February 9, 2017 - Quality Care Board Meeting




Michael McCotter, Inspector General; William Diggins, Deputy Inspector General; Susan Keegan, Chairperson; Neil Posner; Thane Dykstra; Untress Quinn; Pamela Oller

Chairperson Keegan stated Mike Behrens' will receive a copy of the approved December minutes after the meeting today.

Call to Order

Chairperson Keegan called the meeting to order at 2:06 p.m. She would like for Secretary Dimas to receive a copy of the Quality Care Board meeting minutes in order to keep him informed. Seems there might be a different measure of oversite of the OIG and this will be constructive.

Approval of Minutes

Chairperson Keegan asked for a motion to approve the minutes of December 19, 2016. No changes to minutes. Motion to approve the minutes - Neil Posner Motion Seconded - Thane Dykstra All in Favor, no opposed, minutes approved.

Inspector General's Report

Inspector General McCotter reported on personnel changes:

  • The OIG had several employees retire at the end of 2016 and beginning of 2017:Carol Mills, Hotline Manager; Pablo Lozada, Cook County Bureau Chief; Jim Nesler, Southern Region Bureau Chief; and Lois McCarthy, Legislative & Policy Chief all retired in December 2016. Kelly Ohzourk, Training Coordinator retired in January 2017.
  • OIG has received numerous applications and in the process of setting up interviews for these vacant positions.
  • The headquarters for the legislative & policy position has been moved from Cook County to Sangamon County.
  • Hired one investigator, for the Northern Bureau. He is in training and on probationary period.
  • The backlog of cases has been reduced by 21% since the beginning of the year.
  • The OIG will be undergoing an audit by the auditor general. All requested documents have been submitted for their audit. There will be a "progress" meeting scheduled for the end of February.
  • DHS Secretary convened numerous meetings based on the transparency issues with CILA's. DHS/OIG will be sharing agency profiles to the agencies, as soon as it is approved by the DHS Secretary.
  • Jayma Bernhard, Bureau of Quality Management will present at the next board meeting and will address any questions from the board.

Thane Dykstra - Inquired as to which CILA's will receive agency profiles.

Inspector General McCotter - all CILA's will receive the profile which will show quality, number of complaints, number of investigations by OIG, types of cases reported from agencies, number of late reports, general case findings, status of OIG investigations and written responses, and incident locations.

Thane Dykstra - Inquired whether it would be site specific within an agency.

Deputy Inspector General Diggins - this is for calendar year 2016 and will list all sites that had allegations and the number of allegations at each of those sites. This will provide a snapshot of OIG's involvement at all agencies. As well as show the agencies progress.

Thane Dykstra - inquired whether or not this information will be listed on the website?

Deputy Inspector General Diggins - Some of the information that will be provided could be accessed through the internet. However, this report is a little more specific in certain areas and not accessible via the internet.

Neil Posner - Inquired if the board will receive copies of the report.

Deputy Inspector General Diggins - a copy of the reports will be provided to the board, if they wish to receive them.

Chairperson Keegan - Would like to receive them as soon as possible.

Inspector General McCotter - DHS Secretary has the final determination of when the reports will be sent.

Neil Posner - Inquired how the backlog reduction by 21% was accomplished.

Inspector General McCotter - Stated this is due to Deputy Inspector General Diggins instructing all Bureau Chief's to concentrate on the older cases first. Even though OIG receives a constant flow of cases, it has been requested to focus on the older cases first.

Thane Dykstra - Inquired if the "preliminary report card" will include findings since January 1, 2016, or new cases reported since January 1, 2016.

Deputy Inspector General Diggins - The report is called the community agency profile. It will report entries from January 1, 2016, through December 31, 2016. After this initial report, the profiles will be reported on fiscal years beginning July 1, 2017.

Thane Dykstra - Inquired as to which staff will be working on the profile project.

Deputy Inspector General Diggins - The database used by the OIG has all the information needed for the profile and is used internally to review agencies. Based on discussions with DHS Secretary and other areas of DHS, it was realized this report was very useful and should be available.

Thane Dykstra - Inquired about specific CILA's addresses being publicly listed and the stance of DHS Secretary regarding this issue.

Deputy Inspector General Diggins - DHS/OIG is allowed to only release the addresses to the Agencies due to the fact the Agencies already have the addresses of sites. According to DHS legal the addresses of sites remain confidential and cannot be released to the public at this point.

Thane Dykstra - Believes if parents are researching sites this would be useful for that purpose. He understands the reasoning of not releasing such information to the public.

Deputy Inspector General Diggins - DHS/Secretary has established a committee to create a report which will provide an informed choice and transparency. The OIG is assisting with an abundance of information towards the goal of informed choices and transparency.

Thane Dykstra - Suggested case coordination agencies to have access to addresses, so they are able to verify whether someone is receiving services or for someone seeking to move into that Site. This could serve as a transparency mechanism without being public.

Deputy Inspector General Diggins - Thane's suggestion will be brought to the committee.

Chairperson Keegan - Inquired whether or not the neighborhoods are aware of a CILA located in their area.

Thane Dykstra -Believes the surrounding neighbors are aware that a CILA exists in their neighborhood. He has heard there are some issues when a new CILA is opened in a neighborhood (i.e. protesting neighbors).

Chairperson Keegan - Inquired whether or not this issue has been addressed to their representatives/legislators; or does this appear to be something minor.

Thane Dykstra - Believes the DD Divisions perception is the importance of safeguarding privacy at some levels. He believes people are aware of such issues.

Inspector General McCotter - this will be discussed with the DHS/Secretary at the next scheduled meeting.

Thane Dykstra - Reiterated the point of allowing the case coordination agencies access to certain information and the benefits of doing so. Believes the parents need to have informed choices of what is happening with such CILA's and OIG investigations.

Chairperson Keegan - believes the board should not take a position on this, however, feels this is an important point and should have a decision made.

Neil Posner agreed.

Legislation Update

Inspector General McCotter - Representative Patricia Bellock has introduced a CILA bill that would require DHS to conduct inspections of records on premises of each CILA at least once every two years.

Thane Dykstra - Stated there is a bill being introduced about hiring OIG Investigators.

Inspector General McCotter - Confirmed Thane's comment and reiterated the importance of how this particular bill will allow the OIG the capability of hiring the qualified candidate with investigative experience.

Deputy Inspector General Diggins - reported the bill will remove Internal Security Investigators and Nurses from the bargaining unit. DHS is reviewing this, as well as other movement on the labor front regarding titles currently within a bargaining unit and whether or not they should be removed from said bargaining unit.

Chairperson Keegan - Inquired as to the reason for removing certain titles from the bargaining unit.

Deputy Inspector General Diggins - As Inspector General McCotter stated at the hearing, the issue with hiring per the bargaining unit you receive an employee due to seniority not necessarily their investigative experience. This bill will allow the OIG to hire an individual with the acquired skills necessary.

Inspector General McCotter - believes this bill will allow OIG the capability to reach out to a pool of well qualified investigators.

Thane Dykstra - Inquired about the hiring processes of vacant positions (i.e., internally filled or candidate outside of OIG).

Inspector General McCotter -There is a hiring process that must be followed per the personnel code.

Deputy Inspector General Diggins - Clarified the positions of a Bureau Chief the OIG is allowed to conduct interviews and choose the best candidate. However, with an Internal Security Investigator position or positions within a bargaining unit, there is not a choice of conducting an interview. The candidate that is at the top of the list, according to personnel, is the individual that would be offered the position. The introduced legislation will remove this process and allow the Inspector General and Deputy Inspector General the flexibility of screening individuals and conducting interviews.

Chairperson Keegan - Inquired if Inspector General McCotter assisted in drafting this bill.

Inspector General McCotter/Deputy Inspector General Diggins - Stated they did not assist with this bill. However, believes the comments/concerns raised at the hearing provoked the drafting of said bill.

Thane Dykstra - Inquired if any updates have been received in regards to the Tribune article.

Inspector General McCotter - Responded not at this time. However, he did receive a call from Social Security Administration regarding disability services (on a federal level) and they are looking into their practices.

Chairperson Keegan - Inquired to the situation that prompted such a review.

Deputy Inspector General Diggins - the services had ceased and they were still receiving federal funding.

Training Chairperson Keegan - Inquired about the individual who will attend a future meeting for training and/or discussion.

Deputy Inspector General Diggins - Reported the Bureau of Quality Management within the Division of Developmentally Disabilities. They perform site visits at agencies and make a determination as to whether or not the agencies are following DHS standards. They also, approve the written responses based on our cases. The OIG interfaces with this bureau quite a bit. This came about through the discussion in the December board meeting and this individual will better answer the questions the board addressed in the previous meeting.

Deputy Inspector General Diggins - Reported the OIG continues with training for Internal Security Investigator's. Most recent training was provided through a PowerPoint regarding special meals, meal planning, and different types of meals an individual is to receive per their medical plan. Also, creating training for Rule 116 (medication) outlining the training for staff in providing medication to individuals. As well as training for the Rule 119 (Developmental Training).

Chairperson Keegan - Inquired if the Rules are new.

Deputy Inspector General Diggins - The Rules are existing rules, however, feels the necessity to train Internal Security Investigators in these areas for a better understanding. It will assist them with neglect investigation findings and these rules are referenced for support of a neglect case.

Inspector General McCotter - Stated this training is given initially to new hires, and this is refresher training.

Deputy Inspector General Diggins - Reported the OIG is in the early stages of developing training to cover preparation of a deposition, testifying at hearings and/or court appearances.

Review of Recent Investigative Reports

Chairperson Keegan - Stated in her opinion she feels the investigations are good and the reports are well written. Stated she doesn't always agree with what is considered negligent and what is not. Would like to have a better idea of how the findings are determined.

Deputy Inspector General Diggins - Stated the PowerPoint of Rule 50 which was distributed to the board explains how the rules and the definitions determine what is or isn't considered to be substantiated.

Neil Posner - his concern is with the determination of whether or not a case is considered to be egregious.

Chairperson Keegan - Inquired as to what constitutes gross.

Deputy Inspector General Diggins - This is not defined in the rule. It goes above and beyond regular neglect (i.e., death, serious injury). Explained such scenarios are a case-by-case basis which is discussed among management.

Neil Posner - In reviewing incidents that involve abuse, neglect or exploitation as the case may be has several functions. Such as identifying individuals that should not be working in this field (corrective aspect) as well as (utilitarian aspect) educating the board and disseminating the information to the providers with hopes of continual quality improvement at the individual facilities and industry wide. Feels if the findings were more consistent with the conclusions or vice versa, it may be clearer as to why a particular conclusion was found. Question regarding protocol of follow-up. Understands once the investigation is complete, the OIG is discharged from its duty. Inquired the responsibilities of the board after the OIG has finished it investigation and feels this warrants an explanation.

Deputy Inspector General Diggins - stated the follow-up is done through the Bureau of Quality Management on the issues raised by the OIG. Along with accreditation and licensure who actually license the agencies; which the OIG is planning to have the head of this division give a presentation at a board meeting in the future. Stated there are automatic triggers in regards to findings of investigations. When the OIG substantiates physical abuse, financial exploitation, sexual abuse and egregious neglect it is the first step of putting the individual on the healthcare registry to prevent them from working in this field. The Department also has processes in place for follow-up of OIG investigations. Bureau of Quality Management will be able to address the concerns regarding type of follow-up being done on OIG investigations. Also, plan to have Bureau of Licensure and Accreditation attend a future meeting to present their role in OIG investigations. Bureau of Quality Management will present at the next board meeting, which is scheduled in May 2017.

Inspector General McCotter - In response to Neil's question regarding OIG's involvement at the conclusion of an investigation: The OIG does their due diligence and in turn makes recommendations to the appropriate agencies. The appropriate agencies is then responsible for taking further action, based on the OIG investigations.

Neil Posner - stated the next scheduled meeting on May 11, he may not be able to attend due to a conflict. Will solidify his schedule within the week and will know for sure if he will be in attendance at that board meeting.

Chairperson Keegan - requested an email be sent regarding his attendance at the board meeting.

Neil Posner - stated he will let everyone know as soon as possible.

Inspector General McCotter - stated the OIG's schedule is flexible and if need be, the meeting can be rescheduled.

Chairperson Keegan - Commended the detail of the investigative reports.

Thane Dykstra - questioned if OIG reports to Bureau of Quality Management when a provider is showing up in the investigative reports a disproportionate amount of times.

Deputy Inspector General Diggins - If an issue is seen with an agency this is communicated and/or referred to Bureau of Quality Management and Bureau of Licensure and Accreditation. They receive the OIG reports as it relates to their duties in the investigations.

Chairperson Keegan - Inquired when a referral is made does the OIG continue with further investigation.

Deputy Inspector General Diggins - When a referral is made by the OIG to the Department to review the overall problems and/or issues found, they will send the OIG a copy of their report in order to close out the OIG case. This does not constitute another investigation by the OIG.

Chairperson Keegan - Discussion regarding duplicates of cases and/or providers.

Deputy Inspector General Diggins - The OIG enters information into a database and it cross referenced.

Chairperson Keegan - inquired if there were any suggestions of flagging individual reports and discussing them specifically.

Neil Posner - is open to such a suggestion.

Chairperson Keegan - inquired if the board has concerns about a specific case should they flag those by case number and bringing to the Inspector General/Deputy Inspector General's attention.

Inspector General McCotter - Reminded everyone the reports the board receives are completed investigations and their suggestions/concerns about such investigations will not alter the findings of those cases. However, the OIG is open for suggestions and/or recommendations they may find with the investigations and the OIG can look further into their concerns and possibly include in investigation training.

Chairperson Keegan - Suggested the board identify issues that may need more training and/or brought to authority attention; bring the issues to the next board meeting. Believes the board should be providing substantial feedback that might help the patient, client, and the OIG (constructive recommendations). To be further discussed at the meeting in May.

Thane Dykstra - stated concern about discussing specific information in an open meeting.

Chairperson Keegan - agrees and believes the issues found can be discussed generally and not case specific. Suggested everyone think about how such concerns/issues can be addressed without breaking any HIPPA/confidentiality laws.

Board Members Appointments

Status of Appointments Chairperson Keegan - Reported she called Secretary Dimas and has not heard anything further on this issue. She will reach out to Dimas for an update on this.

Outstanding Issues

None to report.

New FOIA Requests

Chairperson Keegan - Inquired of any pending FOIA's. Deputy Inspector General Diggins The office received one request and it has been answered.


Chairperson Keegan - asked for a motion to adjourn Motion to adjourn - Neil Posner Motion Seconded - Thane Dykstra All in favor/No opposed Meeting Adjourned 3:01 p.m.