How Could You? Hall of Shame-Damaud Martin and David Davis case/LifeLine-Child Death UPDATED
This will be an archive of heinous actions by those involved in child welfare, foster care and adoption. We forewarn you that these are deeply disturbing stories that may involve sex abuse, murder, kidnapping and other horrendous actions.
From Laurel,Maryland, a “10-year-old disabled foster child”, Damaud Martin, “died last week while under the care of a group home in Anne Arundel County that Maryland health regulators were in the process of closing down, state Health Secretary Dr. Joshua M. Sharfstein confirmed Thursday.
Regulators, he said, are conducting investigations into the July 2 death at the Laurel-area home operated by LifeLine Inc., a state contractor that had provided round-the-clock care for such children — and that was recently warned it would lose its license for having inadequate staff to meet the “health and safety needs of each child” and other issues.
In the meantime, 10 other youths have been moved from LifeLine’s care.
Sharfstein could not specify when the moves took place but said all were completed the day after the boy’s death. He did not link the events and said the children were not moved sooner from LifeLine’s care because it takes time to find other contractors to provide housing and the necessary medical care.
“Since we identified in 2014 inspections that there have been problems, we’ve been working to transition the children,” he said. “It’s fair to say we have felt some urgency ever since we identified the problems. The important thing is that the kids are safe.”
But Connie West, who supervised the deceased boy’s education plans, said it was odd that the state had been considering moving the children for several weeks before the death and then suddenly decided to move them. “They’re thinking, ‘Oh, crap, we’d better get them out of there because suppose if another one dies,’ ” the Millersville woman said.
West said the boy’s first name was Damaud but could not share his full name because of confidentiality rules. He breathed through a tracheostomy tube connected to a ventilator and was under a “do not resuscitate” order authorized by social services officials, said West, who was appointed by Anne Arundel County’s school system to work with the boy.
“He probably would have passed,” West said. “That doesn’t mean he would have passed this soon.”
County police confirmed the boy’s age and date of death but did not release any other details about him.
LifeLine has run into problems with state regulators in recent years. In 2012, the state revoked the company’s license to care for disabled adults. The revocation came after two residents died at an Owings Mills facility and the state cited the company for violating standards of care, an investigation by The Baltimore Sun found.
But state officials allowed the company to continue providing care to disabled foster children, saying they had not found similar problems with that program. In September 2013, the state awarded LifeLine a $4.9 million contract to provide services to 13 “medically fragile” children.
Health officials had been monitoring Damaud and the other children in the Laurel-area apartments every week since determining in late May that LifeLine had not employed sufficient staff to address the “health and safety needs of each child,” according to an inspection report dated June 20. The report also found that the company had failed to keep another resident “free from abuse, neglect and mistreatment” because it was “unable to manage” the resident’s bedsore.
A previous inspection in February identified other problems with feeding residents, changing their diapers and administering their medications.
An inspector with the state health department’s Office of Health Care Quality told LifeLine in late May that the agency would recommend that its license be revoked because of those combined findings.
In addition, The Sun found that county police and fire services had been called to LifeLine’s apartments for multiple reports of abuse and injury. State regulators said that the company did not disclose those incidents as it is required to do.
LifeLine’s chief executive, Theresa Martin, wrote to state officials June 5 that she intended to close her company’s program for children on Sept. 30 because state payments did not cover the costs of care. “The care provided the children cannot be simply dollars and cents, yet without adequate funding it is impossible to provideREF the quality level of service they deserve,” she wrote.
She could not be reached for further comment.
West said the state should have formally revoked the company’s license regardless of Martin’s letter.
West, who has adopted two disabled children who were in LifeLine’s care, including a teen who uses a tracheostomy tube, said Damaud could have easily died if his tube became clogged and was not quickly changed. An investigation will determine whether LifeLine was properly staffed to provide Damaud with the proper round-the-clock care, she said.
Sharfstein said investigations by health and social services regulators are standard procedure when someone dies in a group home. The state is not releasing any information about the boy’s death until an autopsy is performed and the investigations are completed.”
[The Baltimore Sun 7/10/14 by Doug Donovan]
REFORM Puzzle Piece
Update:”The Baltimore Police Department homicide unit has taken over an investigation of the death of a 10-year-old boy at a home for medically fragile children because of the possibility that abuse he suffered five years ago played a role in his death.
Damaud Martin died July 2 at a home run by LifeLine Inc. in Laurel, Maryland, where state inspectors had found significant problems with staffing. The state has removed the other 10 children living there, said the Maryland health secretary, Dr. Joshua Sharfstein.
The Anne Arundel County police began investigating Damaud’s death, but brought in Baltimore police after determining that there had been a “prior trauma abuse incident in Baltimore city.”
That incident occurred in January of 2008, when Damaud was hospitalized with severe brain trauma. Damaud’s mother, Tamekia Martin, was convicted of child abuse in May of 2009 after accepting an Alford plea, according to Damaud’s grandmother, Rosita Martin. That’s when a defendant maintains her innocence, but acknowledges that the prosecution has enough evidence to convict her.
Rosita Martin said after Damaud was hospitalized, his 7-year-old sister, Sandoria, was placed in foster care.
The children were first taken into state custody in 2006, then placed in Rosita Martin’s home. The Department of Social Services returned the children to Tamekia Martin in November 2007, two months before Damaud’s hospitalization.
Baltimore Police spokesman Jeremy Silbert said Friday that the direction of the investigation into Damaud’s death will depend on the findings of the state medical examiner’s autopsy.
“If they do rule the death was the result of the incident that happened in Baltimore city, this will become a homicide,” Silbert said.
Rosita Martin said Friday that her daughter never abused her children.
“This is the most disgusting thing I’ve ever experienced. These were two sweet, innocent children and they robbed us,” Rosita Martin said of the Department of Social Services. “They robbed us of our happiness with them.”
She said the Department of Social Services notified the family Friday that Damaud had died.
“In 2014, they began to have more significant violations, and those included problems with the care that they were providing and that led us to No. 1, intensify our oversight, No. 2, start a process of closing them and transitioning the youth,” Sharfstein said.
The facility indicated it would give up its license in September, and the remaining children were moved over the July 4 weekend.
LifeLine did not immediately return messages seeking comment.
The Baltimore Sun first reported the boy’s death and previous problems with the facility.”
Police, state probe Maryland foster care death[Washington Post 7/11/14 by Associated Press]
Update 2:”The July death of a 10-year-old disabled foster child has been ruled a homicide — six years after the Baltimore city boy’s mother was accused of shaking him into a coma-like state, Baltimore police announced Monday.
Damaud Martin died July 2 at an Anne Arundel County group home that state regulators were in the process of closing down for multiple problems. State health officials are investigating whether Damaud received adequate care while living at the home, which was run by a company called LifeLine, but have cautioned against drawing any premature conclusions.
A LifeLine nurse who was caring for Damaud when he died on the morning of July 2 told The Baltimore Sun that she was caring for three disabled children who relied on feeding and breathing tubes even though their care plans called for one-on-one supervision. A Baltimore Sun investigation of LifeLine showed that the state awarded contracts worth millions of dollars to LifeLine despite numerous poblems at its Anne Arundel operations — problems with medical care, a founder imprisoned for arson, unpaid taxes and police reports of abuse and neglect unknown to regulators.
Regulators had told the Laurel company in June that its license was going to be revoked after they found that “staffing patterns addressing the health and safety needs of each child had not been maintained” among other problems, records show. LifeLine’s CEO responded by notifying regulators that the company was closing due to inadequate state reimbursements.
LifeLine officials could not be reached for comment. An attorney for Damaud’s family said it appears unlikely that the Anne Arundel contractor or any of its employees would be implicated in homicide because Baltimore law enforcement officials are investigating.
The state medical examiner’s office has not released Damaud’s autopsy because of the continuing investigations by the Maryland health department and Baltimore police. The office ruled Damaud’s death a homicide Sept. 17.
Homicide determinations are made when the medical examiner finds that “injuries that caused death were inflicted by another person,” said Bruce Goldfarb, spokesman for the medical examiner’s office.
A Police Department news release about the newly designated homicide details injuries Damaud suffered on Jan. 19, 2008. It also states that his mother, Tamekia Martin, 34, had been charged with first-degree abuse stemming from the 2008 injuries. She was convicted in 2009 of first-degree child abuse for causing her son’s injuries.
But she has not been charged in connection with her son’s death.
“We have not made any arrests, and our detectives are continuing to investigate the case,” police spokesman Jeremy Silbert said.
She could not be reached for comment, but she told The Baltimore Sun in 2008 that she did not hurt her son, who had been removed from her custody in 2006 after an allegation of abuse but was returned to her care the next year. She said Damaud’s injuries in 2008 resulted when the then-3-year-old fell off a bike and hit his head and later that day fell down a flight of stairs. She received a 15-year sentence, with most of the prison time suspended.
The Baltimore Department of Social Services became the boy’s legal guardian, and he was placed under LifeLine’s care on Dec. 4, 2013, according to an Anne Arundel County police report.
Connie West, who supervised Damaud’s education plans, said the boy underwent surgery before arriving at LifeLine that resulted in complications that left him unresponsive. Damaud breathed through a tracheostomy tube connected to a ventilator and was under a “do not resuscitate” order authorized by social services officials, said West, who was appointed by Anne Arundel County’s school system to work with the boy.
Paramedics arrived at LifeLine’s apartments in the Russett Green community in the Laurel area about 4:30 a.m. July 2 and found Damaud in cardiac arrest and a nurse performing CPR. An hour later, a Howard County doctor advising the CPR by phone declared Damaud dead.
Martin’s grandmother, Rosita, said that she does not believe her daughter caused the boy’s injuries. She said he has suffered other injuries in the eight years he has spent in the foster care system while she has tried to gain custody of him. In October 2006, state authorities had placed Damaud and his sister, Sandoria, now 14, with their grandmother, a licensed foster parent at the time. They stayed with her until November 2007, when a juvenile court judge ruled that they should go back to their mother because she had taken a parenting class, leased a rowhouse and had part-time work.
Damaud was injured Jan. 19, 2008.
Rosita Martin said she has been fighting to keep custody of the children since 2006.
“We begged for his life for eight years,” Rosita Martin said. “Our cries went unheard for eight years.”
Rosita Martin hired a Pennsylvania attorney, Michael Pisanchyn, who filed notice with the state in August of their intent to sue — a required legal step before a lawsuit can be filed against the state and LifeLine.
Pisanchyn pointed out in his letter to the state that LifeLine lost its state license to care for disabled adults in 2011 after the deaths of three residents whose care was deemed “inadequate.”
Disabled foster child’s death ruled a homicide [Baltimore Sun 10/13/14 by Doug Donovan]
Update 3: “Maryland health regulators say they found serious violations at the group home for disabled foster children where a 10-year-old Baltimore boy died in July — including conflicting records on his care, and miscommunication between staff and the emergency responders and medical personnel who labored to save him — but nothing that contributed to his death.
That conclusion, issued more than four months after the death of Damaud Martin at the Laurel-area group home, surprised child advocates. They call the failure of investigators to interview the nurse who cared for the boy on the night he died a major flaw.
The nurse told The Baltimore Sun in July that the group home, which was managed by a state contractor called LifeLine, was not properly staffed — a violation that state inspectors had found weeks earlier.
An investigation that fails to interview an involved staff member is incomplete, and its findings are questionable,” said Nancy Pineles, managing attorney for the Maryland Disability Law Center.
“To perform an investigation of any incident, particularly a serious incident such as a death,” Pineles said, “the investigator must make every effort to interview the staff who were directly involved, including all staff who were on duty and possibly staff who were not on duty but may have information about care in the home.”
Damaud had been in a coma-like condition since 2008, when he suffered trauma that doctors described as the equivalent of shaken-baby syndrome. After his death July 2, Gov. Martin O’Malley promised a thorough investigation, and his Cabinet officials promised to reform oversight of group home contractors. But investigators say they were unable to interview the nurse.
The Baltimore Sun phoned the nurse, Mary Zelio, on Thursday, using the number listed in the Anne Arundel County police report about Damaud’s death. She said no one from the state had tried to interview her.
There is no indication that two other nurses working the night of Damaud’s death were interviewed.
Maryland Health Secretary Dr. Joshua M. Sharfstein told state lawmakers in a letter that investigators “did not find evidence that the services provided by [LifeLine] contributed to the death.”
The state medical examiner ruled the death a homicide and said it was caused by complications from head trauma Damaud suffered when he was abused in 2008.
Sharfstein said inspectors were not able to make a determination on staffing based on the evidence to which they had access before their investigation was completed on July 7, five days after Damaud’s death. Investigators based their findings on nursing notes, the 911 recording, police and autopsy reports, staff records and interviews.
“The regulators make the findings that they have evidence for,” Sharfstein said. “The absence of a finding is not the same as if they found no problem.”
The “mortality investigation” found mismanagement with the boy’s care — including conflicting orders to save him and to let him die if he suffered a life-threatening condition such as cardiac arrest.
On the night of Damaud’s death, LifeLine staff “failed” to provide “all relevant information” about the boy’s “medical status during a medical emergency,” the investigators found. Staff also provided the wrong address to a 911 operator and wrote in notes that the emergency number was called 25 minutes earlier than was recorded. In addition, the nurse on duty failed to inform a 911 operator that another nurse had already begun to perform CPR on the boy.
Investigators also found that months earlier — in “the winter of 2014” — Damaud had been hospitalized for seven days. They cited LifeLine for violating state regulations because no one from the company could be reached to provide hospital doctors with essential medical information, including current medications and ventilator settings.
LifeLine staff “did not communicate with the hospital regarding [Damaud] until the sixth day of [his] hospitalization,” the investigators wrote.
State officials say they could not determine the staff-to-resident ratio at the group home on July 2. There were 10 children living at the LifeLine apartments. Regulators were in the process of relocating the children after LifeLine chief executive Theresa Martin informed the state she was closing the company because of what she characterized as inadequate state funding. Martin could not be reached for comment.
Her decision came shortly after regulators told her they were going to revoke LifeLine’s state license to care for disabled foster children. They made that decision after inspectors cited LifeLine in late May for what they found was a failure to provide sufficient staff to protect the “health and safety” of all of its children.
They also cited the firm for providing what they said was inadequate care to a 19-year-old resident who had to be hospitalized for an infection that spread from a gaping bed sore on his buttocks into his bones. Their investigation was spurred by complaints from the guardian and physical therapist of the 19-year-old.
The police report on Damaud’s death indicates there were three nurses on duty with a supervisor on call — although the supervisor did not answer his phone when Zelio called him for help, the police report states. Zelio told The Sun that the care plans for each child called for one-on-one supervision and that she and other staff had been complaining for months about being understaffed.
Advocates for foster children questioned the findings of the report, and the fact that investigators placed so little blame on LifeLine.
“It’s not like the report says that everything that LifeLine did was according to regulation and he just died anyway,” said Joan Little, chief attorney for the Maryland Legal Aid Bureau’s Baltimore child advocacy unit.
Melissa Rock, child welfare director for Advocates for Children and Youth, noted that several deficiencies in Damaud’s care were flagged by investigators.
“The deficiencies do seem directly related to Damaud Martin’s medical condition and care,” she said.
The state medical examiner said Damaud’s death was caused by “complications from cerebral palsy due to [the] head trauma” he suffered in 2008.
The full autopsy will not be available until Baltimore law enforcement officials complete their investigation.
Damaud’s mother, charged with child abuse, entered an Alford plea in 2009. The plea means she did not admit guilt, but acknowledged prosecutors had enough evidence to convict her. She has denied hurting Damaud.
The state has relied on four contractors to provide services to medically fragile foster children. Last year the state awarded $35 million in contracts to LifeLine, Second Family and two small operators to provide 62 beds with around-the-clock nursing care.
A Baltimore Sun investigation of LifeLine this year found that the firm continued to win contracts from the Department of Human Resources despite several problems at its Anne Arundel County operations.
The problems included deficiencies in medical care, a founder imprisoned for arson, unpaid taxes, a bankruptcy filing, office lease problems and police reports of abuse and neglect unknown to regulators.
A separate Sun investigation of Second Family, the state’s largest provider of such services, found that it had its own administrative and care problems. Those included neglect and abuse incidents that led to three employees being fired this year. Two of those employees had hit and kicked a mute autistic child, state inspectors found.
State health and social services officials are continuing to evaluate ways to improve regulation of group homes for disabled children. Those actions began after Sharfstein and Human Resources Secretary Ted Dallas gave a public briefing to two dozen lawmakers in July on LifeLine and the oversight of group homes for disabled individuals.
The state health department sent letters to nearly 300 contractors in August to remind them of their obligation to report incidents that involve police, fire or medical assistance
Sharfstein’s agency last month showed lawmakers a five-step plan to reform oversight by improving coordination among the agencies that supervise group homes, increasing scrutiny of contractors’ finances and appointing an employee to implement and oversee the enhancements.
Sharfstein also established a task force that includes advocates and others to study oversight and present further suggestions by January. The task force is scheduled to meet Wednesday, and again in December and January.
In addition, Dallas created a new “financial incident form” to help his agency improve “monitoring of the financial condition of group homes and foster care providers for children in Maryland,” he wrote in a letter to lawmakers last month.
He said the eight-question form is designed to alert regulators when financial conditions arise that “could potentially affect” medical care. If providers answer “yes” to any of the questions about bankruptcy filings, tax liens, unpaid taxes, insurance policy cancellations, late leases or rent payments, plans must be made for corrective action.
The department sent the forms to 112 providers across the state in September. Six reported such concerns, Dallas reported, but only one — a child placement agency — was unable to resolve its problems. The state has canceled its contract, Dallas said.
Health officials say they are continuing to assess services so they can advise lawmakers on potential legislation to strengthen oversight.
A report on Second Family is expected next week.”
State regulators say Anne Arundel group home where boy died violated rules[The Baltimore Sun 11/15/14 by Doug Donovan]
Update 4:”A state senator who has been scrutinizing Maryland’s regulation of group homes for disabled foster children is questioning results of an investigation into the death of 10-year-old Damaud Martin.
Sen. Joan Carter Conway, who chairs the Senate committee on education, health and environment, called on state health officials to release more details on the July death at a Laurel-area group home.
“I still have questions in reference to the investigation,” the Baltimore Democrat said of the Office of Health Care Quality’s recent report. “I have a problem that I have still not seen the full autopsy. I don’t know if the autopsy substantiates the findings of the investigation.”
Conway said she is drafting legislation that calls for a task force to strengthen the regulation of group homes. She is also considering asking the task force to examine whether the medical examiner, an agency of the Department of Health and Mental Hygiene, has a conflict of interest in sensitive cases.
The investigation by health inspectors determined that LifeLine, the company that ran Damaud’s group home, did not contribute to the severely disabled boy’s death.
The investigation did note multiple deficiencies with LifeLine’s treatment of the boy, including conflicting orders for his care and miscommunication between staff and the emergency responders and medical personnel who labored to save him July 2.
Another legislator joined advocates for foster children in questioning why inspectors did not interview the nurse who was caring for Damaud on the night he died.
“It is disgraceful not to have interviewed the nurse,” said Sen. Karen Montgomery, a Democrat from Montgomery County. She added, “I am very sorry that this very ill child died. I don’t know what we can do except insist on higher standards. But we’re not willing to pay for them.”
Health and social services regulators have been criticized for their oversight of LifeLine, which won state contracts to care for disabled children despite years of problems.
State officials said that the investigation of Damaud’s death was thorough and that regulators act quickly and appropriately when they find problems. The autopsy by the medical examiner has not been released because Baltimore law enforcement officials are still investigating the death as a homicide.
When Damaud died, regulators were in the process of relocating him and 10 other disabled foster children from LifeLine’s Anne Arundel County apartments. The company had a $4.9 million contract to provide around-the-clock medical care to children suffering from conditions such as cerebral palsy.
A Baltimore Sun investigation revealed that the state had awarded $18 million in contracts since 2010 to LifeLine despite years of problems: deficiencies in medical care, a founder imprisoned for arson, unpaid taxes, a bankruptcy filing, and police reports of abuse and neglect unknown to regulators.
In 2011, regulators shut down LifeLine’s homes for disabled adults after three residents had died, but allowed the company to continue operating homes for children.
In May, health inspectors — responding to a complaint about staffing and care at LifeLine — cited the company for not providing enough staff to guarantee the health and safety of all its children. They also cited LifeLine for improper care of another boy and said they were going to revoke the company’s license. LifeLine’s chief executive later announced that she would close the firm, saying state payments were not enough to cover care.
Conway said she has no reason to doubt the autopsy’s findings. But without seeing the full report she cannot verify the health inspectors’ determination that LifeLine’s care did not contribute in some way to his death.
Conway added that because Damaud’s family has threatened to sue LifeLine and the state over the boy’s death, she worries that the medical examiner’s office may have a conflict of interest in determining whether a contractor licensed by the health department had a role in the death.
“I have a huge question mark as to whether or not the autopsy report is correct,” she said. “I’m not saying that it’s not. I’m saying what we might have to do is to have an independent person who is unassociated with the state” review the autopsy.
The health inspectors’ investigative findings were “consistent” with the medical examiner’s rulings, Health Secretary Dr. Joshua M. Sharfstein wrote to Conway and Del. Peter Hammen, a Baltimore Democrat. The two lawmakers chair committees on health.
A health department spokesman said in an email that state officials “stand by the excellence and independence” of the medical examiner’s office. “We intend to work with Sen. Carter Conway and Del. Hammen on legislation, as we offered during the briefing this summer,” the statement says.
The investigative report, dated July 7, states that an inspector attempted but failed to interview the nurse who was working in the home on the night of Damaud’s death.
But The Sun contacted the nurse, Mary Zelio, last week by calling the phone number listed for her in the Anne Arundel County police report about the death. She said no state official had tried to contact her. In July she told The Sun that understaffing was a recurring problem at the LifeLine apartments, including on the night of Damaud’s death.
The investigation of Damaud’s death rendered no opinion on staffing issues. Sharfstein said last week that the absence of such a finding often means there was not enough evidence to make a determination. A spokesman said the secretary was not speaking specifically about LifeLine, and the department typically does not release information beyond what is reported in such investigations.
This week, the health department released a statement that said LifeLine “provided the staffing required in Damaud’s individual plan.” It did not say if staffing for all the children was adequate.
The statement detailed the steps inspectors took to conduct their investigation, reviewing “his complete agency record — including the individual plan, medical records, and nursing notes.” Inspectors also “reviewed Lifeline’s personnel records, the 911 recording, EMS record, hospital record, police report, death certificate, and autopsy report. OHCQ’s surveyor also interviewed four Lifeline employees, including a nurse who helped to care for Damaud on the night of his death.”
At an Annapolis briefing about LifeLine that Conway convened in late July with two dozen state lawmakers, Sharfstein and Human Resources Secretary Ted Dallas, whose agency awards contracts for group homes, acknowledged that their departments need to do more to monitor contractors’ financial problems, which could signal declining medical care.
Conway said the task force would be charged with figuring out the best way to determine whether contractors have the financial capability to provide the care they’re being hired to deliver.
She had considered introducing bills in the 2015 General Assembly session that would propose regulatory changes, but chose a task force because of this month’s election results.
A new governor, Republican Larry Hogan, will take office in January just as Sharfstein voluntarily leaves his post for a job at the Johns Hopkins Bloomberg School of Public Health. Hogan’s administration, including the new health secretary, need to be involved in crafting stronger regulations, Conway said.
If her bill is approved by the legislature, the task force would be getting started just as a similar group set up by Sharfstein will be completing its review. The group established by the health secretary held the first of three monthly meetings Wednesday and has been asked to deliver recommendations by the end of January.
Conway said it’s possible the existing task force’s recommendations could result in proposed legislation in 2015. That group’s report also might be used to help her task force formulate its own proposals.
“We probably could take up new legislation if we get agreement with the new administration” on the issue, she said
A spokeswoman for Hogan said the new governor’s team was not commenting on policy issues until he takes office.
Hammen, who chairs the House committee on health, did not return calls for comment.
Lawmakers question probe into boy’s death at Maryland group home [The Baltimore Sun 11/21/14 by Doug Donovan]
Update 5:”The Maryland attorney general’s Medicaid fraud control team is investigating LifeLine Inc., the state contractor that managed a group home for disabled foster children where a 10-year-old Baltimore boy died last summer.
Five people who have direct knowledge of the investigation told The Baltimore Sun that Medicaid fraud investigators have been examining whether LifeLine’s Laurel-area facility was appropriately staffed with nurses for children who require around-the-clock care.
They said investigators are examining LifeLine’s staffing levels, the qualifications of nurses and other business practices. Most requested anonymity because the probe is continuing and they are not authorized to speak about it.
Maribeth Donohue, a guardian for a former LifeLine resident who was hospitalized last year for an infected bedsore, said Medicaid fraud investigators contacted her in January about the company. She filed a lawsuit earlier this month on behalf of the resident, 19-year-old David Davis.
Another person who was contacted by investigators in January said their questions centered on how many nurses were working at the homes, as well as on food supplies and cleanliness.
“They are looking for any and all information about the business practices of LifeLine,” said the person, who provided care to LifeLine residents and spoke on the condition of anonymity because of concerns about jeopardizing future jobs.
A spokesman for the attorney general’s office would neither confirm nor deny that an investigation was underway.
LifeLine officials did not respond to requests for comment. The Baltimore-based company’s chief executive said last year that she was disbanding the children’s group home operation because state funding was inadequate.
A Sun investigation revealed that staffing shortages, fiscal mismanagement and deficient medical care were recurring problems for LifeLine. The state awarded the company about $18 million in contracts since 2010 to operate homes for disabled adults and foster children, despite its problems, including a founder imprisoned for arson, unpaid taxes and a bankruptcy filing. Regulators also were unaware of police reports of abuse and neglect.
Nancy Grimm, the former director of Maryland’s Office of Health Care Quality, which regulates such group homes, said that, based on her experience, investigators typically try to determine whether patients received the services that Medicaid paid for.
For example, investigators will likely examine whether LifeLine provided proper staffing to meet the needs of paraplegic and quadriplegic children who rely on tubes to eat and breathe, said Grimm, an attorney now in private practice. In addition, investigators examine whether less qualified — and less expensive — staff were providing services that registered nurses should have been delivering, she said.
Staffing and training issues were cited in a lawsuit filed Feb. 11 on behalf of Davis, who was hospitalized for three weeks last May for a bedsore infection that had spread to his bones. The lawsuit cited allegations by a LifeLine nurse that the Laurel-area group home was not properly staffed on the July night 10-year-old Damaud Martin died.
Such questions about staffing and training are typical in a Medicaid fraud investigation, said Dennis Jay, executive director of the Coalition Against Insurance Fraud, a Washington-based nonprofit. The national group of insurance companies, regulators and consumers helps to detect and deter fraud through research and training.
Jay said investigators generally “chase where the money is going.
In its report for the fiscal year that ended June 30, the fraud unit said it was involved in 234 ongoing probes. The unit has existed since 1978 but was strengthened by a 2010 law that encouraged whistle-blowers to bring cases to the state. The unit closed 89 cases in the fiscal year that ended June 30, including 54 prompted by whistle-blowers.
In one settlement, the state and federal government recovered $750,000 from the nonprofit Foundation Health Services, which failed to follow appropriate protocols for handling bedsores and infections, mishandled medications and did not “employ a sufficient number and skill-level of nursing staff to adequately care for the residents,” according to the annual report.
Foundation Health Services operated facilities in several states, including Ravenwood Nursing and Rehabilitation Center, a Baltimore home that was closed in 2012. The parent company did not admit wrongdoing, but agreed to a five-year monitoring program with federal health regulators.
Donohue and others complained about LifeLine’s care last year.
Donohue’s complaint to state regulators in May prompted an inspection by the state Office of Health Care Quality that found LifeLine was not providing sufficient staff to protect the “health and safety” of its young residents. Inspectors also said LifeLine’s nurses were not providing adequate care to Davis.
An earlier inspection from February stated that LifeLine had failed to properly administer medications and food, and that a quadriplegic had been left in her urine and feces.
After the May inspection of Davis’ condition, state regulators told LifeLine chief executive Theresa Martin that they might close the Laurel facility. She responded by saying she would shut down LifeLine’s children’s program, because state funding — about $11,000 per month per child — was insufficient to provide adequate care.
Before the remaining nine children living at the home could be moved, Damaud died on July 2. The nurse caring for the boy that night said she was the only nurse caring for three disabled children who breathed through tubes and had care plans that called for a one-on-one staffing level.
A state investigation found mismanagement in the boy’s care — including conflicting orders to take extraordinary measures to save him or to let him die if he suffered a life-threatening condition — but ruled that LifeLine did not play a role in his death. The state medical examiner ruled the death a homicide caused by complications from head trauma Damaud suffered when he was abused in 2008, before he arrived at LifeLine.
Damaud’s death was not the first at a LifeLine facility. In 2011, regulators shut down the company’s homes for disabled adults after three residents died. The state allowed LifeLine to continue operating homes for children because it did not find problems with their care at the time.
Since The Sun’s investigation was published, state officials have proposed reforms to improve oversight of group homes for medically fragile foster children. The Department of Human Resources, which awards group home contracts, has implemented new financial monitoring aimed at spotting fiscal problems before they affect the quality of health care. The Department of Health and Mental Hygiene, which monitors medical care at the facilities, is scheduled to implement a similar system in April.
In January, the state also hired a company to assess staff training at the three remaining contractors that manage group homes for disabled foster children. There are currently about 40 children in those homes.
Most of them live in homes managed by Second Family, a Landover-based nonprofit.
On July 3, the state moved LifeLine’s remaining eightchildren to Second Family’s homes in Prince George’s County. Three weeks later, health inspectors found that nurses caring for the children there were not properly trained. Four of the LifeLine children were taken to emergency rooms after the relocation. Inspectors cited Second Family for failing to train the nurses and for failing to inform regulators about the hospitalizations as required.
Second Family has since corrected the training issues and has been found to be delivering adequate care, state officials have said.
At a Jan. 28 hearing before a state Senate committee, Deborah Ramelmeier, Maryland’s acting executive director of social services, said the untrained nurses referred to in the citation had actually been LifeLine nurses who had moved over to Second Family.
That raised alarms among some advocates, who questioned how the nurses could not have been properly trained in the care of LifeLine children.
Given that there were only eight children to be moved, the state should have done more to ensure the adequacy of care they would receive at the new facility, Joan Little, chief attorney for the Maryland Legal Aid Bureau’s Baltimore child advocacy unit, said after the hearing. She questioned how the state could have missed training lapses in nurses who had already been caring for the children at LifeLine’s group home.
Health inspectors from the state Office of Health Care Quality conducted several unannounced inspections of LifeLine between late May and July 3, when the children were moved, and reported no problems. The office could not say how many inspections were conducted because such data is not tracked, said spokesman Christopher Garrett.
Melissa Rock, child welfare director for Advocates for Children and Youth, said the new information about the nurses “does raise grave concerns” that state health inspectors did not look at the nurses’ training in the six weeks between Davis’ hospitalization and Damaud’s death.
“I still have concerns about accountability,” Rock said.
Grimm said the training issue is likely to be critical to Medicaid fraud investigators.
“Staff must be competent to perform the tasks required,” Grimm said. “Nonlicensed staff may not perform certain nursing tasks. … The investigators may look to see if staff were being shared between homes, whether licensed practical nurses were substituted for registered nurses, and whether there was an on-call supervising RN available for emergencies.””
Medicaid fraud team investigates Maryland group home operator[The Baltimore Sun 2/28/15 by Doug Donovan]
America! Please help us end medical abuse and foster care corruption. Please sign and circulate our national petition on http://signon.org/sign/accountability-and-justice.
….The American Holocaust….