Family advocates address state's criticism of training center reports

By Jane Powell, CVTC Families and Friends Inc., and Peter Kinzler,  NVTC Parents and Associates. Powell and Kinzler are members of parent groups fighting the proposed closure of state-run facilities for the intellectually disabled, like the Southwestern Virginia Training Center in Carroll.

Meghan McGuire of the Department of Behavioral Health and Developmental Services recently took issue with a document prepared by training center families that summarized some of the negative findings of Donald Fletcher, independent reviewer for Virginia’s settlement agreement with the Department of Justice.
McGuire criticized the claim that waiver rates and structures did not permit removal to the community of training center residents with complex needs, and that no one with complex needs had been discharged for that reason.
This claim is correct, by the department’s own admission, though it is not a direct quote from Fletcher’s report.
Fletcher found that while his sample group of 32 discharged training center residents had “significant” needs, the group did not represent those whose needs were “complex.”
In an April 17, 2012, letter, Secretary Hazel of Health and Human Services claimed that waiver rates would have to be increased in order to accomplish training center discharge goals. Yet, Hazel stated in a Senate Finance Committee briefing on Jan. 31, 2012, that waiver rates and structures would not have to change.
During the 2013 General Assembly, Commissioner Stewart requested additional millions of dollars for “exceptional” waiver rates to fund community placement of those with complex needs.
This series of contradictions undermines credibility of the department. Recent efforts by the department to correct waiver rates do not appear sufficient, and a study, if undertaken, will not help those discharged in the near term.
McGuire’s “correction” on the subject of serious injuries in the community subsequent to discharge from training centers (which she did not deny) indicates the policy is to act retroactively in such cases, rather than preventively.
Only injuries requiring repeated attention by a physician meet the settlement agreement’s reporting standard, according to Fletcher, who addressed this question in a parent meeting Jan. 9. He explained that if stitches are removed by a nurse practitioner, the injury would not be reported, and he agreed with parental concern that even some severe injuries do not qualify as reportable.
The mortality rate in training centers is higher than that of the general population, since this is an at-risk population with multiple diagnoses in addition to intellectual disability, some of which are very serious.
The circumstances of death are the issue, not the numbers.
The death that occurred under the settlement agreement involved a man with a history of aspirations, who inhaled food and could not be revived by his caregiver, a woman who operated a sponsored home.
Had the man remained in his training center home of origin, there would have been immediate onsite medical response that could have saved him.
Predictably, the department did not find negligence by the caregiver. Negligence is arguably on the part of the department which, in haste to hustle people out of training centers, discharged this vulnerable man who had lived safely at a training center for decades to a home not equipped or prepared to handle his aspiration emergencies.
McGuire said she could not find any information in Fletcher’s report to support the families’ claim that Fletcher found significant deficiencies in oversight, case management, medical and dental arrangements and other findings, expressed in terms of percentages. This information is in Appendix A of the report.
Judge Gibney issued a temporary order allowing the state to plan implementing the settlement agreement on March 6, 2012, well before the April date McGuire referenced. One should be able to expect the Department of Behavioral Health would honor the agreement, given that early legal authority, and would accept responsibility for providing quality services from that date rather than quibble about the eventual date of the agreement’s approval on Aug. 23.
McGuire inadvertently confirmed in her rebuttal that the department has been recklessly discharging people in advance of needed protections and oversight, both of which even the department has found lacking in the intervening period, as evidenced by its creation of a “task force” to find ways to improve community protections and oversight.
No corresponding task force has been created to improve protections in training centers; solid protections are already firmly in place.