Who Watches the Watchman?

When allegations are reported and investigated – what happens if the investigators are actually part of the group the allegations are against?  Who provides an independent review of the allegations if the investigative agency can not be objective and actually do a real investigation?

These are questions I have regarding allegations of medical/nursing neglect and abuse  in the treatment of my son at the state operated intermediate care facility where he lived for 5 years.  The agency which does the investigation is the agency which runs the facility.  Unfortunately, even though the allegations are all medical and nursing care issues, the investigator did not have one healthcare provider review the allegations, documents or look into the fact that policies are outdated or do not meet the minimum standard of care.

But these “experts” have decided that the allegations are unfounded based on interviews with agency staff (non-healthcare) and administration.

We hear that the ICF/ID provides “comprehensive care” including healthcare and that there is oversight to ensure the care is being provided. Maybe in doing random surveys and looking at random samples, it may appear that the care is being provided.  Also in those surveys they do not look at the quality of healthcare or if the healthcare meets the community standard of care.  They seem to check that the providers have current licenses to practice their profession.  I think that we all know that having a license is not the same as providing quality care.

In my attempts to have an objective investigation I have contacted several other agencies in the state, including the Department of Health, and have gotten nowhere.  They all point to the Department of Social and Health Services as the agency providing oversight of the care.  Even though the ICF/ID is a medical facility by federal definition, our state defines it as a long term care facility yet the Long Term Care Ombudsman does not consider it a long term care facility and is of no help.

Clearly there are issues of neglect and abuse – any sane person could look at the records and documents and make that conclusion – for some reason though the Department of Social and Health Services and their investigative team has chosen to continue this neglect by failing to see the obvious and make corrections.

The issues fall into various categories of medical malpractice, medical neglect, restraints without consents, multiple injuries including fractures, false documentation of over 8 medications for over 2 years, failure to communicate with guardian regarding psychotropic medication changes, failure to provide prescribed medical treatments and transport to medical treatment center for prescribed treatments, applying splint to wrong foot, applying splint over shoe rather than inside shoe and failure to protect from client-to-client abuse are just a few of the allegations.  Maybe some of the issues actually fall into criminal categories.

Certainly in my mind the lack of ability of the investigators and the DSHS administration to do an objective and fact finding investigation is criminal.

Does one need to file a lawsuit to get anything done about this?



Healthcare disparity in Washington – what about your state?

As I am in the process of trying to remedy a healthcare disparity situation for people with intellectual and developmental disabilities, I am very curious how the oversight of healthcare in the Intermediate Care Facilities for People with Intellectual Disabilities (ICF/ID) is managed in the various states.

In Washington, we refer to these communities as Residential Habilitation Centers (RHCs) and are either State Operated Skilled Nursing Facilities for people with Intellectual Disabilities, an ICF/ID or a combination of both types of facilities.  The 4 remaining RHCs are all campus based communities.

One of the several problems that I have encountered in this journey is that the laws and rules are different for skilled nursing facilities  (SNF) and the ICF/ID even though they are both under the RHC umbrella.  The SNF clearly has full oversight by the Department of Social and Health Services and is clearly a “long term care facility” by  both state and federal regulations. The residents of the SNF are represented by the Long Term Care Ombudsman in our state.

In the Revised Code of Washington (RCW) the ICF/ID is not included in the definition of “long term care facility”  yet it is considered a long term care facility by the Department of Health, the Department of Social and Health Services and the Health Care Authority – but under the FEDERAL SOCIAL SECURITY LAWS  the ICF/ID is considered a healthcare institution and that the resident’s healthcare be provided for under the Social Security Act. The RHCs are promoted as “full service, therapeutic communities” and it is believed that the “healthcare clinic” is a licensed clinic when it fact there is no healthcare oversight of the medical and nursing care provided at the RHC to ensure the standards and quality meet the current standards of care.

The medical providers at the RHC act as the primary care providers for the residents and even if a resident is seen by a community provider or specialist or referred to another provider, it is the RHC provider that is required to write the order for medications to be prescribed or for nurses to carry out treatments. The healthcare for RHC residents is managed as a “health home” with the exception of policies , quality standards to meet and oversight.

The ICF/ID functions as a “Medical Home” as the healthcare provider for the residents.   The definition provided in  RCW 74.09.710 states the following:

“Medical home” means a site of care that provides comprehensive preventive and coordinated care centered on the patient needs and assures high quality, accessible, and efficient care.”

“Health home” or “primary care health home” means coordinated health care provided by a licensed primary care provider coordinating all medical care services, and a multidisciplinary health care team comprised of clinical and nonclinical staff.

As I read the Social Security Laws and the Code of Federal Regulations, it seems clear that the State health agency should be responsible for establishing and maintaining health standards for the recipients of medical assistance under the plan (as all residents in the RHC do).

This is clearly not happening in Washington – what about your state?