Deny and Defend

We are all aware that our society is driven to lawsuits  but why is this?  I’m sure there are many theories out there but my theory is that the continual denial of any wrongdoing (by total mistake, ignorance or malice) and the inability to say “I’m sorry”, “you’re right, I made a mistake, how can we fix this?” or any acceptance of responsibility leads to anger and frustration on the part of the parties harmed which then leads them to the court – the last resort for some sense of reality check on what really happened.

What a waste of time, talent and money – money that could be used for good if only people (agencies) could accept responsibility and be accountable.

Working in Labor and Delivery for many, many years, knowing that at any moment a disaster could happen which would change the lives of the family, I saw every birth as a miracle – for many reasons.  Knowing that one moment in time a disaster could happen which was no fault of anyone but just happened in the birth process, I was amazed that any child came out alive (or mother for that matter.)  Yet, Obstetrics is one of the highest areas of litigation and also has some of the highest rates for malpractice insurance.  Yes, there is malpractice but not every thing that goes wrong is caused by malpractice or misjudgment on the part of the healthcare providers.  Things just happen.

In recent years I have been the involved in several situations in which I was told “you should sue” but I don’t want to sue just because I could.  I wrote letters to those involved and received apologies, acceptance of responsibility, strategies to improve and re-train the healthcare staff in appropriate practices and documentation.  That’s all I wanted – I just didn’t want others to experience the same things that we experienced when they could be fixed.  Why sue when people accept responsibility and make efforts to improve?

I am writing this post because I recently submitted an inquiry on the Washington State Auditor’s Citizen Hotline.  This past year the Washington State Auditor did a so-called audit on the Developmental Disabilities Administration.  This audit (DD Audit) was riddled with inaccurate and incomplete data and opinions yet was treated as “fact” in recent legislation.  It is shameful that this document was used in our legislative process for decision making.  Many of us attempted to point out the glaring errors in the DD Audit but apparently it is assumed the State Auditor has the facts and there is no need to question reports that are generated.  Interesting to note though is that our state paid over $400,000 for a local company which also subcontracted to an out-of-state entity, well known across the country, to be biased in assessing needed supports for our most vulnerable.

In submitting an online Citizen’s Hotline referral, I was hoping there may be some new insight into this issue and I may receive some sort of response which acknowledged the glaring errors.  I was so wrong.

I have attached the response letter that I received.  It is a great example of the “deny and defend” policy.  I now understood why people are driven to sue – I was more than angry – giving the Auditor an opportunity to accept responsibility and look at the errors and admit there were mistakes only lead to more denial.  The people in the auditor’s office cannot even see the facts or respond to questions that were asked.

I am more than disappointed with this – I am ashamed that we allow our government to treat us this way and am ashamed that those in our government cannot accept responsibility that they are given.

Deny and Defend policy hurts us all.  The medical field is learning this and is trying to change it’s ways.  By being honest and trying to promptly disclose medical errors and offering earnest apologies together with fair compensation, the medical community is hoping to restore integrity.  The hope is this will dilute the anger that is built up in those wronged by continually being told inaccurate and incomplete information which will in turn reduce lawsuits.

I would hope our government agencies take notice of this too.

Auditor response to citizen complaint




What is a continuum of care?

A continuum of care is a model which strives to serve the needs and supports of the people – this is a holistic approach, respecting and honoring the person and their choices.  In my mind, this is the logical and just model but it is a continual fight to try to educate and enlighten others to the benefits to ALL by providing a continuum of care.  Supporting a continuum of care does not deny people the needed supports and services nor does it coerce or threaten people to make choices which would endanger their safety and lives.

Researching issues with the recent audit by Washington State Auditor of the Developmental Disabilities Service System, I learned of the North American Industry Classification System (NAICS).  The North American Industry Classification System was developed under the direction and guidance of the Office of Management and Budget (OMB) as the standard for use by Federal statistical agencies in classifying business establishments for the collection, tabulation, presentation, and analysis of statistical data describing the U.S. economy.

I found something very interesting which actually describes a continuum of care very well:

Sector 62 — Health Care and Social Assistance

The Sector as a Whole

The Health Care and Social Assistance sector comprises establishments providing health care and social assistance for individuals. The sector includes both health care and social assistance because it is sometimes difficult to distinguish between the boundaries of these two activities. The industries in this sector are arranged on a continuum starting with those establishments providing medical care exclusively, continuing with those providing health care and social assistance, and finally finishing with those providing only social assistance. The services provided by establishments in this sector are delivered by trained professionals. All industries in the sector share this commonality of process, namely, labor inputs of health practitioners or social workers with the requisite expertise. Many of the industries in the sector are defined based on the educational degree held by the practitioners included in the industry.

Below are some examples of what are included in this category – it’s odd that the auditors did not include any of these in their recommendations –

62   Health Care and Social Assistance

621   Ambulatory Health Care Services

6211   Offices of Physicians

6212   Offices of Dentists

6213   Offices of Other Health Practitioners

62133   Offices of Mental Health Practitioners (except Physicians)T

62134   Offices of Physical, Occupational and Speech Therapists, and Audiologists

62139   Offices of All Other Health Practitioners

6214   Outpatient Care Centers

6215   Medical and Diagnostic Laboratories

6216   Home Health Care Services

6219   Other Ambulatory Health Care Services

622   Hospitals

6221   General Medical and Surgical Hospitals

6222   Psychiatric and Substance Abuse Hospitals

6223   Specialty (except Psychiatric and Substance Abuse) Hospitals

623   Nursing and Residential Care Facilities

6231   Nursing Care Facilities (Skilled Nursing Facilities)T

6232   Residential Intellectual and Developmental Disability, Mental Health, and Substance Abuse Facilities

6233   Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly

6239   Other Residential Care Facilities

624   Social Assistance

6241   Individual and Family Services

62412   Services for the Elderly and Persons with Disabilities

6242   Community Food and Housing, and Emergency and Other Relief Services

6243   Vocational Rehabilitation Services


The organizations which did the audit and wrote recommendations did not consult with the professionals in the field, nor are they themselves experts in the fields listed above.  BERK & Associates (523930 – Investment Advice) and Human Services Research Institute (HSRI) (541720 –  Research and Development in the Social Sciences and Humanities) only looked at one part of the continuum and tried to fit all people into that section.

For being researchers, HSRI really misunderstands people and the supports and services they may need to keep people healthy and safe.

It is shameful that HSRI is recommending changes in a service system which they clearly are not experts in and clearly do not understand the impacts their recommendations will make to not only the people who utilize those supports and services, but the community as a whole.

Below is a list of the areas of expertise of the BERK & Assoc. and HSRI contracted people for this audit:  Where are the healthcare professionals on this panel?


M.A. – Public policy

B.S. – Finance

MBA – Business Administration

B.A. – Politics

M.A. – Urban Design

B.A – Art History

M.A. – Urban and Regional Planning

B.A. – Geography

B.S. – Mathematics and Economics

M.A. – Urban and Regional Planning

B.A. – Sociology

Ph.D. – Special Education and Rehabilitation

M.A. – Psychology

B.A. – Political Science

M.A. – Public Policy Administration

B.A. – Business Administration and Management

B.A. – Special Education

M.S. – Public Policy and Administration

B.A. – Management of Human Services

B.A. – Psychology

M.A. -Public and Non-Profit Management

B.A. – International Relations

MSW – Social Work

B.A. Health Care Management

M.A. – Administration of Higher Education

B.S. – Family and Human Services,

M.S. – Special Education,

MSW – Social Work

B.A. – Social Work

Performance Audit – Second Flaw

Washington State Auditor’s Office published the Performance Audit “Developmental Disabilities in Washington:  Increasing Access and Equality”.  It is very unfortunate that the Auditor’s researchers did not understand the issues and what the data represented.  Many significant issues were left out or misrepresented in this report.   There are many flaws in this report.

This flaw relates to the inclusion of and information provided with the National Core Indicators (NCI).  The National Core Indicators are a project of Human Service Research Institute (HSRI) one of the two agencies contracted by Washington State to perform this audit.

The audit states that the data from the NCI is from the years 2009-2010 and the “National Core Indicators (NCI) provides outcome measures used by 25 states to assess the performance of state developmental disabilities service systems and the experiences of individuals receiving support.”  The data reported in the Audit charts does not match with the 2009-2010 data which is recorded in the NCI reports.  Also, there are only 19 states involved in the survey for the year 2009-2010.  Please, as auditors, it is important to get your information and sources correct!

“To understand Washington’s performance from the perspective of those it serves, we compared Washington’s results for National Care Indicator (NCI) outcome measure surveys to other states’ results.”  (Kelley, 2013)  This quote leads one to believe that the NCI provide an overall view of the outcome measure by those who Developmental Disabilities Administration (DDA) serves.

Unfortunately, this if far from the truth.  Those who live in the supportive communities of the Residential Habilitation Centers or in nursing homes are not surveyed.  In addition to excluding this population, the survey itself is in two phases.  If a person is unable to answer the questions in phase 1, they are eliminated.  Those remaining are advanced to phase 2 of the survey. Depending upon the year the survey was administered and if proxy answers were allowed, the actual percentage of valid surveys changed.  For the year 2009, an average of 68% were allowed from phase one, of which 98% of those were valid in phase 2.

This means that only 61.7% of those surveyed had valid responses in the year 2009-2010.

In addition to the issues of percentages of survey answers which are valid, it needs to be noted that NCI uses a minimum sample size of 400 to be valid. They do include states which did not meet this number for a 95% confidence level.  One needs to understand this when comparing states and when looking at the national average.  In 2009-2010, 4 of the 19 states did not meet this sample size to ensure a 95% confidence level but were included in the national averages.

Washington State survey had about 623 for phase one and 395 for phase two – which means that about 63.4% of the surveys were valid.  This is difficult to accurately count due to inaccurate information provided from the audit and limited availability of data from NCI.

These surveys are not helpful, particularly when they are not reported accurately, to assess the needs of our population with ID/D.  Excluding whole segments of this population from even participating is an indicator that those who cannot speak for themselves are not valued.  All people matter and all need to be heard – stop excluding and dehumanizing those who are unable to communicate by speaking.  Just because their voice cannot be heard (or understood) does not mean that they cannot chose and make decisions by other means.

We need to listen to those who cannot speak for themselves too!

National Core Indicators – charts which highlight the misrepresentation used by the State Auditors.

Human Services Research Institute. (2009-2010). NCI Charts. Retrieved from National Core Indicators:

Kelly, Troy. (2013). Developmental Disabilities in Washington: Increasing Access and Equality. Permormance Audit Report No. 1009938, Washington State Auditor.