As Maryland health officials begin reforming their oversight of services for adults and children with disabilities, advocates are demanding greater urgency and specific fixes to address a reported increase in incidents of abuse and neglect.
The Maryland Disability Law Center wants regulators to move quickly because reports of serious incidents jumped 15 percent in a recent six-month period, according to its analysis. There were 2,608 reported incidents across all services regulated by the state between March and September, a marked increase over the previous six-month period, the center found.
"We need you to act now because people who receive services need more protection from harm," Nancy Pineles, managing attorney for the center, wrote recently to state health secretary Dr. Joshua Sharfstein. "Reports of abuse, neglect and other concerns are on the rise."
On Sunday, Sharfstein released a plan to strengthen government supervision of group homes for disabled foster children and announced a task force to examine oversight and quality issues with the regulated care provided to nearly 23,000 disabled people in Maryland.
The recommendations in his report are being reviewed by General Assembly leaders who have focused renewed attention on the issue since The Baltimore Sun began revealing significant problems at two group home contractors. The Sun highlighted issues at LifeLine, which ran the Laurel-area facility where a 10-year-old disabled foster child died, and Second Family.
Sharfstein has made reform at his department's Developmental Disabilities Administration a priority since hiring a new agency director, Bernard Simons, in April. Simons is co-chairing the task force with Tricia Tomsko Nay, executive director of the health care quality office.
"It's an area that has needed an overhaul for quite a while," Sharfstein said. "There needs to be a clear public process to move through several different issues."
Any rise in reports of abuse and neglect is due to an increase in the number of people receiving services and improved reporting by service providers, "not necessarily as a result of increased incidents," Simons wrote in a reply to the disability law center. "At the same time, we understand that there is room for improvement in quality and quality oversight."
The task force, which is not fully formed, is expected to make its recommendations by January.
Meanwhile, the Health Department is implementing reforms for group homes, aiming to improve coordination among the government agencies that supervise group homes for disabled foster children, increase scrutiny of contractors' finances, and add an employee to implement and oversee the enhancements.
The reforms were announced after The Baltimore Sun detailed significant problems with LifeLine and Second Family. The Sun found that the state awarded contracts worth millions of dollars to LifeLine despite numerous problems, including deficiencies with care, a founder imprisoned for arson, unpaid taxes and police reports of abuse and neglect that were unknown to regulators.
The death of 10-year-old Damaud Martin is being investigated by Baltimore police as a homicide. The medical examiner has ruled that his death was caused by complications from cerebral palsy and past head trauma, injuries suffered before he was in LifeLine's care. Health inspectors are also reviewing the circumstances of his death.
On Sunday, The Sun revealed that the homes where regulators moved most of LifeLine's residents had problems of their own. In January two employees at the homes run by Second Family in Capitol Heights and Bowie were fired for abusing a mute autistic child.
The Health Department's report showed that state inspectors found 192 regulatory violations between January 2011 and August of this year at the four contractors who have provided homes for disabled foster children. The contractors were most frequently cited for not providing documentation that staffers were properly trained to treat special-needs children.
"The review did not find unexpected serious gaps in the oversight of group homes for medically fragile foster care youth," the report stated. "However, the review did find multiple areas for improvement."
Advocates questioned the state's meaning of "unexpected serious gaps."
"What does that even mean?" asked Joan Little, chief attorney for Maryland Legal Aid Bureau's Baltimore child advocacy unit. "Does that mean they expected children to be harmed in these homes?"
Little said the lack of documentation indicates that many workers at the homes likely are not equipped to dispense proper discipline, provide basic care, and spot abuse or neglect by co-workers. She said the state's proposed reforms could improve safety and care if implemented, but noted the report lacked the detail that advocacy groups recommended at a legislative briefing in July..
"It lacks specifics. It lacks urgency," Little said.
Several advocacy groups presented ideas for reforms at the briefing, called in the wake of The Sun's investigation of LifeLine. The Maryland Disability Law Center's letter to Sharfstein provided some of those specifics.
The law center calls for the state to develop a database of employees of state-licensed care providers. The proposed policy would require contractors to check the database before hiring new workers and to call previous employers to determine if the employees were terminated for abuse and neglect — even if they were never charged with a crime.
Del. Barbara Robinson, a Baltimore Democrat, introduced such legislation in 2011, but the measure failed. The state opposed it because of the cost of implementation.
"These people are going from agency to agency abusing," Robinson said, adding that she intends to introduce similar legislation next year. "There should be some way you can identify these individuals who have a history of abuse before they're hired."
Pineles' letter asks health officials to support — "or refrain from opposing" — efforts to develop a database and rules requiring facilities to use it.
"It is rare for staff who are terminated from their jobs for poor performance to be criminally charged and, therefore, criminal background checks are insufficient to screen for staff with a history of abuse, neglect, exploitation or other poor performance," she wrote.
In July, another advocacy group, Advocates for Children and Youth, called for a system that would record reports of abuse and neglect by facility, so local social workers could spot concerns sooner. The nonprofit also supported a public "report card" for all contractors that care for children.
Simons wrote in his response to the disability law center that the new task force could consider the database issue.
He also agreed with the law center that health inspectors need "a range of sanctions" to immediately impose remedies on facilities when they find problems — rather than waiting for a hearing or taking the drastic step of closing a facility.
The law center provided one example of an incident in which such power would be effective: An April 11, 2013, dental exam of a disabled resident recommended the extraction of eight teeth, yet 10 months later the procedure had not been performed. Inspectors "should have the authority to order that the individual receive immediate dental attention," Pineles wrote.
Such authority, she wrote, would "save licensure revocation for a last resort."
In addition, the law center requested that the state produce a comprehensive analysis of abuse and neglect data throughout the year to spot dangerous trends. The state does compile such reports, Simons said in his letter. But he said the task force would discuss other ideas for data review and analysis.
The law center analyzed several categories of incident reports at state-regulated services for adults and children with disabilities. It found, for example, a 25 percent increase in reports of neglect and a 10 percent increase in reports of abuse.
Sharfstein said Sunday that the state needs a more sophisticated data management system to produce more timely reports that flag trends.
"There are multiple systems that track large amounts of data, but unfortunately not all of these systems can communicate with each other," the report states. "Some tracking is still done manually or on a Microsoft Excel spreadsheet."
"The process is too informal," Sharfstein said.
So, too, is the coordination that exists among health and human resources inspectors, police, and county social workers, according to the state. The report set January as a projected deadline for clarifying the roles and responsibilities within and between state agencies, including inspectors at the Department of Human Resources.
The report also called for better oversight of a contractor's finances, acknowledging that inspectors "are not expert at reviewing business plans, assessing the sustainability of financial models, and identifying fraud and abuse."
The Maryland Disability Law Center, which analyzed reports of serious incidentsacross all services regulated by the state between March and September, found a marked increase over the previous six-month period. Among the findings:
A 67 percent jump in reported use of chemical restraints.
A 25 percent increase in reported neglect cases.
A 22 percent rise in reported use of unauthorized restraints.