The government agency charged with providing care and services to “some of the state’s most vulnerable citizens” isn’t living up to its mission, according to a performance review by the Tennessee comptroller’s office.
A report by the comptroller’s Division of State Audit outlined a number of “serious problems” in the way the Tennessee Department of Intellectual and Developmental Disabilities is being run.
The DIDD provides care and protection services for more than 8,000 Tennesseans with debilitating health conditions. Among the deficiencies and failings auditors cataloged in their analysis of department operations were inadequate “safety practices, service delivery system(s), and information system implementation efforts.”
Auditors detected cause for concern with the department’s background check systems and its review of background checks from outside service providers. According to the report, DIDD’s lack of safeguards allowed employees to start work before background checks were completed, volunteers had no background checks performed and provider employees with disqualifying drug convictions went unnoticed.
But perhaps the audit’s most disquieting discovery was that a high-ranking official with DIDD, who has since transferred to another critical leadership post in Gov. Bill Haslam’s administration, inappropriately set aside “the substantiated investigations into the deaths of two service recipients.”
“Specifically, the former Deputy Commissioner (of DIDD’s Office of Policy and Innovation) modified or overturned the results of an investigation in April 2012 that had been reviewed and upheld by the Investigation Review Committee,” the report stated. “The Deputy Commissioner also overturned an investigation in May 2012 that had not been reviewed by the Investigation Review Committee. Both investigation cases involved the same provider agency.”
In the comptroller’s report, the auditor’s chose to “refrain from publishing the details of these cases due to their sensitive nature and to protect the privacy of the service recipients’ family members.”
However, The Tennessean published a story Thursday indicating it had obtained internal state investigation documents revealing that the cases involved two patients in the care of Cordova-based Behavioral Services of Tennessee — one was a female who choked to death on improperly prepared food in the presence of care providers last year, and the other was a male who died in 2011 from a drug overdose.
In both instances state investigators determined that care-provider negligence was involved, but the DIDD deputy commissioner at the time, Scott Modell, reversed the investigation’s findings, The Tennessean reported.
The comptroller’s report indicated that by doing so, Modell, who now serves as deputy commissioner of child safety for the long-troubled Tennessee Department of Children’s Services, had “acted outside his authority and bypassed the department’s existing internal controls.”
“Our inspection revealed that at the time of the former Deputy Commissioner’s actions, the department’s Protection from Harm policy did not give any one individual the power to overturn, uphold, or modify a Protection from Harm investigation,” the performance audit of DIDD stated.
The comptroller’s report noted that Modell had indicated that at the time of the incidents he “believed that a newly drafted policy giving the Commissioner or the Commissioner’s designee the power to overturn Protection from Harm cases had been signed and approved.”
“Based on our review, however, the drafted policy did not explicitly give the Commissioner or his or her designee this authority,” wrote the DIDD performance review’s authors.
The 155-page report suggests “the General Assembly may wish to consider statutory changes to improve the efficiency and effectiveness of the Department of Intellectual and Developmental Disabilities’ operations.”
On Wednesday, DIDD Commissioner Debra Payne defended her agency’s shortcomings before the General Assembly’s Government Operations Joint Subcommittee on Education, Health and General Welfare.
“Our Protection from Harm system has been recognized nationwide,” Payne said. “We take protection-from-harm cases seriously.”
Payne acknowledged Modell had improperly assumed he had the authority to overrule findings of misconduct and neglect against service-provider employees. The department has since implemented a new process for analyzing circumstances surrounding patient deaths, which includes reconstituting the Investigations Review Committee, she said.
“We have taken some very strong assertive action to ensure that it will never happen again,” a DIDD spokeswoman assured lawmakers.
DIDD lawyer Teresa Sloane said the department has also developed new policies that safeguard individuals and rectify the lack of criminal background checks being conducted to vet employees, providers and volunteers.
Sen. Rusty Crowe, R-Johnson City, made a motion to recommend granting DIDD authority to continue its operations for four years with statutory changes to be introduced by the General Assembly related to the background checks matter. The motion carried on a unanimous voice vote.
Rep. G.A. Hardaway, D-Memphis, said the agency’s woes stem from want of financial resources.
“We all share the guilt and responsibility in failing to provide adequate funding so these citizens can enjoy a quality of life,” Hardaway said. “They can’t solve the problem until they have adequate funding.”
Payne and former DIDD Commissioner Jim Henry, who now heads the Department of Children’s Services, repeated that assessment. Henry said the agency has cut more than $20 million from its budget in the past few years.
Payne said the state has reduced its mental health workforce, which includes DIDD, by 48 percent since 2006. Most of the department’s funding comes through TennCare allocations and finding a way to serve the most people while staying in budget has been a constant struggle, she said.
Said subcommittee Chairman Ferrell Haile, a Republican senator from Gallatin: “In the form of government we have, we will always have a conflict between protecting taxpayers and taking care of the least among us.”