April 30, 2013 - Quality Care Board Meeting


Open to the Public


Tuesday, April 30, 2013


1:00 - 3:00 pm



If you are interested in listening to this meeting, please call 217-786-6889


  1. Speaker:  Lois McCarthy
    1. Legislation - HB 0948 update (Adult Protective Services Bill)
  2. Quality Care Board's Role - "Oversight" reference update
    1. Letter to Governor's Office
    2. Letter modifying/clarifying language in the statute
  3. Reorganization of OIG Update
  4. Review of first five OIG directives (ADMIN) on the Table of Contents
  5. Discussion of physical abuse cases
  6. Approval of February 28, 2013's meeting minutes
  7. Miscellaneous Issues/Questions
    1. Next meeting is August 29, 2013 at 3:00 pm

Meeting Minutes

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

Absent: Untress Quinn

Robert Morgan, from the Governor's Office, provided Susan with a status update on HB 948. HB 948 will eliminate Rule 51 from OIG and put it over into Adult Protective Services (APS) without changing the duties of the Board. Lois indicated it is up for a Senate hearing this afternoon.

Susan also informed Mr. Morgan that we need additional members on the Board and he is going to look into the matter. Susan asked if anyone here has a suggestion, they should e-mail it to her for consideration.

1. Speaker: Lois McCarthy - Legislation - HB 948 (Adult Protective Services Bill) update

Replaced the primary bill - HAM 1 is the bill now. It is a 167-page bill (text language) Lois will touch on the highlights. Status of amendment: Passed out of the House April 19th; arrived in the Senate on the same day. Senator Haine sponsored the bill. He also had a companion bill, Bill 1164. This bill will not be going anywhere because this is the primary bill that everyone is working on. On April 24, 2013 it was assigned to the judiciary committee and that committee is scheduled for today at 3:00 p.m.

The first item the amendment discusses is that Illinois has a very decentralized investigatory system. It was interesting to me because I was the chairperson for House Resolution 201 and that was the premise behind the work we did on the committee. We submitted a report to the Governor and the legislature in March 2011 with 13 recommendations. The very first recommendation was to create a centralized reporting system in Illinois. Nothing was done with those recommendations until now. It creates an exploratory committee for a statewide, centralized hotline for the Department on Aging as the lead agency for convening the committee with DHS and DPH to determine how a centralized hotline will function and what types of funding, staffing and training are needed to support this operation. Currently, Aging does not have an abuse and neglect hotline. From House Resolution 201, during the day time, Aging's regular staff take abuse and neglect calls. On off-hours, sister agencies take the abuse and neglect calls. With regard to this part of the amendment, a committee report is required within six months after the effective date of this Act. They want findings and recommendations, including a budget proposal on how to implement a centralized hotline for the state.

There are many acts that are amended in this bill. I will focus mainly on the Elder Abuse and Neglect Act because they are the heart of the bill. It repealed DHS'/OIG's Statute, 20ILCS2435, Abuse of Adults with Disabilities Prevention Act on July 1st of this year, the Open Meetings Act, FOIA, State Employee Indemnification Act, and various banking laws. We had already amended a lot of those to allow us to get banking records. Aging will be able to get the information they need.

They are amending the DHS Act, Section 1 - 17 which is the OIG Enabling Act section. The Illinois Police Training Act adds training to police officers in the new APS. They amended the Home Health, Home Services, and Home Nursing Agency Licensure Acts; the Clinical Social Worker and Social Worker Practice Act. If a mandated reporter fails to report they can sanction them. I think there is something in those amendments about a professional who might be accused of abuse or neglect and have a substantiated finding. The Respiratory Care Practice Act, same kind of thing. In addition, the Professional Counselor and Clinical Act; Professional Counseling Licensing and Practice Act.

Also amending the Code of Criminal Procedure of 1963 and the Code of Civil Procedure; Probate Act of 1975 of which they are amending it to include APS. Criminal procedure, they are amending for admissibility of evidence and hearsay exceptions for the victim which is similar to OIG's current statute which we have a hearsay exception for our victims.

In the Department on Aging Act itself, there is not that much that changes except it expands the jurisdiction to Aging to receive and disburse state and federal funds for providing adult protective services in domestic living situations in accordance with the APS Act.

The Elder Abuse and Neglect Act is the heart of it. It changes the title of Elder Abuse to Adult Protective Services (APS) Act. Section 21. It starts on the very bottom of page 106 in the bill text. 320ILCS20 Elder Abuse and Neglect Act.

It also amends the definition section to include additional definitions relevant to the new duties and responsibilities for domestic abuse allegations, burden of proof for substantiated allegations as reason to believe which is what OIG has been using. Responsibility section requires Aging to establish, design and manage a protective services program for eligible adults which now will include adults with disabilities, rather than just elderly regarding allegations of abuse and neglect, financial exploitation, and self-neglect.

Also requires Aging to establish contracts with regional administrative agencies, provider agencies, or both for the provision of the new responsibilities under the APS.

Question: That is sort of the key to this, isn't it? That this is being out-sourced to private agencies as opposed to the OIG office?

Response: Correct. My understanding is private agencies will be conducting the investigations and assessments. I believe they have 41 provider agencies throughout the state.

Question: Does the bill talk about the current investigators and where they will be?

Response: No. I believe that will be in the rules that will be promulgated. It really doesn't talk about the investigators. It just says it is going to go to the provider agencies. It may be a question that can only be answered later.

It also requires Aging to establish by rule standards for minimum staffing levels and staff qualifications, and shall establish mandatory standards for investigations of abuse and neglect, financial exploitation, or self neglect of eligible adults, as well as mandatory procedures for linking eligible adults for services and support. That is, in some ways, similar to OIG's statute which requires us to promulgate rules to establish minimum standards.

In accordance with these rules that are going to be promulgated by Aging, provider agencies themselves shall establish a multi-disciplinary team to act in an advisory role to provide professional knowledge and expertise in handling complex abuse cases involving eligible adults.

Statement: This isn't going to be in the Department of Aging. It is going to be in the provider agencies. Response: It says the provider agency shall establish these multi-disciplinary teams. Correct. I am sure Aging will be involved in it. I think there may be someone from DHS, Aging and HFS and a lot of these agencies will still be involved as the process goes on.

When a provider agency has reason to believe that the death of an eligible adult may be the result of abuse or neglect, the agency shall immediately report the matter to the respective law enforcement agency, and the coroner, or medical examiner and follow-up. They have the same language in the bill as the Governor's Executive Order.

Section 3.5 is Other Responsibilities. The language says contingent upon adequate funding, the Department of Aging shall, within three months of the effective date of this amendment to react, which is July 1, 2013, expand the following activities to adults with disabilities: Prevention of abuse and neglect through promotion of public and professional awareness. OIG did public speaking engagements so that people were aware of the program.

Establish access to and use of the Health Care Worker Registry. However, that portion of the bill is somewhat confusing. They are going to be setting up a work group to work on that as it is not in final language yet. They are also supposed to coordinate efforts with other agencies and councils. For example: Administrative Office of the Illinois Courts, AG's Office, HFS, DHS, Guardianship and Advocacy Office, anybody who can help. They are also to collect and analyze data. Remember this is all contingent upon funding.

Question: Is funding an issue?

Response: When that is in a bill language, I always assume funding is in question. When they make something contingent upon funding, it could be an issue.

Part of these additional responsibilities is to establish an aggressive training program regarding eligible adults with various state agencies, councils, Equip for Equality, etc. They are supposed to solicit financial institutions for the purpose of making information available to the general public warning about financial exploitation of eligible adults. Get the banks more aware of what they should be looking for. Also develop, by joint rule making with Professional Regulations, minimum training standards which shall be used by financial institutions for their current and new employees with direct customer contact and other duties by Professional Regulations in this area. This is also contingent upon funding.

Section 4, page 121 of the bill text, page 91 of printed version discusses reporting. It defines mandated reporters. This is very different than OIG's statute. We did not have any mandated reporters in that statute. They are basically all professional employees such as nurses, social workers, etc. They are to report to the designated agency within 24 hours if they have a suspicion of abuse or neglect.

Observation: This is confusing to me. Who is the designated agency? That is really why we need to have a centralized hotline in this state. I am not sure how they are going to publish their hotline. If I am in Sangamon County and witness someone being abused, who is the designated agency? At some point, if they do establish a hotline, I hope they amend their rule and put the hotline number in the rule. That would be the easiest way to make sure everything is reported. The reporting language will likely change if they do establish a centralized hotline.

Section 5 is procedure. Agencies who receive the report. It starts on page 125 of the text language. Provider agencies designated to receive reports shall conduct a face-to-face assessment. It is identical to our statute. It tells what they do when they get the report. It looks like what we do with a report currently. As you will see, the language in Subsection A states in the absence of sufficient appropriations received by the implementation of assessment, casework and follow-up of reports of self-neglect, the designated adult protective services provider agency shall refer all reports of self-neglect to the appropriate agency or agencies as designated by the department for any follow-up.

Section 7.1 talks about the final investigative report. OIG completes reports on every case we do. They are changing that. The provider agency will complete a report when there is a substantiated finding. It appears they are not going to be writing reports unless it is substantiated. That means for unsubstantiated/unfounded cases, there will be no report. It acts like a final determination. They are making it the final procedure determination. Equip for Equality looks at all of our reports. Susan and Lois both think there is a problem with this. Susan will call the Governor's Office about this. Section 7.1 is flagged.

Section 7.5 - Health Care Worker Registry. I am very involved with the registry cases. Lois works with Legal on these cases and preps the witnesses. Under HR201, Aging does not have any registry involvement. It does not appear to be final yet. They have nothing set up for reporting to the registry. There will now be a legal procedure. Within six months of the effective date of this Act, it requires Aging to convene and lead a committee together with DPH and DHS to develop access, use and possible expansion of the registry for reporting substantiated cases of eligible adults to the registry. I don't think they mean for reporting eligible adults. I think they mean people that abuse will go to the registry. The committee shall issue a report to the Governor and legislature with its findings and recommendations within 12 months of the effective date of the facts. You will see it is way delayed. The suggested date it would start would be a year. They have 12 months to get the report out.

Reporting to the registry, there are two standards: (1) paid caregivers funded by the state; (2) volunteers and privately paid caregivers. The state-funded caregivers would go to the registry for a verified and substantiated case finding.

For unpaid caregivers or private caregivers, their standard for reporting to the registry is "verified and substantiated decision of significant abuse, neglect or financial exploitation."

Section 7.5, subsection A.1, page 128 of the bill language - If you are on the registry and you want to provide direct care that is state funded, you can't. It precludes any caregiver from providing services anywhere that is licensed, certified or regulated by DPH, HFS, DHS or Aging. It is silent on the caregiver not being paid by the state or privately paid. Lois did some research and found that 10% of the accused in our investigations were caregivers paid by the state. A full 90% of the accused were unpaid or privately paid caregivers.

If someone were thinking of hiring someone to come into their home to care for their relative, they could go on this registry to see if this individual is on there. Most of these people are family members. In cases of very severe neglect, most of the time it is people who cannot handle the situation. There was no intent to harm. We would refer the accused person to one of our divisions who would go in there and help the person. We kept the family intact. Sometimes that is what is needed. Not putting that person on the registry. Family members are often the worst abusers psychologically. They get the property and everything turned over to them. Before you know it, the victim ends up on the street and is not getting anything they need. Susan stated that 80% of their cases fall in this category.

Access to and use of the registry, page 129 - they are restricting it. Its use is limited to certified providers of DPH, HFS, DHS and Aging. It requires registered checks before the state hires a person, including volunteers and subcontractors. Currently the registry is a public registry. Anybody can plug in a name and look someone up. I believe I have heard that they will not preclude Joe from trying to check someone they want to hire as a babysitter, but they will have to complete a form stating why they want to do this check. Not completely sure. I have also heard rumor that they may have two registries - 1 public (state-funded substantiated findings), 1 private (volunteers, privately paid). It is not clear. They have 12 months to work on it. Some of the language for registry placement was almost lifted from the DHS Act. Notice to the Employer, Notice to the Victim, report challenges and registry hearings.

Report challenges and registry hearings - It is similar to OIG's process in that accused people can submit a request for reconsideration to this office and ask that we reverse the findings. If we don't , they can appeal and petition for a 50.90 hearing to contest their name being put on the registry. It sounds like they are going to do something similar to this. They will have a chance to contest it with the department first. If it didn't work, they can request a registry hearing.

They also talk about removal petitions. In our system, you can keep petitioning for removal from the registry once a year for as long as your name remains on the registry. They are saying that the petition for removal can be done, but not more than once for every three-year period.

The burden for removal is on the caregiver/petitioner. However, it is a preponderance of the evidence. It also requires Aging to promulgate rules establishing standards for removal. That could be an issue. Reason to believe is the standard for substantiating a case. They are ratcheting it up to preponderance for removal. You can't have two different standards.

Question: Have you talked to anybody about the issues that you are raising here?

Response: I wrote a position paper that was submitted to DHS. Yes, I did. The two different standards are in the definitions. They define substantiated finding as reason to believe.

Question:Ed asked Lois if this was her role with the OIG or if she worked a lot with legislative affairs.

Response: I am OIG's legislative liaison. I review all of the bills. I have successfully initiated 24 bills that passed into law for this office in the last ten years.

Ed stated that some of the concerns brought up in the meeting last February was that a lot of this is an unfunded mandate and I see that hasn't changed. Lois responded that OIG's statute was completely unfunded. Here they make certain duties and responsibilities contingent upon appropriations. That is different from when we got it. We just took the program and ran with it.

Lois mentioned that there is also another bill she read. She believes it is Senate Bill 1191, where Aging proposes that they will be able to charge fees for their training. She thinks they are trying to think of ways to generate funding.

Ed also stated that was another issue. It appears that the OIG would be on the block in order to train. It appears that it is also increasing the private agencies' role totally in allegations of abuse. Lois was in agreement. It will be done by the provider agencies who are on contract. These are contract workers. They are not state employees.

Ed feels that is a huge concern, just speaking for himself. If their intention is to fix the program, it is a step in the wrong direction. Susan stated that they are privatizing it.

Section 8 - Access to Records - Exceptions to getting the reports. Includes all entities in DHS/OIG's current Statute 20ILCS2435 - It additionally includes the following: For self-neglect cases, they will give the report to the guardian ad litem, if there is one, and also Professional Regulations and members of the Illinois Medical Disciplinary Board, or the Social Worker Examining Disciplinary Board can get the reports or other licensing bodies at the discretion of Aging. HFS can get it when funding the service and same for DHS. Hearing officers presiding over registry cases should get copies of the records. Also Guardianship and Advocacy Services which we have worked with very closely.

Susan stated in the section stating that hearing officers are charged with conducting hearings to determine substantiated findings of significant abuse and they are not even reporting those cases where the agency didn't find significant abuse. Lois added, right, according to this there won't be any reports for those cases anyway.

Question: So what are we talking about here? In other words, they have already called it and so are we just going to go through those called reports and get the administrative hearing officer who is either going to agree or disagree with the provider who already made the cut?

Response:That part is similar to our system where we make a substantiated finding against someone and it is a registry reported case and if the employee does not prevail at the reconsideration level then they can petition, as most of them do except for the sexual abuse cases, then they go to a hearing and at that hearing level there is express language that states the sole purpose of the 50.90 hearing is to determine whether the abuse or neglect warrants being reported to the registry.

It does not overturn the finding. I am not sure how it is going to work in this system. For us, the hearings are intertwined whether that person goes to the registry or not. Not at all whether that finding is upheld. That physical abuse finding will remain in our database whether or not that person goes to the registry.

DIG Furniss explained that at the beginning they didn't understand that someone would be barred from employment forever. At first, they thought it was punitive, but they are beginning to understand it better. One of the things we think will come up during the physical abuse discussion is that anytime you start handling certain cases, you run into problems. You run into problems with standards of proof, what the results are in terms of registry placement, all kinds of things. They are beginning to realize that there is going to be an explosion of potential appeals in these cases. There are a lot of private citizens in the situations described that are not terrible abusers. There are going to be lawsuits.

Section 9 - Consent to services - it is still required unless the eligible adult "reasonably appears" to lack the capacity to consent to an assessment or to necessary services then Aging, or another agency, or another agency shall notify GAC, the Office of the State Guardian, or another appropriate agency of the need for a temporary guardian as noted in the Probate Act. In our experience in running our program, if you try to go to court and take away a person's right to make their own decision, the courts have a pretty high standard and generally speaking it is clear and convincing. If you are a competent adult, and you do not want services, you have a right to say that.

Section 15 - Requirements for an abuse and fatality review team - Regional interagency at risk and fatality review team requires Aging to establish it, leave it and direct it. There may be more information in the rule. There will be a lot of multi-disciplinary people on that.

Section 15.5 page 152 of the bill text - This is a new section subject to appropriations - Equip for Equality shall monitor the system and provide to Aging a review and evaluation of the system in accordance with the rule promulgated by Aging. Equip for Equality will be in a monitoring role if they get the money for this.

Question: How did Equip for Equality get tagged for this?

Response: It was the agency designated by the Governor.

Sections 25 and 30 - Section 25 amends the Code of Criminal Procedure - changes two sections of evidence depositions and hearsay exceptions. Section 30 amends the civil procedure regarding admissibility of evidence and out of court statements to include eligible adults as defined in APS.

At this time, Ginny Conlee joined in the meeting.

Question: Is there any kind of feeling that you have as far as how is this committee that is going to review all of this and set forth the recommendation? Where do these people come from?

Question: What people?

Response: The people that are going to set up the hotline.

Response: Aging will be the lead convening an exploratory committee, with DHS and DPH to determine how the centralized hotline will function, as well as representatives from each of the named agencies. I would guess people from the provider agencies also. It is not specific.

DIG Furniss stated that no one has asked any of us about this. I suppose they will reach out to our hotline staff. They contemplate that we are going to be referring the calls directly over to their hotline.

HR201 tries to set up a centralized hotline for all adult services. This is going to involve a couple more agencies in addition to these agencies. When we talked about this in HR201, we excluded DCFS because they do such a good job publicizing their hotline number. They get over 300,000 calls a year. They should keep their own hotline. Our recommendation was to create one toll free central hotline. It would not be for children, but for everyone else in the state.

Aging doesn't currently have a hotline, but they told us they will have something set up by July 1st. A number we can refer the calls to.

Lois stated that OIG won't have any jurisdiction as of July 1st. We can't do it unless there is some kind of interagency agreement. As of July 1st, we are out of it. That is how this bill reads.

Question: What is happening to our investigators in our hotline? Are they going to participate in any kind of transition?

Response: We are still developing it. They are having a couple of inservices for their supervisors and caseworkers. We will be making presentations to them on probably 5/14 or 6/13. We intend to begin to try to fashion an intergovernmental agreement in which the transition of these cases will begin prior to July 1st. We are essentially going to establish a date, for clarity purposes, those cases we have completed a final report we will continue to address. If a report has been submitted as of a certain date, that case we would continue to see it to the end. Our thinking is that toward the end of May we will take a look at the cases we have and know which cases will still be open as of July 1st. Whatever that date is, we will take a look at the cases we have that are open, attempt to determine what provider agencies are the appropriate hand off for those cases and begin working with the provider agencies to hand the cases off.

The caseworkers and provider agencies will be working with our investigators who will have jurisdiction of those cases and begin the process of moving all of that over. Our concern is technically we will still have responsibility of those cases until July 1st. I think Aging and DHS agree that anything before is ours and after is theirs just doesn't make any sense.

Our major concern is if a case comes in the second week of June and because of what is going on we are unable to finish the case and we don't hand it off until July 1st. It might be 2 - 3 weeks until someone looks at the case again.

Referring to training, in the hotline situation we don't know who we would be talking to at this point. The fact is, the way these cases are handled it's going to be different from what we are doing so I would anticipate many of the cases going forward, there's going to be less analysis as to whether or not it is something that OIG even in the past would have taken as a case or not. In most of these cases going forward, they will identify the person, how old they are, where they live, and the referrals will then be made. APS will have a case worker that will monitor the work of the regional provider. Our intake investigators are asking lots and lots of questions about what is happening, who lives in the house, etc. I think there is going to be a lot less of that in the front end. For those cases coming in, say June 15th, it would be my preference that we would come up with a shorter version of our intake form to capture all relevant information and data and begin passing those cases over to Aging at that point. This is, of course, going to be contingent upon interagency agreements and certain approvals.

Question: As follow up, are the investigators, since there isn't going to be an investigative role with either OIG or Aging, are they going to be absorbed into other duties?

Response: They will all be absorbed into Rule 50 investigator positions. We have one vacant position. Of the five, two of the people who are currently Rule 51 investigators have previously done Rule 50 investigations. One of them was a Rule 50 investigator up until three years ago. One of the remaining two persons was a facility investigator at Howe doing Rule 50 cases so we anticipate this person won't take that much training. Unfortunately, the only person we have from Rule 51 that hasn't done any Rule 50 cases is one of the most hard working individuals we have. They will all be absorbed into Rule 50.

Part of the reorganization is trying to figure out how best to deploy the investigators. We are anticipating that one really good outcome is that when we have the entire investigative staff in place we are hoping that it will lead to as much as a 25 - 30 percent reduction in case load for every investigator. One of the challenges is that most of the people are in the Cook County area, but that is where most of the cases are. We will be redeploying them into Rule 50. We have already started sending them in the Rule 50 training. The vacant position in Rule 51 has been posted, but it will not be filled with a Rule 51 investigator. They will be hired and trained as a Rule 50 investigator. Except for having supervisory personnel in Rule 51 meeting with people in APS and Aging to periodically assist them, we don't anticipate investigators having any investigative role at all. They will be entirely detailed to us. That also goes for our hotline staff. One third of the calls coming into the hotline are DAP calls.

Question: Are we still going to run a hotline for Rule 50?

Response: Yes. Lois stated that I know that we envisioned the centralized hotline in HR201 being a clearinghouse that would take all the calls from everywhere, but we would still need to have our own intake bureau with our own people manning those calls.

It is almost certain that the boundaries of the investigative bureaus are going to be adjusted. We have certain arrangements that will cease to operate. The Metro Bureau, which includes Cook County, has been referring about 170 cases a year to the Northern Bureau. That would stop. We are reconfiguring that at least one of the bureaus would encompass most of the Chicago area. The remainder of the Metro area would become an area in the North. It would be somewhat similar, but we are contemplating the boundaries of these bureaus changing. The only bureau not changing a great deal would be the Southern Bureau. They have the fewest number of cases.

We have a couple of open positions. It is certainly possible that we may try to change the nature of what some people do in order to primarily assist the investigative function. In one area, we are very short handed in clinical staff. We have two full-time nurses who do death reviews and clinical consults. Our investigators are not medically trained and never could be adequately to make these judgments and there are cases where we need medical expertise. If there is some way our workforce could be reconfigured a certain way to get more clinical people, that would be beneficial.

2. Quality Care Board's Role - "Oversight" reference update

 - Letter to Governor's Office

 - Letter modifying/clarifying language in the statute

In regard to the letter to the Governor's Office, Susan has spoken to the Governor's Office on two occasions to Robert Morgan and Jack Lavin. Robert Morgan is the point person on this. Our intention was to find out what our oversight reference will be and it is my understanding that it is going to stay as oversight. I am not sure if I am going to be able to get a definition of that in this bill, but since the Rule 51 cases are being taken out it is not quite as overwhelming as it was before for a Board that meets four times a year. I would like to set up some kind of regular reporting that we can refer to so that we can back due what is commonly interpreted or recite so that we can be in compliance. The worst case scenario is that if we don't do any oversight and something happens we would be in breach of our responsibility and no one really wants that. I would like to have everyone at OIG go through all of your reports and determine what reports we should have some access to and how we could have access to them without a breach of confidentiality. If we have to sign some confidentiality agreement, we can do that. I will clear that with the Governor's Office. I will get some clarification on this since it won't be addressed in this amendment to the statute.

IG McCotter spoke to the Governor's Office also for the same reason, as well as vacancies on the board. He talked to Robert Morgan and John Schomberg. They will do their best to get them filled. Regarding the reorganization, this is still in the discussion stage. Verbally they have told us we are not going to lose any bodies.

Susan indicated that it seems that OIG has been understaffed for years and it actually might not be able to comply with Rule 50 responsibilities and tasks. IG McCotter indicated that it would sure help. Susan said that this might be something the Board could take a look at and asked to please keep the Board informed.

Susan stated that it is her understanding that for Rule 51 responsibilities most states do have a department that handles these kinds of cases and it may be the best practice to do that. I want to make sure that we are doing what we should be doing and that we are meeting our responsibility of oversight of the OIG's office.

Ed is concerned about that we will remain an oversight and they aren't going to change it or consider it advisory. I was under the impression that we were going to send them a letter because we know if it isn't on paper, it didn't happen. Even with us looking at the changes in OIG and DHS with Rules 50 and 51, that is still a huge responsibility. When you are sitting in front of legislators as we did and there are questions about the role of the Board and it is listed you monitor and oversee the operations of policies and procedures, that is a lot more involved than having a committee that meets four times a year.

Susan stated that is her biggest concern. Rule 51 hasn't been taken away from OIG yet and we are not off of the hook yet. (AT THIS TIME THE RECORDER UNEXPECTEDLY STOPPED WORKING, SHUTTING DOWN THE RECORDER. THE REST OF THE NOTES ARE TAKEN ENTIRELY BY SHORTHAND) I stopped short because I was told I needed to see the bill first. I was told the responsibilities wouldn't be as great. I am willing to draft a letter stating that we would like an amendment added, if you think that is what we should do. Does anybody have any thoughts on this?

IG McCotter stated he would welcome any clarification if we can get it in a timely manner. Ed stated that the Board has tried for years to get clarification. Discussion included letters that were previously sent to the Governor's Office. It is possible that Rita Burke, previous Board Chairperson, sent the letters when she was on the board.

Thane felt that during the Chicago hearing they treated us like we were an oversight board. It is a daunting task for a board that meets quarterly.

Susan raised issues regarding that the board has no access to reports. The reports we get are just spot reports. We serve as volunteer members. It would be quite a commitment to review all of the cases that come before OIG. That is why the language is too broad. In the next week or so I will do a draft letter and send it around to the board members for all of our signatures. Motion to do the letter - Ginny; Motion seconded - Thane; all in favor - unanimous. Susan will call the Governor's Office and tell them to expect it and include the Attorney General as well.

3. Reorganization of OIG Update

It is almost certain that the boundaries are going to be affected. We have certain arrangements now that will cease to exist. Metro has been referring about 170 cases a year to the North. That is going to stop. I would anticipate that the boundaries will change somewhat. The only bureau that may not change much would be the Southern Bureau. They have the fewest cases by quite a bit.

We have a couple open positions and other staffing questions. It is possible that we may try to change the nature of what some people do in order to assist others. We are short handed in clinical staff. We have two nurses on contract. One does site visits. Most of our personnel are not medically trained. There are cases where we need medical expertise.

4. Review of first five OIG directives (ADMIN) on the Table of Contents

Question: Are your directives manually available?

Response: Yes they are.

Lois advised everyone that we are doing an overhaul of the directives at this time. She has not had the time to finish them yet.

Susan suggested that the Board could look at the existing directives and get a revised copy as changes are made.

Question: In 002 Training, Section 3. C. 2. - Why isn't that mandatory for supervisors?

Response: That may be the way the DHS directives were written. Lois can check on that. It may be that some of the training is not offered any longer.

Question: Do all of your employees actually comply with submitting the next week's itinerary?

Response: Yes they do. There has been a number of changes that have come from the top down. A lot of the timekeeping changes, for example, we have to comply with the DHS rules. We have some variation with respect to travel due to the amount of travel we do.

The whole directive related to past practice teams is being revised because we do not have the luxury of having hours to devote to this. We haven't done much of this because we can't. Pulling investigative staff off to do this is not going to work. Deb DiLello is working on this directive.

Lois indicated that she is pretty good with the ADMIN section of the OIG directives. It is the INV section she needs to dig into. There is a lot of work.

Susan stated that she would like to make the four people at this meeting a committee to have a conference call on the directives and case advice. If you don't have time to be on the committee, let Susan know, but participate if you can. Motion to make a policy and procedure committee - Ginny motioned. Thane seconded the motion. Motion carried.

Lois will check on the training for supervisors from the training directive.

5. Discussion of physical abuse cases

DIG Furniss stated these case reports illustrate the fact that in Rule 50 we have a very low threshold for physical abuse. We had a case where a staff person tried to get a sexually inappropriate person that was in a room with clients out of the room. The staff person had to physically drag the person out of the room. We have to be very mindful that when we are substantiating a physical abuse case, in almost the majority of these cases that person is going to lose their job whether or not they go on the registry. We still have to be aware that these are people in a very stressful position dealing with very difficult people in very bad job conditions.

In the dragging case, we know it happened. We have to leave it to the administrative law judge to determine if the conduct is at the level to go on the registry. In this case, there were certain stipulations that we brought to the administrative law judge's attention and the person did not go on the registry. It would have been an injustice.

Susan asked if anyone had any questions on how any of the cases were handled. Ed asked about the differences in format. We seemed to have changed it. DIG Furniss responded that he didn't see the reason to provide the cover sheet on one of them and on some he took the box out so the format has not changed. It was just how the information was copied.

Ed indicated that the dragging case goes back to 2011. Bob responded that he had asked the bureau chiefs to find cases that illustrate an example of a situation where a lot of people would have done the same thing. Because of our mandate to protect people, I asked the bureau chiefs to find cases that had close calls one way or the other.

Ed stated that with the dates missing, it is hard for us to say how long an investigation took. Report 32939 was one of the worst reports I have ever read. In 33003, personal opinions were included in the report. We have a doctor in there that saw it happen and didn't report it. Is there training that can be done? Is there something that we can do?

DIG Furniss pointed out that one of the road blocks is to get these people to come forward. These are pretty serious cases. In the case with the doctor, I don't know if we would have reported the doctor. If I recall, there was some confusion on what he saw. It is something that we see time and time again. In one case they were afraid of someone they worked with. That is why they didn't bring it to anyone's attention. In that case I think the union representative thought they were untouchable.

Ed stated that 32939 and 33003 were just poorly done. What process could be set up? Some of the sentences are incomplete. You need to redo these reports and resubmit them. It was not a very good report.

Questions: What is the process if you get reports and they are not done well? Do you send them back? Response: Yes. Case #3 is an unsubstantiated case. If we think something has been poorly done, they are sent back. When we have a case and you have a witness and the witness is talking about what they saw, we have trained these people to put what these people say. When DPA A is saying that so and so walked out the door, she is saying that is what they saw. There are staff that may not be abusing clients, but are difficult to deal with.

Question: Are there any follow-up on these?

Response: They have to do a written response. We have had transportation issues. We did not substantiate neglect, but the agency is loose with what they do in transportation issues. We aren't sure that the business they contract with is taking people where they need to go. We will alert the division that we have had some issues with this business.

Question: Do you ever come across where staff are stealing meds?

Response: Yes. We notify the police. If it is a facility, we would notify ISP. The biggest problem is med administration.

Ed asked DIG Furniss if he took out the people's names in the reports and put the PA, RAR and RAC. Bob stated they are abbreviations for their positions. I put them in when redacting.

Question: Is there some other way these reports should be done regarding the grammatical errors if you think that we need more information on it?

Response: When you are trying to redact with initials it could get confusing. There has to be a clearer way of doing this. I just wanted to show some scenarios. I think it would be better if we just give them a name throughout a summary.

Question: Would that be sufficient? What about board members?

Response: Ed stated that he doesn't know if we have to talk to Legal, but if we are oversight, I don't know why we couldn't see the originals. Susan stated the members could sign some documents. We could just run through them quickly.

Probably will have to sign HIPPA and confidentiality agreement.

Question: How confident are you that Rule 51 will be taken from OIG?

Response:DIG Furniss responded 100% sure. There are wrinkles that still need to be worked out. IG McCotter stated it passed out of the House 106 - 0.

Susan stated she is going to ask the Governor's Office for an amendment on the review and oversight language. That would be a small amendment that could be a separate amendment because it is a separate statute.

Lois advised that they are amending 948. The DHS Act is in there because they took out the domestic abuse language. The Quality Care Board starts on page 44 of the bill text. It already is in that bill. It should be quite easy to get the language amended.

Susan is also going to suggest the language be amended to take out the word oversight. She is ok with review. Is everyone else ok with that?

Ed stated that it actually says monitor and oversee.

Susan wants it to change the board "will to shall" review the operations and procedures of the OIG …, and take out monitor and oversee.

In fulfill this responsibility the Board is to do the following … Susan will draft it and give it to the Governor by Friday. If she has a signed version from all of the members, Susan will indicate that all of the members are in agreement. Motion: Ginny; Motion seconded: Ed; Motion carried.

6. Approval of February 28, 2013's meeting minutes

Susan - approval of February 28, 2013's meeting minutes. Motion: Ed; Motion seconded: Ginny; Motion carried: Approved as written.

7. Miscellaneous issues/questions

- Next meeting is August 29, 2013 at 3:00 pm. It was decided to have this meeting by teleconference.

Question: Could we take 10 investigative policies since there are 30 of

them? Should we do them in order or by importance?

Lois suggested probably in order because that is how she is doing them.

Ed suggested the Board take the first 10 in Section 2.

Lois informed everyone to not think they are missing a directive if it goes from

23 to 25. That was intentional. 23, 26 and 27 are open waiting for a new


Schedule for review:

 1st 10 by 5/30 (1 - 10)

 2nd 10 by 6/28 (11 - 20)

 3rd 10 by 7/25 (21 - 30)

Susan told Lois that the Board will give you their comments and asked if she

wanted to meet by phone before 5/30. We can set that now or when we get

ourselves organized. The second and third group in June and July. The Board

will meet and send in their recommendations.

Susan asked if there were any other questions or issues.

Motion to adjourn meeting - Ed; Motion seconded: Thane; Motion carried.

Meeting adjourned at 3:40 p.m.