QUALITY CARE BOARD MEETING
September 29, 2016
3:15 P.M.
TELECONFERENCE (RECORDED)
PRESENT: Michael McCotter, Inspector General; William Diggins, Deputy Inspector General; Susan Keegan, Chairperson; Neil Posner; Thane Dykstra; Untress Quin; Pamela Oller; Mike Berens (Chicago Times)
CALLED TO ORDER *
Quality Care Board meeting was called to order at 3:15 p.m. with a quorum.
APPROVAL OF MINUTES *
Chairperson Keegan asked for a motion to approve the minutes of July 21, 2016. Motion to approve the July 21, 2016, minutes - Thane Dykstra Motion Seconded - Neil Posner All in Favor Motion carried to approve the July 21, 2016, minutes
Neil Posner excused himself from the meeting.
INSPECTOR GENERAL'S REPORT *
Inspector General McCotter reported that due to the board members being bound by Illinois Ethics and Confidentiality laws they are to complete the HIPPA training required by the State of Illinois. He stated that Mark Kraus will send the form to all members. The form is due by October 7, 2016. Since Neil Posner was not present during Inspector General McCotter's report, he asked for one of the present board members to inform him of the required HIPPA training. If the HIPPA training is not completed, the OIG cannot send case records to board members for their review.
Inspector General McCotter emphasized to the board to bring any concerns and/or questions about OIG to either himself or Deputy Inspector General Diggins and not contact any OIG staff directly. Once Inspector General McCotter and/or Deputy Inspector General Diggins receive their requests, they will get the answer and respond to the board.
Inspector General McCotter reported on OIG Staff: ?
As of July 1, 2015, OIG had 15 investigators; As of September 29, 2016, OIG has 28 investigators (2 new hires middle of September); Currently one investigator is out on medical leave; As of September 29, 2016, OIG has 3 staff assigned as an Investigative Team Leader. The duties comprise of supervisory as well as handling a caseload as a senior investigator. The caseloads have decreased: As of July 1, 2015, each investigator carried an average of 82.1 cases. As of July 1, 2016, the caseload decreased to an average of 37.3 cases each. Resulting in a 55% caseload reduction; the total cases received has increased overall by 26%. The investigators are doing a great job at this point. The investigators are concentrating on the older (60 days or greater) cases; Deputy Inspector General Diggins has regular management meetings; which has resulted in the reduction of the older (60 days or greater) cases by 51%. It is estimated that by the end of the calendar year, OIG will be able to reduce the backlog of older cases (60 days or greater) to approximately 125 cases. This will represent a total reduction of 88% for this category.
Thane Dykstra inquired if the reduction is due to having new investigators hired. Inspector General McCotter reported it is a combination of the new hires and the role of Deputy Inspector General Diggins ensuring everyone is on task. Chairperson Keegan stated the fact of not having enough investigative staff which increased the older cases has been an issue since she became a board member. Inspector General McCotter stated with hiring experienced investigative staff it has a positive outcome on the OIG.
Inspector General McCotter reported on the type of cases and the facilities increase of completed cases over the last fiscal year:
Facilities Cases: FY15 - 923 cases (vs) FY16 966 cases; CILA cases: FY15 - 1,924 cases (vs) FY16 1,946 cases.
Thane Dykstra asked if the new investigative format is saving time on investigations. Inspector General McCotter stated yes it does save time especially on cases that are a repeat offender. Chairperson Keegan asked if the repeat offenders/cases can be linked in order to track a pattern. Inspector General McCotter stated that the OIG Bureau of Intake track the cases by type. Deputy Inspector General Diggins reported in such circumstances of a repeat allegation, the facility/agency is contacted to verify whether or not it is a legitimate allegation, to inform them of such situations, and to inquire if they can assist with such issues that don't give rights to abuse or neglect. There is a full investigation completed on all allegations made. Thane Dykstra inquired if there is a certain way to identify staff members who repeatedly report allegations. Deputy Inspector General Diggins stated it depends upon the allegations being reported. Occasionally in community agencies OIG receives repeated allegations and a full investigation pursues. However, if OIG recognizes a criminal aspect of making false allegations, the OIG has the ability to refer to the States Attorney for a possible misdemeanor charge. Proving false allegations is very difficult and the States Attorney does not accept many referrals with such allegations. The OIG does not receive a lot of repeat allegations from staff. Occasionally during certain circumstances a few repeated allegations are received from the same staff. Thane Dykstra stated from an agency perspective, they keep their own database of individuals and staff members involved in each allegation that is made to the OIG. Inquired if OIG keeps a similar database. Deputy Inspector General Diggins stated at this time the OIG does not keep anything formally. He stated each Bureau is knowledgeable of their assigned jurisdiction. If they see a staff member regularly accused, they will bring it to the bureau chief's attention. Each case stands alone. In such scenarios the investigators are aware when conducting an interview and a different approach is utilized. The OIG may inform an agency of a critical finding. The OIG has full investigative staff at this point and the next possibility is to hire additional administrative staff to perform trend analysis (i.e., focusing on repeated names, locations, types of allegations, etc.).
Thane Dykstra commented on the cases he reviewed. He noticed common trends of relation to medication, physical care and inadequate supervision (dominant allegations); especially when individuals having behavioral add-ons and that person was not present. Deputy Inspector General Diggins stated the OIG has noticed the same trends. OIG has communicated these findings/trends with the division especially Developmental Disabilities (division over CILA'S). If the case has a recommendation or a substantiated finding, Developmental Disabilities receive a copy of the report. They are responsible for following up on written responses. The same trends are seen through the OIG reports.
Inspector General McCotter stated the OIG's responsibility is to make recommendations and it is up to the Division to follow up on the OIG recommendations. OIG has been inundated with case reports and trying to keep from falling behind which has made it difficult. However, with the additional staff and the caseloads being distributed among all investigators the OIG has the opportunity to focus on trends etc. The OIG met with the Developmental Disabilities Division in regards to analysis and spotting of trends. The goal is to have something in place within the upcoming year.
Thane Dykstra stated both the mental health centers and developmental disabilities division has a formal mechanism for learning or communicating with community providers. There was a bulletin a couple of months ago regarding choking prevention and best practices related to choking. Inquired as to whether this was a result of the OIG providing feedback based on trends OIG noticed. Deputy Inspector General Diggins reported it was due to a referral from the OIG.
Chairperson Keegan stated she is pleased to see that trends spotting are being looked into and it is something she would recommend. She inquired as to whether or not the OIG receives a formal report of follow through (based on OIG recommendations) from the Division of Developmental Disabilities.
Deputy Inspector General Diggins reported the formal procedure is as follows: A finding of substantiated or any recommendations by OIG, there is a written response generated and sent to the agency. The agency receives the form and they have to come up with a plan of correction for that recommendation. After completing their plan they send to the appropriate division (Mental Health or Developmental Disabilities) who will complete the follow-up to ensure it meets the standards for the specific site. Once the division approves the plan of correction, the OIG receives a copy. The Bureau Chief will review the plan. If he/she notices an issue with the written response not being appropriate per the OIG recommendations, it is red flagged and sent back to division for further follow-up. Bureau of Compliance and Evaluation per Rule 50 are required to complete a random sample (10%) of cases with written responses on a quarterly basis. The Bureau currently does a random sample of 15%. The Bureau will directly contact facilities and/or agencies to ensure the written response is complete and that the OIG receives the paperwork verifying the training, written responses and actions taken were actually completed.
Chairperson Keegan inquired about the status of the Rule 50 revisions. Deputy Inspector General Diggins reported the revisions are not complete. There will not be a substantial change to Rule 50; basically doing "clean-up" (i.e. the community agencies no longer take primary responsibility on non-registry cases). Chairperson Keegan requested a copy of the revised Rule 50 once it is complete. Deputy Inspector General Diggins stated once they are complete and approved the board will receive a copy.
Chairperson Keegan would like to amend the agenda to state Inspector General Report instead of Directors report, as she had originally put on the draft agenda. The agenda was amended accordingly.
TRAINING
Thane Dykstra reported he attended one of the days during the 2nd week of the ISI training and the trainer did an outstanding job. Chairperson Keegan requested to be notified of the next scheduled training; she would like all members to attend one before the end of the year. Deputy Inspector General Diggins stated the training is scheduled for new employees and as of today, training has not been scheduled. The board will be made aware of the next scheduled training. Chairperson Keegan appreciated the information. Thane Dykstra will try to attend a different day during the two week training session.
Thane Dykstra inquired about providers training staff on Rule 50. Deputy Inspector General Diggins stated information was gathered from agencies in Southern Illinois to analyze their Rule 50 training process. Thane Dykstra is interested in how the data is analyzed and with the trends and/or concerns the OIG may have from the data received. Deputy Inspector General Diggins stated the report should be complete within the next few months.
BOARD MEMBERS APPOINTMENTS
Chairperson Keegan had an appointment with Ed Murphy of the Governor's office. He oversees board appointments. She expressed concern regarding board membership: three board members short and having only four members serving on the board makes it difficult to always meet a quorum during board meetings. Without a full board it is difficult to adequately have complete and thorough oversight. She is trying to reschedule the meeting
OUTSTANDING ISSUES
Chairperson Keegan inquired about the board's involvement with DHS Death Review Committee. Inspector General McCotter stated currently OIG representation (Lois McCarthy/OIG Legal Liaison) is on the Death Review Committee. Lois McCarthy's term will end and at that time the OIG representative will be Deputy Inspector General Diggins. Inspector General McCotter will have Lois McCarthy to keep the board informed about the possibility of their involvement on the committee. Chairperson Keegan believes it is imperative for a board member to be involved with the death review committee. Thane Dykstra stated the reports of cases resulting in death have been included in the cases sent to the board for their review. Deputy Inspector General Diggins emphasized that when the reports are complete, they are sent out monthly to the board members for their review. Chairperson Keegan requested for OIG to ensure the investigative reports from those cases are included. Deputy Inspector General Diggins stated he will ensure the board continues to receive the reports on a monthly basis.
Chairperson Keegan requested to receive a courtesy email to their personal email addresses, making them aware of new email on the state.illinois.gov account. She reported that the board members have had several issues getting into the State of Illinois email system. She questioned why reports and Quality Care Board information has to go through the State of Illinois server instead of sent to their personal email accounts. Deputy Inspector General Diggins stated the purpose for using the State of Illinois email account is due to an encryption rule. The encryption rule does not allow email through an unsecured account. Thane Dykstra prefers a courtesy email to boards personal email accounts alerting they have an email in their State of Illinois account. Deputy Inspector General Diggins stated the case reports are usually sent out on the 5th of every month and a courtesy email will be sent.
Thane Dykstra inquired about the name he submitted for a possible board candidate. Chairperson Keegan stated according to statute there needs to be representation of a person with a disability or a family member, parent of a child with a disability or someone in a facility (will review the statute to pinpoint the specific vacancies on the board). She submitted the names received and has not heard anything about the appointments. Requested for referrals of possible candidates be submitted to her.
Chairperson Keegan would like for the DHS website to list the board members, appointment specifics (i.e. county, terms etc.); would like to see it all broken down by member. Currently the only current member of the board is Neil Posner. Inspector General McCotter stated he will have Mark Kraus take a look into this. Deputy Inspector General Diggins reiterated the OIG does not have control of the contents on the DHS website.
INVESTIGATIONS
Chairperson Keegan asked if there were any general questions regarding the cases they received to review.
Thane Dykstra commented on the trends and the process of sharing the information with Developmental Disability Division to ensure awareness of trends in a community. The prominent thing he noticed was the lack of supervision; especially for people that are funded with the behavioral add-ons. Community providers are short staffed and he doesn't disagree with OIG findings, just believes this is a concern and Developmental Disabilities Division needs to be made aware there is a trend related to staffing and supervision from a nonbiased 3rd party. Deputy Inspector General Diggins stated this issue has been raised. A case with different types of funding and types of supervision are brought to their attention. If the OIG has case specific questions, George Bengall is contacted. The Developmental Disabilities Division receives all cases with a finding of being substantiated and/or has recommendations. If an issue is seen or a trend is recognized on a house or individual with their supervision, a call will be made to the Bureau of Quality Management. The Bureau of Quality Management has the ability to push funding or get a SST team involved. A SST team is a special team that helps agencies with behaviors. Overall trends analysis but if specific issues are seen that requires immediate response, OIG will report it.
Thane Dykstra commended OIG for making recommendations that agencies specify in the ISP the specific hours the add-ons will likely occur. An add-on is not generally for every shift 24 hours day.
Chairperson Keegan inquired as to who makes the determination on cases whether or not it has been determined substantiated. Inspector General McCotter reported there is a chain of command and ultimately ends with the Inspector General. Each investigator within each bureau makes a determination based on preponderance of evidence and totality of circumstances that results in the finding. Findings go through a second and/or third level review before reaching the Inspector General. Deputy Inspector General Diggins reported the process of case review: cases with a finding of unfounded or unsubstantiated the Bureau Chief can approve; if the finding is substantiated and not registry reportable (i.e., mental abuse, simple neglect) the Deputy Inspector General can approve; and anything registry reportable the Inspector General approves and has final review of those cases. Chairperson Keegan asked if this was codified. Deputy Inspector General Diggins stated this is found in the OIG's directives. Deputy Inspector General Diggins and Inspector General McCotter stated the directives are currently being updated. Chairperson Keegan requested a copy of the revised directives. Deputy Inspector General stated once they are complete, reviewed and approved by Inspector General McCotter a copy will be distributed to the board members. The target completion date for the revised directives is the end of October. Chairperson Keegan believes the directives will assist during the case reviews.
Deputy Inspector General Diggins explained the case investigation process. The investigator looks at the definitions and rule when figuring out the preponderance of a case. The training on writing an analysis of a report is focused on the definitions. The definitions are referred to as the elements within (the various components you have to prove that are present). It is driven by whether or not the evidence supports the elements within a given definition.
Deputy Inspector General Diggins welcomed any specific questions from the members regarding a case. Chairperson Keegan stated if such questions arise, they need to include the board as a whole and be addressed formally at a board meeting. Deputy Inspector General Diggins reiterated the fact of only generality of cases can be discussed in a public meeting; not specific information.
STATUS OF OUTSTANDING FOIA REQUESTS
Chairperson Keegan stated she received additional FOIA information today and wondered why it was received. Inspector General McCotter stated the additional information was sent today to fulfill the request for all FOIA's being sent to the board members. The FOIA responses are up to date. Chairperson Keegan pleased to hear this and to please let the board know if anything is from them.
NEXT MEETING
Next scheduled meeting is December 8, 2016, at 2:00 p.m.
ADJOURNMENT
Chairperson Keegan asked for a motion to adjourn. Motion to Adjourn - Thane Dykstra Motion Seconded - Untress Quinn All in Favor Motion Carried Meeting Adjourned - 4:08 p.m.
