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IG out, Quinn issues executive order

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* I’m still trying to catch up on the stuff I missed during my week off. Here’s a big one from the Belleville News-Democrat…

The head of a state agency set up to protect disabled adults has resigned after the News-Democrat reported that the agency did not investigate the deaths of people who were neglected or abused.

William M. Davis, the inspector general for the Department of Human Services, offered his resignation after Gov. Pat Quinn ordered him to meet with Michelle R.B. Saddler, the head of the Department of Human Services, regarding the findings of the stories. His resignation takes effect Aug. 1.

You have to wonder what, if anything, will happen to the people responsible for this policy besides IG Davis. So far, nothing.

* Davis’ resignation coincided with an executive order issued by Gov. Pat Quinn last week. From a press release…

Under Governor Quinn’s executive order, the state will strengthen protections for adults with disabilities who are suspected victims of abuse and neglect. The order will ensure referrals to the appropriate authorities are made and follow-up occurs after any death of an adult with disabilities who is the subject of a pending complaint investigation by the Department of Human Services’ (DHS) Office of the Inspector General (OIG), regardless of the circumstances.

Starting immediately, such cases will be reported, in writing, to local law enforcement and local coroners or medical examiners, and referrals will be documented. The OIG will follow-up on the cases to determine and document what actions have been taken and what determinations have been made by the law enforcement agency. In the past, the Office of the Inspector General referred many of these cases to local law enforcement and/or the medical examiner/coroner. In some cases, contact was made but not documented by OIG staff or the receiving entity, which is unacceptable. The OIG has also swiftly taken steps to strengthen policies and procedures to ensure referrals/notifications are properly documented.

The EO also calls for a review of all deaths of an adult with disabilities who was the subject of a pending investigation by the OIG since 2003. In such cases where documented referrals were made to law enforcement agencies, the OIG will follow up on the outcome. For all other cases, the OIG will undertake a detailed review of each file to determine whether further DHS OIG action or referral is required.

In the future, all cases, regardless of allegations, will be referred to local law enforcement.

* React…

State Sen. William Haine, D-Alton, said he thought the plan of bringing coroners and the police quickly into the investigation when a disabled adult dies is one of the strong points of the governor’s plan announced Friday.

“I think it’s an excellent plan. I’m very impressed by the quick turnaround by the governor and Secretary Saddler of the DHS,” Haine said.

State Rep. Greg Harris, D-Chicago, said Friday afternoon that he hadn’t seen the executive order but from a description supplied by a reporter said he thought it sounded like it could affect positive change. As for whether he will push for a convening of the House’s Human Services Committee, which he chairs, to inquire into past OIG procedures, he said he needed to study the order to detect “what gaps there may be.”

* The Tribune is half-impressed…

What the executive order does not address is the overly bureaucratic culture within DHS, which needs an overhaul. One provider told us the agency primarily pays attention to paperwork: An investigator might look at medical records or a financial audit, but thorough home visits are rarities. There’s not enough face-to-face contact with the disabled. […]

DHS needs more than a reactive executive order from Quinn. The state’s crisis-of-the-day management style in response to these cases doesn’t supply the focus on patients, not just paperwork, that DHS needs. “If someone gets into a community setting and they’re put in a place where their caretaker becomes their abuser, we need to react to that,” state Rep. Greg Harris, D-Chicago, told us. “If it’s necessary to appoint a guardian and move them out, we need to be able to do that. There are so many things wrong with this picture.”

Illinois often finds itself fixing problems after the damage is done — and, we’d point out, often in reaction to atrocities uncovered by journalists, not the state’s own army of investigators and inspectors general.

Harris will hold a committee hearing on the issue this month. That’s good. Illinoisans deserve answers.

But legislators and the governor need to look beyond DHS and its front-line services. Illinois needs a comprehensive strategy at DHS, the Department of Public Health and the Department on Aging to coordinate their staffs, pool resources and fill systemwide gaps that put fragile lives at risk.

The governor’s executive order doesn’t reach that far. But we agree with the mission it sets forth: “The state has an obligation to protect its most vulnerable citizens from abuse, neglect and exploitation.”

Agreed.

And, in my opinion, IG Harris shouldn’t be forced to shoulder the blame alone. Did an order come from the top to stop investigating deaths because the dead didn’t qualify for services? The News-Democrat reporters haven’t been able to find that out yet. We need some answers here.

* Related…

* ‘All safe now’: The ordeal of one victim: But behind that apartment door, Robert Loveless called his disabled wife “a stupid retarded b*tch,” according to a 24-page report by an investigator for the Office of the Inspector General of the Illinois Department of Human Services. He didn’t work and spent her Social Security disability check on himself. He paid more than $500 from her monthly stipend to buy a laptop computer and an Internet hookup to watch pornography.

* ‘Why is someone dropping the ball?’ Coroners aren’t called after deaths of disabled adults: A week after Smith’s death, a juvenile relative said she saw the caregiver slip something into Smith’s drink, according to an OIG hotline call summary and a police report. Neither White County Coroner Carl McVey nor Carmi police knew about the June allegation to the OIG hotline. McVey never ordered an autopsy or directed that blood be drawn for a toxicological screening, he said.

* Committee will review role of state agency at center of fatalities investigation

posted by Rich Miller
Wednesday, Jul 11, 12 @ 11:00 am

Comments

Can the Belleville News Democrat be hired to oversee our state agencies? If not for these two reporters, we wouldn’t know about DCFS child neglect deaths, Tamms, the Menard workers comp fraud, and the OIG/DHS abuse deaths. It is chilling to read these stories.

Comment by Dan Bureaucrat Wednesday, Jul 11, 12 @ 11:10 am
And maybe the House Human Services Approps. Committee members would like to explain why they they tried cut the funds for the DHS OIG office last year.

Comment by Give Me A Break Wednesday, Jul 11, 12 @ 11:14 am
…the overly bureaucratic culture within DHS… Now there’s the understatement of the week.

Comment by Rufus Wednesday, Jul 11, 12 @ 11:29 am
Give Me A Break -

Excellent point - the OIG responses smell of “we don’t have staff” … .

Comment by Anyone Remember? Wednesday, Jul 11, 12 @ 11:45 am
I’m still not understanding why the law creating this inspector general didn’t require the investigation of these deaths. You’d think that would be one of their primary responsibilities as an agency responsible for investigating possible misfeasance.

And do inspectors general get full discretion to decide what they’ll investigate or not. I guess Mr. Davis is taking the fall here, but if he decided not to investigate these deaths, should he have had the authority to make that decision.

Comment by cassandra Wednesday, Jul 11, 12 @ 11:49 am
I’ll second Dan Bureaucrat’s motion. And Rich’s notion.

This runs deeper than just one person (IG Davis). This embodies an entire culture and attitude requiring readjustment from the top down.

And if the BND has been able to uncover this much thus far, how much deeper may the rabbit hole run? Who knows what else is out there the public and media have not heard yet? How many others have slipped through the cracks and weren’t reported, or were discouraged from being reported, in the first place?

Beyond tragic. And frustrating.

Comment by Freeman Wednesday, Jul 11, 12 @ 11:54 am
Ten years ago DHS had over 15,000 staff, now they have a few over 12,000, not saying this is the problem but sometimes staffing levels do create problems. But take 3,000 staff out of anything, public or private, you are going to have problems.

Comment by Give Me A Break Wednesday, Jul 11, 12 @ 12:02 pm
–…the agency did not investigate the deaths of people who were neglected or abused.–

It’s hard to believe that it takes an executive order to at least refer cases to the authorities.

Doesn’t someone in authority — an EMT, a doctor, a copper, etc.,– already have to sign off a death certificate before a corpse is taken to a funeral home?

Comment by wordslinger Wednesday, Jul 11, 12 @ 12:02 pm
For a decade, services to individuals with disabilities have been cut, cut, and cut some more. Illinois never had Cadillac services, but we used to be a pretty decent SUV. With the cuts we have now, we offer the equivalent of a used Yugo. It is no surprise that it is all about responding to the latest crisis.

The number of crises will only increase. Families who need services to cope are put on a waiting list with over twenty thousand people on it. Between cuts at DHS, OIG, and community services abuse, neglect, and exploitation will increase

Take a look at this situation: http://www.cnn.com/2012/07/10/us/mother-abandons-disabled-daughter/index.html

Watch for more like this as families decide they can’t cope.

Comment by Aldyth Wednesday, Jul 11, 12 @ 12:10 pm
“If not for these two reporters, we wouldn’t know about DCFS child neglect deaths, Tamms, the Menard workers comp fraud, and the OIG/DHS abuse deaths.”

What do we have to do to get them nominated for a Pulitzer Prize? I think they’ve earned it — seriously.

Comment by Secret Square Wednesday, Jul 11, 12 @ 12:17 pm
I think there may be some criminal negligence here warranting a grand jury investigation(s). Much in the same vein as the Penn State administrators who failed to report/investigate the sexual abuse committed by Sandusky.

Comment by Leave a Light on George Wednesday, Jul 11, 12 @ 12:21 pm
Something rings familiar in this story… It reminds me of MGT Push at Dept. of Corrections, and the bureaucratic nonsense that turned it on and off like a disco light.

Comment by Newsclown Wednesday, Jul 11, 12 @ 12:25 pm
10 years ago many things were set up to to decay or bedestroyed - It is not just the number of staff that have been reduced, there are the funding reductions for driving anywhere (plus has anyone seen what the legislature is proposing for driving a state car)- if you go somewhere in the county you may/may not get reimbursed. So - cut the staff, add responsibilities, and don’t let people go anywhere - but the examples given in this should have set off somekind of a stampede to check what was going on.

Comment by STP Wednesday, Jul 11, 12 @ 12:49 pm
It’s the culture of DHS, not just one person.

Comment by Just a Citizen Wednesday, Jul 11, 12 @ 2:36 pm
So now the iron fist will come down everywhere to show the need for abuse and neglect investigations. DHS needs to decide what is the priority: investigate a claim that someone called a person a bad name or concentrate on deaths/serious injury. Seems most the the cases the reporters brought up were in independent settings with families being the primary provider. Graywood and now this. Tough times at OIG. Keep up the funding cuts and do not be surprised when more stuff like this occurs.

Comment by zatoichi Wednesday, Jul 11, 12 @ 2:40 pm
The Gov will be trying his best to get this story to go away as fast as possible as he continues to close state institutions and get the disabled adults into corporately run homes where there is less oversight and more injuries and deaths…

Comment by Flan Wednesday, Jul 11, 12 @ 6:55 pm
This issue is far more reaching than reported.For instance,Dept. of Registration commonly “administratively close” cases involving criminal acts [that were not reported to the police] by M.D.s if the doctor leaves his/her practice to move to another state.Unfortunately,many states do the same thing.It’s easy and no longer their problem.

Comment by Jimbo Wednesday, Jul 11, 12 @ 8:30 pm
This is exactly what the guardians and parents are in a stir about. DHS wants their loved ones placed in homes that are’nt monitered and unlicensed. True they said they would check on the disabled for 1 year and then there is no oversight. DHS will not be involved with the oversight of these places. Some will be unlicensed. The plain truth is that most of the licensed homes won’t make any money off of the most fragile so DHS and CRA will settle for smaller homes with a stipend. Foster homes included. And agreed, with the OIG and the neglect of that office to investigate the calls and the deaths, they all need to be investigated by a Grand jury and held accountable for their actions. This is only the beginning of how bad DHS has neglected the oversight of abuse and neglect in the community.

Comment by for real Thursday, Jul 12, 12 @ 12:54 am
for real: You might want to tell CILA home operators they are not monitored and unlicensed.

Comment by Give Me A Break Thursday, Jul 12, 12 @ 6:46 am
Davis isn’t out. I heard that he is still in office. Wasted taxpayer dollars. Since he is incompetent enough to be forced to resign then why is he still on the payroll?

Comment by Trained Observer Monday, Jul 23, 12 @ 9:37 pm