Maryland's health department has alerted state contractors caring for disabled adults and children that they are obligated to report incidents at their facilities that involve police, fire and medical assistance.
The advisory — which comes as broader safeguards are being proposed by child advocates — was sent this week to nearly 300 professionals who work with disabled clients. Regulators said it was spurred by a recent Baltimore Sun investigation of an Anne Arundel County group home operator, LifeLine, which failed to notify regulators about numerous reports alleging abuse and neglect by its staff.
"I was concerned with the number of reports that did not come in to the state [from LifeLine]," Bernard Simons, executive director of the Developmental Disabilities Administration, said Friday. "I would venture to guess that they're in the minority. The majority of providers are doing what they're supposed to be doing."
Damaud Martin, a 10-year-old boy, died July 2 as state officials were attempting to remove 11 disabled foster children living in LifeLine's Laurel-area apartments. The state cited the company for inadequate care in mid-June after being informed that The Sun investigation had discovered troubling incidents reported to Anne Arundel County police and fire officials.
State officials have said they could have identified problems with patient care sooner if they had been aware of the incidents, as well as the company's financial and management problems.
"This is a reminder that all DDA licensed providers are required to report incidents that threaten the health, safety, or well being of people receiving services," Simons' Aug. 7 memo states. "The purpose of this requirement is to protect individuals from harm and enhance the quality of services provided to them."
But the Maryland Disability Law Center and Advocates for Children and Youth want regulators to do more.
Advocates were frustrated that it took publicity to prompt state officials to improve a reporting process that suffers from "existing general systemic weaknesses," according to a letter to Gov. Martin O'Malley from the top executives at the two advocacy groups.
"The disturbing exposé [by The Baltimore Sun] of a death and unreported injuries to children with disabilities in state care at LifeLine, Inc. demonstrates the great harm that can befall vulnerable individuals if provider agencies fail to adhere to reasonable standards of care," their letter adds.
The law center, the only external entity notified of incidents through the state's official incident reporting policy, and Advocates for Children and Youth offered specific recommendations for the Department of Human Resources, which awards contracts to providers such as LifeLine.
"To help identify trends and patterns of abuse and neglect at provider agencies, local Departments of Social Services should create a mechanism to track numbers of abuse and neglect incidents that are perpetrated by staff in a single provider agency," the groups' letter says, adding that the data should be used for a group home "report card" available to the public.
The groups also recommend that the state designate a single agency "charged with receiving, investigating and addressing complaints or concerns about quality of care or problems with a provider agency," the letter states. Legislation should require that first responders report allegations of abuse or neglect to the agency.
One state lawmaker has called for similar measures.
Del. Samuel I. Rosenberg, a Baltimore Democrat, said police, fire and medical personnel who respond to reports of abuse or neglect should alert state agencies to the incidents rather than only telling local social services agencies. He also said he will propose legislation requiring state auditors to alert the Board of Public Works — a panel that includes the governor and approves all major contracts — when contractors are deemed "fiscally insolvent."
Simons' reminder comes as state officials, lawmakers and advocates are developing proposals to toughen the existing incident-reporting process, which now relies on health care providers to report on themselves. Those efforts began at a July 24 hearing in Annapolis before two dozen lawmakers who questioned health secretary Dr. Joshua Sharfstein and human resources secretary Ted Dallas about their agencies' oversight of LifeLine.
The two officials, members of O'Malley's Cabinet, told lawmakers at the hearing that they were unaware of "several significant events" revealed by The Sun.
"One consequence of lack of reporting may have been that it took longer for the agencies to identify serous health and safety problems at LifeLine," states the testimony the officials presented to the joint hearing of the Senate education, health and environmental affairs committee and the House health and government operations committee.
Sharfstein and Dallas said they supported exploring ways to improve the reporting process.
Sharfstein, who recently announced that he is leaving his post in January for a position at the Johns Hopkins Bloomberg School of Public Health, also stated in his testimony that his agency wants "direct authority to fine providers for individuals with developmental disabilities for failing to make required reports, as it can with other provider types. Such a sanction can promote compliance before serious patient care issues emerge."
Sharfstein and Dallas said their agencies need to improve their ability to spot business issues that could portend patient care problems.
LifeLine, for example, failed to notify state regulators that it had filed to restructure its debt in federal bankruptcy court in late 2012 and never alerted them that the Internal Revenue Service filed a $1.2 million lien against the company last summer for unpaid taxes.
Even before the Baltimore boy's death, LifeLine had struggled for years to provide around-the-clock care for its residents — adults and foster children often in a bed or wheelchair because of paralysis, cerebral palsy or other disabilities. Founder Randall Martin Jr. is imprisoned on a 50-year sentence for felony arson, the state revoked the company's license for adult care after the death of three residents at its Owings Mills home, and it is burdened by debts.
The state has awarded LifeLine $18 million in contracts since 2010 — when Martin was charged with arson — to care for children, despite reports that warned of financial difficulties and inspections that highlighted shortcomings in care. It wasn't until July 3 — a day after Damaud Martin died — that all of the children were removed from LifeLine's residences.
State regulators are investigating the circumstances of Damaud's death. The probe will consider whether LifeLine's care was inadequate, but officials cautioned that it is too early to draw conclusions.
Lawmakers are expected to propose new policies to improve oversight in the fall. The Maryland Disability Law Center and Advocates for Children and Youth asked the governor to act quickly.
"Children and adults with developmental disabilities will continue to be at risk until Maryland state agencies significantly improve quality oversight and communication," their letter states.