July 21, 2016 - Quality Care Board Meeting

July 21, 2016

2:00 P.M.

Teleconference

Recorded

PRESENT: Susan Keegan, Chairperson; Michael McCotter, Inspector General; William Diggins, Deputy Inspector General; Thane Dykstra; Neil Posner; Untress Quinn; Lois McCarthy, OIG Legal; Megan Powers DHS Communications; Pamela Oller

CALLED TO ORDER:

* Quality Care Board meeting was called to order at 2:00 p.m. with a quorum.

APPROVAL OF MINUTES

* Chairperson Keegan asked for a motion to approve the provisionally approved minutes of February 16, 2016.

Motion to approve the provisionally approved February 16, 2016, minutes - Neil Posner

Motion Seconded - Untress Quinn

All in Favor

Motion carried to approve the provisionally approved February 16, 2016 minutes

* Chairperson Keegan asked for a motion to ratify the provisionally approved minutes from September 2015 and February 2016.

Motion to ratify the provisionally approved minutes from September 2015 and February 2016- Neil Posner

Motion Seconded - Untress Quinn

All in Favor

Motion carried to ratify the provisionally approved minutes from September 2015 and February 2016.

* Minutes of April 14, 2016, meeting discussed. Chairperson Keegan asked for a motion to approve the April 14, 2016, minutes as drafted.

Motion to approve April 14, 2016, minutes as drafted - Neil Posner

Motion Seconded - Thane Dykstra

All in Favor

Motion Carried to approve April 14, 2016, minutes as drafted

* All minutes have been approved.

INSPECTOR GENERAL REPORT

Michael McCotter, Inspector General reported:

Audio recorder purchased and the meeting today is audio recorded.
Office of the Inspector General (OIG) staff: The current headcount is sixty-two employees. One year ago the OIG had eighteen Internal Security Investigators. As of today OIG has thirty-one Internal Security Investigators. August 2016 there will be two Internal Security Investigators hired. Promoted two Internal Security Investigators to Investigative Team Leader.
With the additional Internal Security Investigators the OIG has gained a good momentum on the caseload; due to having more investigators to complete the work.
New Employee Training: Training schedule for new employees consists of three weeks of training (first week being in classroom, second week in the field, and third week return to classroom). Training is open for board members to attend. The next training session will begin August 22, 2016, at Madden Mental Health Center. Training materials will be sent to the board members.
AFSCME (state employee union) is possibly moving toward a work stoppage with a rumored effective date of September 1, 2016.; the OIG is planning for this possible stoppage

William Diggins, Deputy Inspector General reported:

The hired staff consists of ten new staff and the remaining hires replaced those that retired.
With additional staff it has reduced the backlog of old cases by 33%. When additional staff is hired the reduction in backlog cases will reduce further by the end of year.
In FY16 - OIG received over 3500 allegations and completed 3556 investigations; once OIG is fully staffed with investigators there is the potential of being able to complete investigations as they are received.
Neil Posner inquired about expressing it in the number of days between when an allegation is made and the number of days it took to complete an investigation both before and now since backlog has been reduced by 33% . Deputy Inspector General Diggins responded OIG does not have an average number of days for a completion rate. Feels this number would not decrease even with a reduction of the backlog due to there being a large number of older cases. As far as the timeliness of a case investigation from start to completion, it will more than likely take at least a year or so to reduce the overall timeliness.
Neil Posner inquired about the strategy being used to complete cases, whether it is based on severity, receipt date, alleged harm, etc. Deputy Inspector General Diggins reported the strategy being used right now is the new cases are being handled by the new staff and the older cases are being handled by the experienced staff. The strategy for case completion is based on the following criteria: severity of allegation, substantiated, etc. There are multiple levels of cases in triage with the ultimate goal being to complete them in a timely manner. This has been the practice of the OIG and when fully staffed the cases have a steady flow.
Chairperson Keegan inquired whether or not some of the older cases have been delayed due to being an investigation that involves law enforcement. Deputy Inspector General Diggins responded yes that is the situation. The OIG cannot complete their investigation until after the law enforcement cases are complete. Chairperson Keegan inquired as to the purpose of the OIG putting a hold on those specific investigations. Deputy Inspector General Diggins reported this practice is in accordance to the Directives, in the Executive Order regarding State Police, and in the interagency agreement; this is carried over with local law enforcement. The OIG will ask law enforcement if a concurrent investigation can be done; when law enforcement states it cannot be done the OIG ceases its investigation until law enforcement has completed their investigation.
Neil Posner requested that copies of interagency agreements held by the OIG be distributed to the board.
Neil Posner inquired about the reason the OIG steps aside is due to the statute and rule regarding duplicity and redundancy, is this part of the process of when OIG has to step aside and let law enforcement take the lead. Deputy Inspector General Diggins reported partially due to that but mostly the rule and regulations pertain to other administrative investigations (i.e. DCFS or DPH). Criminal and administrative are separate and they are kept distinct. Due to different levels of evidence and different rights and responsibilities the accused may have the OIG stands back so law enforcement can investigate first due to the possibility of leading to criminal charges and a criminal trial. OIG stands back to avoid inhibiting any possible criminal charges that may come out. Neil Posner inquired if the other agency is not a law enforcement agency but an administrative agency, what is the deciding factor of who proceeds with an investigation first. Deputy Inspector General Diggins stated the OIG has not experienced such scenarios due to the fact the jurisdictions are so distinct. Most of the investigations that cross over jurisdictions are criminal and OIG will refer information to law enforcement due to the nature of the incident.

CURRENT FOIA REQUESTS AND RESPONSES

* Chairperson Keegan requested copies of all FOIA requests and responses. Neil Posner reported they were received yesterday. Chairperson Keegan inquired if it was possible to receive the FOIA requests when the OIG receives them for the purpose of keeping the board members aware and up-to-date. Inspector General McCotter reported that legal will be adhering by her request beginning today forward. Thane Dykstra stated he has not seen the FOIA, as of yet. Untress Quinn stated with the large amount of documents the board received yesterday, he reiterated the importance of receiving them within a timely manner. IG McCotter reported this is a unique situation with the Tribune's FOIA. Also, from this point forward the FOIA officer will be sending all FOIA's received regarding the Quality Care Board to the members of the board as soon as they are received.

Lois McCarthy, OIG Legal, reported there will be a lot of FOIA's requesting reports, etc. Chairperson Keegan requested to see those FOIA's and reports and all serious reports involving death and/or serious injury. As the oversight of the OIG would like to ensure everything is complete, the purpose of the allegation and to make recommendations to the OIG in order to prevent repeated incidents.

* Neil Posner stated the jurisdiction of OIG is clear. However, to keep in mind that the board's oversight is to possibly make changes to statute and rule making. The more the board understands about the processes it would improve the board's role. Chairperson Keegan would like this to be one of the board's objectives; believes that purpose of the Quality Care Board was to have the ability to make changes to the statute and rules. Neil Posner believes this falls within their scope of duties to ensure the OIG improves their job and to make recommendations that would in turn have an impact on an agency wide level, reducing the bad outcomes.

Deputy Inspector General Diggins asked for clarity on whether they are referring to making changes to rules and legislation beyond Rule 50; DHS rules. The statute prohibits the OIG from making licensure and/or recommendations in such areas. Lois McCarthy agreed with Deputy Inspector General Diggins.

Neil Posner agreed. However believes it would give the board a better understanding of what is going on in the outside world and within OIG. He was expressing an insight on the type of thinking from a board members perspective and in addition to what is in the statute.

Chairperson Keegan stated with the QCB meeting requirements of only four meetings a year, she would like to be up-to-date with reports and serious cases that would involve both death and/or neglect throughout the year; whether or not recommendations had been made from the OIG on such cases. This would assist the board in completing the tasks they are appointed to complete.

Lois McCarthy stated she is part of a death review committee that is shared by DHS. The name of the committee is Brian's Law. Every death that is reported to DHS is reviewed by this committee. They meet quarterly and the committee consists of doctors, nurses, among other individuals with expertise in this field. The cases are reviewed very closely with a goal to review all of the death reports received by the committee.

Chairperson Keegan stated the intent is to not duplicate any services. However, inquired as to whether or not the board members can be a part of this group due to the fact of their role as overseeing the OIG. Untress Quinn agreed with Chairperson Keegan.

Lois McCarthy stated the meeting is not open to the public. The minutes are not accessible by FOIA. The goal of this committee is prevention and identifying system wide issues that possibly contributed to the negative happening; they have authority to make recommendations to the Secretary and issuance of a subpoena.

Chairperson Keegan stated neither she nor Neil Posner was aware such a committee existed. Lois McCarthy gave the Public Act/Statute number: Brian's Law Public Act 0961235; 405ILCS82

Chairperson Keegan suggested the possibility of the board being involved with this committee as a representative of OIG. Lois McCarthy stated that Section 16 of Brian's Law specifically states the membership of the committee and in order for the QCB members to participate it would require an amendment to the Act. Chairperson Keegan inquired about the rule making of the Act; Lois McCarthy stated to her knowledge there is not rule making. Chairperson Keegan stated possibly the Secretary of DHS will allow their participation.

* In regards to the Tribune FOIA and the article that will run in the Chicago Tribune; Megan Powers stated her supervisor, Marianne Manko (DHS Public Information Officer), has been involved in the discussions with the Chicago Tribune.

Inspector General McCotter reported Marianne Manko is handling the response and planning an interview with himself and Mr. Behrens. Mr. Behrens has reached out to Neil Posner and Untress Quinn. Untress Quinn stated he did not return the call. Inspector General believes the Chicago Tribune is looking at the entire program; State operated facilities vs CILA's.

CONSIDER RECOMMENDATION TO CONFORM ALL INVESTIGATION REPORTING INCLUDING DISABILITY REPORTS IN THE DHS ANNUAL REPORT

* Chairperson Keegan inquired as to whether or not the OIG reports can be conformed with Disability Determination Services (DDS) reports. Inspector General McCotter reported the OIG and DDS report their numbers differently. The OIG reports exact (raw) numbers. DDS reports are filtered which doesn't result in same (raw) numbers as the OIG. Therefore, both OIG and DDS numbers were sent to the Tribune. DDS is having a meeting next week to go through their reporting of data.

Lois McCarthy stated the OIG's numbers are higher than DDS' numbers due to the fact of the way each agency reports. Deputy Inspector General Diggins reported the OIG's numbers have not been questioned due to the fact of being solid and the type of database utilized for such reports. The OIG reports are not filtered by specific criteria.

Chairperson Keegan would like each agency to use the same reporting system. Deputy Inspector General Diggins reported the OIG and DDS are working together on way to conform the reporting by each agency.

Thane Dykstra pointed out there is a website that will list each vendor and their numbers.

Inspector General McCotter reiterated that DDS is currently working on their reporting system. Chairperson Keegan would like to add the outcome of the meeting regarding reporting to the agenda for September 2016 meeting.

REVIEW POLICY & INVESTIGATIVE PROCEDURES/INCLUDING CILA'S

Chairperson Keegan inquired about the rules regarding self-investigations done by the CILA's.
Deputy Inspector General Diggins reported that within the guidelines of Rule 50, OIG can assign cases to outside agencies that have approved investigative protocols. Protocols include agencies are in agreement to certain parameters to be part of the program. This includes excessive training by OIG to ensure there is no conflict of interest by staff involved. A contract existed with these agencies. During the time protocol was in place only 130 agencies out of 500 were a part of it. Over this period the OIG assigned approximately 2% of the investigations to community agencies. The types of cases referred to outside agencies were non-registry reportable (mental abuse or simple neglect etc.) the very simplest of cases. The OIG focused on the registry cases. The protocol process was ceased at the end of 2015 due to the fact that in FY15 there was 3534 investigations opened and 57 were assigned to CILA agencies. Sole purpose was to alleviate some of the workload to allow the OIG to focus on the more serious and neglect cases. It was not successful and the OIG ceased this process.
Per Rule 50 (50/30F) CILA is required to inform the OIG of an allegation within 4 hours of becoming aware of an incident. They are required to do basic health and safety checks to ensure the health and safety of individuals, basic documentation, etc., in order to initiate the investigation. Due to the fact the OIG cannot immediately respond to all cases. The OIG provides training on the process of initiating an investigation to these agencies. This process expedites the gathering of initial information. A referral of the allegation is sent to the OIG investigator and the OIG investigator will complete the investigation.
Lois McCarthy reported she is currently working on amending the language in Rule 50 regarding the primary responsibility and assignment of cases to agencies.
Deputy Inspector General stated the OIG does not assign primary responsibility of abuse and neglect cases to CILA's any further.
Chairperson Keegan inquired if the upcoming trend of people living in smaller facilities that are a home-like setting would require the OIG to increase investigative staff. Deputy Inspector General Diggins reported due to this trend it justifies the increase of investigative staff. With the closing of the larger facilities there has been an increase in the smaller CILA's statewide; resulting in an increase of community allegations which is the jurisdiction of the OIG. The CILA's need of care is expanding, resulting in complex investigations, and extended time of investigating such cases.
Neil Posner requested the board be made aware of when the change of Rule 50 is ready for publication and/or public comments. Lois McCarthy stated the OIG will make them aware.

REVIEW ADDITIONAL PHYSICAL ABUSE CASES

Chairperson Keegan stated her concern with this issue was the length of time it takes to complete an investigation. However, this has been corrected and wants the OIG to track the reason for lengthy investigations. Deputy Inspector General Diggins reported the OIG has a database that tracks such information, staff meetings are held monthly to discuss such matters and guidance of how to move the cases forward is provided to staff. The investigators are simultaneously working old and new cases.
Deputy Inspector General Diggins reported the office is amending OIG's directives for requirements of investigations, with a deadline of September. Chairperson Keegan requested a copy of the amended directives. Deputy Inspector General Diggings stated once they are complete and approved, he will provide a copy to the board.
Neil Posner inquired as to why some investigative reports are marked as amended. Deputy Inspector General Diggins stated when an investigative report is complete, it is sent out to the agency, redacted copy to the accused, and a letter is sent to the guardian and/or victim of the case. There is a 30 day window to file a reconsideration of the decision. Reconsideration requests are required to include information justifying the reconsideration request. Reconsideration requests received is reviewed by a committee. If the committee finds errors in the report, whether or not the reconsideration is granted and reinvestigated would result in an amended investigative report. Neil Posner inquired as to whether or not the Bureau Chief can list the reason for an amended report in their summary. Deputy Inspector General Diggins stated he would remind Bureau Chiefs to include this in their summaries. Also, reiterated how crucial it is to use the OIG database.
Inspector General McCotter and Deputy Inspector General stated they will work with OIG's IT person in setting up email (State of Illinois addresses) for the board. The purpose would be to prevent emailed cases from being compromised when sent to an email address outside of the State of Illinois server. Also, it would prevent the problems board members are experiencing when opening encrypted files.
Neil Posner inquired the reference of the assigned case numbers. Deputy Inspector General will send the logistics of the OIG case numbering system.
Chairperson Keegan requested for the board to receive all cases that have been closed whether substantiated and/or unsubstantiated with death or serious injury; would like to review and see how the decision was determined.
Chairperson Keegan inquired as to whether or not Brian's Law Committee reviews cases that do not result in death. Lois McCarthy stated it is a death committee for death cases within and outside of DHS. They do not review cases unrelated to death.

CURRENT BOARD COMPOSITION AND ISSUES

Chairperson Keegan reported the board is short three members. Inquired as to why the board member table is no longer available on the DHS website. Deputy Inspector General stated the DHS website is constructed outside of the OIG and does not have an explanation as to why the table is no longer available.
Inspector General McCotter went over the background criteria of an appointment to the board and this is listed on the website. Chairperson Keegan reported the current board comprises of three attorneys and an industry member. Thane Dykstra, Untress Quinn, and herself have expired terms and will continue to serve on the board until replaced. Neil Posner's term is current.

BOARD APPOINTMENTS - REPORT OF MEETING WITH GOVERNORS OFFICE

Chairperson Keegan had a scheduled meeting with Ed Murphy of the Governor's office to discuss board appointment on July 20, 2016. However, the meeting was cancelled because Ed Murphy was not present. Ed Murphy informed Chairperson Keegan the appointments for the board are difficult to fill. Chairperson Keegan will try to reschedule the meeting before the next Quality Care Board meeting in order to have an update regarding the appointments. Also, suggested if there are any interested individuals willing to serve on the board to refer to Ed Murphy (ed.murphy@illinois.gov). Chairperson Keegan addressed whether legal had anything to add.
Chairperson Keegan touched on the fact that there is an appointee in the industry and that could be a conflict of interest due to the fact the OIG oversees those individuals. Thane Dykstra stated as being part of the industry he should be excused from seeing cases from his agency due to conflict of interest. Untress Quinn was in agreement with Thane Dykstra and that he should not be involved with discussions in such cases. Chairperson Keegan reported that Thane Dykstra has always dismissed himself from the involvement of discussions as a board member on Trinity cases due to the conflict of interest. Thane Dykstra stated he has not been involved with any discussions of Trinity cases. Chairperson Keegan asked for any further suggestions.

Inspector General stated the OIG will check with the IT person about whether or not cases can be selectively sent to board members in order to prevent conflict of interest in such scenarios.

Chairperson Keegan asked Lois McCarthy, Legal staff, if she seen an issue with Thane Dykstra appointment to the board due to the fact of his position at Trinity. Lois McCarthy stated in listening to the discussion regarding the conflict of interest, she does not see an issue with Thane Dykstra being a board member. Especially if he is excusing himself from any discussion of substantiated cases from his agency she doesn't see an issue with his appointment. Neil Posner clarified Lois' opinion; specifically does not see an issue with Thane Dykstra being on the board. Lois McCarthy stated that is correct. However, Trinity receives OIG cases and Thane Dykstra more than likely reviews the cases within his agency. Thane Dykstra reported his position with Trinity is the Director of Human Health Program; he is one of seven residential directors. The vast majority of cases reviewed at Trinity he has no involvement with or any knowledge of them. The program Thane Dykstra works with has a total of approximately nine to eleven allegations being investigated by the OIG. Thane Dykstra excuses himself from case discussions that involve Trinity in order to avoid conflict of interest.

MISCELLANEOUS ISSUES/QUESTIONS

Chairperson Keegan the Quality Care Board meetings were previously audio recorded; Inspector General McCotter reported the meetings will resume to be recorded. Inspector General McCotter stated the previous Administrative Assistant Chris Milbrandt, audio recorded the minutes of the meeting in order to assist her with transcribing meeting minutes, and she retired in the Spring of 2015. The Administrative Assistant, Louise Branick resumed this responsibility until Chris Milbrandt's replacement was hired and was not sure if she audio recorded the minutes. Pamela Oller, Administrative Assistant was hired and began taking minutes of the meeting. At that time there was an issue with the audio recording device which is the reason the meetings were not audio recorded. Chairperson Keegan stated audio recording of the meetings is not required by the Open Meetings Act. However, specific issues such as personnel issues or discussion regarding specific cases she would close the meeting under the terms of the Open Meetings Act. The meetings will continue to be audio recorded and if audio recording is unavailable this will be made clear during the course of the meeting.
Chairperson Keegan Next meeting date - currently set for September 15, 2016. Originally thought of scheduling a meeting in October to follow the quarterly meeting requirement. However, with the content of today's meeting and the need for follow up on certain issues will resume with the meeting scheduled for September 15, 2016. All in agreement to resume with the meeting scheduled for September 15, 2016 at 2:00 p.m.
Chairperson Keegan would like to schedule a meeting in December and/or January. December 8, 2016, meeting date was discussed. December meeting scheduled for December 8, 2016, meeting at 2:00 p.m.
No further discussion.

ADJOURNMENT

* Chairperson asked for a motion to adjourn.

Motion to adjourn meeting - Neil Posner

Motion Seconded - Untress Quinn

All In Favor

Motion to adjourn carried

Meeting adjourned - 3:35 p.m.