A state senator who has been scrutinizing Maryland's regulation of group homes for disabled foster children is questioning results of an investigation into the death of 10-year-old Damaud Martin.
Sen. Joan Carter Conway, who chairs the Senate committee on education, health and environment, called on state health officials to release more details on the July death at a Laurel-area group home.
"I still have questions in reference to the investigation," the Baltimore Democrat said of the Office of Health Care Quality's recent report. "I have a problem that I have still not seen the full autopsy. I don't know if the autopsy substantiates the findings of the investigation."
Conway said she is drafting legislation that calls for a task force to strengthen the regulation of group homes. She is also considering asking the task force to examine whether the medical examiner, an agency of the Department of Health and Mental Hygiene, has a conflict of interest in sensitive cases.
The investigation by health inspectors determined that LifeLine, the company that ran Damaud's group home, did not contribute to the severely disabled boy's death.
The investigation did note multiple deficiencies with LifeLine's treatment of the boy, including conflicting orders for his care and miscommunication between staff and the emergency responders and medical personnel who labored to save him July 2.
Another legislator joined advocates for foster children in questioning why inspectors did not interview the nurse who was caring for Damaud on the night he died.
"It is disgraceful not to have interviewed the nurse," said Sen. Karen Montgomery, a Democrat from Montgomery County. She added, "I am very sorry that this very ill child died. I don't know what we can do except insist on higher standards. But we're not willing to pay for them."
Health and social services regulators have been criticized for their oversight of LifeLine, which won state contracts to care for disabled children despite years of problems.
State officials said that the investigation of Damaud's death was thorough and that regulators act quickly and appropriately when they find problems. The autopsy by the medical examiner has not been released because Baltimore law enforcement officials are still investigating the death as a homicide.
When Damaud died, regulators were in the process of relocating him and 10 other disabled foster children from LifeLine's Anne Arundel County apartments. The company had a $4.9 million contract to provide around-the-clock medical care to children suffering from conditions such as cerebral palsy.
A Baltimore Sun investigation revealed that the state had awarded $18 million in contracts since 2010 to LifeLine despite years of problems: deficiencies in medical care, a founder imprisoned for arson, unpaid taxes, a bankruptcy filing, and police reports of abuse and neglect unknown to regulators.
In 2011, regulators shut down LifeLine's homes for disabled adults after three residents had died, but allowed the company to continue operating homes for children.
In May, health inspectors — responding to a complaint about staffing and care at LifeLine — cited the company for not providing enough staff to guarantee the health and safety of all its children. They also cited LifeLine for improper care of another boy and said they were going to revoke the company's license. LifeLine's chief executive later announced that she would close the firm, saying state payments were not enough to cover care.
The state medical examiner has said the boy's death was a homicide caused by the severe head injuries suffered years ago. In 2009, his mother was convicted of child abuse after entering an Alford plea, which means she did not admit guilt but acknowledged Baltimore prosecutors had enough evidence to convict her. Confined to a wheelchair, Damaud ate and breathed through tubes and was entirely reliant on nursing care and machines.
Conway said she has no reason to doubt the autopsy's findings. But without seeing the full report she cannot verify the health inspectors' determination that LifeLine's care did not contribute in some way to his death.
Conway added that because Damaud's family has threatened to sue LifeLine and the state over the boy's death, she worries that the medical examiner's office may have a conflict of interest in determining whether a contractor licensed by the health department had a role in the death.
"I have a huge question mark as to whether or not the autopsy report is correct," she said. "I'm not saying that it's not. I'm saying what we might have to do is to have an independent person who is unassociated with the state" review the autopsy.
The health inspectors' investigative findings were "consistent" with the medical examiner's rulings, Health Secretary Dr. Joshua M. Sharfstein wrote to Conway and Del. Peter Hammen, a Baltimore Democrat. The two lawmakers chair committees on health.
A health department spokesman said in an email that state officials "stand by the excellence and independence" of the medical examiner's office. "We intend to work with Sen. Carter Conway and Del. Hammen on legislation, as we offered during the briefing this summer," the statement says.
The investigative report, dated July 7, states that an inspector attempted but failed to interview the nurse who was working in the home on the night of Damaud's death.
But The Sun contacted the nurse, Mary Zelio, last week by calling the phone number listed for her in the Anne Arundel County police report about the death. She said no state official had tried to contact her. In July she told The Sun that understaffing was a recurring problem at the LifeLine apartments, including on the night of Damaud's death.
The investigation of Damaud's death rendered no opinion on staffing issues. Sharfstein said last week that the absence of such a finding often means there was not enough evidence to make a determination. A spokesman said the secretary was not speaking specifically about LifeLine, and the department typically does not release information beyond what is reported in such investigations.
This week, the health department released a statement that said LifeLine "provided the staffing required in Damaud's individual plan." It did not say if staffing for all the children was adequate.
The statement detailed the steps inspectors took to conduct their investigation, reviewing "his complete agency record — including the individual plan, medical records, and nursing notes." Inspectors also "reviewed Lifeline's personnel records, the 911 recording, EMS record, hospital record, police report, death certificate, and autopsy report. OHCQ's surveyor also interviewed four Lifeline employees, including a nurse who helped to care for Damaud on the night of his death."
At an Annapolis briefing about LifeLine that Conway convened in late July with two dozen state lawmakers, Sharfstein and Human Resources Secretary Ted Dallas, whose agency awards contracts for group homes, acknowledged that their departments need to do more to monitor contractors' financial problems, which could signal declining medical care.
Conway said the task force would be charged with figuring out the best way to determine whether contractors have the financial capability to provide the care they're being hired to deliver.
She had considered introducing bills in the 2015 General Assembly session that would propose regulatory changes, but chose a task force because of this month's election results.
A new governor, Republican Larry Hogan, will take office in January just as Sharfstein voluntarily leaves his post for a job at the Johns Hopkins Bloomberg School of Public Health. Hogan's administration, including the new health secretary, need to be involved in crafting stronger regulations, Conway said.
If her bill is approved by the legislature, the task force would be getting started just as a similar group set up by Sharfstein will be completing its review. The group established by the health secretary held the first of three monthly meetings Wednesday and has been asked to deliver recommendations by the end of January.
Conway said it's possible the existing task force's recommendations could result in proposed legislation in 2015. That group's report also might be used to help her task force formulate its own proposals.
"We probably could take up new legislation if we get agreement with the new administration" on the issue, she said.
A spokeswoman for Hogan said the new governor's team was not commenting on policy issues until he takes office.
Hammen, who chairs the House committee on health, did not return calls for comment.