<DOC>
[109th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:28625.wais]
DISABLED SERVICES IN THE DISTRICT OF COLUMBIA: WHO IS PROTECTING THE
RIGHTS OF D.C.'S MOST VULNERABLE RESIDENTS?
=======================================================================
HEARING
before the
COMMITTEE ON
GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
__________
JUNE 16, 2006
__________
Serial No. 109-158
__________
Printed for the use of the Committee on Government Reform
Available via the World Wide Web: http://www.gpoaccess.gov/congress/
index.html
http://www.house.gov/reform
______
U.S. GOVERNMENT PRINTING OFFICE
28-625 WASHINGTON : 2006
_____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512ÿ091800
Fax: (202) 512ÿ092250 Mail: Stop SSOP, Washington, DC 20402ÿ090001
COMMITTEE ON GOVERNMENT REFORM
TOM DAVIS, Virginia, Chairman
CHRISTOPHER SHAYS, Connecticut HENRY A. WAXMAN, California
DAN BURTON, Indiana TOM LANTOS, California
ILEANA ROS-LEHTINEN, Florida MAJOR R. OWENS, New York
JOHN M. McHUGH, New York EDOLPHUS TOWNS, New York
JOHN L. MICA, Florida PAUL E. KANJORSKI, Pennsylvania
GIL GUTKNECHT, Minnesota CAROLYN B. MALONEY, New York
MARK E. SOUDER, Indiana ELIJAH E. CUMMINGS, Maryland
STEVEN C. LaTOURETTE, Ohio DENNIS J. KUCINICH, Ohio
TODD RUSSELL PLATTS, Pennsylvania DANNY K. DAVIS, Illinois
CHRIS CANNON, Utah WM. LACY CLAY, Missouri
JOHN J. DUNCAN, Jr., Tennessee DIANE E. WATSON, California
CANDICE S. MILLER, Michigan STEPHEN F. LYNCH, Massachusetts
MICHAEL R. TURNER, Ohio CHRIS VAN HOLLEN, Maryland
DARRELL E. ISSA, California LINDA T. SANCHEZ, California
JON C. PORTER, Nevada C.A. DUTCH RUPPERSBERGER, Maryland
KENNY MARCHANT, Texas BRIAN HIGGINS, New York
LYNN A. WESTMORELAND, Georgia ELEANOR HOLMES NORTON, District of
PATRICK T. McHENRY, North Carolina Columbia
CHARLES W. DENT, Pennsylvania ------
VIRGINIA FOXX, North Carolina BERNARD SANDERS, Vermont
JEAN SCHMIDT, Ohio (Independent)
------ ------
David Marin, Staff Director
Lawrence Halloran, Deputy Staff Director
Teresa Austin, Chief Clerk
Phil Barnett, Minority Chief of Staff/Chief Counsel
C O N T E N T S
----------
Page
Hearing held on June 16, 2006.................................... 1
Statement of:
Bobb, Robert C., Deputy Mayor/city administrator, government
of the District of Columbia; Brenda Donald Walker, Deputy
Mayor for Children, Youth, Families, and Elders, government
of the District of Columbia; Marsha Thompson, former
administrator, District of Columbia, Mental Retardation and
Developmental Disabilities Administration; Robert M.
Gettings, executive director, National Association of State
Directors of Developmental Disabilities Services; Holly
Morrison, vice president and chief administrative officer,
the Council on Quality and Leadership; and Tina M.
Campanella, executive director, the Quality Trust for
Individuals With Disabilities.............................. 19
Bobb, Robert C........................................... 19
Campanella, Tina M....................................... 105
Gettings, Robert M....................................... 87
Morrison, Holly.......................................... 99
Thompson, Marsha......................................... 79
Walker, Brenda Donald.................................... 24
Letters, statements, etc., submitted for the record by:
Bobb, Robert C., Deputy Mayor/city administrator, government
of the District of Columbia, prepared statement of......... 21
Campanella, Tina M., executive director, the Quality Trust
for Individuals With Disabilities, prepared statement of... 107
Cummings, Hon. Elijah E., a Representative in Congress from
the State of Maryland, prepared statement of............... 16
Davis, Chairman Tom, a Representative in Congress from the
State of Virginia:
Prepared statement of.................................... 3
Prepared statement of University Legal Services, Inc..... 6
Gettings, Robert M., executive director, National Association
of State Directors of Developmental Disabilities Services,
prepared statement of...................................... 90
Morrison, Holly, vice president and chief administrative
officer, the Council on Quality and Leadership, prepared
statement of............................................... 101
Thompson, Marsha, former administrator, District of Columbia,
Mental Retardation and Developmental Disabilities
Administration, prepared statement of...................... 81
Walker, Brenda Donald, Deputy Mayor for Children, Youth,
Families, and Elders, government of the District of
Columbia:
Information concerning Evans v. Williams................. 26
Prepared statement of.................................... 74
Watson, Hon. Diane E., a Representative in Congress from the
State of California, prepared statement of................. 136
Waxman, Hon. Henry A., a Representative in Congress from the
State of California, prepared statement of................. 133
DISABLED SERVICES IN THE DISTRICT OF COLUMBIA: WHO IS PROTECTING THE
RIGHTS OF D.C.'S MOST VULNERABLE RESIDENTS?
----------
FRIDAY, JUNE 16, 2006
House of Representatives,
Committee on Government Reform,
Washington, DC.
The committee met, pursuant to notice, at 10 a.m., in room
2154, Rayburn House Office Building, Hon. Tom Davis (chairman
of the committee) presiding.
Present: Representatives Tom Davis, Kucinich, and Norton.
Staff present: Rob White, communications director; Andrea
LeBlanc, deputy director of communications; Victoria Proctor,
senior professional staff member; Shalley Kim, professional
staff member; Teresa Austin, chief clerk; Sarah D'Orsie, deputy
clerk; Tony Haywood, minority counsel; and Jean Gosa, minority
assistant clerk.
Chairman Tom Davis. The committee will come to order.
I want to welcome everybody to today's hearing on the
District of Columbia's Mental Retardation and Developmental
Disabilities Administration.
We convene this morning because at a time when so many
things are going right for the District, a longstanding,
seemingly intractable problem has painfully reemerged and
demands our attention.
The District's fundamental responsibility to be a humane
and nurturing custodian of those with mental retardation and
developmental disabilities is not being met. Some say the
situation is irreparable, and the entire function should be
taken out of the District's hands and given to a receiver. But
even if that happens, the District has to find a way to reform
the current system and meet the needs of these most vulnerable
citizens.
How did it come to this? The story is a long and sad one.
In 1976, after the deaths of two residents at Forest Haven, a
facility for this population, a Federal class action lawsuit
was filed against the District. Today captioned as Evans v.
Williams, the case challenged the conditions of the confinement
for residents of the institution which was subsequently closed.
But the judgment against the District also imposes continuing
obligations, under court supervision, to protect class members
from harm and to provide services in the least restrictive
setting for the duration of their lives. Generally, that meant
the District should be able to provide community-based living
situations in group homes.
In 1999, the Washington Post chronicled the tragedy of at
least 24 deaths of residents in group homes operated in the
city agency, the MRDDA. The articles highlighted chronic abuse
and neglect of developmentally disabled individuals and
described profiteering by some vendors operating group homes.
Six years later a day program worker was charged with criminal
negligence for burning an adult home resident. In March 2006,
an employee of a day program for disabled persons pled guilty
to charges of sexually abusing a patient. MRDDA made headlines
again when the court monitor reported in February 2006 that a
woman and three men had died since November 2004 because of
inadequate health care. The report attributes the deaths to a
systemic pattern of negligence in the homes and lack of
oversight. The court monitor said that, ``for a period of over
1 year the District repeatedly failed to notify providers of
the results of mortality investigations conducted by its own
reviewer. As a result, corrective actions were never discussed,
let alone implemented or evaluated.''
Some attribute this lack of accountability to scattered
lines of authority in the city government. In effect, MRDDA has
the responsibility, but not the authority over key functions
required to provide quality care and protect vulnerable lives.
Enforcement, personnel, facility licensing and contracting
powers are scattered across disparate city agencies. In that
structure MRDDA can achieve some reform, but not nearly enough
to meet the court mandate or meet the needs of current and
future residents. The inability of agencies with varying levels
of responsibility for this population to communicate
effectively has added to the failure to act timely and
decisively.
The bottom line is there needs to be a single point of
authority and accountability, and there must be performance and
outcome measures to gauge the city's progress.
The committee has conducted oversight of several D.C.
agencies and departments which have been the subject of lengthy
lawsuits, many of which resulted in court appointed
receiverships, including the child welfare system, mental
health services and the housing authority. Five district
agencies were placed in receivership in 1999 when Mayor
Williams came into office. He made the commitment to regain
control of the agencies and has successfully done so. It's past
time to bring the same commitment and sense of urgency to
fixing the MRDDA.
Thirty years of court orders, monitors and compliance plans
have not worked to fix a broken approach to this special
population. Today, we need to hear how the District plans to
end this agonizing era of neglect, reform program management,
establish visible and meaningful quality controls, and assume
full responsibility for those who need and deserve the city's
compassion and care.
I like to include in the record a statement by University
Legal Services; and without objection, so ordered.
I would now recognize another champion of the disabled in
this particular city, Ms. Norton.
[The prepared statement of Chairman Tom Davis follows:]
[GRAPHIC] [TIFF OMITTED] T8625.001
[GRAPHIC] [TIFF OMITTED] T8625.002
[The prepared statement of University Legal Services, Inc.
follows:]
[GRAPHIC] [TIFF OMITTED] T8625.003
[GRAPHIC] [TIFF OMITTED] T8625.004
[GRAPHIC] [TIFF OMITTED] T8625.005
[GRAPHIC] [TIFF OMITTED] T8625.006
[GRAPHIC] [TIFF OMITTED] T8625.007
[GRAPHIC] [TIFF OMITTED] T8625.008
[GRAPHIC] [TIFF OMITTED] T8625.009
[GRAPHIC] [TIFF OMITTED] T8625.010
Ms. Norton. Thank you very much, Mr. Chairman.
Mr. Chairman, I really regret that the committee has found
it necessary to hold this hearing on services provided by a
local D.C. agency. And we all know that this Chair does not do
so often, and he doesn't do it lightly, because he is a strong
supporter of home rule. And this is, frankly, a classic home
rule matter that doesn't belong in the U.S. Congress. As a
matter of fact, Mr. Chairman, I have a letter coming to you
concerning hearings I wanted the U.S. Attorney, who is
unfortunately a Federal official--and on structural deficit,
where you promised me a hearing. But I can understand why this
caught the attention of the chairman. Congress has learned that
when--the city has learned that when matters that are quite
inflammatory come to the attention of the Congress through the
newspapers it gets congressional attention.
The recent request for a receivership, provided by the
Mental Retardation and Development Agency brings this matter
too close to the congressional orbit for comfort because the
Federal courts would be involved or if the D.C. courts were
involved, those come under the jurisdiction of the Congress at
this point.
So the death in group homes, the abuse of helpless people
making the papers--anybody in this city knows that Congress
reads the papers, too. And of course one doesn't have to be
personally affected to understand why mentally--retarded, and
developmentally disabled residents would catch the attention of
this body. These are our citizens that are often at the mercy
of whoever is in charge, and has the responsibility for their
well-being. Well, who has the responsibility is not the
Congress of the United States, it is the society defined as the
citizens of the District of Columbia, and of course the MRDDA.
So the concern could not be more well placed.
I raise the issue of whether a Congressional hearing is
necessary or appropriate, not because of the seriousness of the
issue--nothing could be more serious than the issues involving
people who can't take care of themselves when no one else seems
to be taking care of them. I do note that the hearing is being
held at a time when in the papers there is evidence both of
some council leadership indicating that there is oversight in
the city which knows the issue best, and of course where there
have been some changes made; tardy though they were--for
example, an experienced and new director on board. The council
certainly takes the matter seriously. They take it so seriously
that they have invoked the harshest punishment; denying the
agency increases pending improvement. You couldn't get people's
attention better than that. And of course it has a terrible
downside that I hope all involved will understand so that we
can quickly get the matter back to some sense of normalcy.
It is an extremely complicated matter. Many agencies
providing the necessary services, or even finding group homes
in a city like this where people are being chased out every day
by the cost of housing, as the market has escalated those
costs. Nobody wants a group home, even for these residents who
are helpless. The problem the city has found in getting
contractors, people who supervise these citizens is itself a--
who are competent to do so--is a story all its own. And of
course the difficulty is magnified by the fact that these
citizens are not located in one place. They are spread across
the city, as well they should be because we're trying to
provide a normal environment for them in the least restrictive
setting.
So I stress that the only way to get systematic oversight
is for the city to increase oversight, and the alternative to
that is not congressional oversight. The alternative to that is
something that the city wants least, and that is third party
oversight, like a receiver. And what a shame that would be, to
head back to 5 or 6 years ago when so many agencies were in
receivership. This happens all across the country in other
cities as well. But here was the District, after the control
board period--which literally brought troubled agencies out of
receivership, every last one of them. And as a result, there
hasn't been much said here in Congress because the fact that
they were in receivership brought them right under our nose and
jurisdiction.
It was a great achievement, but in a real sense--it was a
great achievement because it shows that the government was
working, because the courts would not have released these
agencies' receivership if the courts didn't think that the city
could do it. But if the agencies that have responsibility for
these citizens aren't working, the conclusion will be the
government isn't working. This is a real test of whether the
government works. I know we don't want to head back to 30 years
ago, and I really don't believe that's where we're headed.
Those of us who group up in this city remember Evans v.
Williams, the class action that started it all, went on for so
many years, the closing of the old Forest Haven, the move to
group homes for the least restrictive environment.
Given recent responses, what we're trying to find out is
whether the city gets the point and is on a systemic road, the
kind of systemic road it will take to straighten this out
before we go all the way back to control board times when in
essence we had a control board for these agencies.
This hearing is yet another outside intervenor that should
get the city's attention. The city finds congressional
intervenors particularly undesirable, but worse, much worse
would be a receivership. I can't believe, I don't believe that
this administration intends to come full circle and head back
to the bad old days, but I can't know for sure. That's why I
will be listening very attentively to the witnesses today. I
welcome them and appreciate their testimony.
Chairman Tom Davis. Thank you, Ms. Norton.
I can just say that we didn't rush into this hearing willy-
nilly . I mean, we've been waiting a long, long time for some
action. It just gets worse. And I think I would be not
fulfilling my responsibility as chairman to move forward and
shed some light on this, as we have always worked together to
try to give the city the resources it needs and understand the
particulars of home rule. But I think this situation has
dragged on and on and on, and that's the reason for the hearing
today.
Members will have 7 days to submit opening statements for
the record.
[The prepared statement of Hon. Elijah E. Cummings
follows:]
[GRAPHIC] [TIFF OMITTED] T8625.011
[GRAPHIC] [TIFF OMITTED] T8625.012
Chairman Tom Davis. We're going to recognize our
distinguished panel. Mr. Robert C. Bobb, the Deputy Mayor/city
administrator; Ms. Brenda Donald Walker, the Deputy Mayor for
Children, Youth, Families and Elders, Government of the
District of Columbia; Ms. Marsha Thompson, former administrator
for the District of Columbia Mental Retardation and
Developmental Disabilities Administration; Mr. Robert Gettings,
executive director of the National Association of State
Directors of Developmental Disabilities; and Ms. Holly
Morrison, vice president and chief administrative officer of
the Council on Quality and Leadership; and Tina Campanella, the
executive director of the Quality Trust for Individuals with
Disabilities.
We may have a vote on the floor between 11 and 11:30. If
we're not through, it would be my intent at that point to just
hand the gavel over to Ms. Norton, if she has questions, to
allow that to happen while I go vote. I regret that she can't
come over and vote on this resolution and cancel my vote out,
but we're working on that. But just to kind of keep things
going and try to--if we have questions.
It's our policy that all our witnesses be sworn before they
testify, so if we can have the witnesses come forward. And let
me thank you all for coming today. If you could raise your
right hands. Thank you.
[Witnesses sworn.]
Chairman Tom Davis. Thank you very much.
Mr. Bobb, you're no stranger to the committee, and I'll
start with you. We have a light in front of you--your entire
statements are in the record. The light will turn green when
you start, orange after 4 minutes, red after 5. Since your
entire statement is in the record and we have some questions
we're prepared to ask off that, you don't need to go forward
unless you feel you have to. And we, of course, don't--if you
feel you have to say, we won't cut you short, but it makes it
go crisper if we can stay within it.
Mr. Bobb, thanks for being with us. And as I said before,
this city is doing a lot of things right. And this is just one
area that we've not been able to get our hands around and
solve, and that's the purpose for the hearing today. But I
don't want to be overly critical on so many other things that
are going right in this city, and we appreciate you and the
mayor's leadership.
STATEMENTS OF ROBERT C. BOBB, DEPUTY MAYOR/CITY ADMINISTRATOR,
GOVERNMENT OF THE DISTRICT OF COLUMBIA; BRENDA DONALD WALKER,
DEPUTY MAYOR FOR CHILDREN, YOUTH, FAMILIES, AND ELDERS,
GOVERNMENT OF THE DISTRICT OF COLUMBIA; MARSHA THOMPSON, FORMER
ADMINISTRATOR, DISTRICT OF COLUMBIA, MENTAL RETARDATION AND
DEVELOPMENTAL DISABILITIES ADMINISTRATION; ROBERT M. GETTINGS,
EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF STATE DIRECTORS OF
DEVELOPMENTAL DISABILITIES SERVICES; HOLLY MORRISON, VICE
PRESIDENT AND CHIEF ADMINISTRATIVE OFFICER, THE COUNCIL ON
QUALITY AND LEADERSHIP; AND TINA M. CAMPANELLA, EXECUTIVE
DIRECTOR, THE QUALITY TRUST FOR INDIVIDUALS WITH DISABILITIES
STATEMENT OF ROBERT C. BOBB
Mr. Bobb. Thank you very much. And good morning, Chairman
Davis and Ms. Norton, members of the Committee on Government
Reform.
I'm Robert C. Bobb, city administrator/Deputy Mayor for the
District of Columbia, and I'm here today on behalf of Mayor
Anthony Williams.
It is my pleasure to address the committee concerning the
work that has been and is being done in the District to improve
the Mental Retardation and Developmental Disabilities
Administration. Mayor Williams and I remain committed to making
the necessary changes to improve this agency.
MRDDA is facing tremendous and diverse challenges. As you
are well aware, MRDDA has struggled for years to improve its
service delivery and to attract and maintain competent
providers.
In addition to addressing service delivery concerns, the
Williams administration is working to ensure that the day-to-
day management of the agency is strengthened. For the past
several months I have been a regular participant at the weekly
meetings with Deputy Mayor Brenda Donald Walker and MRDDA
senior management. During our budget review process, we have
been working with the District Council to make certain that the
agency is appropriately funded.
In selecting the new MRDDA Administrator Cathy Sawyer, the
Mayor and I sought a strong director with a proven track record
of turning a troubled agency around. A lot can be accomplished
in the next 6\1/2\ months, and we are convinced that Ms. Sawyer
is the right person to be at the helm. During her tenure, we
will also conduct a search to identify candidates for the
permanent director.
In summary, we truly believe that we are laying the right
foundation for MRDDA so that it will provide the necessary
services and care that we all want for District residents
facing mental and developmental challenges.
Let me also state unequivocally that we are opposed to the
appointment of a receivership. The Williams administration
continues to seek the necessary changes to make MRDDA a better
functioning operation. Yes, the task has taken longer than we
anticipated; however, with the concerted attention the agency
is under, internally and externally, and with the addition of a
nationally recognized expert in these matters, we are convinced
that improvements will be made before the end of the year.
Thank you.
[The prepared statement of Mr. Bobb follows:]
[GRAPHIC] [TIFF OMITTED] T8625.013
[GRAPHIC] [TIFF OMITTED] T8625.014
[GRAPHIC] [TIFF OMITTED] T8625.015
Chairman Tom Davis. Thank you very much.
Ms. Walker.
STATEMENT OF BRENDA DONALD WALKER
Ms. Walker. Good morning, Chairman Davis and Congresswoman
Norton. My name is Brenda Donald Walker, and I am Deputy Mayor
for Children, Youth, Families and Elders for the District of
Columbia.
Prior to being appointed Deputy Mayor in November 2005, I
was the director of the Child and Family Services Agency for
the District. I was recruited to CFSA as a chief of staff to
help guide that agency through major reforms and transition out
of court imposed receivership. By virtue of a tremendous amount
of work, fiscal responsibility, innovative practices and a
solid management team, we were able to create what is now a
well regarded child welfare agency.
I offer this history because the challenges facing MRDDA
today resemble very much the issues facing CFSA when I started
there 5 years ago.
As you know, MRDDA faces formidable challenges, including
budget, management and service delivery. We have had literally
decades of decay at MRDDA, yet I come before you today to
testify that I believe we are on the right track.
As with our accomplishments at CFSA, MRDDA cannot be
transformed in months, but rather over several years. However,
the critical foundation--that upon which substantial reform
will be built, can be laid in the next 6 months.
As the city administrator just mentioned, the Mayor
recently appointed Cathy Sawyer as the new administrator for
MRDDA. Ms. Sawyer has consulted for the agency since last
October, thus developing a working knowledge of the agency, so
she will hit the ground sprinting when she starts on Monday.
In accepting the position, Ms. Sawyer has identified three
primary goals for the next 6 months; one, positioning MRDDA to
effectively operate within its budget; two, successfully
amending the existing home and community based waiver; and
three, establishing a solid organizational foundation to enable
MRDDA to function more efficiently and effectively in its
delivery of services.
The coming months will be intense and critical. Everyone
who has met Cathy Sawyer comes away impressed with her
confidence, experience and commitment to improving the lives of
persons with disabilities. I would like to have her brief you
and your staff in the next few months after she has had a
little bit of time to begin work on executing her goals.
Ms. Sawyer represents only one component of our recent
efforts. As I mentioned, a strong management team is essential.
We have also added a Chief Operating Officer, Dr. Heather Stow,
who is here with me today. Dr. Stow has over 20 years of senior
management experience in the human services field. We've also
recently hired a highly regarded quality assurances manager, a
new director of programs, and several other senior staff.
Over the last several months we conducted an organizational
and staffing analysis of MRDDA. And the city administrator and
I will support Ms. Sawyer's rapid implementation of the
critical management and organizational changes needed to move
the agency forward.
Much of our work at MRDDA since I became Deputy Mayor, and
more intensely in the last 4 months, has been driven by the
systems improvement plan that I outlined to address the
agency's basic structural deficiencies. This plan has seven
major components: one, expansion of provider capacity; two,
provider monitoring and accountability; three, contracts
management; four, feasibility of waiver operations; five,
improvement in day programs; six, case management; and seven,
training. Through intensive weekly meetings which I chair, we
are closely tracking our progress, modifying things when
necessary and, most importantly, remaining focused.
As you are aware, we also face a significant legal
challenge to our stewardship of MRDDA. Counsel for the
plaintiffs' class in the U.S. Department of Justice filed
motions for receivership and contempt in the longstanding class
action lawsuit, Evans v. Williams. I am making available for
the committee's records copies of the District's oppositions to
those motions, as well as my declaration submitted to the court
on Monday.
[The information referred to follows:]
[GRAPHIC] [TIFF OMITTED] T8625.016
[GRAPHIC] [TIFF OMITTED] T8625.017
[GRAPHIC] [TIFF OMITTED] T8625.018
[GRAPHIC] [TIFF OMITTED] T8625.019
[GRAPHIC] [TIFF OMITTED] T8625.020
[GRAPHIC] [TIFF OMITTED] T8625.021
[GRAPHIC] [TIFF OMITTED] T8625.022
[GRAPHIC] [TIFF OMITTED] T8625.023
[GRAPHIC] [TIFF OMITTED] T8625.024
[GRAPHIC] [TIFF OMITTED] T8625.025
[GRAPHIC] [TIFF OMITTED] T8625.026
[GRAPHIC] [TIFF OMITTED] T8625.027
[GRAPHIC] [TIFF OMITTED] T8625.028
[GRAPHIC] [TIFF OMITTED] T8625.029
[GRAPHIC] [TIFF OMITTED] T8625.030
[GRAPHIC] [TIFF OMITTED] T8625.031
[GRAPHIC] [TIFF OMITTED] T8625.032
[GRAPHIC] [TIFF OMITTED] T8625.033
[GRAPHIC] [TIFF OMITTED] T8625.034
[GRAPHIC] [TIFF OMITTED] T8625.035
[GRAPHIC] [TIFF OMITTED] T8625.036
[GRAPHIC] [TIFF OMITTED] T8625.037
[GRAPHIC] [TIFF OMITTED] T8625.038
[GRAPHIC] [TIFF OMITTED] T8625.039
[GRAPHIC] [TIFF OMITTED] T8625.040
[GRAPHIC] [TIFF OMITTED] T8625.041
[GRAPHIC] [TIFF OMITTED] T8625.042
[GRAPHIC] [TIFF OMITTED] T8625.043
[GRAPHIC] [TIFF OMITTED] T8625.044
[GRAPHIC] [TIFF OMITTED] T8625.045
[GRAPHIC] [TIFF OMITTED] T8625.046
[GRAPHIC] [TIFF OMITTED] T8625.047
[GRAPHIC] [TIFF OMITTED] T8625.048
[GRAPHIC] [TIFF OMITTED] T8625.049
[GRAPHIC] [TIFF OMITTED] T8625.050
[GRAPHIC] [TIFF OMITTED] T8625.051
[GRAPHIC] [TIFF OMITTED] T8625.052
[GRAPHIC] [TIFF OMITTED] T8625.053
[GRAPHIC] [TIFF OMITTED] T8625.054
[GRAPHIC] [TIFF OMITTED] T8625.055
[GRAPHIC] [TIFF OMITTED] T8625.056
[GRAPHIC] [TIFF OMITTED] T8625.057
[GRAPHIC] [TIFF OMITTED] T8625.058
[GRAPHIC] [TIFF OMITTED] T8625.059
[GRAPHIC] [TIFF OMITTED] T8625.060
[GRAPHIC] [TIFF OMITTED] T8625.061
[GRAPHIC] [TIFF OMITTED] T8625.062
Ms. Walker. Our work over the next few months--over the
last few months and in the 6 months ahead is designed to lay
the foundation for long-term systemic reform. With the
commitment of the Mayor, the support of the city administrator
and MRDDA's new leadership, we are confident that we can
finally get this agency on track.
Thank you for the opportunity to update you on our plans
for MRDDA, and I'm available for your questions.
[The prepared statement of Ms. Walker follows:]
[GRAPHIC] [TIFF OMITTED] T8625.063
[GRAPHIC] [TIFF OMITTED] T8625.064
[GRAPHIC] [TIFF OMITTED] T8625.065
[GRAPHIC] [TIFF OMITTED] T8625.066
[GRAPHIC] [TIFF OMITTED] T8625.067
Chairman Tom Davis. Thank you very much.
Ms. Thompson.
STATEMENT OF MARSHA THOMPSON
Ms. Thompson. Hello, Chairman Davis and Congresswoman
Norton. I'm Marsha H. Thompson, former administrator of the
District of Columbia's Mental Retardation and Developmental
Disabilities Administration.
I believe that while Mayor Williams may have already made
changes in structure and policy to support the incoming
administrator, my sincerest hope is that my comments can
contribute to improving the outcomes for this population, which
I tried my very best to serve as administrator.
I began as interim administrator in May 2005, just in time
for the mid-year budget review with D.C. Department of Human
Services. DCDHS is the cabinet level agency above MRDDA.
Former Deputy Mayor Neil Albert and I determined that
amending our MRDDA Medicaid waiver to reduce the burden on the
local budget was a critically needed step. I hired a waiver
specialist, formed a waiver work group, communicated budget
pressures and possible solutions to the provider, advocacy and
client community, and began work on the needed waiver
revisions.
The parties associated with the Evans court decree insisted
that MRDDA quickly move people from homes fully funded by the
D.C. Medicaid budget, implement a restructure, and provide
improved specialized health care services through private
health care practitioners and hospitals. I communicated the
increasing spending pressures to Mr. Albert. He called an all-
hands meeting to develop a plan for funding to continue
services during that year, and after which he determined what
should be done to meet the needs in fiscal year 2006. He
advised that I complete the amendment for the current MRDDA
waiver, prepare a supplemental budget request to the Mayor for
fiscal year 2006, and collaborate with an expert to better
leverage local funds for the capture of the Federal match in
other ways.
Even though former Deputy Mayor Neil Albert and I had
previously mapped out a structure for MRDDA, I was unable to
implement it due to funding challenges and the hybrid legal
status under which we were operating. As of June 6, 2006, MRDDA
was in need of internal legal counsel to handle the daily court
appearances around client services and many other legal
obligations, internal budget staff with adequate fiscal acumen
who could directly access fiscal reports and forecasts,
internal contract staff with the authority to negotiate
contracts and monitor performance, an internal human resources
office to manage personnel functions. MRDDA did have an
assigned personnel specialist, but the office was not
adequately functioning as of June 6, 2006. Internal information
technology staff with the requisite skills to manage complex
information management needs and design improvements for
responsive and comprehensive information.
MRDDA is one of many city agencies that must work closely
together to achieve the outcomes required by the Evans plan.
These agencies include D.C. Medicaid, D.C. Office of
Contracting, etc. The coordination and responsiveness of these
agencies in support of people with disabilities has always been
recognized as critical to meeting the compliance measures in
Evans. The Mayor has delegated responsibility for coordination
to the Deputy Mayor for Children, Youth, Families and Elders.
The District MRDDA is in need of radical realignment. The
replacement of the administrator is, quite frankly, a woefully
inadequate step in alleviating the systemic problems of this
administration. I submit a few items to be considered and given
support to be implemented: MRDDA needs the undivided attention
of executive leadership and should therefore report directly to
the city administrator. Mr. Bobb is a well known and well
respected administrator.
Consistent budget overruns from a social services program
of this magnitude and with these persistent issues cries out
for adequate funding and appropriate performance measures.
A new Medicaid waiver and the resources to carry out the
program's mandate must be implemented now.
Executive leadership coupled with a legislative committee
chair who will commit the time to understanding the community.
And without the above minimal commitments, the agency
should be immediately placed into receivership.
While the District is moving in a positive direction and
I'm sure will continue to buildupon its accomplishments to
date, much is left to be done at all levels of government. My
primary regret is that I was unable to garner the appropriate
level of support to bring systems change to MRDDA.
Thank you.
[The prepared statement of Ms. Thompson follows:]
[GRAPHIC] [TIFF OMITTED] T8625.068
[GRAPHIC] [TIFF OMITTED] T8625.069
[GRAPHIC] [TIFF OMITTED] T8625.070
[GRAPHIC] [TIFF OMITTED] T8625.071
[GRAPHIC] [TIFF OMITTED] T8625.072
[GRAPHIC] [TIFF OMITTED] T8625.073
Chairman Tom Davis. Thank you very much.
Mr. Gettings.
STATEMENT OF ROBERT M. GETTINGS
Mr. Gettings. Thank you, Mr. Chairman.
Mr. Chairman, my name is Bob Gettings, and I am the
executive director of the National Association of State
Directors of Developmental Disabilities Services, an
organization that represents public developmental disabilities
agencies in the 50 States and the District of Columbia.
I come before you today to discuss my observations
concerning the prerequisites of an effectively managed service
delivery system for persons with developmental disabilities. In
drawing together these observations, I draw upon 40 years of
experience in working with State and local disability officials
to improve services to this population.
You have already heard from the previous witnesses some of
the issues that are faced. I just want to bring it back to this
level. Two of the foundational rules of public administration
are that authority must be commensurate with responsibility and
public servants must be held accountable for their performance.
I'm pleased to hear from Mr. Bobb and Ms. Walker that the
District is committed to changing some of the issues, but the
truth is that is not the way in which--and these rules have not
been followed in the past.
The Mental Retardation and Developmental Disabilities
Administration is responsible under the city code for
delivering high quality services to eligible individuals, but
because the city is highly reliant, as all 50 States are
reliant, on Medicaid as a funding source, the funding of
services are divided between MRDDA and the Medical Assistance
Administration, which is the single State Medicaid agency in
the District. As a consequence, funding an administrative
authority for the city's services are not carried out in a
unified manner.
I think that--and I want to stress that Federal Medicaid
regulations allow States, to administer programs in a unified
way. In the District of Columbia prompt steps need to be taken
to develop an effective interagency agreement between the
Medical Assistance Administration and MRDDA, governing the
management of Medicaid dollars that support specialized long-
term services for persons with developmental disabilities.
A central aim of this agreement should be to assign clear,
unambiguous authority to MRDDA to manage services in a unified
manner. That means pulling together all specialized services,
whether they're derived from Medicaid or non-Medicaid sources.
I think you said it well in your opening statement, Mr.
Chairman, there needs to be a single point of responsibility
and accountability within city government for assuring that
services in this population work.
Unlike most jurisdictions, the District continues to rely
heavily on the ICFMR service model as its primary method of
drawing down Medicaid assistance. Over 60 percent of the budget
for services in fiscal year 1994 went to payments for ICFMR
services, and only 3 percent went to the home and community-
based waiver program.
You've heard from the previous witnesses a commitment to
make the home and community-based service system work. The home
and community-based waiver program has been in existence since
1998, and I think we're still waiting for those kinds of
changes.
At the moment, the District operates one of the smallest
MRDDA waiver programs in the Nation. Expanding and improving
the District's waiver program would not only open a variety of
new financing options, but also allow city officials to claim
Federal financial participation in the cost of existing
services to Title XIX eligible persons that are currently being
funded fully through city revenues. This potentially could add
$30 to $35 million in additional Federal payments that could be
deployed to improve some of the weaknesses in the existing city
infrastructure.
The District really needs to move aggressively to improve
the home and community-based waiver program, but I just would
stress with you that unless existing lines of responsibility
and accountability are clarified and a single District official
is charged with assuring that this task is successfully and
expeditiously completed, recent history strongly suggests that
the waiver renewal process will remain mired in a sea of
bureaucratic infighting.
I want to stress as well that in the 2001 compliance plan
MRDDA is responsible for developing a comprehensive quality
management program, yet at the current time the responsibility
for monitoring and complying with city rules currently rests
with the Health Regulation Administration within the Department
of Health. Because of this division of responsibility and
because of the lack of effective interagency coordination,
provider agencies often receive mixed signals about where their
emphasis should lie. There is an urgent need for the District
government to develop a global plan for monitoring and
improving the quality of services.
Within the next 10 months, the city will be responsible for
submitting waiver renewal requests to the Centers for Medicare
and Medicaid Services. That request will have to include a
comprehensive quality management plan, which is now a new
requirement of CMS. That's going to take a lot of work. That's
an area that needs to be given attention.
Faced with the catastrophic consequences of the city's past
failure to protect its most vulnerable citizens from harm,
there is, I think, an understandable tendency on everybody's
part to grasp for quick solutions. Certainly anyone familiar
with the current problems facing the District's DD service
system has to acknowledge the need for prompt, corrective
actions, and a sense of urgency in implementing them. Immediate
steps to stabilize the situation, however, need to be linked to
a broader set of systemic change strategies aimed at improving
the District government's capacity to effectively manage
services for individuals with disabilities over the long haul.
One of the central lessons that can be drawn from the sad
history of the Evans litigation, and indeed from similar class
action lawsuits across the country, is that deep-seated
systemic failures won't be resolved by a series of quick
overnight fixes. The service
system needs to be rebuilt from the bottom up, and that
requires commitment and sustained leadership from government
officials at all levels, especially top elected and appointed
officials.
Thank you, Mr. Chairman.
[The prepared statement of Mr. Gettings follows:]
[GRAPHIC] [TIFF OMITTED] T8625.074
[GRAPHIC] [TIFF OMITTED] T8625.075
[GRAPHIC] [TIFF OMITTED] T8625.076
[GRAPHIC] [TIFF OMITTED] T8625.077
[GRAPHIC] [TIFF OMITTED] T8625.078
[GRAPHIC] [TIFF OMITTED] T8625.079
[GRAPHIC] [TIFF OMITTED] T8625.080
[GRAPHIC] [TIFF OMITTED] T8625.081
[GRAPHIC] [TIFF OMITTED] T8625.082
Chairman Tom Davis. Thank you very much.
Ms. Morrison, thanks for being with us.
STATEMENT OF HOLLY MORRISON
Ms. Morrison. Good morning, Chairman Davis and
Congresswoman Norton. My name is Holly Morrison, and I'm with
the Council on Quality and Leadership. I'm currently the vice
president and chief administrative officer. It's a pleasure to
be here this morning.
I think CQL's experience and history make us uniquely
qualified to discuss performance, measurement and quality
improvement for services for people with disabilities. National
organizations founded CQL as a standard setting body in the
field of intellectual disabilities in 1969. CQL has revised and
published successive editions of its standards on a continuous
basis in 1971, 1973, 1978, 1984, 1989, 1991, 1993, 1997, 2000,
and again in 2005.
CQL remains a private, nonprofit organization incorporated
in the District of Columbia and sponsored by the leading
national organizations in the field of intellectual
disabilities, including the American Association on Mental
Retardation, ANCOR, which is the American Network of Community
Options and Resources, the Arc, the Autism Society of America,
Easter Seals, Mosaic, National Association of Qualified Mental
Retardation Professionals, SABE, Self Advocates Becoming
Empowered, the United Cerebral Palsy Associations, Inc.
Today, I want to focus attention on accountability rather
than specific minimum standards, organizational processes or
accreditation programs.
CQL and other leading national organizations in the field
of intellectual disabilities define quality in terms of
responsiveness to the individual in addition to compliance with
regulations and organizational processes.
Compliance with standards and mandated processes provide
uniform and routine performance requirements, but compliance
with standards may not result in personal outcome attainment or
performance improvement. Organizations must measure personal
outcome attainment, and then constantly adjust standards and
organizational processes to optimize outcomes.
Organizational accountability and quality performance
requires outcome-based assessment. Basic assurances in the
areas of health, safety, human security and legal rights
require well-defined performance expectations for staff.
Quality performance is linked to facilitating the outcomes that
are important to the individual, to their family, to their
friends, and the community that supports them.
Organizations staff professionals and families realize that
each person is a unique sample of one, that each person has
unique expectations for such important outcomes as best health,
safety, respect, friendship and employment.
The distinction between outcome measurement and compliance
with process is particularly important for service systems
operating under close public scrutiny, government reform
initiatives, and court oversight.
Standards and organizational processes, policy and
procedure must facilitate outcomes. Public accountability,
quality improvement and fiscal responsibility require the
measurement of outcomes, not just compliance with minimum
standards.
Finally, clear definition of outcomes provides the
necessary platform for staff training and board of director
education for all service providers. Board of director
orientation and staff training are necessary components for
organizational accountability and performance improvement.
Thank you very much.
[The prepared statement of Ms. Morrison follows:]
[GRAPHIC] [TIFF OMITTED] T8625.083
[GRAPHIC] [TIFF OMITTED] T8625.084
[GRAPHIC] [TIFF OMITTED] T8625.085
[GRAPHIC] [TIFF OMITTED] T8625.086
Chairman Tom Davis. Thank you very much.
Ms. Campanella.
STATEMENT OF TINA M. CAMPANELLA
Ms. Campanella. Good morning, Chairman Davis.
My name is Tina Campanella, and I am the executive director
of Quality Trust for Individuals with Disabilities, an
independent nonprofit advocacy organization for people with
developmental disabilities in the District of Columbia. Thank
you for this opportunity to testify.
Our organization is a product of the 2001 settlement
agreement in the Evans v. Williams class action lawsuit and was
created to represent all citizens with developmental
disabilities in D.C., not only the 665 Evans class members.
The situation for people with developmental disabilities in
D.C. is very troubling. The current structure and framework for
services is not working well at all. The critical question is
how to make fundamental changes in the organization and
operation of the service system. Quality trust issues are
advocacy experience to inform our recommendations for change. I
have included with my testimony a 4-page working document that
describes the broad changes we feel are needed within the D.C.
service system to make services responsive to the needs of the
people it supports.
While we recognize and commend the efforts of the D.C. City
Council Humans Services Committee Chair Adrian Fenty and Deputy
Mayor Brenda Donald Walker, it is important to underscore that
the D.C. service system cannot be improved without bold and
dramatic action. The difficulties extend well beyond the
individual appointed as administrator. The fragmented structure
of the administration, funding and enforcement functions is at
the root of problems with performance and accountability.
Our recommendations target essential elements of a
functional system. These recommended actions will not fix the
situation quickly, but they will advance the dialog about how
to bring greater accountability to the administration, funding
and oversight of services and supports to people. Some of these
issues have already been mentioned so I won't go into detail
here.
Obviously we need a comprehensive plan to manage the
dollars that will be coming into the city to fund services to
the Medicaid program, and that needs to cross over agency
lines. The waiver application has also been made as a
recommendation and a priority for many people, and we agree
that must be made a primary priority.
Additionally, a coordinated strategy to ensure that
providers enter the system with prerequisite qualifications,
and that performance over time is tracked to identify areas
where difficulties are encountered as needed.
The functions for licensing, certification and quality
monitoring now spread over MRDDA and the Department of Health
Regulatory Agency need to be linked and closely coordinated,
and again, as you have heard, preferably with one agency taking
the lead.
Case management again is a serious issue. We believe it
needs to be grounded in the tradition of individual advocacy
and support for people's right to create lifestyles of their
own choosing to the greatest extent possible.
An additional issue is that D.C. law provides that all
individuals who are receiving residential services are entitled
to an advocate. The structure in process in D.C. to meet this
requirement is part of the D.C. Supreme Court Family Division.
This function has not been implemented as envisioned, and it
has no dedicated funding. Funding for this function has been
included in the current budget request, and we believe must be
funded.
And finally, funds and efforts should be devoted to
developing a strategy for working together with families and
providing support to people in their family home. In-home
family supports provide an important alternative to group
living arrangements and need to be part of D.C.'s long-term
strategy for services and supports. The framework for funding
exists, but will remain unused without specific efforts to
develop the provider capacity needed to develop this support.
We are encouraged that D.C. has secured assistance from Ms.
Cathy Sawyer. We are mindful, however, that these problems that
she faces are substantial and cannot be fixed overnight through
policy development and planning.
The solution requires everyone to remain clearly focused on
the immediate planning and intervention needed to provide
adequate and reliable supports for people today, while at the
same time designing and implementing the structure and capacity
needed for the future.
Further, we see great urgency to move forward quickly to
ensure people with developmental disabilities are protected
from any additional harm as they are supported to live full and
productive lives.
Thank you again for the opportunity to testify, and I will
be happy to answer any questions.
[The prepared statement of Ms. Campanella follows:]
[GRAPHIC] [TIFF OMITTED] T8625.087
[GRAPHIC] [TIFF OMITTED] T8625.088
[GRAPHIC] [TIFF OMITTED] T8625.089
[GRAPHIC] [TIFF OMITTED] T8625.090
[GRAPHIC] [TIFF OMITTED] T8625.091
[GRAPHIC] [TIFF OMITTED] T8625.092
[GRAPHIC] [TIFF OMITTED] T8625.093
[GRAPHIC] [TIFF OMITTED] T8625.094
Chairman Tom Davis. Thank you all very, very much.
I've got a few questions. I'm going to start, I think, Mr.
Bobb, with you and Ms. Walker.
Does the city have any plans to regulate case management?
Ms. Walker. We do have a case management work group as part
of the systems improvement plan, and they're looking at all
aspects of case management, including some different models.
And the subject of regulation has not come up in my
conversations specifically, but we'll make sure that's on the
table.
Chairman Tom Davis. Yeah. I'll tell you why I say that.
There is a report that's scheduled to be released on June 22nd,
and the court monitor states there is a lack of standards
relating to the case management in MRDDA and that the
individual support plans fell short of implementation. And that
may be where you start on this.
Ms. Walker. I was a little confused by your word
``regulate,'' but certainly the adoption of standards and case
management, monitoring and a whole system is definitely needed
and is part of the short-term plan.
Chairman Tom Davis. Now on August 4, 2005, Deputy Mayor
Albert notified the court of plans to reorganize MRDDA, and to
do so the parties agreed to the 90-day initiative which was
designed to demonstrate the District's ability to increase
meaningful systematic reorganization.
Does the District still plan to reorganize MRDDA, and can
you give us a sketch of what you're looking at?
Mr. Bobb. Yes. MRDDA, this department was part of the
larger Department of Human Services, and so what we want to do
is, make it a single agency itself and give it the independence
that it needs as a single agency. So part of our work this
coming Monday is to look at, although we've separated it from
the Department of Human Services, our work is to take it even
further in terms of how we restructure it as a single agency
with a lot more independent authority than it currently has,
and also to ensure some of the issues that have been raised
with respect to interagency collaboration that's really needed
at the end of the day to make this agency function even better.
Chairman Tom Davis. The city put a lot of effort into
regaining control of the agencies that were in court ordered
receivership, a lot of effort. And of course we worked with the
city on that. Mayor Williams even hired a separate counsel to
spearhead the effort. But back in 2003 the judge in the Evans
case found it necessary to order the city to appoint a Deputy
Mayor or other senior official to coordinate the agencies
responsible for various aspects of compliance with the court
order.
Does the Mayor plan to appoint a special counsel or other
senior official to reform services for the developmentally
disabled?
Mr. Bobb. Yes, one of the discussions--I've been involved
in the Jerry Young case, for instance. So in my office I have
kind of an internal receiver that works with me and I work
directly with the plaintiffs in that case; and we're looking at
a similar model with respect to this agency itself.
Chairman Tom Davis. Do you have any plans to alter the
relationship between MRDDA and the Medical Assistance Agency,
which is the State Medicaid agency?
Ms. Walker. We certainly are looking at that and have that
as a major agenda item, because that is mentioned time and time
again, as it has been today, that it's important to have some
more coordination if not colonization. I do want to caution the
committee, as I do our team, that at this point MRDDA really
needs to focus on its core mission, and that is delivering high
quality services to the consumers that the agency serves. And
certainly we know the importance of the interagency
coordination, and I have found all of our agencies, including
MAA, to be very responsive. And with the Mayor's directive and
the city administrator's support, that we--supporting MRDDA is
a top priority where we are certainly going to be doing that
over the next few months while we look at the best
organizational structure. We just have a lot to do over the
next few months.
And I want to add, my former agency, CFSA, did have some
independent authority in certain areas that has been suggested
that might be beneficial for MRDDA, but I also know that it
took 3 to 4 years to build that infrastructure, which takes
away from the core services. And so my direction is that we
have to focus on the basics first, while at the same time we're
looking at all of the structural impediments or opportunities
to make MRDDA better.
Chairman Tom Davis. Could you elaborate on the systems
improvements plan, Ms. Walker? What is the objective of the
plan? And then I'm going to ask anybody else on the panel to
comment on that, if they have a comment on it.
Ms. Walker. My assessment of the agency is that some of the
basic systems have just not been in place. I think that there
has been a lot of improvement over the last few years in a lot
of different areas, but you don't have the basic infrastructure
laid to just operate smoothly. And so we're focusing again on a
number of areas, but the provider monitoring and accountability
is a critical area and one that we get criticized, and I think
rightfully so, by the court monitors and others because we
don't have a centralized system for really evaluating and being
able to respond quickly to problems with our providers or when
consumers have problems with services. We need a centralized
system, and we have that, we developed that for CFSA, and I'd
like to look at a similar model. But basically it's where all
of the information comes together so that you're making
informed decisions about who is a good provider, who is not, is
case management business being done on time, and while that
information comes together, right now it is very chaotic.
So provider accountability is one key area. Contracts
management is another area that goes to our ability to access
better services, including the waiver services.
The feasibility of waiver operations, we're looking at day
programs and the whole case management model, as well as basic
training. So we have that, and we have details. If you'd like
us to forward the plan to the staff, we'd be happy to do that.
Chairman Tom Davis. Ms. Thompson, the District brought on
two new contractors to take on 16 group homes. Several agencies
had to help with this transition. Could you walk us through
some of the steps you had to take?
Ms. Thompson. Yes, I'd be pleased to do that, sir. Let me
start at the end and work back to the beginning.
The end was having people in place, providing services in
legally licensed safe environments. To get there, each of those
providers had to get an inspection from our Health Regulation
Administration, and they had to the get the inspection on the
day they were taking over. It could not be before they took
over. That is just our regulation.
Prior to them getting the inspection, they had to submit a
Certificate of Occupancy, which means that they had to go
through our agency that handles the building permits, which is
normally a difficult process, but we were able to negotiate
that properly.
Before they got a Certificate of Occupancy, they had to
have a signed lease for the facility that they were going to
operate. Before they could have a signed lease, they had to
have an agreement with the District which guaranteed them that
they would have funding with which to pay the lease. To get the
agreement with the District, they had to negotiate a budget and
a contract with our Office of Contracts and Personnel.
To negotiate the contract, first they had to respond to a
public request for proposals. So all of this was a tightly
organized, quickly moving train. But it had many, many, many
stops it had to make along the way.
In the end, everything came together well. It took my
interagency coordination with the Medicaid Administration,
Contracting and Personnel, Consumer Regulatory Affairs, the
Health Regulation Administration, the D.C. Fire Department,
MRDDA itself, and the advocate agencies and the court monitor.
And it was a huge job to get done. And those agencies did a
very good job following with me every single step.
It was a nightmare but it was something that had to happen
and I think the people will be better served by those folks.
Chairman Tom Davis. Thank you.
Mr. Gettings, what steps need to be taken, in your opinion,
to develop an effective interagency agreement between the
Medical Assistance Administration in the Department of Health
and MRDDA in the Department of Health Services that would
govern the management of Medicaid dollars for services for the
mentally disabled?
Mr. Gettings. I think that, first, there are plenty of
models around in other States where that has been done.
But the principles behind this, the management agreement
between the two, are that you manage a unified budget across
Medicaid and city dollars, that has a single focus on creating
a sense of accountability for how the system is going to
operate.
Again, the problem that the District has faced in the past
is not unique. Other States have faced exactly the same problem
of saying we have a single State Medicaid agency that manages
our Medicaid program, and we have a program agency that is
responsible for making this happen.
The task is to bring those things together and define in
clear terms what the interaction between those two accountable
agencies has to be, so that there is an absolutely unified
approach to developing policy and funding services.
Chairman Tom Davis. Thank you, very much. Ms. Morrison. Let
me start with Ms. Bobby Walker. Does the city plan to require
accreditation caregivers?
Ms. Walker. We are looking into accreditation. We have a
team looking at that. Our recommendation is that we do not
pursue that in this next year. That is a very involved process
in that it's very labor intensive. We can adopt standards and
we can--in terms of our whole QA process we are going to be
moving in that direction, but it's my recommendation that we
not pursue formal accreditation. At least not this year.
Chairman Tom Davis. Mrs. Campanella, let me ask you, when
the city meets the court's requirements in the Evans case,
services to class members will obviously be improved. What do
you foresee the need for reforms that go beyond Evans'
compliance to make sure non-class members receive adequate care
and service?
Ms. Campanella. Good question. Basically where we are
focusing our efforts around quality is not at setting the bar
at the floor, which is what we see the compliance with the
Evans plan as defining the minimum standards, but going beyond
that to begin to look at the kind of individually responsive
services and individually supportive services that Ms. Morrison
described earlier.
So we have begun to focus on the basic assurance areas of
health safety rights, safe environments, and other kinds of
supports like that to really assist providers to think broader
than just minimum compliance.
Chairman Tom Davis. Thank you very much. I have more
questions. I am going to go--although I may or may not make it
back--I am going to turn the gavel over to Ms. Norton. If I
don't get back, I want to thank everybody for this. We may have
some other additional questions for the record. Again we don't
like to get into these things, but given what has transpired
and the length, and really the severity of the problem, we are
going to continue to exercise some oversight. But I just want
to thank everybody for being here today and trying to work to
get this resolved.
Ms. Norton [presiding]. Thank you, Mr. Chairman. The
chairman does turn the gavel over to me. In the past I've
always turned it back. I am kind of like a trustee in the jail.
You know, you let the trustee have greater freedom because the
trustee is not going to break out. One of these days I may have
to break out. But because we have a bill pending, maybe that
will be unnecessary.
Let me start with what appeared to be a loss of confidence
by the counsel in the ability of the agency to improve itself,
taking the drastic step of denying funding. Was this a denial
of increase in funding? Very harsh step considering the
vulnerability of those involved.
One, is this a denial of an increase in funding? And what
is the effect?
Mr. Bobb. Thank you. Well, we stated to city council that
we have several requests them before them. One was a request to
address the budget pressures in the current fiscal year, as
well as a request for additional funding in the 2007 budget.
We also during the course of our budget deliberation, have
reduced the budget by approximately----
Ms. Norton. You wanted funds for this fiscal year plus an
increase next year?
Mr. Bobb. That is correct. We need additional funding this
current fiscal year, as well as additional funding in the 2007
budget effective October 1st. And so we have been working
through both of those issues with the city council.
Ms. Norton. I thought the city council had made a decision.
And what was the decision that was made?
Mr. Bobb. They made one decision last week, which was to
provide us with, I think, $10 million of one funding request.
And that decision was made last week.
We still have a decision pending before the city council
with respect to the 2007 budget.
Ms. Norton. So they have, in fact, given you $10 million
that you wanted for this year's budget?
Mr. Bobb. That's correct.
Ms. Norton. And what made them decide to do that?
Ms. Walker. If I could address that, having had to testify
many times about the budget needs of the agency, the chairman
of the Human Services Committee told us point blank that he
withdrew an opposition to our funding request in view of the
management changes that we made and the systems improvement
plan and the mayor's and city administrator's commitment to
stand behind the agency and to drive this reform.
But the $10 million that was improved last week, we still
have another close to $8 million pending before the council for
this year. So, this year there is $18 million----
Ms. Norton. Why were those funds needed?
Ms. Walker. Well, there are several reasons. One, the
agency received a budget cut last year for fiscal year 2006 and
did not adjust its spending accordingly.
So the budget cut of, there was a budget cut of $5
million----
Ms. Norton. Is that a budget cut or not as much money as it
requested?
Ms. Walker. Last year it was a cut as part of the budget
process. But going in when you know your budget has been
reduced $5 million, then it's the responsibility of the agency
to just adjust its spending plan accordingly. But that didn't
happen----
Ms. Norton. Why didn't that happen?
Ms. Walker. A management issue. We also had some unusual
circumstances this year. The closure of the local forming group
homes that has been mentioned before, which was written in the
papers, what a bold step and necessary step, and I commend the
former administrator for doing that. What that meant is the
providers had a number of homes that were Medicaid-funded
homes, the ICFMRs. When they come in as new providers, they
have to go through the process to get certified again, which
meant that for a period of--we are projecting 90 days and we
are close to the end of the 90 days--to get them certified,
then we have to take them off the Medicaid dollars and they get
funded totally with local dollars. So that was another $4
million total for that period of time.
So that was an unforeseen expenditure but one we felt was
necessary due to the performance of those agencies.
And then the other primary driver of the budget issues this
year was that, as Ms. Campanella and other advocates in our
Evans parties push us to do, is to provide placements for
clients in the least restrictive environment, and which we
support, but the agency has done that irrespective of the
funding available.
And so decisions have been made, policy and practice
decisions, that have not been consistent with the budget
authority to fund them. And so we find that we have more and
more clients who are in apartments, who need a lot of
individualized services that our current waiver does not cover.
Now, those are decisions that, you know, always have to be
weighed out. But certainly if those are the practices an agency
is going to undertake, then it has to have the budget authority
in order to do that. So you have those things running, pushing
the budget into a major deficit this year.
Ms. Norton. Which brings to us the waiver. If what we are
talking about is the Federal Government picking up part of
services that otherwise you would be providing, I can't think
of more of an incentive to try to get a waiver. What stands in
the way of a larger Medicaid waiver?
Ms. Walker. Well it's the process. It is a long and
involved process----
Ms. Norton. It is not the process.
Ms. Walker. Part of it is----
Ms. Norton. It is the same process for everybody in the
United States. So it's not the process.
Ms. Walker. The process should have been started a long
time ago. It was started but it was wasn't completed. Here is
where we are today. We do have the expert consultants on board.
We have signed a contract to take us to the place where we can
finally fully submit a completed application to the Federal
Government to expand the waiver and----
Ms. Norton. So somebody missed the process and the
consultants are in the process now?
Ms. Walker. Yes. Yes. There already has been an
application. A large part of the application has been
completed. There are two sections that have to be done, and
that is where we needed the expert consultants----
Ms. Norton. Are you going to seek this larger waiver or
simply the renewal of the existing waiver?
Ms. Walker. No. We are seeking a larger waiver that is more
expansive and will cover more services and more hours for the
types of services that our consumers need.
Essentially, right now the local government is paying, like
you said, a disproportionate amount under our current waiver.
So we want to refine that waiver, have that expanded and that
will be part of the renewal application for the waiver, so we
would go in for renewal with the expanded waiver.
Ms. Norton. I am very pleased to hear that. You owe that
not only to these residents, you owe that to the taxpayers of
the District of Columbia.
Ms. Walker. I totally agree.
Ms. Norton. Because they're picking up the rest. I am
interested in that because I have put in a bill--I have a
series of bills called the Free and Equal D.C. Series. When we
got the increase in Medicaid, we still were left paying, as the
District of Columbia, a larger share than any city in the
United States, even New York, which is the only other city that
pays 25 percent. We pay 30 percent. That is much better than
before.
But this bill seeks to put the District in the same
position that any city would be in. So it asks that at least
part of this be picked up by the Federal Government, as the
quote states.
Now, obviously, if the waiver process in the District is
all out of kilter, that would seriously interfere with
Congress, seriously considering my bill.
I haven't heard anyone--I was out of the room for a moment,
but I understand that no one has advocated receivership. Does
anyone at the table believe that receivership is necessary at
this time?
Ms. Thompson. I only believe that would be necessary if Mr.
Robert Bobb does not take over the agency and manage it as an
internal receiver, as he has done with DYRS.
Ms. Norton. Mr. Bobb, do you believe that the agency should
report directly to you? MRDDA should report directly to you?
Mr. Bobb. Technically it does.
Ms. Norton. How technically?
Mr. Bobb. We have the deputy mayors work directly with
these agencies with respect to their daily operations, but at
the end of the day they are accountable to me and the mayor.
Ms. Norton. They're accountable, yes. I am now talking
about--would you speak to Ms. Thompson's notion--is it your
belief that improvements would be made--let me give you some
background here. A number of us have some bills over here
involving FEMA, following the Katrina disaster.
None of them--all of them--they differ somewhat, but all of
them believe that FEMA should report directly to the President
of the United States and should not have to go through any
bureaucracy; in other words, if an agency has a mission that is
either difficult or important, it may be that what would
otherwise make sense--and here we have the Department of
Homeland Security--would otherwise make sense, may not make
sense for this particular agency. Given the long history of
problems in this agency I ask whether or not Ms. Thompson's
suggestion should be considered?
Mr. Bobb. Yes, it definitely has been under consideration.
Let me just say we had a similar situation----
Ms. Norton. I know that is putting a lot of, I don't know
how much you can put on one person but you know, that is like
saying I don't know how much I should put on the President of
the United States. It's his job to make sure that it works, so.
And I recognize, Mr. Bobb, that you are the real problem
solver in the government. I know from firsthand experience.
So I ask you, not only as a structural matter, I have run a
big troubled agency in the Federal Government. I ask you as a
pragmatic matter, is this suggestion feasible?
Mr. Bobb. Yes, it is feasible.
Ms. Norton. So you are considering doing that?
Mr. Bobb. Yes, we are considering.
Ms. Norton. Is it likely to happen?
Mr. Bobb. After consulting with the Mayor we will be able
to say, what we did, just as a point of contact, what we did
with the Department of YSA, the former Youth Services
Administration which has been in receiver for 20-plus years as
well, is while that agency reports directly to the Deputy
Mayor, I have an internal receiver that works with me and the
Mayor's personal attorney, executive lawyers for the Mayor. So
I have a lawyer that works for me that helps to move the
reforms forward with the director. And then I meet personally
with the plaintiffs in the case.
And so I am directly engaged with the lead counsel for the
plaintiffs in the Jerry M. case, for example. So to that extent
I am very, very involved in pushing the reforms in that case.
And so we are looking at a similar model with respect to this
agency.
Ms. Norton. That is very wise if you want to avoid
receivership. Does anyone else believe that receivership is,
should or should not be considered or appointed?
Ms. Campanella. Ms. Norton quality trust fully understands
why the plaintiff's attorneys have filed for receivership in
this case. As I stated in my testimony, the situation for
people in the city is very troubling.
There have been continued promises, continued deadlines
missed, and, unfortunately, continued harm that has come to
people who rely on the service system here. So while we are
very encouraged by some of the things that have happened, the
time is past for when we can actually wait for some sort of a
solution. As we all know, receivership takes time to work
through the system.
At such time that considers--receivership is actually
considered by the courts, the substantial administrative
changes have been made by the district, and possibly we can
reconsider at that point, you. But at this point, the needs of
people with disabilities in the District of Columbia are too
significant and not being supported enough for us to say that
pursuing receivership is not a reasonable course of action.
Ms. Norton. So you favor receivership?
Ms. Campanella. I favor the course of action in seeking
receivership that the plaintiffs have taken.
Ms. Norton. You favor the shot across the bow in applying
for receivership, in hoping they get their act together so the
court will not have to do so.
Ms. Campanella. Again, I am going to say based on my 4
years of experience in the District of Columbia, again, we have
worked very seriously and we are very committed to working in
concert with the District, Ms. Brenda Donald Walker, and at
various times we have seen many players change. I don't
question the earnesty of any of those folks. But the bottom
line and the actual track record remains that some serious and
significant changes have not been made as evidenced by where we
are today with the waiver. So yes, given the situation as it is
today, we do support the filing for receivership.
Ms. Morrison. Ms. Norton, obviously from my testimony, I am
here representing an organization that defines, measures, and
improves quality for people with disabilities.
And we would like to say that receivership or no
receivership, it really won't matter if we don't start looking
at outcomes for individual people, if we don't look at being
responsive to people rather than layering different levels of
organizational process and playing the compliance game.
Bringing in a receiver that would not pay attention to
individual personalized outcomes would only add another layer
and make it even more difficult to get things done.
So I think the issue of paying attention to personnel
outcomes, measuring that, and moving forward in designing the
system based around what people with disabilities say is
important to them.
Mr. Gettings. Ms. Norton, I would just add to that, having
watched situations in which the courts have intervened in such
a radical manner to appoint a receiver, that one of the things
that has to be taken into account is, what is the end gain?
Where does accountability ultimately reside? And serious
situations call for serious interventions.
And I agree with Ms. Campanella that if you look at the
testimony that is presented to the court, it certainly
justifies some radical interventions to correct the situation
as it exists for a very, very long period of time.
At the same time, I don't think a receivership should be--
is a solution, unless you have a very clear plan for how
government is going to reassume responsibility. So the best of
all possible courses of action is that you avoid it. And I
think, I hope that would not happen in this situation because
it carries----
Ms. Norton. Receiverships don't operate that way. They are
open-ended and they end when the court says they end. And it
could be years and years, and we know because we have been
through that before. I am agnostic on it.
Let me ask the Members of the panel from what you have head
here today, for example, that they have hired a consultant,
that they think they are going to get a comprehensive Medicaid
waiver, does anything you heard here today indicate to you that
a receiver may well not be necessary?
Ms. Campanella. Again, let me start. I think, again, and I
included in my testimony, a commendation for Deputy Mayor
Brenda Donald Walker, because I think she has taken on a very
serious job with a very serious approach and has begun to
organize people in a way that would address some of these
significant issues.
I am glad to hear that they have the consultants on board
and they're going to pursue the new application. But, at best,
we are looking at implementing a new expanded waiver in the
fall of 2007.
Ms. Norton. That would happen whether or not there is a
receiver, wouldn't it? Because if you got to have--the court
can't mandate or won't mandate the Medicaid--more comprehensive
Medicaid waiver, it would have to work it through as well in
order to decide, I mean, what I am saying is I don't see what
you are saying has to do with receiver.
When it would start, when the waiver would start, yes, and
over here it is, here the Federal Government, it's slow as
molasses. But you have--D.C. hasn't even gotten it in and the
taxpayers of the District of Columbia are paying for what the
Federal Government should be paying for. And the expanded
waiver has enormous implications for the improvements that you
are indicating. So the only question about the receiver end and
Medicaid is whether or not the receiver facilitates that or
not. You could argue that the receiver delays that, because I
can say without fear of contradiction that the agency is quite
unlikely to give a Medicaid waiver while something is in court.
Ms. Walker. Ms. Norton, if I could respond to this whole
receivership and what we are doing, I ran an agency that had
been under receivership. And when we took over the agency in
2001, it was after they had negotiated a settlement to end the
receivership and the mayor elevated this to a Cabinet-level
agency--we took over that agency and it was in shambles. There
were no structural foundations. We had to build everything from
scratch.
And the same thing is true about the Department of Mental
Health which exited receivership at the same time. So we are
vigorously opposing the notion of receivership.
Ms. Norton. I understand that. But the point is--what my
question is, in order to get the comprehensive Medicaid waiver
it does seem to me you would have to show such substantial
improvement. It may even be a proxy for----
Mr. Gettings. That is very true, because essentially what
the city----
Ms. Norton. Proxy for a receiver.
Mr. Gettings. Is requesting a special dispensation under
Medicaid policy to gain that waiver and, yes indeed--and that
is why I said in my written testimony, there is a lot of work
to be done in order to get to the point where you can do that.
I am very encouraged by the commitment that I have heard here
today and I hope we can move ahead rapidly on it.
Ms. Norton. I don't see anything inconsistent with what has
been said here. And, Mr. Campanella I don't know if you had
wanted to say something further.
Ms. Campanella. I would just add I am encouraged by the
focus on the new application. I would encourage, and I have
encouraged, this administration to continue to be focused on
what can change today about how we implement the local rules
that govern the waiver program. Because we believe there is
potential there to make some improvements long before 2007.
Ms. Norton. In the chairman's opening testimony, he
detailed some of the abuses that brings a matter like this to
the attention of the Congress, these, of course, are anecdotal
but they are so horrendous that even a few of these leads
people to believe that there is something wrong that has not
been reported. He spoke about charges of sexually abusing a
patient or burning a patient.
But what was most, most troubling was the part of his
opening statement that said that the monitor had said that for
a period of over a year the District failed to notify the
providers where these residents lived or the results of the
investigations, even though these investigations were conducted
by the District's own reviewer.
And then, of course, he said--here I am quoting the
chairman--as a result--no, no I am not quoting the chairman. He
is quoting the article I think. As a result, corrective actions
were never discussed, let alone implemented or evaluated.
Yes, Ms. Thompson.
Ms. Thompson. Congresswoman Norton, in 2004 when I was an
employee of MRDDA, my job at that point was to work with the
Evans compliance piece. And I followed a committee called the
Mortality Review Committee, which began at that time to share
those evaluations and recommendations and the actual reports
from Columbus with the providers, the hospitals etc.
I was moved from that position to work for the deputy mayor
to oversee the health care plan.
In late April, early May, I was sent back to MRDDA as the
interim administrator, at which time, by the way, we only had
about a month's worth of funding in the pot. When I got back
there, there were so many things to fix that it took me a few
months to recognize that the committee had stopped meeting when
I left.
So I reinstituted it in November 2005 and broadened it to
include the monitor staff, case management staff, the quality
trust, and many others. So we put a process in place to ensure
that these recommendations and reports were distributed
appropriately to everyone who touched the client at the time.
So that has restarted----
Ms. Norton. You are telling me that these reports are now
always made available?
Ms. Thompson. Now they are. Now they are.
Ms. Norton. All right. Let me go to what is my real concern
here. You would think that is the least that could be done.
I noticed that in Ms. Campanella's testimony--I am not
interested--of course, I am interested in finding out what
happened and preventing it and so forth. But you see it should
be, if somebody has been seriously hurt you wonder how, what
the agency is doing to make sure that doesn't happen. And she
says in her testimony, she speaks about the advocate. ``Each
person by law is entitled to an advocate,'' and says that there
is no dedicated funding, although funding has been included in
the current budget request. Now, let me ask, because the point
here is to have somebody who will watch over me, as they say,
``somebody to watch over me.''
And very often there is no relative, and even if there is
somebody, the relative may not feel it is his responsibility to
perform this function.
Is the advocate the best way to prevent this kind of abuse,
the fact of actually going and monitoring the residents often?
Is there now dedicated funding? Does every resident in one of
these group homes have an advocate?
Ms. Thompson. Ma'am, the answer to the last part of your
question is no. Every person in those group homes does not have
an advocate. A critical function that I think when we are
really sort of dancing around the edges is the role of active
and advocacy-based case management where the intent of case
management is around advocating for the client as though that
person is your best friend or your family member.
And until that intent of case management is properly
developed----
Ms. Norton. I am not talking about intent of case
management? Are you talking about case workers?
Ms. Thompson. Yes, I am.
Ms. Norton. Are there sufficient case workers? Once I hear
you talk about case workers, my eyes really begin to roll,
because it's so hard to find people to deal with people in many
different kinds of situations. So, is the answer that every
person should have a case worker that comes so often that, in
fact, burning somebody or sexually abusing somebody is
deterred?
Ms. Thompson. I think that is part of the answer, Ms.
Norton.
Ms. Norton. How often do case workers----
Ms. Thompson. They are supposed to see people as far as I
know now, at least once per month. But that is the floor. That
is not what real case management advocacy is about.
Ms. Norton. What is real case management advocacy about? I
am interested in somebody watching over. I only have one
question. If they know somebody is, if they knew I was going to
come in there very often, they are less likely to harm the
person I am coming to see. And all I am asking is, and when you
tell me about case management and case workers, then I really
get scared because we have had hearings on foster children, we
know nobody is going into social work. I don't want to go
through that one again.
So, I was caught by this notion of an advocate because I
can't ask the District to do the impossible.
Mr. Gettings. There are several issues that are being
raised here. One of them is the issue of an individual legal
advocate. That is through the Superior Court.
That's not budgeted as part of the city's budget, and when
Ms. Campanella talks about a budget request there is a budget
request that has gone forward to the superior court to put in
funding for those advocates. That is an act of Congress. It is
not an act of the city government, by the way.
Ms. Norton. But what does the advocate do and how often
does the advocate come?
Ms. Campanella. The court-appointed advocate would work
under the supervision of the D.C. Superior Court Family
Division. And the idea in their volunteer advocacy program is
that it would introduce into the lives of people with
disabilities, who may not have family, someone who is committed
to going and visiting that person and staying involved in that
person's life, over time.
Ms. Norton. Mr. Bobb, please. I am trying to get, how many
advocates do we have? And how often do you believe the advocate
should come in order to have at least a deterrent effect on
abuse?
Ms. Campanella. Again, my best estimate at this point is
for an estimate of 1,200-plus people who should be accessing an
advocate. There are around an average of 200 advocates
available.
So they assess AREAs. Any people that don't have an
advocate.
The advocacy program, as it currently exists, is not
supervised. It has a half-time clerk assigned to it, and it is
not really staffed to oversee any of the recruitment and
supervision activities that it would need to make it a
functional program.
Ms. Norton. Now let's get to the funding. You say in your
testimony that there hadn't been dedicated funding in the
budget request. Mr. Bobb or Ms. Walker or Ms. Thompson, again,
is the money--budget--has this been approved in a budget which,
by the way, is already over here? Then, Bob, the answer to the
question is no. We don't have this as a ``be candid,'' this is
the first time I have known, seen this D.C. law. You know this
particular code. And I don't know that if this is a requirement
if it's a requirement that the D.C. government, and no one has
called this to my attention, if it is a requirement of the
courts. And we should be advocating with the court to provide
this funding.
Ms. Campanella. Again, Ms. Norton, just to clarify, we have
been advocating over the past 4 years with the D.C. Superior
Court to acknowledge and figure out how to address and
implement the responsibilities associated with this.
It is my understanding that Judge Rufus King in the D.C.
Superior Court has included just under $1 million in the budget
request that was sent to Congress for the superior court.
Ms. Norton. In the court budget.
Ms. Camanella. The court budget. Yes, because this was
supervised and overseen by the D.C. Superior Court.
Ms. Norton. And these are volunteers?
Ms. Campanella. It's a volunteer advocacy program. Again it
was designed back in, I believe, 1978 when the law was
designed. The local D.C. law is the Citizens with Mental
Retardation Rights Act of 1978, I believe. And it defines
individuals' rights to have access to an advocate to help them
understand what's happening to them. And when this program
works well, and as we have seen at least in a few individuals,
it introduces again into the person's life somebody who is
there, that cares about them, and who will ask the hard
questions not because they're paid to, but because they just
care about the individual. Which is a significant safeguard.
Ms. Norton. I want to know where we have something
involving Federal funding, I do wish people would be in touch
with me. I am very pleased that the court, the court has been
very vigilant now, particularly now that we have done that
court, put a lot of money into that court. But I had no idea,
and I am very pleased that Judge King has indeed put this in.
But I didn't even know about it.
This is the best way, short of the complicated notion of
case management that the District still has to do to assure
somebody will be there for the advocate, and perhaps we can
prevent some of the incidents that have been in the paper and
that were----
Mr. Gettings. It's a piece.
Ms. Norton. I am not suggesting--look, we have discussed
the whole--excuse me--darn thing. And you know, it's very nice
for us to talk about structural stuff. I am trying to deal with
the fact that these people need to be taken care of right now.
So while they're getting their act together--and nobody
suggested an advocate or even a case worker can do this job--
but meanwhile people are sill sitting in these group homes now.
And I picked this up, really, from Ms. Campanella's testimony,
because it seemed to me that even what you've described, Ms.
Thompson, going in and catching it, going back and evaluating
it after it's done, is a terrible thing to have to do. There
should be very few of those.
So what's the answer? The answer is I am at the mercy of
this group home, with nobody to watch over me. Then of course,
I have no confidence in myself that there will not be some
minimum wage person untrained or whatever, who may abuse
somebody.
But, let me ask you, is there another way--other than the
advocates or redoing the whole case management which they are
in the process of doing--is there another way, other than the
advocate to get this kind of frequent oversight by one person
dedicated to the client--or is this really the best way to do
it and deter it? Because if there is another way, I want to
know about that other way, too.
But if it's let's reform the system, yes, of course. But
meanwhile there are people that could be abused today,
tomorrow, and the next day while you're reforming the system
which hasn't been reformed in a very long time.
Ms. Thompson. In today's terms I think that is probably the
very best way to go right now.
Ms. Norton. Let me tell you one thing. That's a Federal
matter because the courts come under us. I am going to be in
touch with Judge King. They have run their programs well. Do
you believe this $1 million funding would be enough for every
resident in a group home to in fact have an advocate?
Ms. Campanella. Again, based on what I've seen, I don't
know if it is totally enough but I think it's a good--it
provides a good foundation and starting point.
Ms. Norton. I'm going to call Judge King and ask him. And
if it's not enough, the budget has beautifully gone through the
House without any attachments. When they were cutting to
smithereens, we were able to keep things from being cut that
were critically needed. But the budget has not yet gone through
the Senate.
So I would like you to--this is my counsel. I would like to
know by the end of the day from Judge King, whether or not the
million dollars is enough to cover an advocate for each of the
clients? How many are there, please?
Ms. Campanella. Approximately 1,200 people that we estimate
need an advocate.
Ms. Norton. That would be the total pool.
Ms. Campanella. There is approximately just under 2,000
served by MRDDA Service System but I think it is only certain
people that are in residential services that need the advocacy.
Ms. Norton. But Federal funds a lot of this may have
happened, and I am just pleased to know about it. I understand
that there is a consulting firm that investigates these deaths.
But the district has been hammered because these reports are
not made public. I don't understand what the, ``privacy
concerns'' would be. Somebody has been killed while literally a
ward of the State. That is the worst intrusion of privacy I
ever heard of.
But I don't understand the privacy concerns. Once there is
a death, that is a matter of public record, I thought. No
matter who it was, there is a death. So I want to understand
why it is that this is not routinely disclosed; if it would be
disclosed with, for example, the investigative work that Ms.
Thompson has described, and what is the state of that?
Because that makes a city look worse than ever, if the
people get killed or abused and get investigated and then
nobody is told. Then you get the press going after you, and you
get people no longer having confidence in you because you don't
report things that are--that have happened are untold. Look,
something is going to happen that is untold. This is not a
perfect world. And it's been investigated and you can then at
the same time talk about what the investigation shows and what
you have done. I don't see that the city is going to be held to
the standard of perfection. It is held to that standard though
when people only find, when the press or somebody else hammers
them. So I would like to know if there is a systematic way to
report the deaths, particularly the deaths or other such
concerns along with what the city is doing to correct it.
Ms. Walker. The answer is, yes, Ms. Norton. There is a
systematic way. There is a citywide fatality review committee.
The debate about the records is the amount of redacting or
protecting the confidentiality that is tied into a lot of other
legal issues such as HIPAA, the family members. And I think,
though, that we can certainly respond more openly with the
council and our other stakeholders in this, even though you can
redact and protect an individual's confidentiality, we
certainly need to be held responsible for reporting on what the
findings were, what we have done in response, and if there are
certain providers where you have multiple occurrences, then we
have to be forthcoming with that information. And we are still
working through that with the city council as far as the level
of information that is provided. It is pretty much of a legal
battle.
Ms. Norton. Well, if it's a legal battle, then of course,
what can be reported should be reported.
Ms. Walker. Correct.
Ms. Norton. The public has a lot more confidence when the
government comes forward and reports on it itself than it does
when a FISA or something has to be filed by the press, who can
always then find out. And apparently the press has found out.
So I don't know what these privacy concerns are if the press
can find out.
Let me close with this hearing, I am very pleased with the
notion of this advocate, that restores some confidence in me
that a system that is spread all out in the city, nobody can
possibly know what is going on every moment, the best you can
do is to try to deter it. And if you know that somebody is
coming in there, it does seem to me the deterrent effect can be
extremely important here.
There was a report from a hearing, a recent hearing, that
47 out of 1,800 patients get the, ``requisite monthly visits
each year.''
What is that about? Is that about the case management
system?
Ms. Thompson. Yes, ma'am.
Ms. Norton. Is that, in turn, dependent upon hiring more
case workers? Are we back into the revolving issue that has
never been solved and I am convinced will never be solved?
Unless we can get to the point where we can get something like
what we have in the school system, paraprofessionals or
something, you will never convince women--and that is who you
are talking to--who can now be anything they want to be, that
they ought to take the low pay that goes along with being a
case worker, which means you have some sort of social work
background, rather than using that same background on something
that pays better.
So I would like to know what you are going to do about the
case worker personnel problem. Or is there one? Maybe you don't
have that problem.
Ms. Walker. I think it's a matter of training
accountability, and effectively----
Ms. Norton. I am asking one question so we won't go on. The
chairman is back. He said my 5 minutes were up.
The Chairman. Almost. Almost.
Ms. Norton. I am asking--I am talking about one visit, 47
out of 1,800 patients got the required one visit per month. Now
I am trying to deal with part of this through the advocate.
But if we are talking about case workers, then my question:
what are we talking about, case workers?
Ms. Walker. Yes. We are talking about staff case workers
from MRDDA.
Ms. Norton. If we are talking about case workers, then
unless you have had something to happen to the District that
has not yet been reported, there is a severe shortage of case
workers.
Ms. Walker. MRDDA actually has an adequate number of case
workers.
Ms. Norton. Who, in fact, visit once every month.
Ms. Walker. Yes. Their caseload ratio is among the lowest
in the country.
Mr. Gettings. Absolutely.
Ms. Norton. Go right ahead.
Ms. Walker. This is why I get to accountability and
training and oversight----
Ms. Norton. Training? Just going out there once a month?
Ms. Walker. Maybe it's accountability and oversight. And I
understand the issue about not having enough case workers and
social workers. I have had that with CFSA. That's not the case
here.
Ms. Norton. Are these trained social workers, do they have
to have a college degree?
Ms. Walker. No. But they do have a college degree. No.
Ms. Norton. They don't have to have a college degree, it
seems to me. That is why I talk about paraprofessionals or
something----
Ms. Walker. I believe they fall in that category. Ms.
Thompson would know better about the requirements.
Ms. Norton. You think the reason they have not been going
out once a month, if they had been going out once a month maybe
we would have less of what was in the chairman's testimony. But
between the caseworkers going out once a month, and we got
enough case workers, and the advocates going and spelling when
they go out does seems to me to go a long way toward preventing
abuse and deaths.
Why have they not gone out? That doesn't take training. It
just says go out there and report whether you have gone and
sign this thing here that you have gone out there.
Ms. Walker. I have to turn it over to Ms. Thompson.
Ms. Thompson. Basically I think the reason, I think what is
two things: you have somebody go out and come back and don't
report that they have been out. I have run into that myself in
the homes. And then I go back and I check on the internal
information management system and they haven't put their notes
in. And then the other issue is the ones that just don't go
out. And they don't go out. It was the building was wrong or
they didn't know who they were supposed to see, or they had no
way of getting there because MRDDA doesn't provide the
transportation.
There is, again, the issue of caring and intent, and
understanding what case management is supposed to be about and
wanting to do that. And wanting to have a good government job
is one thing, and wanting to be a good case manager is, say, a
separate thing. And those two just don't meet right now in
MRDDA's case management work force.
However, when I left I was hopeful, because I was beginning
to see the turnaround, the change, in case management interest.
They were beginning to want to go out, and I mean, that is
where it comes down to.
Ms. Norton. Maybe that is what Mrs. Walker meant when she
said training and, of course, accountability.
Let me ask one more question. This comes from Ms.
Campanella's testimony. I am very leery of anecdotal evidence
but they do tell us things. And she spoke about a woman who was
found living in a dilapidated apartment, so dilapidated her
health was threatened. And then she says that despite intense
efforts by the advocate and the personal intervention from the
court monitor and the administrator of MRDDA, it took nearly 7
months to successfully transition this woman into a new living
arrangement.
Are you talking about somebody who was going to be put into
a new apartment?
Ms. Campanella. Yes, ma'am.
Ms. Norton. That may explain it all, Mrs. Campanella,
because if you are trying to find a new apartment for anybody
in the District of Columbia, the average person in the District
of Columbia, good luck. Because at least I think MRDDA may be
willing to pay rents that the average person here can no longer
afford.
And then you are trying to place somebody in an apartment
who is so troubled that she was living mired in health risk in
her own apartment. How do you find apartments for people like
that in the District of Columbia?
Ms. Thompson. Ma'am, let me respond a little. This person
apparently has lived on her own with her husband for a number
of years. Their living situation was deplorable from what I
found myself. I think that there was some communication issues
back and forth between what they felt they would be obligated
to submit to intrusiveness as opposed to their choices to live
the way they were living.
And it was a matter of education and urgency and diplomacy
on the part of case management at MRDDA. And when Mrs.
Campanella's staff and the court monitor staff brought it to my
attention--I worked with Mr. Brian Willbom and we were
quickly--when we had our hands around it--we were quickly able
to convince them, yes, you don't want to live there when you
could live here.
And guess what----
Ms. Norton. You were able then to find--it was a question
of them not wanting to live----
Ms. Thompson. Yes, it was a communications issue, I really
believe, but it was resolved.
Ms. Norton. I was concerned about that because if in fact
this so troubled a person anywhere she lived, might in fact get
her in the same situation. I think it would be hard to find a
living arrangement for her in her own apartment even if she
were able to take care of herself. But then maybe somebody
coming in and helping her would be all that was needed.
Ms. Campanella. It underscores and illustrates many of the
things that have been discussed here this afternoon that need
to be urgently addressed about case management and
communication.
Ms. Norton. I compliment Mrs. Thompson that she was
willing--they went all the way to the top and she was willing
to step in.
Ms. Campanella. We do too.
Ms. Norton. Testimony, very, very helpful. You heard from
the Congress; I am sure you don't need to hear from us again.
Thank you very much, Mr. Chairman.
Chairman Tom Davis. Thank you all very much. I want to
thank you for being here we look forward to working with you as
we try to get this program in shape. This hearing is adjourned.
[Whereupon, at 11:55 a.m., the committee was adjourned.]
[The prepared statements of Hon. Henry A. Waxman and Hon.
Diane E. Watson follow:]
[GRAPHIC] [TIFF OMITTED] T8625.095
[GRAPHIC] [TIFF OMITTED] T8625.096
[GRAPHIC] [TIFF OMITTED] T8625.097
[GRAPHIC] [TIFF OMITTED] T8625.098
[GRAPHIC] [TIFF OMITTED] T8625.099
<all>