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Protection program to get federal scrutiny

State officials vow to address flaws
RUTH TEICHROE, SEATTLE POST-INTELLIGENCER
Published 10:00 pm, Wednesday, November 23, 2005
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Federal officials are investigating reports in the Seattle Post-Intelligencer of abuse of clients and insufficient oversight of the state-run Community Protection Program, which pays contractors an average of $93,000 a year per person to closely supervise dangerous developmentally disabled adults.

Also, state legislators vowed to address flaws in the program, including tightening staff background checks and requiring the Department of Social and Health Services to crack down on contractors who misuse public funds or provide inadequate care.

The $42 million annual state program contracts with 16 residential vendors to provide 24-hour supervision of 381 clients who need monitoring because they are sex offenders, physically aggressive or set fires. All but two of the contractors are for-profit companies.

An investigation by the P-I found that although the program is protecting the public most of the time, vulnerable clients are suffering abuse and neglect at the hands of housemates and low-paid, poorly trained staffers. At least 813 serious incidents were reported to DSHS between 2000 and 2004, resulting in 520 calls to police.

Advocates have raised questions about civil rights violations because clients referred to the "voluntary" program by DSHS must enroll or lose state-funded services. No court monitors who must enroll or who is allowed to graduate. There is no appeal. Clients live in houses with alarmed doors and windows.

For the most violent clients, even this level of supervision is not enough. Others don't seem to belong there at all.

"We are going to work with the state on these issues," said Michael Marchand, regional spokesman for the Centers for Medicare and Medicaid. "It's going to be part of our ongoing review. ... We are looking to modify and improve the program."

Medicaid pays for half the cost of the program. Federal officials were finishing an audit of the program in preparation for a new five-year funding agreement with the state when the P-I series ran last week.

"(The federal government) has a pretty big stick in this," said David Girard, an attorney with the federally funded Washington Protection and Advocacy System in Seattle. "The state is abdicating its responsibility to care for these folks."

The advocacy group has been asked by federal officials to submit recommendations for the "essential but gravely flawed" program, Girard said. Those reforms include:

  • Require DSHS to enforce mandatory abuse/neglect reporting by contractors, ensure staff who abuse clients are fired and prosecuted, and ensure state case managers follow up when incidents occur;

  • Require the state to monitor contractors' finances and quality of care and increase pay and training for staff;

  • Improve due process for clients and ensure only those who pose safety risks are put in the program.

    "There are ... problems which we clearly need to look into," said Rep. Ruth Kagi, D-Lake Forest Park, chairwoman of the House Children and Family Services Committee.

    One of her priorities will be writing legislation that gives DSHS more clout to fine contractors or stop placements, Kagi said.

    The lack of oversight of providers and poor staff pay and training troubled Sen. Karen Keiser, D-Des Moines, chairwoman of the Health and Long-term Care Committee.

    "I was very disturbed," Keiser said. "We need to look at that very carefully."

    She questioned whether the program should rely so heavily on for-profit companies.

    Legislators agree that national criminal background checks for all staff working with vulnerable adults are needed.

    "The background check is something we should address rather quickly," said Sen. Debbie Regala, D-Tacoma, vice chairwoman of the Senate Human Services and Corrections Committee.

    Gov. Christine Gregoire said in a statement that she "is confident that Secretary Robin Arnold-Williams and her staff at DSHS will continue to look for ways to improve the program."

    Legal reform must address the lack of due process, said Sue Elliott, executive director of the Arc of Washington State.

    Boosting minimum staff qualifications and paying higher wages would help reduce turnover, Elliott said.

    State case managers should have lower caseloads than the 75 clients they now supervise in the program, she said.

    Elliott said an independent ombudsman would give parents or guardians somewhere to turn when problems arise.

    The state also needs the legal authority to review medical records when a client dies, she said. DSHS began internal mortality reviews in 2003 but can't review medical records without permission from a relative. The state also does not require autopsies to be done, leaving that decision up to local authorities.

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