Agency warns state's care system 'flawed'
| • | Arc doesn't want repeat of 'dark' Sunday |
By Robbie Dingeman
Advertiser Health Writer
The federal agency that oversees care facilities for the mentally retarded is calling the state's system for handling complaints about the institutions "seriously flawed" and charged that the state has ignored dozens of reported problems that allowed abuse and neglect to continue.
Caroline Krewson of the Centers for Medicare & Medicaid Services — part of the federal Department of Health and Human Services — wrote last month to state health director Dr. Chiyome Fukino expressing serious concerns about the actions of the Hawai'i Office of Health Care Assurance.
Most of the criticism was aimed at intermediate care facilities for mentally retarded adults run by Arc in Hawaii. In the past year, four facilities that care for the mentally retarded run by Arc have lost their Medicaid money — and been forced to shut down — because of living conditions that included a lack of proper food and treatment, abused and neglected residents and the failure of staffers to report injuries, according to federal documents.
Overall, there are 18 such intermediate-care facilities run by Arc and other organizations, as well as dozens of homes for the developmentally disabled.
Krewson's letter called for "immediate attention" to various problems, including a report that one client on Maui had been sexually abusing other clients in the home.
The letter included allegations of clients getting the wrong doses of medication, not enough food, unexplained injuries and a lack of therapy. One allegation involved a facility employee allegedly punching, slapping, grabbing and pushing clients.
The neglect allegations included charges that one client was allowed to grab and eat raw meat and drink three ounces of rubbing alcohol.
Fukino, who did not start her job until last December after the incidents occurred, acknowledged many of the problems in a letter of response and in an interview with The Advertiser.
She said the office has suffered from high staff turnover, hiring freezes and budget restrictions and is in the process of a much-needed reorganization. She also acknowledged the seriousness of the situation, saying the federal government has the power to eliminate about $1 million a year in federal money used for salaries for the programs.
"This is an office that has to be brought up to snuff," she said. "It's a critical function. It is core to what we do."
State House Health Chairman Dennis Arakaki said the letter presents a "very disturbing" picture of conditions for mentally retarded citizens. "We're talking about the most vulnerable in our population and generally people who can't speak for themselves."
Arakaki, D-30th (Moanalua, Kalihi Valley, Alewa), said he wants to find out more about why these incidents weren't being investigated and reported and is concerned that more state-supervised clients are being placed in the community.
"Do we have the kind of resources we need to do proper monitoring?" he asked.
The Arc in Hawaii is a nonprofit organization whose programs are designed to improve quality of life and help people who are mentally retarded lead independent lives. The federal government stopped Medicaid money last year at two of its facilities — one on Dominis Street in Makiki and one in Wailua on Kaua'i — forcing them to shut down. Two more Arc facilities in 'Ewa and Halawa closed a week ago after Medicaid money was terminated last month.
Fukino said that the worst situations outlined in the federal letter occurred at facilities that have been closed and that their staff has seen marked improvement at the other Arc facilities.
"Every facility that had the really bad stuff has been shut down, so they're not going to continue to injure people," Fukino said. She said the staff is working to improve community residential living facilities. "The public is trusting us to do this."
Dianne Okumura, assigned by Fukino as acting chief of the office in charge of monitoring, said the independent monitor that her office required has been working with Arc to help them revamp "abuse and neglect investigations, medication administration, looking at the total system of staffing." She said her state staff has inspected homes since the monitor began and has seen improvement.
Krewson's letter also charged that the state received 50 reports of problems but only investigated two of them. Okumura said the state office conducted investigations into reports that required immediate investigation, but thought that the other reports would be addressed during other staff inspections.
Fukino said her office was aware of and working to address some of the problems because of complaints from the community. She said she believes the department can provide the appropriate staff and make improvements by shifting resources within the department.
"If you're understaffed and undermanned, we're hard-pressed to do the job," she said.
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
