The death of a severely disabled foster child earlier this month while under the care of a group home in Anne Arundel County that Maryland health regulators were in the process of shutting down inevitably raises the question of whether the boy's life could have been saved if state officials had acted more quickly. The state has launched three separate investigations into 10-year-old Damaud Martin's death, but the results may not be known for months. Regardless of whether anything could have changed Damaud's fate, though, the investigative reporting by The Sun's Doug Donovan into the troubled history of LifeLine raises real questions about whether the state's oversight of such care providers is adequate to protect some of the state's most vulnerable young people.
Officials at the state health department and the Department of Human Resources, which had primary responsibility for the boy's care, say they carried out regular monthly and annual inspections of LifeLine's facilities as required by law and that they acted promptly to remove the 13 children there as soon as they learned of the company's problems. As Mr. Donovan reported this week, by April of this year officials clearly were aware of deficiencies in the quality of care LifeLine was delivering, as well as of serious financial and governance issues that could affect its ability to fulfill its contract obligations.
But the nature of the work companies like LifeLine do is such that they can't be shut down on a moment's notice. It takes time to find adequate facilities to care for such medically fragile patients; indeed, the last children were not removed from its facilities until after Damaud's death on July 3. That's why it's crucial to determine whether the state's protocols for monitoring these contractors and its powers to seek remedies for deficiencies allow it to take action far enough in advance to avoid the kind of deteriorating conditions that may have contributed to Damaud's death.
There were certainly enough red flags to put officials on alert well before April, but if it is indeed the case that health officials followed the mandated inspection and oversight policies to the letter of the law, there clearly are holes in the system. Mr. Donovan uncovered a long list of financial, governance and quality of care issues, many of which state regulators did not learn of until after the fact. As such, lawmakers are right to demand a thorough review of the state's oversight role regarding contractors who care for the state's medically fragile foster children, and if necessary they need to strengthen those procedures in order to prevent similar incidents from happening again.
Among the questions that need to be answered are why state officials continued to award contracts to LifeLine even after it had filed for bankruptcy reorganization and a state audit had found it insolvent. Why didn't the state's decision in 2012 to close an adult care facility run by LifeLine for those reasons raise more alarms over the group's Anne Arundel youth facility, which was allowed to continue operating until this month? And why was the state left in the dark for years about repeated visits to the youth facility by county fire and police officials in response to complaints of alleged neglect, abuse and injuries?
State officials insist there are reasonable answers to all those questions, though in retrospect they hardly seem so. For example, inspectors made repeated visits to LifeLine's youth home after the adult facility was closed but ultimately concluded conditions there were unaffected by the financial and governance problems uncovered at the adult site. Yet wouldn't it be reasonable to suspect that the company's shortage of money might eventually carry over into the quality of care it was able to offer at its youth facility as well? (For that matter, might not the imprisonment of LifeLine's founder on felony arson charges suggest the possibility of management turmoil?) The inspectors who conducted the review may have been expert at judging health conditions at the home, but were they skilled enough at examining the company's finances and governance to see the potential for problems down the road?
Similarly, state officials were unaware of the numerous calls to fire and police from the youth home because emergency personnel are not in the practice of contacting them about the incidents and LifeLine itself failed to report them as required by law. Yet it's hardly surprising that an agency contracted by the state to provide 24-hour-a-day intensive care to medically fragile children might be reluctant to report that it was instead accused of neglecting and abusing them. State officials have suggested that the health department be given the authority to fine contractors who fail to make such notifications — a fine idea but one that would only be effective if the state knew what it wasn't being told. Did it never occur to state officials to simply ask the county police and fire departments to notify them directly whenever they received such calls?
It is too soon to know whether any of these lapses were a factor in Damaud Martin's death, and given the seriousness of the boy's condition, we may never get a conclusive answer. But the matter surely bears looking into. When incidents such as this occur, there's nothing more common than for authorities to claim that all the rules and regulations were meticulously followed even if the result is a tragedy. That's not good enough. Somewhere along the line the system broke down, and Maryland health officials need to fix it.
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Correction: An earlier version of this editorial misstated LifeLine's corporate status. It was initially registered as a non-profit but later switched to for-profit status. The Sun regrets the error.