Jennifer Wood, Leader of RI DD Consent Decree Compliance, To Leave State Government

Photo by Anne Peters

Photo by Anne Peters

By Gina Macris

Jennifer L. Wood, largely responsible for accelerating Rhode Island’s lackluster response to a federal consent decree affecting adults with developmental disabilities, is leaving state government to become director of the Rhode Island Center for Justice.

The non-profit public interest law center works with community groups and the Roger Williams University School of Law to strengthen legal services and advocacy on issues that reflect the most pressing needs of low-income Rhode Islanders, including housing, immigration, and workers’ rights.  

Miriam Weizenbaum, the board chair for the Center for Justice,  announced the appointment Wednesday, May 3, saying that Wood’s legal background in public interest law, combined with her extensive experience in education and health and human servicesin state government, “makes her an ideal leader for the Center for Justice at a time when basic rights are under significant challenge.” 

Wood was deputy secretary and chief legal counsel to Elizabeth Roberts until Roberts resigned in mid-February as head of the Executive Office of Health and Human Services amid fallout from the UHIP fiasco, the botched roll-out of a computerized Medicaid benefits system. Thousands of Rhode Islanders were left without a wide range of benefits, including from food stamps, health coverage, subsidized child care, and even developmental disability services. At the time Roberts left, Wood was demoted to general counsel.

AshleyG. O’Shea, spokeswoman for OHHS, noted in a statement that Wood has devoted two decades of her life to state service and said, “We wish her the best in her new endeavor.” 

In March, the office of the U.S. Attorney in Providence issued a demand for UHIP documents, saying it is investigating the “allegation that false claims and/or payment for services and/or false statements in support of such payments have been submitted to the U.S. government.“

In a statement May 3, Wood indicated that since the November election, she has been considering a change in career to go back to her roots. As a lawyer in the private sector, her work emphasized civil rights and disability rights. She represented inmates at the Rhode Island Training School and special education students, among others who otherwise might have lacked a legal voice.

Wood joined state government in 1998 as chief of staff at the Rhode Island Department of Education, leaving in 2007 to work as Roberts’ second-in-command after the latter was elected Lieutenant Governor. When Governor Gina Raimondo appointed Roberts as Secretary of Health and Human Services in 2015, Wood followed as deputy secretary and chief legal counsel.

At the end of 2015, when U.S. District Court Judge John J. McConnell, Jr. signaled that he would personally oversee enforcement of the consent decree affecting daytime services for adults with developmental disabilities, Wood took charge of moving the implementation forward.

At that point, the agreement had brought virtually no change to the lives of adults with developmental disabilities since it was signed in April, 2014. By all accounts, Wood moved the implementation into high gear. 

O’Shea, the OHHS spokeswoman, said Wood is turning over her responsibilities in developmental disabilities to other officials, including Dianne Curran, a lawyer who is consent decree coordinator, and Kerri Zanchi, the new director of developmental disabilities. They are in touch with the federal court monitor and the U.S. Department of Justice weekly, according to O’Shea.

The consent decree requires the state replace sheltered workshops and segregated day programs with community-based supports so that adults with developmental disabilities may seek regular jobs and enjoy non-work activities in a more integrated way. The desegregation of services for everyone with disabilities was ordered by the U.S. Supreme Court in the Olmstead decision of 1999, which re-affirmed Title II of the Americans With Disabilities Act. 

 

 

Roberts Resigns as RI Health and Human Services Secretary; Wood's Future Role Unclear

By Gina Macris 

Rhode Island’s Secretary of Health and Human Services, Elizabeth Roberts, resigned late Tuesday, Feb. 14, over the quagmire created by UHIP, the state’s computerized human services benefits system.

Governor Gina Raimondo, in a press conference outside her office, said she met with Roberts “and she presented me with her resignation, which I accepted.”

“It was her choice, and I commend her for it. I think she realized, as I realized, that the challenges we’re having with UHIP require a new set of eyes, and a fresh set of eyes. “

Roberts’ top aide for many years, Jennifer Wood, who is Deputy Secretary of Health and Human Services, has been involved closely with the roll-out of the UHIP computer system and also has directed the state’s compliance effort with a 2014 federal consent decree affecting adults with developmental disabilities.

Asked whether Wood’s position is at all affected by the problems of the UHIP rollout, Raimondo’s spokesman, David Ortiz, said in an email that the Governor would give a “full update” on Wednesday.

The resignation came on the eve of a briefing Raimondo has scheduled for the media on Wednesday, Feb. 15, to discuss an analysis of UHIP conducted during the last month by her chief operating officer, Eric Beane, and steps that will be taken going forward.

“Secretary Roberts has been in public service for decades and has done so many good things for the people of Rhode Island,” Raimondo said.

In a statement, Raimondo said Roberts has “fought her entire career to expand access to affordable healthcare for more people. As my Secretary of Health and Human Services, Elizabeth played a key role in our successful efforts to drive Rhode Island’s uninsured rate to one of the lowest in the nation while reducing costs.”

Roberts was criticized by Nicholas A. Oliver of the Rhode Island Partnership for Home Care.

In a statement, he said that “Roberts’ rigid view of the state healthcare system blinded her from understanding the realities of operating healthcare practices and agencies in Rhode Island.”

“Because Roberts was a visionary stemming from her healthcare public policy interest as a state senator and a lieutenant governor without practical operational experience as a healthcare provider, her naivete and inexperience led to her ineffectiveness in the role of Secretary,” Oliver said.

Roberts’ is the third resignation connected to the $364 million computer fiasco. Melba Depena Affigne, director of the Department of Human Services, and her chief digital officer, Thom Guertin, resigned in January under pressure from Raimondo. 

Kerri Zanchi, Former Massachusetts Rehabilitation Official, Named DD Director for Rhode Island

Kerri Zanchi

By Gina Macris

Kerri Zanchi, a former high-level developmental disability service official in Massachusetts, has been named Rhode Island’s Director of Developmental Disabilities in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).

Zanchi, who has past ties to Rhode Island, begins her job here Jan. 23, according to Rebecca Boss, acting director of BHDDH.

 “We are certain that she’ll be a strong leader and we look forward to introducing her to you at our upcoming community forums” in February, Boss said.

“She has focused on quality services that encourage independence as well as community integration.” 

Boss said Zanchi embodies four characteristics at the top of the list of qualities identified in community forums held before the search: 

  • ·  hands-on experience with individuals living with developmental disabilities
  • ·   experience with government
  • ·  a deep understanding of how Medicaid works
  • ·  good communication skills

Zanchi, meanwhile, issued a statement saying she accepted the job because of the “tremendous opportunity” and “strong commitment” on the part of state leaders “to transform the development disability system to deliver high quality services that individuals and families deserve.”

She praised the “strong vision and clear goals” guiding the work of the developmental disability leadership team and said she found the community “engaged, with much expertise to offer as this work unfolds.”

“I look forward to partnering with individuals, families, the community and my colleagues in government to build on this momentum and move the service system in a direction that results in better services, better outcomes and more opportunities for all Rhode Islanders living with developmental disabilities,” Zanchi concluded.

Her salary will be $102,860, according to a spokeswoman for the Executive Office of Health and Human Services (EOHHS).

Zanchi, 43, is a native of Massachusetts who grew up in East Lyme, CT. She began her career working directly with adults with developmental disabilities in Rhode Island and received her master’s degree in social work from Rhode Island College in 1999.

After completing her studies, she worked at the administrative level in both the public and private sectors in Massachusetts, rising in 2014 to Assistant Commissioner of the Massachusetts Rehabilitation Commission, one of several agencies falling under the jurisdiction of that state’s Executive Office of Health and Human Services.

The Commission provides an array of services that promote empowerment and independence for individuals with disabilities, according to its mission statement. As Assistant Commissioner, Zanchi provided leadership and advocacy for six departments of state government focused on community living, covering the gamut of concerns from consumer issues to independent living, assistive technology, protection from abuse and specialized services for individuals with brain injuries, according to a resume released by Rhode Island officials.

The resume says she implemented performance management practices and contributed to cross-agency collaboration. These issues are relevant in Rhode Island because of the demands of a 2014 consent decree that requires various state agencies to work together to  desegregate daytime services for adults with developmental disabilities following specific goals set by the U.S. District Court. 

Zanchi left Massachusetts government in the fall of 2015, according to the Massachusetts Rehabilitation Commission’s annual report that year. She became Associate Executive Director of the Center for Living and Working, Inc., based in Worcester, leading the organization through a restructuring that emphasized staff development, quality improvement and performance-based outcomes.

In addition, she served as Coordinator of the Massachusetts Aging and Disabilities Resource Consortium for five partner agencies in central Massachusetts, strengthening community and provider collaborations, according to the resume.

Zanchi will succeed Charles Williams, who retired as Director of the Division of Developmental Disabilities last July 22.

The current budget for the Division of Developmental Disabilities is $246.2 million, providing services for a total of about 4,000 adults with intellectual and developmental disabilities, most of whom receive direct care from 36 private agencies under contract with the state.

The division director oversees a staff of about 350 that determines eligibility, the level of individual need, conducts case management, oversees the state-run group home system, and provides administrative support, according to the EOHHS spokeswoman.

It is expected Zanchi will play a key role in shaping the state’s implementation of the 2014 consent decree, which has come under close scrutiny by District Court Judge John J. McConnell Jr., after the federal Department of Justice challenged the state’s progress.

The EOHHS spokeswoman, Sophie O’Connell, said Zanchi “will work very closely with the leadership teams at BHDDH and EOHHS to move forward the Division’s work to achieve the terms of the consent decree and strengthen services for individuals with developmental disabilities.”

O’Connell noted that both the state’s Consent Decree Coordinator, Mary Madden, and the Deputy Secretary of Health and Human Services, Jennifer Wood, served on the search committee for the new director.

In the last year, since McConnell made it clear he would personally weigh in on the progress of the consent decree, Wood has taken the lead in assembling a team of officials to respond to the court’s requirements. She has a legal background in developmental disability law.

Besides Wood and Madden, the search committee for the developmental disability director included Brian Gosselin, Senior Strategy Officer at EOHHS; Jane Gallivan, former interim director of the Division of Developmental Disabilities and a consultant to the state; and Deanne Gagne, CEO/Founder of Bridge Building Services; Coordinator of Advocates in Action; and Assistant Coordinator of the Cross Disability Coalition.

A total of 74 applications were screened. Nine candidates were interviewed initially and four were called back for second interviews. The names of finalists – O’Connell did not say how many – were forwarded to Boss and to Health and Human Services Secretary Elizabeth Roberts, who made the final decision. 

Gallivan Tapping National Network of DD Professionals to Spark Interest in RI Job

By Gina Macris

The search for a new director of developmental disability services in Rhode Island is well underway, even though the position has not yet been advertised. 

Jane Gallivan, the interim director, has been drumming up interest in the job through her national network of contacts in the field of developmental disability services.  In an interview Sept. 13, she said she has spoken to several likely candidates. 

One of the reasons Gallivan was recruited for the post on an interim basis was her ability to tap into the leadership network in developmental disability services across the country, according to Jennifer Wood, Deputy Secretary of Health and Human Services. 

Gallivan, a longtime director of developmental disabilities in Maine and more recently in Delaware, belongs to the National Association of State Directors of Developmental Disabilities Services (NASDDDS). 

Recent directors have not been required to have any particular expertise in serving adults with intellectual challenges. But that will change with revisions to the job description, which Gallivan said she hopes to complete by the end of the week. 

An ad Gallivan sent Thursday to NASDDDS said Rhode Island is looking for an experienced leader in the field who also has a track record in “affecting and driving change.”

The ad described Rhode Island as “undergoing a significant redesign in the delivery of services to individuals with developmental disabilities and their families,” by focusing on putting individual needs first, boosting employment, and supporting families better.

Gallivan said the NASDDDS notice will reach hundreds of professionals in the field.

She also plans to spread the word through the National Leadership Consortium on Developmental Disabilities at the University of Delaware, best known for training up-and-coming leaders in the field and helping build networks among them. 

Next week, the position will be posted on the state’s employment website and then the process of screening applications will begin, Gallivan said.

Gallivan will serve on the screening committee, along with Jennifer Wood, Deputy Secretary of Health and Human Services; Brian Gosselin, Chief Strategy Officer at the Executive Office of Human Services (EOHHS); and Mary Madden. 

Madden, based at EOHHS, coordinates the state’s efforts to comply with a federal consent decree that enforces a 1999 Olmstead decision of the U.S. Supreme Court mandating desegregation of developmental disability services nationwide. 

Madden indicated Tuesday during a meeting of a task force empowered by the 2014 consent decree that there may be at least one “listening forum” at which members of the screening committee would hear comments from the public on the characteristics most desired in a new director. 

The public may also write to the screening committee via the following email address: BHDDH.AskDD@bhddh.ri.gov , according to an EOHHS spokeswoman. 

Neither Madden nor Gallivan could offer an official timeline for the appointment of a new director. 

The screening committee will make recommendations to Elizabeth Roberts, Secretary of Health and Human Services; and Rebecca Boss, Interim Director of the Department of Behavioral Health, Developmental Disabilities and Hospitals, who will jointly make the selection.  

In the short term, Gallivan will remain a consultant but will step down as interim director at the end of September because of family responsibilities. 

While the Division of Developmental Disabilities awaits a new director, there will be a meeting of a team of administrators “every single morning” to go over issues that need follow-up that day, Gallivan said. 

The administrators include Madden, Gosselin, Heather Mincey, administrator of the division; Anne LeClerc, the program improvement chief, and Tracey Cunningham, the chief employment specialist, Gallivan said.

The new director will have the primary responsibility for implementing policy changes driven by the consent decree, which requires that the state move away from sheltered workshops and other segregated programs toward a system of individualized services based in the community. 

The division is part of BHDDH, but in the long run, it’s not clear where the director’s position will fit into the administrative structure. 

EOHHS has taken the lead in shaping efforts to respond to the consent decree. And a spokeswoman acknowledged that the office is considering restructuring BHDDH, which also has jurisdiction over mental and behavioral healthcare and public hospitals. 

Former BHDDH Director Maria Montanaro has said she does not believe all three kinds of services belong in one department. . 

There is no timeline for a search for a new BHDDH director, according to the spokeswoman, Sophie O’Connell. Rather, the new director of developmental disability services is a top priority, she has said. O'Connell declined to elaborate on any restructuring options EOHHS might be considering. Structural changes would have to be approved by the General Assembly.

Rhode Island Considers Reorganizing BHDDH; Finding "Strong" DD Director Is Top Priority

By Gina Macris

The Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals  may undergo restructuring, if it is determined that a different organization of services would better serve the  needs of it clients, a spokeswoman for the Executive Office of Health and Human Services (EOHHS) confirmed on Friday, Sept. 9  

Asked whether a departmental reorganization is on the table, Sophie O’Connell replied in an email: “No decisions have been made, but we are considering the option to make sure that we are delivering the best quality care and services to some of the most vulnerable people in our state.” 

Before she left in June, former BHDDH Director Maria Montanaro recommended that BHDDH be split up. The Eleanor Slater Hospital should be run by a dedicated board of directors, she said, while mental health and developmental disability services each should have a commissioner under the direct supervision of EOHHS. 

Such sweeping changes would require gubernatorial and legislative approval. On an ad-hoc basis, however, EOHHS has established direct oversight of the Division of Disabilities in recent months, primarily in response to the demands of a federal consent decree. 

O’Connell said there is no timeline for recruiting a permanent BHDDH director while EOHHS and BHDDH work on a plan that would take into account “how we can most effectively blend fragmented program, policy and funding streams to ensure Rhode Islanders are receiving the best possible care and services.”  Rebecca Boss serves as interim director of BHDDH. 

“Secretary (Elizabeth) Roberts as well as the BHDDH and EOHHS management teams are personally committed to ensuring continued progress on the important reforms taking place at BHDDH. This includes the ongoing work to improve services for individuals living with developmental disabilities and to recruit talented DD leadership into the agency,” O’Connell said. 

“Our most pressing concern at the present moment is recruiting a strong leader for the Division of Developmental Disabilities,” she said. 

The developmental disability director’s post is particularly critical as the state tries to comply with the federal consent decree by shifting away from sheltered workshops and segregated day programs toward integrated employment and community-based non-work activities. 

The division has been without a permanent director since July 22 when Charles Williams retired.

Jane Gallivan, who was coaxed out of retirement to serve as interim director of developmental disabilities, will step down at the end of the month because of family responsibilities, according to O’Connell. 

Although Gallivan will remain a consultant – primarily a long-distance one – the state has not announced who will administer developmental disability services in the short term or when a new director might be named. 

 As of Friday, September 9, the post had not been advertised on the state’s employment website. Nor has a search committee been seated.  

In response to repeated inquiries, over the past week, O’Connell said that Gallivan would providemore information Sept. 14 about the search for a director for the division. 

Gallivan, former developmental disabilities director in Maine and Delaware, plans to spend the winter in Florida with her 101-year-old mother, who has been staying on Cape Cod for the summer. 

Montanaro Says Rhode Island DD Services Have a Long Way to Go; She Won't Miss the Politics

Photo by Anne Peters 

Photo by Anne Peters 

By Gina Macris

When she became director of Rhode Island’s developmental disability agency in February,  2015,  Maria Montanaro inherited a budget with no relation to actual costs that was destined to run a deficit.

 She had to work with a state­-run system of group homes resistant to change, which she said exists to preserve jobs and not to serve clients.

And she had virtually no high-­level staff to form the leadership team necessary to move forward on compliance with the 2014 federal consent decree that requires Rhode Island to transform its services for adults with disabilities from segregated programs to integrated, community­-based supports.

A little more than a year into the job, as she was trying to reduce costs to hit a budget target that seemed plucked out of thin air, Montanaro realized that working in state government was not for her.

She said Governor Gina Raimondo and the Secretary of Health and Human Services, Elizabeth Roberts, have been very supportive. After favorable state revenue estimates in May, Raimondo added to her budget request for developmental disabilities, and the General Assembly gave her most of what she wanted.

Nevertheless, the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) needed everything the governor asked for - a total of $16.9 million in new Medicaid funding, Montanaro said.

In March, Raimondo had asked her to stay on until the budget process was complete, Montanaro said, and she agreed.

In the end, the political aspect of running  BHDDH proved to be ‘very draining,” said Montanaro. Her last day at BHDDH is June 24.

“It takes an enormous amount of effort to move the levers” of state government, she said in a recent interview. Formerly CEO of Magellan Behavioral Healthcare in Iowa and the Thundermist Health Center in Rhode Island, Montanaro had never worked in state government before she came to BHDDH.

In public statements in recent weeks, Montanaro has helped start a new conversation about splitting up BHDDH – a change that could not come without legislation enacted by the General Assembly.

Accustomed to dealing with budgets as professional challenges, Montanaro said she found that trying to get funding in the right places is also a political issue in state government. That was “very difficult for me,” she said.

It was “enormously frustrating,” she said, to inherit a system of fragmented services and balance sheets always running millions of dollars in the red. (The deficit has averaged about $4.6 or $4.7 million for the past eight years.)

 She offered a frank analysis of what’s wrong at BHDDH, and the reasons the Division of Developmental Disabilities should be a separate entity, with its own commissioner, working hand in hand with the state’s Medicaid administrator.

 “Politics aside, there is a responsibility to adequately fund the system,” Montanaro said.

Actually, there are two systems of care in Rhode Island for adults with developmental disabilities, and Montanaro indicated that is one of the problems.

One division of BHDDH operates a network of 25 group homes serving roughly 150 adults with a staff of less than 400 employees. The division is known as Rhode Island Community Living and Supports (RICLAS).

BHDDH also contracts with about two dozen private agencies which, in turn, hire some 4000 workers to serve roughly  3,600 clients day and night, including some 1,120 adults with intellectual challenges who live in about 250 group homes.

Montanaro said the one good thing about the state­-run homes is that employees are paid adequately. Their pay ranges from $15 to $25 an hour. Direct support workers in the private sector make minimum wage or a little higher -  an average of about $11.50 an hour. Burnout is high, and turnover runs an average of about 35 percent, according to testimony presented to the House Finance Committee last month.

 “RICLAS as a provider system needs to make changes, and it’s very hard to enact change with a unionized workforce with very rigid views on change,” she said. “We have a lot of limitations in negotiating those changes. Do we need a state-­run residential system?” Montanaro says she thinks not.

“Why not do that in the private sector; use contracts and incentives in the private sector to make sure we get people what they need,” Montanaro said.

“We should not be running a system to employ people. We should be running a system to serve clients,” Montanaro said.

Services for adults with developmental disabilities are all funded by Medicaid, Montanaro said, and the future costs can be projected fairly accurately by looking at the state’s costs for the past three years.

Montanaro contends that the social support services funded by Medicaid through the Division of Disabilities probably avoid medical costs in the long run. The social supports, like job coaching and other services, “allow them to live their best life, doing meaningful work and having a meaningful personal life,” Montanaro said. People who are more active and engaged in their communities are not as sick, using fewer medical services, Montanaro said.

“That is why I am arguing to change the structure,” she said, She envisioned a separate unit run by a commissioner of developmental disabilities – someone like Charles Moseley, a developmental disability career professional who formerly served as commissioner in Vermont.

Moseley is now the federal court monitor for compliance with the 2014 consent decree which requires Rhode Island to transform its segregated system into an integrated one over a 10-year period in accordance with the 1999 Olmstead decision of the U.S. Supreme Court. That decision clarified the integration mandate of the Americans with Disabilities Act (ADA).

Together, Rhode Island’s developmental disabilities commissioner and the state Medicaid administrator “should have a sight line over the whole experience,” so they are able to see how day supports affects utilization of medical services, Montanaro said.

“It’s pretty easy to look at caseload and utilization and set your budget,” she said. This exercise should be carried out as part of the state’s twice yearly caseload estimating conference, she said. Prior to Governor Raimondo, every administration has set an arbitrary budget target that did not reflective of projected costs, and BHDDH has responded by either lowering rates paid to private providers or running a deficit without worrying about the consequences, Montanaro said.

There’s an assumption in state government that the Division of Developmental Disabilities can lower costs by better managing the utilization of services, she said, but that’s not true.

 “The population is “fairly static,” and the needs of clients are stable, she said. Individuals who meet certain criteria are entitled by law to residential services and employment and other social supports.

The only way to reduce costs is to cut reimbursement rates to providers, which has been done in the past, she said. 

Montanaro said it appears that prior to her arrival, BHDDH may have created bureaucratic delays to save money by delaying the adjudication of appeals.

“We tried to terminate unfair practices,” she said. “We have a responsibility to plan for the service to clients.” In nearly 18 months at BHDDH, Montanaro said, her team “removed those operational barriers that we found in place here."

"Were they in place deliberately, or were they here because the department was wildly inefficient, with eligibility delays and claims lagging as a result? I won’t speculate on that,” she said.

The amount of time and effort necessary to bring about change in the state bureaucracy leads to “a lot of crisis management,” Montanaro said. “It’s designed to protect institutions from constant, fast change that could come with changes in administration every four to eight years,” she said.

In addition to having a realistic budget, Montanaro said the ideal developmental disability agency would be staffed by experts needed to move reforms forward.

As it is, she said, “the Division of Disabilities has lacked critical leaders in critical roles for all the years far back that I can see.”

For about 16 months, Charles Williams, the outgoing director of developmental disabilities, has split his time between that job and running RICLAS. His professional expertise is in mental health services rather than developmental disabilities, Montanaro said.

As a result of the consent decree - and Montanaro's efforts - BHDDH now has a chief transformation officer, Andrew McQuaide, and has just hired Tracey Cunningham of the James L. Maher Center in Newport as an Employment Specialist.

Funding has been authorized for a quality improvement officer to focus on programmatic improvements for BHDDH staff and private service providers. In addition, a high-level chief operations officer will be hired to round out the leadership team.

As for her own future, Montanaro, 58, said she will take the summer off to recharge. She plans to visit her son and daughter-in-law in France, where the couple are expecting their first child.

 

Maria Montanaro to Step Down from RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals

By Gina Macris

Maria Montanaro, director of Rhode Island's Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) since February, 2015, will resign from her post effective June 24, according to a statement from the Executive Office of Health and Human Services. 

Montanaro

Montanaro

 "Montanaro will continue to work tirelessly in the weeks ahead to secure the additional funding that Governor (Gina) Raimondo has advocated to support the requirements of a 2014 federal consent decree and provide higher-quality services for Rhode Islanders living with developmental disabilities," the statement said.

Health and Human Services Secretary Elizabeth Roberts named Rebecca (Becky) Boss, the deputy director of BHDDH, to lead the department during a transition to new permanent leadership, the statement said. 

In a letter to friends and colleagues, Montanaro said that the governor and Roberts "have been 'very supportive' of my decision, which as you can imagine, I have come to with mixed emotions."

She said she had "every hope" of seeing through the changes that have begun in BHDDH, "but the demands of the job, coupled with the constraints facing the Department have led me to conclude that my personal and professional priorities would be better met by returning to the private sector."  

Montanaro, a native Rhode Islander and an experienced health care administrator, had never worked in state government before taking the BHDDH job.

In her letter, Montanaro said, "I am sorry to leave my role after such a short tenure, but I must follow my own wisdom in determining what is right for me at this stage of my life." 

"I have been very honored to serve the State at Governor Raimondo's request. I think the work we have undertaken at my direction sets the Department and its various divisions on the right road" to ensure the agency's clients get the services they need and the care to which they are entitled, Montanaro said in the letter.  

In the EOHHS statement, Raimondo said, "Over the past 18 months, Maria has worked tirelessly to address inherited challenges at BHDDH that are holding us back from providing safe, high-quality care to some of Rhode Island's most vulnerable residents."

"While our work is far from over, with Maria's leadership we have made substantial progress and built a solid foundation for future reform," the Governor continued. "Maria has also played a critical role in our work to develop and implement an action plan to save lives from drug overdose. I am grateful to her for making BHDDH a stronger agency and positioning us for success in the next phase of reforms," she said. 

Roberts said, "I am thankful for Maria's strong and effective leadership of BHDDH."

"Under her tenure, we have strengthened the leadership team at Eleanor Slater Hospital, improved compliance with the Consent Decree to provide integrated, community based services for Rhode Islanders living with developmental disabilities, and taken swift action to ensure safety and improve accountability and transparency at our state-run group homes." 

 Montanaro was president and CEO of Thundermist Health Center in Rhode Island from 1997 to 2011.  Sheworked as a senior advisor at Blue Cross Blue Shield of Rhode Island briefly before taking a job as CEO of Magellan Behavioral Care of Iowa in September, 2012.  Montanaro returned to Rhode Island in February, 2015 as Raimondo’s nominee to run BHDDH.

This article has been updated.  

 

 

Newly Disclosed Details About Group Home Indicate Delays in Care and Incident Reporting

By Gina Macris

COLLEGE PARK APARTMENTS

COLLEGE PARK APARTMENTS

Newly-disclosed incidents at College Park Apartments in Providence, the state-run group home closed after the death of a resident, indicate a troublesome pattern of delay in treating injuries and reporting alleged abuse or neglect.

The incidents were disclosed in documents obtained through a reporter’s request under the Rhode Island Access to Public Records Act. (APRA).

While the reports fill in some detail about the kinds of problems that prompted the state’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) to close College Park Apartments, they raise as many questions as they answer.

In addition, the internal BHDDH reports highlight different interpretations of the public’s right to know, in that they were denied in a reporter’s records request to BHDDH, but they were released in response to the same reporter’s request to the Rhode Island Attorney General.

In the aftermath of the death of the College Park resident, the state Secretary of Health and Human Services, who oversees BHDDH, recently acknowledged that the department’s privacy laws are overly restrictive and that there needs to be a better balance between confidentiality and government transparency.

The troubles at College Park surfaced after 70 year-old Barbara Annis died on Feb.15, 2016 at Roger Williams Medical Center. A leg fracture had gone untreated and a massive infection set in. Two criminal investigations into her death are still underway, one by the Medicaid Fraud and Patient Abuse Unit of the Attorney General’s Office, and another by the Rhode Island State Police.

The newly released documents obtained by Developmental Disability News disclose three other incidents. 

On March 8, 2016, the staff of College Park found an 89 year-old woman unconscious, with a bloody mouth and other unexplained head and shoulder injuries. Although the resident was discovered at 5 a.m. and needed oxygen to regain consciousness, it wasn’t until nine hours later – at 2 p.m.-  that she was taken to the hospital.

She was admitted and held overnight at Roger Williams Medical Center, returning to College Park the next day. That incident remains an open case in the Attorney General's files, according to a spokeswoman.

Two months before Annis died, on Dec. 11, 2015, another woman who lived at College Park complained that a staff member had assaulted her. All reports of suspected abuse or neglect must be made promptly to the internal investigatory unit of BHDDH, but that one did not reach investigators until Dec. 28, more than two weeks after the fact.

According to an internal report, two supervisors at College Park were involved with the complaint and each believed the other had called the patient abuse hotline. The same resident complained she had been assaulted a year earlier, and in each instance, she accused the same staff member. That case also is still open with the Attorney General, according to spokeswoman Amy Kempe. 

A separate report involved a complaint from a nursing home to the Alliance for Better Long Term Care, apparently about bedsores on a terminally ill College Park resident the nursing home had treated. The bedsores worsened during the last nine months of her life, a period when she was hospitalized twice. A family member or guardian, whose name was redacted, also expressed dissatisfaction with hospital care, according to the report. This case has been closed by the Attorney General because there was not enough evidence to warrant criminal prosecution, according to spokeswoman Kempe. 

It appears that Annis’ death on Feb. 15, combined with the issues raised by the other internal investigations into College Park –particularly the unexplained injuries three weeks later - prompted the BHDDH director to ask Day One for an outside report on the operations of the group home.

Day One, the sexual assault and trauma center, was chosen for its expertise in interviewing children and adults with limited communications skills.

The BHDDH director, Maria Montanaro, and the Executive Office of Health and Human Services kept under wraps the fact that a group home resident had died for a month while Day One completed its report. BHDDH and EOHHS have declined to release that report, citing privacy laws.

Montanaro announced on March 18 that five College Park employees had been placed on paid leave and that BHDDH had revoked the group home’s license. The last residents moved March 24 and the doors closed for good the following day.

Questions Persist

The internal BHDDH reports released by the Attorney General’s office, while disclosing other incidents at College Park, still leave many questions unanswered.

The reports responded to an APRA request for all reports from BHDDH involving suspected neglect or abuse that had been forwarded to the Attorney General’s Office for review during 2015 and the first three months of 2016.

No group homes other than the state-run College Park were mentioned in the information released by the Attorney General’s office.

BHDDH is required to share allegations of neglect, mistreatment or abuse with the Attorney General’s office.

BHDDH itself declined to release these same reports in response to a separate, voluminous APRA request for information on the safety of individuals living in group homes for persons with developmental disabilities.

The department did, however, summarize complaints about College Park Apartments during 2015 and the first three months of 2016, ending March 22.

In a letter responding to the APRA request, BHDDH lawyer Thomas Corrigan said that there were a total of 17 complaints about College Park during that period. The letter said: 

  • Six investigations were opened.
  • Five have been closed and one remains open.
  • Two did not require corrective action. 
  • Three cases which required corrective action focused on staff training, employee discipline, incident reporting, management challenges, security, staffing, review of individual support plans (blueprints for each person’s program of services) clarification of management and staff roles, improved documentation and equipment and hygiene inspections.

Corrigan also provided statistics about complaints regarding College Park during 2013 and 2014, with the caveat that BHDDH began to change its incident reporting and classification system in January, 2014, and numbers before and after that date cannot be compared accurately.

 Corrigan’s letter did not say how many complaints from 2013 and 2014 warranted investigations or corrective action plans. He said there were 32 complaints in 2013 and 17 calls in 2014.

Collecting this information was a time-consuming process. Corrigan said in a telephone interview. BHDDH is not required to keep aggregate data on complaints as standard operating procedure, he said.  

Corrigan also responded by telephone to other questions about the operation of College Park and more than two dozen state-run group homes.

In the interview, Corrigan was asked why BHDDH did not change the staff, rather than closing the home and further disrupting the lives of the remaining residents – 13 individuals.

He said, “There were too many unknowns about what was happening at College Park, as opposed to going where we know there isn’t a problem.”

At state-run group homes, operated by a division of BHDDH called Rhode Island Community Living and Supports (RICLAS), each nighttime shift is staffed by a nurse and direct care workers. Supervisors are not present at night, but two coordinators for all the homes - more than two dozen facilities - are available by telephone, he said.

College Park was divided into three self-contained units or “apartments”, each one with four or five residents, Corrigan said.

BHDDH released several hundred pages of redacted staff logs from College Park that indicated it operated much like a nursing home.

One supervisory note warned staff not to falsify time sheets – they are kept on paper, not electronically. Other notes reminded staff to stay in their self-contained “apartments” for their entire shifts.

The staff logs contain a notice for Barbara Annis’ funeral service Feb. 24 at the Russell Boyle Funeral Home on Smith Street in Providence. Burial was to be in North Burial Ground off North Main Street.

There was no public obituary or death notice. Corrigan said Annis had no next of kin and her estate was not sufficient to pay for a notice.

Ombudsperson Could Provide Transparency

Elizabeth Roberts, Secretary of Health and Human Services, cited overly restrictive privacy laws about a week ago, when she appeared before the Senate Health and Human Services Committee and presented the results of 30 unannounced group home inspections  that were conducted jointly by the state Department of Health  and BHDDH investigators in the wake of Annis’ death and other problems at College Park.

L TO R: MARIA MONTANARO AND ELIZABETH ROBERTS AT THE STATE HOUSE.

L TO R: MARIA MONTANARO AND ELIZABETH ROBERTS AT THE STATE HOUSE.

Alluding to media inquiries prompted by the College Park situation, Roberts highlighted the fact that “current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release.”

“The original intent of these restrictions was most likely a well-meaning effort to protect individuals’ privacy, but we can protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety,” she said.

Later in the week, a spokesman for Roberts said the Secretary sees the potential for an ombudsman for persons with intellectual or developmental disabilities to serve as a “conduit” for releasing information of public interest that otherwise would remain shielded.

A bill creating such an ombudsperson was prompted by Annis’ death and its aftermath. The bill, H-8038, was introduced by state Rep. Eileen Naughton, D-Warwick, and has been referred to the House Finance Committee.

Eileen Naughton 

Eileen Naughton 

As the bill is now written, however, the ombudsperson may not be able to provide the transparency that Roberts envisions. The ombudsperson would be required to make annual public reports on the activities of his or her office. But the legislation does not contain specific details about the extent of that reporting. Files maintained by the ombudsperson would be confidential, according to the bill.

The ombudsperson would be appointed by the Governor from a list of candidates recommended by a nominating committee. The new office would be part of the state Department of Administration.

Group Home Inspections Show Deficiencies; Need for Ombudsman to Add Transparency

In the RI Senate Lounge, Maria Montanaro, director of the RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, left; listens to the report on group home  by Elizabeth Roberts, Secretary of Health and Human Services.

Click Here for Report  

By Gina Macris                               

A random inspection of 30 Rhode Island group homes for adults with developmental disabilities did not show systemic problems as severe as the ones at a state-run facility where a resident suffered an unexplained injury and died in February.

But the Executive Secretary of Health and Human Services, Elizabeth Roberts, told the Rhode Island Senate Committee on Health and Human Services that the inspections revealed many operational lapses at individual homes, including medication errors. She said accountability and transparency must improve in all the group homes in the state.

Roberts said she favors legislation that would create an ombudsman for individuals with developmental disabilities and their families, similar to the Child Advocate and the Mental Heath Advocate. 

Roberts also said there is a need to remove the conflict now inherent in the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) licensing and investigating its own group homes.

BHDDH director Maria Montanaro said she has learned that during a previous administration, management did not always follow the professional recommendations of the investigatory unit.

While the recent inspections found no life-threatening situations, they did raise medical concerns, including numerous overdue physical exams and various medication errors. For example, in 10 of the 30 homes, there were medication orders that weren't filled. There was also a lack of documentation of numerous other requirements, including many related to communications with residents and guardians.

According to a summary of the findings, 17 of the 30 homes were not carrying out all provisions of behavioral support plans written for residents with behavioral problems.

In 15 homes, residents were not receiving all the services required by the individual service plan, the “master plan” of activities and supports. 

Another 10 homes have participants who do not have these “master plans” at all.

 In 14 of the 30 homes, inspectors heard about “staffing issues” that were not described in more detail in the report given to the committee.

Low pay and high turnover are pervasive problems in the developmental disability system. Governor Raimondo has asked for higher pay for workers in this field in her budget for the next fiscal year. 

The report did not specify where the deficiencies occurred, but listed the names of all the group homes surveyed and the agencies which operate them. In the report, RICLAS homes are operated by the state, and the remainder are privately operated.

All the group homes will be notified of specific violations and given 30 days to file corrective action plans, according to the report.

The unannounced inspections were prompted by the death Feb. 15 of Barbara A. Annis, 70, who lived in College Park Apartments in Providence – a state run group home that operated more like a nursing home.

Five of the 27 staff members have been put on paid leave and the facility’s license has been revoked. The Rhode Island Attorney General’s Office and the Rhode Island State Police are conducting criminal investigations.

At the Senate HHS briefing Tuesday, Roberts said, “We have responsibility for the care and well-being of some of the most vulnerable Rhode Islanders. I take that responsibility very seriously and I hold the entire Health and Human Services Secretariat accountable for delivering high-quality services.”

Roberts said an ombudsman would bring a new level of transparency to the state’s developmental disability system, serving as a conduit for releasing information of public interest.

“Public reporting on investigations is extremely limited by current statute and regulation,” she said. “Current statutes restrict BHDDH from releasing information most other – if not all other – licensing bodies would be obligated to release,” Roberts said.

She suggested she would support new laws that would “protect residents’ privacy and ensure that the public – especially families who count on these residential services – are aware of issues with resident safety.”

Roberts said she has asked Montanaro to begin a review of the department’s licensing and investigatory procedures.

Montanaro said during initial remarks at the hearing that her department has a “robust” investigatory arm, but she later acknowledged that three of the five investigative  positions have been vacant sometime in the last fiscal year.

Two of the vacancies were due to the fact that the positions were on loan from the Department of Human Services, but funding for those positions did not come through, Montanaro said. She said Secretary Roberts straightened out that problem. Interviews are now underway to fill the last remaining vacancy, she said. 

BHDDH had two investigators working at the time Annis died. The head of the investigatory unit told Montanaro she had noticed a pattern of problems at College Park dating from the previous year, Montanaro recalled. That was one of the factors that led to the three week-long series of group home inspections, performed with assistance from inspectors from the Department of Health.

After the hearing, Roberts acknowledged that unless an investigator notices a pattern of problems and notifies a supervisor, it is not easy to for management to spot system-wide concerns.

“We haven’t had an organized database to do that,” she said, repeating her contention that part of the problem is overly restrictive state confidentiality laws. She said public reporting is one of “a number of ways to focus on consumers’ needs and public accountability.”  

Attorney General Identifies Group Home Resident Whose Death Prompted Investigations

Rhode Island Attorney General Peter F. Kilmartin has named Barbara A. Annis as the 70 year-old woman whose Feb. 15 death has triggered criminal investigations and unannounced inspections of hundreds of group homes for persons with developmental disabilities. 

Kilmartin’s spokeswoman released Annis’ name April 1, but gave no additional information, according to the Providence Journal. 

Annis lived in the now-closed College Park Apartments at 612 Mount Pleasant Avenue, Providence, a state-run facility built to accommodate patients who have chronic medical conditions as well as intellectual or developmental challenges. 

She was admitted to Roger Williams Hospital Feb. 9 for what the College Park staff reported as a bad bruise, but which the hospital found to be a broken thigh bone that had become infected. After she responded to initial treatment, she was transferred to a nursing home, according to an official of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).  But her condition soon worsened and she was readmitted to the hospital, where she died. 

There have been a total of six allegations of abuse or mistreatment at College Park since January, 2015, including an incident that occurred after Annis died. The State Police and the Attorney General’s Medicaid Fraud and Patient Abuse Unit have begun criminal investigations, and 5 of 27 state employees who worked at College Park were placed on paid leave. 

In addition, surprise inspections have begun of all licensed group homes in the state, about 278 private and state-run facilities, according to a spokesman for Elizabeth Roberts, Secretary of Rhode Island’s Executive Office of Health and Human Services. Nine of the 278 homes are vacant. 

Residents who remained at College Park – a total of 14 people – all have been moved, according to BHDDH, which ran the home. The Rhode Island Disability Law Center has opened an investigation into the welfare of those people.   

After College Park closed March 25, Roberts said, “I remain outraged by the alleged incidents at the College Park Apartments group home.” 

Unannounced Group Home Inspections Begin in Rhode Island

By Gina Macris

Unannounced inspections of Rhode Island group homes for adults with developmental disabilities began Monday March 28 in the wake of the recent death of a woman who lived in the College Park Apartments in Providence, according to a spokesman for the Executive Office of Health and Human Services.

College Park closed March 25, the day after the last of the 14 people still living in the apartments were moved to new housing. Since the beginning of 2015, College Park had been the subject of a total of six complaints of patient abuse or mistreatment, according to a spokeswoman for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). 

In addition to criminal investigations underway by the State Police and the Attorney General’s Office,  Elizabeth Roberts, the Executive Secretary of Health and Human Services, has ordered a “comprehensive review” of all licensed group homes in Rhode Island whether they are privately owned or run by the state, according to her spokesman, Michael Raia. He clarified previous indications from BHDDH that the inspections were to target only state-run group homes.

Raia said March 29 that Roberts had asked BHDDH Director Maria Montanaro and Department of Health Director Nicole Alexander-Scott to work together on the review, starting with inspections of the homes with the “highest risk assessment.” 

Inspectors and investigators from both the health department and BHDDH are working as a team on the inspections, which are being prioritized according to “incident reports and complaints for a set period of time,” Raia said. He could not immediately elaborate on the time period in question, although he said the initial round of inspections includes both private and state-operated facilities.  

Updating previously available statistics, Raia said there are 27 licensed state-run group homes, excluding College Park, and 251 licensed homes owned by private agencies.

Nine of the privately-run group homes are vacant, leaving 242 homes that house a total of 1,162 people as of Feb. 29, he said.  Raia said 156 individuals live in state-run group homes, and 284 people are with families in shared living arrangements.   

DD Agency Faces Scrutiny From RI Law Enforcement, Governor and Federal Court

By Gina Macris

With criminal investigations underway into the death of a woman with developmental disabilities in its care, the Rhode IslandDepartment of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) is gearing up for an important deadline on another front.

April 1 is the date by which BHDDH must submit a court-ordered fiscal plan for complying with a 2014 consent decree that enables people with developmental disabilities to get jobs and enjoy other  activities in their communities as required by the Americans With Disabilities Act. Judge John J. McConnell, Jr. has scheduled an evidentiary hearing on the state’s plan for April 8 in U.S. District Court, Providence.

The federal monitor in the case has expressed doubts that the state will be able to rearrange its budget in the next year to make the needed changes.

The Rhode Island consent decree, the first of its kind in the nation, also has received high-level attention from the U.S. Department of Justice in Washington. On Friday, March 18, the Acting Assistant Attorney General for the Civil Rights Division, Vanita Gupta, met with Governor Gina Raimondo to discuss the consent decree.

Coincidentally, the meeting occurred the same day that state human services officials announcedthe death of a 70 year-old woman with developmental disabilities, who had succumbed to a massive infection as a result of a leg fracture that had gone untreated for several days at the College Park Apartments group home on Mount Pleasant Avenue, Providence. Her death on Feb. 15 is under investigation by the Attorney General and the State Police.

The Attorney General’s Office is conducting a total of three investigations in connection with College Park, according to spokeswoman Amy Kempe. She declined to elaborate.

 Including the woman’s death, there have been a total of six incidents of patient abuse at College Park since January, 2015, according to a BHDDH spokeswoman.

 The remaining 14 College Park residents all had been moved elsewhere by the end of the day Thursday, March 24, and the state-owned facility closed March 25, according to Michael Raia, communications director for the Executive Office of Health and Human Services.

He said Governor Raimondo gets regular updates on the investigations related to College Park and is “very focused” on reviewing those findings and receiving an assessment of any systemic problems that health and human services officials may identify.

The Executive Secretary of Health and Human Services Secretary, Elizabeth Roberts, has ordered spot-checks of state-rungroup homes beginning next week, Raia said on Friday , March 25. These checks are to be cooperative efforts between the Department of Health and BHDDH, which currently only has two investigators in Quality Assurance/Quality Improvement.

Raia described the meeting between the Governor and the DOJ’s civil rights chief as a “courtesy call.”

The DOJ requested the meeting, Raia said. The two discussed the state’s appointment of a Consent Decree Coordinator, funding, and the collection of data, he said.

“The meeting was an opportunity for the Governor to listen to the U.S. Department of Justice’s thoughts, opinions and concerns,” Raia said.

The court monitor in the case, Charles Moseley, expressed his concerns in a report to Judge John J. McConnell, Jr. that was made part of the court file on March 18.

The report that the state must turn into the Judge by April 1 is to contain evidence that there is a defined consent decree budget, including a per-person allocation based on the actual costs of implementing community-based activities required by the consent decree.

Moseley, however, said he is concerned the state will not be able to free up enough money in the next year or so to satisfy the consent decree.

According to Raimondo’s budget, the bulk of the funding for mandated services would come from moving a total of 500 people with disabilities, 38 percent of Rhode Island’s entire group home population, into less costly “shared living arrangements” with families by June 30, 2017. 

In the past ten years, a total of 267 people have gone into shared living.

The shift of 500 people would realize a total of $15.5 million in savings by June 30, 2017, but Moseley said he is worried that those targets are “too optimistic” and that BHDDH will not be able to achieve them in a little more than a year’s time.

Moseley also wrote that he is concerned BHDDH will not be able to clearly identify a per-person cost as a foundation for projecting the budget needed to help people obtain supported employment and access to community-based activities.

The state now pays below-cost rates to more than 20 private agencies providing most of the services to more than 3,600 Rhode Islanders with developmental disabilities. The agencies either operate at a loss or depend on outside grants as well as income from programs not dependent on BHDDH funding.

“Although the state has not yet provided the needed financial data, it should be noted that it is, reportedly, meeting consent decree placement targets” for supported employment, Moseley said.

“This must be confirmed, however. From my discussions with providers and state BHDDH staff it appears that these placements are being funded by providers through existing resources, and, as such, may not be sustainable over time. I will be tracking this in the months to come.” 

Moseley noted several positive developments, including staff appointments within state government that he expects will aid implementation of the consent decree.  Among the new positions is the Consent Decree Coordinator, Mary Madden. The full scope of her authority is not yet clear, and Moseley said he has requested a copy of her job description.

In the two years the consent decree has been in effect, both the DOJ and the monitor have cited a lack of interdepartmental leadership and coordination as one of their primary concerns. They have sought appointment of a high-ranking state coordinator who has the authority over n BHDDH and two other agencies responsible for some portion of the reforms, the Rhode Island Department of Education (RIDE) and the Office of Rehabilitation Services of the Department of Human Services (ORS).  

In other developments noted by Moseley, BHDDH has:

  • Hired a Chief Transformation Officer. Andrew McQuaide previously served as consent decree coordinator within BHDDH, but he did not have authority outside that agency.
  • Advertised for a supported employment coordinator to work with private service providers
  • Received approval to hire a chief operations officer and quality improvement coordinator.

“These positions are important to provide leadership and guidance over the systems changes that need to take place,” Moseley said.

Raia said the quality improvement coordinator’s post has been advertised and applications are being accepted.

The new positions, funded in the Governor’s budget for the next fiscal year, reflect the fact that she is “committed to achieving the reforms outlined in the consent decree,” Raia said. He also cited a $2 million increase in funding for community-based daytime activities and an additional $5 million that would provide a raise of 45 cents an hour to staff of private agencies who work directly with people with disabilities. Model progams showcasing community-based services would receive a $1.9 million boost.  

Moseley said BHDDH, RIDE, and ORS are working together on implementing a quality improvement plan in keeping with the consent decree requirements.

Moseley concluded that “the Court’s close oversight over the state’s progress on meeting the terms and conditions of the consent decree is having a very positive impact on both the quality and the pace of change in the state.”  McConnell began holding status conferences on the case in January.