February 28, 2013 - Quality Care Board Meeting

Audience

Open to the Public

Date/Time

2/28/2013 1:00 PM - 3:00 PM

Location

Division of Rehabilitation Services
207 South Prospect
Bloomington, IL 61704

Agenda

Introduction of Quality Care Board members/Inspector General McCotter
The Quality Care Board's Role (By-Laws) Brainstorming
1. Develop method that would allow the Board to operate as written
2. Modify responsibilities
Reorganization of OIG
Discussion on House Bills 0948 and 1508
Areas of OIG the Board would like to have more information on (speaker)
Approval of October 30, 2012's meeting minutes
Miscellaneous Issues/Questions

QUALITY CARE BOARD MEETING MINUTES

February 28, 2013 at 1:00 p.m.

Division of Rehabilitation Services Office
207 South Prospect
Bloomington, IL

Present: Susan Keegan, Chairperson; Ginny Conlee; Ed Baker; Thane Dykstra; Acting Inspector General Michael McCotter; Deputy Inspector General Robert Furniss; and Chris Milbrandt

Absent: Untress Quinn and Cathy Contarino

Introductions: Acting Inspector General Michael McCotter has been with the Office of the Inspector General since December 10, 2012. He has a law enforcement background that is comprised of 37 years with the Chicago Police Department, 1 year with the State Police, and 1 year with the Department of Corrections. His confirmation hearing is scheduled for March 7, 2013. At this time, the Quality Care Board members introduced themselves to Acting IG McCotter.
Chairperson Keegan amended the agenda and we began the meeting with the legislative issues.
Discussion on House Bills: Deputy Inspector General (DIG) Furniss summarized three bills. We were just informed about HB 2997 yesterday. It was introduced by Representative Kay. It is our position to oppose the Bill. It calls for OIG/DHS to contract with an appointed auditor to conduct audits of the TANF program, supplemental nutritional program, and another program, none of which we have any responsibility for. We are presenting an opposition paper to this bill. It is not supported by any statutes that govern us. Also, there is nothing mentioned about monetary support. We were estimating this would cost between $50,000 and $70,000 to do this.

HB 1508 - At the last meeting Dan Dyslin talked about the Executive Order concerning OIG's responsibilities in which a person in our Domestic Abuse Program, or alleged victim in a domestic case, died before we could complete an assessment. This says we would directly make referrals to law enforcement and the coroner's office. Let's say a call was made on a Tuesday from a hospital about a person with a questionable injury and the person expires that day or the next. Our question is what kind of a report is going to be generated in that case because the person would not have spoken to anyone.

HB 0948 - There has been a concerted effort to come up with a structure in which the Domestic Abuse Program, the Elder Abuse Program, and certain other programs would be merged into an Adult Protective Services (APS) entity. That is the thrust of 0948. The APS Bill is decentralized, if not fragmented. The people involved in this felt that Department of Aging had the most desirable framework to handle this in which they contract out to various community entities to provide various services to adults.

There are various issues in our position paper that have not been resolved. The effective date is July 1, 2013. The Bill is absolutely silent on what happens on July 1st. Does this mean on July 1st we give them all of our old and open files? Question: Do they have jurisdiction over anyone who is not considered elderly or above a certain age? Response: No. We informed Aging that on July 1st, at any given time, our Domestic Abuse Program has between 200 - 300 open cases. The Bill is silent on what happens with those cases because this Bill repeals the enabling statute of Rule 51. The real issue here is there is absolutely nothing in the statute about who is going to be responsible for these individuals on this date. They have six months to get a hotline set up. They have repealed Rule 51. Does that mean we are going to continue handling hotline calls related to this?

There are more problems. The Bill also talks about under Rule 50, if someone has a substantiated physical abuse case or egregious neglect case, they are referred to the Health Care Worker Registry (HCWR). This Bill would also refer the caregiver to the HCWR in cases of significant abuse and neglect. There is a completely different legal standard between putting someone on the registry in domestic cases. We have reason to believe. There has to be a preponderance on the cases to be put on the registry. Only about 10% of the domestic cases that we handle involve a paid caregiver. Most of the time, it is a grandmother, mother, sister or brother doing it out of family responsibility. In these cases, many of these people are overwhelmed. They just can't handle it. They aren't vicious. They aren't paid. You are putting up a wanted poster on a caregiver (private citizen) that is overwhelmed.
The other problem with this is they talk about significant abuse and neglect. You have three problems with this:
Burden of proof
Population of people that really don't deserve to be placed on the registry
A fairly involved appeal process for people to be placed on and taken off of the registry
We have an involved appeal process. If the Bill is passed in this form, OIG has powers to pull people out of their homes and establish guardianship if they aren't living in a super home environment. This new APS will have powers to do that. If someone is incapacitated, they can assert guardianship.
Question: … and put them where? Response: Good question. When we have a domestic case, we are assessing that person for services that would be assessed by some DHS entity. This agency is not part of DHS. Absent some kind of interagency agreement, or interagency budgetary agreement, there is nothing in any statute that would give APS, or Department of Aging, access to any DHS service. There is no place for these people to go. Question: Has anyone testified from your office? Response: They haven't had a hearing on this yet. We have never been consulted on any of this.
Thane received a sense from the hearing that they wanted to put everything under one area and not deal with the fragmentations. Response: The final problem is there is nothing in here about money. It just says adequate appropriations will be given. I think their primary issue was the whole Domestic Abuse Program. There were questions about Rule 50, but the Domestic Abuse Program was their main focus.
The Department of Aging handles people aged 18 - 60 years. That is now going to be called Adult Protective Services. Chairperson Keegan stated that kind of makes sense as OIG was never funded to do the job. The Department of Aging has more resources. Acting Inspector General McCotter interjected that he received a phone call that this is pretty much a done deal, this Bill in this form.
They are talking about a 24-hour hotline. There has been some thought of the Department of Aging taking over all of the adults because people aged 18 - 60 is a huge population. The budgetary implications are staggering. People have testified that we wouldn't have a problem with the model, but you better plan on increasing your budget by 60% - 75%. Another concern is that Representative Harris wants us to train all of their people. They are looking at something different than what we do. Instead of having people go out and do assessments like we do, they contract out to someone from a social service agency. Why do we need to train them for something they already know?
From what we have read, they aren't really going to be doing investigations. You will have people going out with a social service worker background to better determine what services are actually representative of the organization that will be providing that service. This makes sense. What doesn't make sense is having our people do the training. When does the training begin? We have a training department, but they don't get involved in Rule 51 that much. That would mean a considerable number of our people would have to be detailed to another agency to do this training. In the meantime, come July 1st , there might be 200 - 300 open cases. If they take half of our staff to train, you can double our open cases. We are very concerned, from our standpoint, about what this means for our involvement. It sounds like we may be involved in this for quite some time.
They are appealing our enabling statute. They are going to take Aging and change it to APS. DCFS will continue to be autonomous and anyone over 18 will fall under APS. The good news is that if our staff is left intact, we will have five Rule 50 investigators, especially in the metro area. The metro area's average caseload is carrying between 35 and 60 cases a piece. The other good news is that would free our OIG hotline of probably 2500 - 3000 calls a year once people learn about APS. Our hotline number is on the web page. Our call volume went up 25 - 30%. We receive calls from everywhere. Rule 50 is not a problem. They have to post our number. DIG Furniss believes there is a six-month window it will take for everyone to figure it out.
The big problem is you have a repeal of statutory authority. We still have an obligation to the individual or subject of these calls. We still want to make sure these people are protected. Thane asked if there is a quick triage the hotline staff would have to do when receiving a call such as: Is this person over 18? Is this person funded? Are they receiving DHS services? Is the parent abusing them? You will have to identify the categories and nature of what happened and where it occurred. It will allow us to better address the calls we do receive.
The hearing is March 5, 2013.
The hotline staff asks questions and tries to determine if it falls within our statute and does assessments. Our people go out and may not be allowed in. If someone says no, we then call local law enforcement. Assuming we get beyond that, we then interview the person.
Chairperson Keegan asked how that will change the oversight responsibility for the Board. Response: We are still going to have responsibility for investigating people receiving DHS services.
3. Reorganization of OIG - We recently had a Rule 51 investigator retire. We will probably make the position a Rule 50 investigator even though we are still conducting Rule 51 investigations at this time. We have a Domestic Abuse Program bureau chief, an Investigative Team Leader and five investigators we need to place. We might split Metro into two parts and push the Northern bureau further north. We may redo the Southern bureau. We have a bureau chief so we will probably end up with a Northern bureau that will be more north and a Metro bureau that will be more East and West. We aren't going to know that until everything is over and the staff are left.
4. Quality Care Board's Role - Chairperson Keegan stated that the "oversight" reference is troubling. It is a tremendous responsibility. DIG Furniss stated the word oversight is qualified later in the statute because there are more specific tasks or responsibilities that the Board may exercise to satisfy that requirement. It is not a limiting definition. DIG Furniss stated the limiting part of it has been that as a practical matter, how does a seven-person Board, with no staff, with no budget, that meets four times a year …
Chairperson Keegan stated the statute says " monitor and oversight."
Acting IG McCotter stated he spoke to former QCB Chair Rita Burke and she said she needed staff and investigators. He stated that the legislature has to approve that. He does not believe anything has changed since forming this new Board.
Chairperson Keegan stated there has to be some way to be more realistic about what the Board does and how we get information so we can look at it. DIG Furniss stated he doesn't know what possibilities we will have in amending the statute, but the word "oversight" may not be the appropriate word.
Chairperson Keegan stated that she has not seen any statistics or anything about number of cases, what has been done, investigations or outcomes. Thane stated that we have seen statistics. When you see how long investigations are taking, you realize we do not have enough staff. Then what do you do about that other than try to advocate for more. Everyone knows there is no money for more positions. DIG Furniss stated the other part that makes this a little awkward is to what extent can a provider/board member oversee/monitor an agency that is sometimes investigating their own staff? Oversight is the wrong word. Chairperson Keegan suggested that we throw this in as an amendment. We aren't going to monitor any facilities. Maybe we should be providing advice. Ed stated he has serious reservations about asking DHS to review our role as a Board the way the statute is written. For example: I am working with a management firm. They contract me to follow one of their employees around. I go up to the person and say, Hey, what do you want me to tell them?
The Board members were in agreement that they should write a letter to Bob Morgan in the Governor's Office and make it reflect more what the Board is going to be responsible for. They do not want to go through DHS. The word "oversight" gives you responsibility and liability. Taking on a responsibility is not a problem - it is just an unknown responsibility. Members felt the "responsibility" is too vague. It doesn't make sense for us to provide anything but giving advice. Chairperson Keegan will write the letter to the Board members. DIG Furniss stated that in order to keep things very clean, we shouldn't have anything to do with the letter to the Governor's Office.
DIG Furniss stated the problem will remain because the language is in the statute. Question: Could it be defined by Rule? Response: We would have to define by statute. Chairperson Keegan stated it is time to do the modification when it is in committee. We need to let them know we think this language should be modified. DIG Furniss stated there may be some push back that they are trying to get out of their responsibilities we think they should have. Chairperson Keegan would like to have on record that we wrote you this letter when you were amending the statute and said this was a problem and you decided not to do anything. Chairperson Keegan feels they need to get the letter clarifying the statute sent within the next week or two.
Ginny stated that OIG is a part of an agency that has a Director who is responsible for behavior of the organization. We will take a look at it and read reports about it and see if it makes sense and ask questions and advise them, but not be an oversight. DIG Furniss stated whatever kind of reports you want, we can probably do. We are in the process of revising the directives. After we talked the last time, we thought maybe, after a period of time, they would be done. Some of the directives are housekeeping. We do investigative spreadsheet reports. How many cases were completed, etc. Whatever you want us to put together. The board can ask questions about the directives, wonder why we do some things, why we aren't doing something. We have management reports that go out monthly and quarterly.
Thane stated that in terms of reviewing the case summaries, he doesn't think we ever talked about how we were receiving the case reports. We never really discussed the selection process. DIG Furniss stated the original idea was at random. Based on what Thane has seen, they were complex cases. If he had known they were random, that would mean one thing to him, but since there was some sort of a selection process, Thane would be comfortable with them. These are ones that you and the bureau chief had to have a discussion.
Chairperson Keegan said we could include five of the best and five of the worst cases for review. It would be good to see the ones that were handled and are done. DIG Furniss stated that we have had situations where we have to be careful because the cases are FOIAble or subject to the Open Meetings Act. Some cases were involved in active discussions with the department about whether or not to sanction an agency, for example. Chairperson Keegan said we could redact that information. If you are being critical of another agency, so be it. It is an opinion and based on some fact. DIG Furniss stated that one of the agencies we ended up decertifying. When we are discussing an ongoing (open) investigation, we could go into closed discussion. The discussion wouldn't be in the minutes.
Question: Do you still get involved in recommending action against employees? Response: We don't technically do that. Question: You wait until somebody reads your findings and let them decide? Response: Yes. We can't.
Thane stated that it's a mute point. If it is substantiated abuse, it goes off to the registry. Question: What if we are talking about an employee of the agency in the state ops? Response: We don't get involved in making specific recommendations. All we do is recommend you address the situation. We don't get involved in the discipline. Sometimes an agency will wait for us to do something. Ginny stated that sometimes there isn't much you can do as it is a Union employee.
Question: Do you ever know what disciplinary action happens? Do you follow up in any way? Response: If we know what happened, we will put it in the report.
Ginny stated that if you find the same problem happening over and over on the same unit, and it just so happens that the same employees are working, someone should start thinking about doing something about it rather than letting it continue. DIG Furniss stated that the agency or facility has to submit a Written Response. We see a lot of bowel impaction problems. We would recommend that management review their bowel impaction protocol. All of the allegations have to stand alone, but there are exceptions. There have been situations where we have used other cases to substantiate a case. Usually they are sexual abuse cases. Ginny stated that those are some of the things the Board wants to know about because we may be able to make recommendations. DIG Furniss stated the Division Director of DD is very proactive, but we haven't had a meeting on this recently. DIG Furniss is thinking of a way we can share information on things such as bowel impaction, resident on resident violations, choking issues, etc. Ginny suggested that we look for patterns. What are we doing? Is it a lack of supervision? Thane pointed out that currently that is not reportable the way it is mandated.
DIG Furniss stated that one of the issues that has come up is they have obtained permission for enhanced supervision and they have not done it. They have the money, but they haven't hired anyone. Ed stated there is a program where you refer a case over and staff will run their names and all of their cases come up. DIG Furniss stated we have a database where we can enter their name and it will come up with a list of their priors. If there is an allegation against a staff person, Intake will have a list of all of the priors of the victim and the accused. Ed asked if it shows relationships for you - where two people might share the same case. DIG Furniss was not sure, but we probably could check that. Staff are going to know that this is the third time this person has made an allegation against this staff person. Start thinking about what kind of information you want to look at. Some reports we may not be able to put together and what type of cases.
The idea of random selection of cases was not liked by the Board. DIG Furniss offered the suggestion of giving them an array of cases regarding a certain allegation: substantiated, unsubstantiated, unfounded, physical abuse cases, etc.
Chairperson Keegan asked how the Board would provide feedback. Response: If there is something of concern, write it down after that particular case. Let's say we send you 4 - 5 physical abuse cases. You looked at them and everybody says I get that. You can always have questions. Chairperson Keegan said we could say this was a good way to do it or you should have done this. IG McCotter asked the Board members to send their responses back through him.
DIG Furniss said that if you want us to send the cases out by allegation, that is easy to do. Chairperson Keegan stated if we have nothing then we can say thank you. DIG Furniss stated that even at the Board meeting we can still discuss it if you have questions or want to discuss it.
Chairperson Keegan asked if guns in the homes of persons with disabilities is taken note of. Ginny responded that it would be in a CILA and if you are paying someone to care for someone. That would be one of the things they would look at. You do that with kids also. DIG Furniss replied that doesn't come up at agencies very often. Chairperson Keegan stated that with mentally ill people it is a very rare occurrence. It is not that common. DIG Furniss stated presumably we aren't going to have responsibility for the Domestic Abuse Program much longer. This doesn't come up very often. I can't think of a case where someone was actually shot.
What is the first allegation you want to look at? Chairperson Keegan stated that physical abuse would be a good place to start. Ginny asked what is the comparison between unfounded and not? DIG Furniss replied that substantiated is between 11 and 13% in Rule 50 cases. It also depends on the facility. Chester I would guess has a higher percentage of unfounded. When you have staff, there are a lot more eyes watching. In some places there are cameras. Staff may think twice about doing something.
Chairperson Keegan stated that she would like for the Board, if something comes up of any importance, to be able to do a conference call. CHRIS: SEND EVERYONE THEIR PHONE NUMBERS. Chairperson Keegan motioned to approve to allow staff to confer on a conference call in the event something of importance occurs and on the reports they will be receiving. All in favor - Yes. Thane Dykstra seconded the motion. Motion carried.
With respect that we are going to be sent cases on physical abuse, send out on a monthly basis. Also send quarterly reports.
CHRIS - SEND GINNY THE FY-12 ANNUAL REPORT
DIG Furniss stated that he will keep everyone apprised of what is going on with these Bills. Chairperson Keegan asked DIG Furniss to let the Board know the status of that periodically if something happens. Chairperson Keegan will also call the Governor's Office regarding the mandate and the word "oversight."
Thane mentioned that there is another OIG office that reviews reports: OEIG.
DIG Furniss stated that we are subject to audits by the Auditor General's Office as needed. They typically focus on timeliness. Chairperson Keegan stated that the Board wants those reports as well.
Thane mentioned reviewing complaints about OIG at some level. We would like to know what people's concerns are. Then we would know what issues people are dealing with. Thane stated he is thinking more like when people are saying OIG dropped the ball, for example. DIG Furniss stated sometimes someone will contact their legislator and their complaint will become a Secretary's Mail Control and we have to respond.
Ed asked if the OEIG gets involved in misconduct of OIG employees. DIG Furniss replied yes, but it depends. Somebody else might also get involved. Ed asked if maybe the Board could look at the information as far as what the allegation may be that an OIG employee was turned over to the OEIG. Ginny stated she would like to see the number of cases that were carried over from the previous month, and the new cases. How long it takes on average. Chairperson Keegan added and how they are being handled.
Ed suggested why don't we tag every 150th case? DIG Furniss stated when we do it randomly, that is what we do. You want to see a few unfounded cases just to see what they look like. An unfounded case has no credible evidence. Chairperson Keegan stated we will work on the ones you send out monthly and see what we need beyond that. DIG Furniss stated he will start out with the array. If you have any suggestions on how to do it differently, let me know. Some cases are easy to redact. We will start with five. Financial exploitation - it might be interesting to pull a few of these so you can see.
5. Areas of OIG the Board would like to have more information on (speaker) - Various OIG staff members come to the meeting and tell you what they do. Chairperson Keegan told DIG Furniss to pick a speaker in the area of whatever he feels would be educational.
6. Approval of October 30, 2012 meeting minutes - Ginny Conlee motioned to approve the minutes; Ed Baker seconded the motion; All in favor - Yes. Minutes approved as written.
7. Miscellaneous Issues/Questions
Ed suggested that at the next meeting we take a block of time to review the first five directives (ADMIN) on the Table of Contents. CHRIS - PUT ON AGENDA
DIG Furniss offered the suggestion that the next Quality Care Board meeting be done by conference call. Chris has the call-in number and the access code.
Motion to adjourn meeting carried at 3:00 p.m.