into below, we intend to appeal this denial of information to the state’s Public Records Division. But first, I’d note that DDS’s reaction to our query appears unfortunately to be part of a longstanding pattern on the part of the department of secrecy concerning deaths of persons in its care.
For years, our member organization, the Advocacy Network, has tried without success to obtain notification from DDS of the deaths of former residents of the Belchertown State School and other facilities in order to arrange to pay proper respects to those people. In one case, the Network learned that the cremated ashes of a resident of a vendor-based group home in the Pioneer Valley had sat disregarded on a shelf in the provider’s business office for two years.
In their Spring 2009 newsletter, the Advocacy Network stated that DDS cited confidentiality and privacy regulations as reasons for not providing notifications of the deaths of DDS residents even when obituaries had been published in newspapers.
Edward Orzechowski, editor of The Advocacy Network News, quotes Donald Vitkus, a former resident of the Belchertown State School as saying, “‘No one ever died at Belchertown. People just were never seen or talked about again.'” Although that apparently was the case at this former state facility in the 1950s, one wonders if that situation still prevails in the DDS system.
To be fair, deaths at the Wrentham Developmental Center appears to be handled much differently. COFAR Executive Director Colleen Lutkevich notes that when Wrentham residents die, residents’ guardians are notified and wakes and funerals are held, which are attended by residents, staff, families and friends.
In refusing to provide any informaton about the reported death of the former Templeton Development Center resident, Meacham appears to have cited an exemption to the Public Records Law [M.G.L. Chapter 4 Section 7(26)] that concerns “medical files or information…(and) any other materials or data relating to a specifically named individual, the disclosure of which may constitute an unwarranted invasion of personal privacy.” She also cited DDS’s enabling statute ( M.G.L. Chapter 123B, Section 17), which states that records of admission and treatment to DDS facilities shall be kept private.
We intend to appeal this denial of information because we were not asking for medical files or medical information or for records of admission or treatment. Instead, we are seeking information about the circumstances under which a client in the DDS system died. Secondly, case law, as we understand it, holds that personal privacy rights end when a person dies.
Not only do we and our member families have an interest in learning about deaths of persons in DDS care, the general public has a legitmate interest in knowing about this as well. What if there was negligence or even foul play involved? DDS has to start using common sense and stop hiding behind false confidentiality and privacy claims in these cases.
Identifying the missing costs
The Patrick administration claims that the average per-person cost of Department of Developmental Services vendor-run group homes is less than the average per-person cost of state developmental centers for persons with intellectual disabilities.
But we’ve now identified some specific missing group home costs that we think the administration overlooked in its analysis.
An apparently typical DDS vendor contract, which we have reviewed, did not specify any psychological or therapeutic services, and only specified minimal nursing services. Developmental center budgets, on the other hand, do provide for all of those services.
This appears to be the first major confirmation we’ve been able to obtain, after months of Public Records Law requests from DDS, that the Patrick administration’s savings claims in closing four developmental centers in Massachusetts are based on an apples-to-oranges comparison. The administration has not fully responded to our follow-up questions about these costs.
I asked DDS Commissioner Elin Howe on June 16, after we had first reviewed the $1.2 million contract, whether medical, clincal, and therapeutic services were available to the residents of the program, and, if so, how those services were funded.
The email I received in response from DDS General Counsel Marianne Meacham, dated July 2, stated the following:
With regard to your questions regarding clinical services available to individuals in the particular…program site, as you know, a full array of clinical services (medical, physical therapy, speech therapy, occupational therapy, psychological, etc.) are available to the individuals in the program through community providers as needed and set forth in the individual’s individual support plan.
This carefully worded answer states only that medical, clinical, and therapeutic services “are available to individuals in the program,” but it doesn’t say how those services are funded — in other words, where the money comes from. Here’s why that is a key question:
In July 2010, the adminstration provided a cost analysis to the Legislature, which claimed a $20 million annual savings in closing the Templeton, Monson, and Glavin Developmental Centers and transferring most of their residents to vendor and state-operated group homes. In the cost analysis, the administration specified a “community residential” cost per client of $107,689. After adding an average “day services” (work and daily living skills programs) rate to that cost and an average transportation rate, the administration computed a total “community services cost” of $140,955 per client.
The administration then compared that $140,955 total community cost to an average per-person cost at the Templeton, Monson, and Glavin centers of $233,902. The administration’s conclusion was that serving a client in the community was $92,947 less expensive than in a developmental center.
After we asked DDS, starting last December, for all documents supporting its community residential cost figure, DDS provided, among other things, a spreadsheet listing total costs of close to 1,000 vendor contracts in FY 2009. We selected one of those contracts for closer review and asked DDS for a copy of it.
The Fiscal Year 2009 vendor contract with the May Institute, Inc. specified 24-hour staffing in a program serving 14 individuals. The contract further stipulated a rate per client of $286 per day, or $104,400 per year. This was quite close to the $107,689 community residential rate in the administration’s analysis.
However, as noted, the $104,400 community residential cost did not include clinical, therapeutic, or full medical costs of care available to community-based residents. The budgets of the Templeton, Monson, and Glavin centers do provide for those services.
On July 6, I emailed back to Meacham at DDS, asking once again how the medical, physical therapy, speech therapy, occupational therapy, psychological, etc. services available to residents of the May Institute program were funded for the residents of the May Institute program. To date, I’ve received no reply to my question.
This is why we need an independent study of the cost of closing the Templeton, Monson, and Glavin Centers.
Compelling testimony in support of a facility cost study
Introductory note:
A proposal for an an independent cost study prior to the closures of the Templeton, Monson, and Glavin developmental centers may have run into a legislative roadblock last spring, but the idea isn’t dead yet.
State Representative Anne Gobi of Spencer is continuing to push for the measure, which was shot down by the legislative leadership during the state budget debate in April and May.
A bill filed by Gobi, which would specify that the study be done by an independent, non-governmental entity appointed by the state Inspector General, was heard by the Committee on Children, Families, and Persons with Disabilities on Tuesday, July 19.
“I’ve heard from officials who would like to close these facilities,” Gobi stated in a press release, “but I have also spoken with the families of patients at these centers – and they have presented evidence that suggests that there would be no cost savings with closures, yet there would be a reduction of services.
“Frankly, I think it is best that an independent study be conducted before any further decisions are made,” Gobi added.
The Patrick administration has produced two virtually identical cost studies in closing Templeton, Monson, and Glavin, which have concluded that closing the centers will save more than $20 million annually. However, the administration’s cost analyses have been seriously flawed.
In testimony submitted on July 19 to the Children and Families Committee, COFAR noted that the administration has thus far been asked to produce after-the-fact analyses of the costs and benefits of a previously announced policy of closing the centers. An independent review of this policy is needed.
The most compelling testimony in favor of Gobi’s bill was not about the cost issue per se, though, although cost is always present as a backdrop to any dicussion about public sector services. That compelling testimony came from family members of developmental center residents. Here is one example of the testimony submitted to the Children and Families Committee:
…I would like to share with you the story of our brother, Danny Healey, and what his life at Fernald meant to him and to our parents. I realize that this letter is long and I appreciate your taking the time to read it. I have also enclosed a copy of Danny’s eulogy, which I trust will offer further proof of the benefit of residential settings for some people.
Danny was diagnosed with Down Syndrome and a host of other problems months after his birth on June 14, 1958. For fourteen years he lived in a two-family house in Somerville with his parents, grandmother, great-grandmother, and four siblings. A great-aunt and her husband lived in the apartment downstairs. Unable to speak, feed himself, drink from a cup, or use the toilet, Danny needed help with every aspect of life. Our parents cherished him and, despite the constant care that he required, they planned to keep him home forever.
Danny’s doctor, however, pointed out that his self-destructive, repetitive behaviors (gouging his ears, banging his head against the wall and windows, etc.) could lead to permanent injury or even death. He suggested firmly that Danny would be better served at a state school like Fernald. My parents were devastated. How could they send their precious child to strangers at an institution known to provide inferior care? But they trusted the doctor, so with heavy hearts they enrolled Danny at Fernald.
Two wonderful people gave them hope that they had not consigned their son to hell. The first was a middle-aged direct care worker, Mary Meaney, who had been sent to Fernald as a child and who had never known any other life. Unlike Danny, who was best served in a residential setting, Mary was someone who could have been well served in a community based group home. She promised my parents that she would protect Danny as if he were her own child, and that is what she did, for years, until he moved to Cottage 13, where he remained, surrounded by people whom he loved, until he died. The second blessing in Danny’s life was Judge Tauro, who put the entire school under judicial oversight. His action was the catalyst for a series of positive reforms at Fernald that allowed Danny to live there happily and safely for 28 years.
The direct care staff and professionals at Fernald were among the finest individuals I have ever been privileged to know. Their respect for the residents was awe-inspiring. Together they created genuine homes for some of the most developmentally challenged and vulnerable citizens of the Commonwealth. Danny thrived there, to the best of his limited abilities. Every year when we attended his annual evaluation, we would leave filled with admiration for the staff who gave unstintingly of themselves for the benefit of the residents. Because my parents didn’t drive, my siblings and I would pick up Danny for regular home visits throughout the years, and at the end of his life, when it was difficult to care for him in our homes, we would visit him at Fernald, drive him around the campus, then feed him his favorite treat of cake crumbled up and mixed with pudding. For twenty-eight years at least one of us was at the school almost every week, and we can attest, from extensive personal experience, that for people like our brother, facility-based care is the optimum choice.
As Danny weakened in the last years of his life, the rumors about Fernald’s closing became more strident and frequent. My parents were in a panic. They knew that Danny would never be able to function in a group residence and that for him the only alternative was a nursing facility, where he would pine for his friends and caregivers. They actually prayed that Danny would go to God before he had to endure such a fate. As Danny’s neurological condition worsened, the staff provided loving and attentive care until he slipped away on January 15, 2001. At his wake and funeral, which were attended by hundreds of people, we celebrated his life as well as the devotion of those who provided him with such a rich and nurturing environment at Fernald. And we were grateful to God that we never had to watch him wither away in a nursing home setting where his physical and emotional needs could never have been met.
I grieve for the families of profoundly limited individuals like Danny who watch helplessly as facility-based care is eliminated for their loved ones. I implore you to consider the value of such an option for those with severe medical and intellectual disabilities. I know firsthand what a difference it made in Danny’s life and I hope that it can be available for others who need it.
Thank you.
Sincerely,
Margaret Chisholm
Another example of testimony submitted on Tuesday to the Children and Families Committee:
I am guardian for my third cousin, Thomas Doherty (DOB 2/25/2951), a native of Woburn, MA. Tommy has lived at Templeton Developmental Center (TDC) since 1973, when he turned 22 yrs. and was discharged from a residential program where he had been since age 10.
To summarize, Tommy has been in care for 50 years, 38 of which have been at TDC, which Tommy refers to as “my school.” Tommy, an only child, was cherished by his parents, who struggled to provide safe, competent and nurturing care for their troubled, developmentally disabled son who could not be managed in their Woburn community in the 1950s and 60s. When they found Templeton, Tommy and his parents were relieved that his needs could be met in such a caring, state of the art facility with strong vocational, behavioral and physical support provided by a dedicated staff.
Throughout his adult life, Tommy has worked in the cow barn under supervision of a watchful staff. He lives with several other men in a lovely cottage, and his medical needs, which include catheterization twice daily and administration of psychotropic medication, are provided without incident. His nutritional needs are monitored, and his diet is adjusted frequently. Tommy knows staff and residents, making frequent visits to “favorites” each day.
When a beloved staff member died, Tommy delivered a heartfelt eulogy. Tommy, cognitively impaired and emotionally disabled, enjoys loving and meaningful relationships with his extended family. Tommy is puzzled by the loss of friends as they are moved from their TDC home, and he is most anxious about his own fate. His mother, prior to her death 14 years ago, requested that I be Tommy’s guardian. This is an honor, with much gratification from my relationship with Tommy. His joy in seeing cousins, however distant, is disarming. His memories of his parents are filled with delight. Tommy’s pleasures are simple…the Red Sox, the Beatles, his picture albums, a good day at work, coffee, a cigar now and then, and his home at TDC.
Mary Ann Ulevich
One more example from a non-family member:
My name is Mark Zanger. I live in Jamaica Plain and work as a Family Partner in mobile crisis intervention on mental health. I wish to register my support and evidence on behalf of H1859, requiring a study before closing the Glavin, Monson, and Templeton Developmental centers, and for S28, requiring the continuing use of state property at Templeton for the care and education of persons with intellectual/developmental disability.
I do not have a relative with ID/D, but became familiar with these
facilities while working for the Coalition of Families and Advocates. As newsletter editor, I visited all six developmental centers then in operation with families and met with staff and residents…Massachusetts has capacity for more than 100 adults with
MR/MH diagnoses at the Glavin Center, a modern facility built and staffed for that purpose. It was never an overcrowded “state school” and families there were not plaintiffs in Ricci v. Okin, and residents are not Ricci class members. The family members I met there have similar stories — their loved one was dually diagnosed as a child in the 50s and 60s and 70s, poorly served by the mental health systems of that era (which relied on talk therapy and crude medication for a population which is not often articulate about feelings or side effects), were not successful in the new group homes, and by enormous family efforts and political interventions were able to secure a place
at Glavin, where their loved ones have thrived and recovered with comprehensive and specialized treatment. Some Glavin residents returned to the community every year since it was founded, but in recent years people with more complex issues have failed expensively to make such moves.Until higher level specialized mental health services for persons with ID/D are developed and available across the state, the Glavin residents cannot be safely or economically supported in the general community or even in state operated group homes, except for a few just off the Glavin property which rely on back-up services from the regional center.
I believe that these same arguments apply substantially to the Monson Center, specializing in MR complicated by seizure disorders, and even more so to the Templeton facility, specializing in persons who might otherwise be imprisoned. Templeton is a beautiful place, a working farm with meaningful work much enjoyed by the residents, a property long dedicated to the support of persons with ID/D, and one with little potential as commercial real estate — another tactical consideration that must be brought to light if the legislature is to make wise decisions.
Many states which are reducing or eliminating
other forms of congregate facilities have in fact invested in and
expanded those, like Templeton, with a mission to serve “forensic
cases.” Some of these individuals will be in secure treatment whether DDS provides or not, and the annual cost of a prison bed (not reimbursed by Medicaid or SSI) in Massachusetts may be larger than the state contribution to an ICF/MR bed at Templeton, Glavin or Monson.It is the complexities of social accounting which drive my support for Rep. Gobi’s bill, which I personally would like to see amended to have the closure studies done independently. Even before I followed this question closely, wildly differing cost estimates, per person or per facility, were published periodically. A collection of these estimates over time would confound a Madoff accountant. On the snowy weekend of the Governor’s announcement of the plan to close four facilities, his press release included two different figures for the annual savings
anticipated, and no reconciliation. A commission appointed by
Governor Romney likewise issued several conflicting estimates.The administration has a quiet agenda to shift all state human services to Medicaid, Section 8, Food Stamps, SSDI, SSI and other federal budgets or cost shares. Leaving aside the intention of both major parties in Washington to cut Medicaid in the coming years; leaving aside the populations entitled to services who are not eligible for Medicaid or other federal services; leaving aside the dilution of specified comprehensive services under Medicaid’s ICF/MR standards; leaving aside the social accounting of what families must give up to keep multiply disabled people at home, accurate and comprehensive accounting of the costs of evicting and relocating these long-termresidents from familiar homes has never been placed before the Legislature or the public. There are individual cases and academic studies indicating that there are few if any savings to the taxpayers.
There is growing public impatience with the outsized salaries paid to private contractors when compared even with the generous benefits of veteran state managers. There is accumulating anecdotal evidence that the land purchases and contracts to build new group homes to replace state facilities, some old and decaying, some reasonably modern and efficient, are not untainted by political dealings and overpriced bailouts in the acquisition and building business — entirely separate
and obscure expenditures of low-income housing loans outside the DDS budget.In several instances, anecdotal but indicative, persons have
been moved from facilities to group homes shortly before their deaths, wasting considerable sums to break up relationships and disorient people who might have been permitted to live out their lives in longterm homes.…I would like to end with two overarching reasons to study carefully the closing of three more state facilities for people with ID/D (and in my own advice, not to do so), and to specifically reserve the property at Templeton for the future needs of this population.
The first reason is demographic. According to the Coleman Institute “State of the States” reports, more than half the clients of DDS are living with parents now 60 years old or older. This is a demographic triple-whammy (better life expectancy for disabled people; the baby boom caretakers aging; the baby boom consumers also aging into increased disability) which has already gridlocked DDS residential services. This year’s budgets do not fully cover residential services for the most disabled youth turning 22, and ArcMass has suggested a supplemental budget request for them.
To see the housing shortage issue in the most realistic terms, it is
important to compare the absolute number of persons served by DDS with the predicted number of qualified people in the Commonwealth, based upon the IQ 70 definition, two standard deviations from mean IQ. The math would suggest that DDS has reached fewer than half the eligible individuals. There are some life expectancy reasons to assume that the reality is a little better than that, but there are still tens of thousands of disabled people outside the gates (perhaps fully as many as double the present enrollment if one adds in the barely ineligible, a fatter slice of the bell curve).Some of these people are in nursing homes despite the Rolland case, some are in prisons, where DDS has no outreach; many are evident in any visit to a homeless shelter; some are transient, some are enslaved (as we learned in the “Raynham House of Horrors” case in the late 1990s); probably the largest unserved
group are quietly supported in homes and families, often those of
immigrants and minorities, to which there is no outreach, or where government services are unknown or culturally stigmatized.Our team periodically finds children and youth in all these invisible categories, and they too are part of the reason the Legislature needs careful study before closing residential options at any level.
This is simply not the time to close any viable residential options
for people with ID/D, and certainly not the ICF/MRs supported by hundreds and hundreds of families who struggled to obtain such excellent placements for their loved ones.The second overarching reason to study facilitiy closures, to delay and avert facility closures, and to secure the permanent use of the Templeton property is the proven mortality that ensues when very disabled people are moved from sheltered settings into “community settings” with increased transportation, unfamiliar and rotating staff, and waits for use of the group home van for medical appointments. You can read a summary of studies of these dangers in the records of Massachusetts by former US Attorney Michael Sullivan that I wrote when working for COFAR at this Internet address:
http://www.cofar.org/documents/safetyfacts.pdfThe definitive Shavelle et al study of de-institutionalization in
California is footnoted in that article. Shavelle found mortality 47% higher than predicted even after throwing out deaths within six months of moving, to avoid the controversy over “transfer trauma.”The most recent international meta study, by Kozma et al, advocates of community-based treatment, freely admits that outcomes (including mortality) remains one of three (out of ten examined) areas in which facility treatment remains superior to existing community-based systems studied. The other two areas where community systems all over the world are falling short are “challenging behaviors” and “overuse of psychotropic medication.” (You can read the full text at
http://www.les-pilotis.be/IMG/pdf/0906_AJIDD_Outcomes_in_different_residential_settings.pdf)I am fortunate in my job to wrestle small problems one family at a
time. I do not envy the Legislature its choices in this difficult
financial environment. We must all be penny-wise. But this is exactly when an independent study of a key decision in the largest human services budget is penny-wise, shilling-smart, and not a bit pound-foolish. To steal from the most vulnerable people served by the Commonwealth is not the right way to get through a budget crisis, even one of long duration.Why study what has been studied before? So we don’t have a concrete block or a lamp falling on someone’s car. So we
don’t parole killers who kill again. So we don’t have another Raynham House of Horrors.
Nonprofit vendor salaries drawing increased attention
Organizations such as the Massachusetts Providers Council may still be defensive about suggestions that scrutiny be applied to the sometimes excessive salaries drawn by executives of human service providers in Massachusetts and elsewhere.
But it’s becoming clear in the wake of the fallout over the recent $4.2 million severance package for a Blue Cross Blue Shield CEO and a number of other similar cases, that even in the nonprofit community, responsible voices are beginning to be raised urging serious consideration of the appropriateness of executive pay levels.
Here’s Ruth McCambridge, editor in chief of the influential Nonprofit Quarterly, discussing in an email to subscribers the Blue Cross severance package to former CEO Clive Killingsworth:
This case is a poster child for why the public does not trust our considerations of pay levels. While most of us are, of course, well within or below reasonable limits for pay, there are these high fliers among us, and in this case the money that Killingsworth walked away with came very directly from millions of families’ pockets, some of whom are legitimately concerned about such stuff as getting by from day to day.
Meanwhile, in an interview with the Nonprofit Quarterly last week, Paul Light of the Wagner School of Public Service at New York University, had this to say:
I think the nonprofit sector has an obligation to get the very best talent it can at the most reasonable cost appropriate to its role in the public service—more broadly defined. Yet you can’t simply say, “We’ve got to pay whatever the market demands, and that’s the only criteria we can use.”…
I don’t think you have to take that vow of poverty, but at the same time I wonder if the sector is obligated to set itself out there as being more a part of the community that it serves—obligated by basic issues of fairness to set reasonable market-sensitive pay, but also stay in touch with the world we serve.
Here in Massachusetts, State Senator Mark Montigny of New Bedford came closer this year than ever before in gaining passage of proposed legislation that would limit pay for both nonprofit executives and board members to $500,000 (a pretty generous threshold in our view, particularly for board members). Versons of Montigny’s measure passed the House and Senate in the form of budget amendments last month, but the measure was ultimately knocked out of the budget conference committee. However, the measure is still alive in the form of a bill before the Judiciary Committee, but has not yet been scheduled for a hearing.
Montigny’s bill is supported by Attorney General Martha Coakley, who has been investigating compensation of nonprofit board members, and found that several health insurers were paying tens of thousands of dollars to their trustees annually. Coakley’s spokesman, Brad Puffer, told The Globe last month that Coakley and her staff are concerned about situations in which “board members of any charity (nonprofit) are paid.”
Massachusetts already limits the amount of state funds that can be earmarked to pay for nonprofit salaries to $143,900. COFAR has reported that in a number of cases, state and federal records regarding salaries subject to that compensation limit don’t match each other.
Meanwhile, Coakley, along with Massachusetts State Auditor Suzanne Bump and Inspector General Gregory Sullivan have been investigating questionable financial practices, including high executive salaries, of nonprofit organizations involved in the state’s special education program. COFAR has called on Bump and Sullivan to expand their probe to examine the entire human services vendor system for persons with intellectual disabilities.
In sum, this is an issue that isn’t going away soon and can’t be ignored. Salaries and financial practices of human service vendors, insurers and other nonprofit organizations should be a major focus of state oversight. The other major focus should be on quality of care and services. To the extent that there are problems or a lack of state oversight in one of these two areas, we believe there are likely to be problems in the other.
This is where our money is going
Inspector General Gregory Sullivan has alleged numerous financial abuses in the state-funded Merrimack Special Education Collaborative, which coordinates special education programs among several school districts in Massachusetts.
Meanwhile, State Auditor Suzanne Bump is investigating whether the case is part of a larger pattern of abuse in the special education system in the state. And Sullivan’s findings are being reviewed by Attorney General Martha Coakley’s office.
While as many as three state agencies are now investigating this matter and potentially other special education contracts, it’s clear that state oversight of the special education system in Massachusetts has been lacking. The system has allowed one man, John Barranco, to allegedly fleece taxpayers of more than $10 million. The allegations include using a credit card for tens of thousands of dollars in personal items, gifts to a family member, and a no-show job to a lobbyst caught up in the Cognos software scandal involving former House Speaker Sal DiMasi.
We’ve just looked at the federal and state financial filings of the Merrimack Special Education Collaborative and related, nonprofit Merrimack Education Center, both of which Barranco allegedly controlled. These two organizations are clearly interrelated in a troubling way; and, as in the cases of some other contractors we’ve looked at, state and federal records don’t appear to match up with each other regarding the salaries of Barranco and other executives of the Special Education Collaborative and Education Center.
For instance, the federal IRS Form 990 for the Merrimack Education Center listed Barranco’s total compensation as $464,411 in FY 2009 and $525,198 in FY 2010.
However, the state Operational Services Division listed Barranco’s total compensation as $427,909 in FY 2009 and didn’t list any compensation for him in FY 2010 on its Uniform Financial Reports on the Merrimack Special Education Collaborative. (The OSD does not appear to have a UFR on file for the Education Center.) Is OSD unaware that Barranco apparently received more than a half million dollars in state-funded compensation in FY 2010?
According to the Globe, Barranco retired as executive director of the Special Education Collaborative in 2005 and appointed John Fletcher and Donna Goodell in 2007 as co-executive directors. Both Fletcher and Goodell were listed on OSD’s UFR for the Special Education Collaborative in FY 2009 as making over $200,000 each, and in FY 2010 as making about $150,000 each. In FY 2009, Barranco, despite his alleged retirement, was still listed on the UFR for the Collaborative as a third executive director.
The UFR and Form 990 reports raise numerous other questions about the financial accounting practices of both the Center and the Collaborative. For instance, although the OSD uses the UFR to disallow state funds for salaries of vendor executives in excess of $143,900, the 2009 UFR for the Collaborative indicates that no funds were disallowed for the Collaborative in 2009, even though five executives of the Collaborative — including Barranco, Goodell, and Fletcher — were listed as making over the threshold amount that year.
The FY 2009 and 2010 UFRs state that the Collaborative received $24.5 million from “Massachusetts local and quasi-governmental entities” (apparently the 10 member school districts in the Merrimack Valley) in FY 2009 and $15.9 million in FY 2010. In addition, the Collaborative received over $800,000 each year from the Department of Developmental Services.
Senate President Therese Murray has promised to introduce legislation to increase oversight of the special education collaboratives. But these collaboratives are only a part of the vast human services contracting industry in Massachusetts, and their alleged abuses are not unique to special education. The entire $2.6 billion vendor system needs better oversight.
Judge rules against Fernald transfer
A state administrative judge has thrown a new hurdle in the path of the closure of the Fernald Developmental Center, ruling that moving one of the remaining 14 residents out would not be in that resident’s best interest.
In a June 9 decision, Administrative Law Magistrate Kenneth Forton ruled that the resident, identified as Daniel O., would not receive improved services and quality of life if he were moved, as planned, to the Wrentham Developmental Center.
This is the first appeals case to be decided in favor the remaining Fernald residents, whose guardians have appealed the transfers to the state Division of Administrative Law Appeals. The appeals have already kept Fernald open a year beyond the administration’s planned closure date; and the administration appears to be projecting that the Center will stay open at least another year as a result of the ongoing litigation.
But before the Association of Developmental Disabilities Providers once again rushes in to blame the guardians of these intellectually disabled residents for the cost of delaying Fernald’s closure, let me pre-emptively make a few points:
1. As the guardians’ attorney, Stephen Sheehy, has pointed out, the appeals are not intended to keep Fernald open. They are based on a state law, which says that the state must show that a resident’s services and quality of life will be improved if he or she is to be transferred to another location.
In the case involving Daniel O., the administrative magistrate has concluded that he will not receive improved services or quality of life as a result of the move to Wrentham, at least under the circumstances established by the Department of Developmental Services. If DDS can demonstrate that the move will be in Daniel O.’s best interest, his guardian will not object to it, Sheehy says.
2. It is DDS, not the guardians, that is responsible for the cost of keeping Fernald running for the 14 remaining residents while the appeals are pending. DDS has continually refused to discuss longstanding proposals by the guardians and other advocates for a settlement of the dispute.
For years, we have proposed a “postage stamp” arrangement for Fernald under which new, cost-effective housing would be provided in a reduced section of the campus for the current residents, while the remainder of the campus was developed for other uses. A compromise based on the postage-stamp idea would end the entire litigation process and allow the state and the Fernald guardians and families to move forward with a cost-effective plan for the future.
Sheehy has stated that DDS remains uninterested in negotiating any type of compromise settlement. The adminisration has even refused to discuss proposals for saving money during the appeals process by consolidating the remaining residents into one building or location. Right now the residents are dispersed among several buildings on the campus.
3. The ADDP has repeatedly inflated the current cost of operating Fernald, stating erroneously that the state is spending as much as $1.3 million per month for the remaining residents there. In fact, the $1.3 million is an average figure for care throughout the entire current fiscal year, during which there have been as many as 70 residents at Fernald. The reason for the per-person cost at Fernald has risen is solely due to the mathematical fact that the number of residents left there has steadily declined. It is a reason to look for more cost-effective ways to operate the Center, but DDS inexplicably refuses to do.
4. The ADDP has wrongly stated that the continued operation of Fernald and the other developmental centers for a small number of people is taking away funding for thousands of people in the community. This is comparing apples to oranges. Most of the people in the community system don’t have the high level of needs that the developmental center residents do. Even if the centers were all closed tomorrow, the state would still have to spend a much larger-than-average amount of money per person to care for those former residents elsewhere.
Think of it this way: A university with 30,000 students buys 80 helmets for the football team. The ADDP is effectively arguing that this is unfair — the school should be buying helmets for everyone. It’s a false argument. Not everyone in the school needs a helmet; in fact, only a small minority need them. If the school, out of a misguided sense of fairness, decided not to buy the helmets for the team, it wouldn’t save money in the long run.
A pattern of denigrating Fernald
Opponents of Intermediate-Facility-Level care in Massachusetts have repeatedly denigrated the Fernald Developmental Center during the past two years as part of a campaign to encourage the shutdowns of that facility and three other state-run developmental centers in Massachusetts for people with severe intellectual disabilities.
Our review shows a pattern in the tactics used by the opponents, which have included repeatedly publicizing inflated figures on Fernald’s per-person cost and falsely characterizing the care at Fernald and other developmental centers as outmoded or obsolete. The ironic purpose of the campaign has been to close the centers as fast as possible without conducting any meaningful cost studies.
The organizations most directly involved in the campaign against Fernald include the Association of Developmental Disabilities Providers and the Arc of Massachusetts. Joining them last year was the Governor’s Commission on Mental Retardation, which the Fernald League noted had previously been reconstituted by the Patrick administration to lobby on behalf of the developmental center closures.
The record appears to show that the efforts to spread misinformation about Fernald have been effective in bottling up cost studies, which would have actually pertained to the three other developmental centers marked for closure. The misinformation has also been damaging to the reputations of guardians and families of the Fernald residents.
Fernald and five other developmental centers are the only sources in Massachusetts of ICF-level care, which must meet federal standards for staffing and supervision. The Patrick administration has targeted the Fernald, Monson, Templeton, and Glavin centers for closure, starting with Fernald, by Fiscal Year 2013. Fernald, which was scheduled to be shut last July, has remained open pending the outcomes of administrative and court appeals filed by the guardians of 14 remaining residents.
For at least the past two years, the ADDP and the Arc have focused during state budget debates in the Legislature on the alleged cost of maintaining Fernald. Our review shows that during this year’s budget debate in April and May, leaders of those organizations repeatedly made inaccurate claims about Fernald’s per-person cost of operation that were as much as 70 percent higher than the most recent projection by the Department of Developmental Services.
That same month, the Governor’s Commission on Intellectual Disability cited a $1.3 million cost per month at Fernald in calling for rejection of that same cost study. This number was unsupported as well in the Commission’s letter.
(By the way, the only publication listed on the Governor’s Commission publications page on its website is the administration’s 2009 developmental center closure plan, which the Commission didn’t even write — the document was written by DDS.)
Meanwhile, as the ADDP and the Governor’s Commission were citing those unsupported cost claims for Fernald in 2010, Sarkissian of the Arc of Massachusetts was claiming erroneously that Fernald and the other developmental centers were providing inferior care to community-based facilities. In an op-ed article in The Waltham Tribune, Sarkissian variously termed Fernald and the other developmental centers “decrepit,” “archaic,” “outdated,” “Dickensian,” and “inferior.”
In the op-ed piece, Sarkissian raised issues from the 1960s and earlier about sexual abuse, military experiments, and other issues at Fernald that have not been current for a half century or more.
Last week, I wrote to Blumenthal, asking him to publicly disavow the inflated cost figures for Fernald that he and his organization cited this year. He declined to do so, saying the cost figures had been provided by DDS. The question we still can’t answer is whether DDS itself knowingly publicized inaccurate figures on Fernald’s cost.
It’s about the care model
A disturbing incident involving an attempted rape of a woman by an intellectually disabled resident of a community-based group home last month can teach us all a valuable lesson.
We’ve been in the midst of the wrong debate here about care for people with intellectual disabilities. We really shouldn’t be having a debate between “community-based” care versus institutional care. What’s really at issue here is the care model for these people in Massachusetts.
Bear with me for a moment.
On June 3, The Lowell Sun reported that a resident of a state-run group home in Chelmsford walked out of his residence, went next door and attacked a pregnant woman as she was sitting in her living room with her husband and three-year-old daughter. The man managed to tear off Amy Hillman’s shirt and jump on top of her before he was pulled away by Hillman’s husband, James.
The group home resident, Tholda Chhom, and James Hillman ended up in the front yard, where Chhom continued to charge at Hillman before running back to his residence just before police arrived, according to witnesses. Chhom was later charged with assault and attempted rape, and has been placed in a “more secure state facility,” according to The Sun.
Meanwhile, the Hillmans and their neighbors have been left asking questions. Will Chhom be allowed to return to the group home? Why were the Hillmans previously told that Chhom did not have violent tendencies, even though he frequently used to yell out of his window at passersby?
The Hillmans, in fact, were so concerned about Chhom, prior to the May 8 incident, that they built a stockade fence around their yard. According to James Hillman, Chhom appeared to be left all day long in his room. But on the day of the attack on Amy Hillman, the staff at the group home reportedly didn’t even know he had left the group residence.
It would be tempting for us to say that Chhom should never have been in a community-based group home; he should have been in a develpmental center, where, at the very least, it would have been more difficult for him to have gotten out out and to attack a resident in the community. But that argument may miss the real point here.
What people like Chhom are missing in the community system — even in state-run community residences — is an intensive care model that meets the federal standards set for Intermediate Care Facilities. ICF-level care, which happens to exist only in the developmental centers in Massachusetts, stipulates that residents receive onsite clinical, medical, and nursing care and full-time supervision. Not everyone with intellectual disabilities needs this level of care. Only a small fraction of them do. But Chhom would appear to be one of them.
That’s why we’re so upset that the Patrick administration is shutting down four of the six remaining developmental centers without replacing the ICF care model available in them. We don’t want the big old buildings there either. It’s the ICF care model we want to preserve for those who need it.
We think the current residents of the developmental centers should be able to stay in their current locations in the most cost-effective residential settings, while receiving the same level of care from their familiar staff. That might well mean they would live in small group homes on the campuses — the “postage-stamp” idea. Meanwhile, other people in the community, such as Tholda Chhom, who need that level of care, should be able to receive it as well.
But the administration is seeking to eliminate the ICF model and replace it with care under which the ICF standards have been waived. It’s referred to as community-based care, but it should really be labeled “waiver based” care, because the standards are lower. Direct-care staffing levels do not have to be as high, clinical and medical personnel can “float” among different homes in geographic regions, and medications can be administered by people with less training.
What does this mean for the safety of neighborhoods around the state where thousands of community-based group homes exist? What does it mean for people like Tholda Chhom, if there will no longer be an ICF-level facility one day to accept him? Will he simply be thrown into prison?
Once again, let me be clear. I’m not trying to make an argument here to preserve the six developmental centers as they exist today, although no doubt we’ll continue to be accused of that.
Go ahead, call it all community-based care. Just keep the care model and let the current residents of the developmental centers stay in their current locations with their familiar staff. And finally, provide the opportunity for ICF-level care for all who need it, such as Tholda Chhom.
COFAR blog 