Newly Disclosed Details About Group Home Indicate Delays in Care and Incident Reporting

By Gina Macris

COLLEGE PARK APARTMENTS

Newly-disclosed incidents at College Park Apartments in Providence, the state-run group home closed after the death of a resident, indicate a troublesome pattern of delay in treating injuries and reporting alleged abuse or neglect.

The incidents were disclosed in documents obtained through a reporter’s request under the Rhode Island Access to Public Records Act. (APRA).

While the reports fill in some detail about the kinds of problems that prompted the state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to close College Park Apartments, they raise as many questions as they answer.

In addition, the internal BHDDH reports highlight different interpretations of the public’s right to know, in that they were denied in a reporter’s records request to BHDDH, but they were released in response to the same reporter’s request to the Rhode Island Attorney General.

In the aftermath of the death of the College Park resident, the state Secretary of Health and Human Services, who oversees BHDDH, recently acknowledged that the department’s privacy laws are overly restrictive and that there needs to be a better balance between confidentiality and government transparency.

The troubles at College Park surfaced after 70 year-old Barbara Annis died on Feb.15, 2016 at Roger Williams Medical Center. A leg fracture had gone untreated and a massive infection set in. Two criminal investigations into her death are still underway, one by the Medicaid Fraud and Patient Abuse Unit of the Attorney General’s Office, and another by the Rhode Island State Police.

The newly released documents obtained by Developmental Disability News disclose three other incidents. 

On March 8, 2016, the staff of College Park found an 89 year-old woman unconscious, with a bloody mouth and other unexplained head and shoulder injuries. Although the resident was discovered at 5 a.m. and needed oxygen to regain consciousness, it wasn’t until nine hours later – at 2 p.m.-  that she was taken to the hospital.

She was admitted and held overnight at Roger Williams Medical Center, returning to College Park the next day. That incident remains an open case in the Attorney General's files, according to a spokeswoman.

Two months before Annis died, on Dec. 11, 2015, another woman who lived at College Park complained that a staff member had assaulted her. All reports of suspected abuse or neglect must be made promptly to the internal investigatory unit of BHDDH, but that one did not reach investigators until Dec. 28, more than two weeks after the fact.

According to an internal report, two supervisors at College Park were involved with the complaint and each believed the other had called the patient abuse hotline. The same resident complained she had been assaulted a year earlier, and in each instance, she accused the same staff member. That case also is still open with the Attorney General, according to spokeswoman Amy Kempe. 

A separate report involved a complaint from a nursing home to the Alliance for Better Long Term Care, apparently about bedsores on a terminally ill College Park resident the nursing home had treated. The bedsores worsened during the last nine months of her life, a period when she was hospitalized twice. A family member or guardian, whose name was redacted, also expressed dissatisfaction with hospital care, according to the report. This case has been closed by the Attorney General because there was not enough evidence to warrant criminal prosecution, according to spokeswoman Kempe. 

It appears that Annis’ death on Feb. 15, combined with the issues raised by the other internal investigations into College Park –particularly the unexplained injuries three weeks later - prompted the BHDDH director to ask Day One for an outside report on the operations of the group home.

Day One, the sexual assault and trauma center, was chosen for its expertise in interviewing children and adults with limited communications skills.

The BHDDH director, Maria Montanaro, and the Executive Office of Health and Human Services kept under wraps the fact that a group home resident had died for a month while Day One completed its report. BHDDH and EOHHS have declined to release that report, citing privacy laws.

Montanaro announced on March 18 that five College Park employees had been placed on paid leave and that BHDDH had revoked the group home’s license. The last residents moved March 24 and the doors closed for good the following day.

Questions Persist

The internal BHDDH reports released by the Attorney General’s office, while disclosing other incidents at College Park, still leave many questions unanswered.

The reports responded to an APRA request for all reports from BHDDH involving suspected neglect or abuse that had been forwarded to the Attorney General’s Office for review during 2015 and the first three months of 2016.

No group homes other than the state-run College Park were mentioned in the information released by the Attorney General’s office.

BHDDH is required to share allegations of neglect, mistreatment or abuse with the Attorney General’s office.

BHDDH itself declined to release these same reports in response to a separate, voluminous APRA request for information on the safety of individuals living in group homes for persons with developmental disabilities.

The department did, however, summarize complaints about College Park Apartments during 2015 and the first three months of 2016, ending March 22.

In a letter responding to the APRA request, BHDDH lawyer Thomas Corrigan said that there were a total of 17 complaints about College Park during that period. The letter said: 

• Six investigations were opened.
• Five have been closed and one remains open.
• Two did not require corrective action. 
• Three cases which required corrective action focused on staff training, employee discipline, incident reporting, management challenges, security, staffing, review of individual support plans (blueprints for each person’s program of services) clarification of management and staff roles, improved documentation and equipment and hygiene inspections.

Corrigan also provided statistics about complaints regarding College Park during 2013 and 2014, with the caveat that BHDDH began to change its incident reporting and classification system in January, 2014, and numbers before and after that date cannot be compared accurately.

 Corrigan’s letter did not say how many complaints from 2013 and 2014 warranted investigations or corrective action plans. He said there were 32 complaints in 2013 and 17 calls in 2014.

Collecting this information was a time-consuming process. Corrigan said in a telephone interview. BHDDH is not required to keep aggregate data on complaints as standard operating procedure, he said.  

Corrigan also responded by telephone to other questions about the operation of College Park and more than two dozen state-run group homes.

In the interview, Corrigan was asked why BHDDH did not change the staff, rather than closing the home and further disrupting the lives of the remaining residents – 13 individuals.

He said, “There were too many unknowns about what was happening at College Park, as opposed to going where we know there isn’t a problem.”

At state-run group homes, operated by a division of BHDDH called Rhode Island Community Living and Supports (RICLAS), each nighttime shift is staffed by a nurse and direct care workers. Supervisors are not present at night, but two coordinators for all the homes - more than two dozen facilities - are available by telephone, he said.

College Park was divided into three self-contained units or “apartments”, each one with four or five residents, Corrigan said.

BHDDH released several hundred pages of redacted staff logs from College Park that indicated it operated much like a nursing home.

One supervisory note warned staff not to falsify time sheets – they are kept on paper, not electronically. Other notes reminded staff to stay in their self-contained “apartments” for their entire shifts.

The staff logs contain a notice for Barbara Annis’ funeral service Feb. 24 at the Russell Boyle Funeral Home on Smith Street in Providence. Burial was to be in North Burial Ground off North Main Street.

There was no public obituary or death notice. Corrigan said Annis had no next of kin and her estate was not sufficient to pay for a notice.

Ombudsperson Could Provide Transparency

Elizabeth Roberts, Secretary of Health and Human Services, cited overly restrictive privacy laws about a week ago, when she appeared before the Senate Health and Human Services Committee and presented the results of 30 unannounced group home inspections  that were conducted jointly by the state Department of Health  and BHDDH investigators in the wake of Annis’ death and other problems at College Park.

L TO R: MARIA MONTANARO AND ELIZABETH ROBERTS AT THE STATE HOUSE.

Alluding to media inquiries prompted by the College Park situation, Roberts highlighted the fact that “current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release.”

“The original intent of these restrictions was most likely a well-meaning effort to protect individuals’ privacy, but we can protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety,” she said.

Later in the week, a spokesman for Roberts said the Secretary sees the potential for an ombudsman for persons with intellectual or developmental disabilities to serve as a “conduit” for releasing information of public interest that otherwise would remain shielded.

A bill creating such an ombudsperson was prompted by Annis’ death and its aftermath. The bill, H-8038, was introduced by state Rep. Eileen Naughton, D-Warwick, and has been referred to the House Finance Committee.

Eileen Naughton 

As the bill is now written, however, the ombudsperson may not be able to provide the transparency that Roberts envisions. The ombudsperson would be required to make annual public reports on the activities of his or her office. But the legislation does not contain specific details about the extent of that reporting. Files maintained by the ombudsperson would be confidential, according to the bill.

The ombudsperson would be appointed by the Governor from a list of candidates recommended by a nominating committee. The new office would be part of the state Department of Administration.