Lawmaker: Beatrice change too slow

LINCOLN — Nebraska should have gotten further during the past year in fixing problems at the Beatrice State Developmental Center, a key state lawmaker said today.

State Sen. Steve Lathrop of Omaha, chairman of a legislative committee overseeing the troubled institution, expressed concern about the state’s failure to fulfill promises made in a settlement agreement one year ago with the federal government.

“Honestly, it doesn’t appear we are making the progress we should have made,” he said. “This isn’t a problem that’s one year old, it’s several years old.”

An independent expert’s report, released Wednesday, concluded the center clearly violated the agreement in the January death of 18-year-old Olivia Manes.

The expert, John McGee of Omaha, said “much remains to be done” in correcting problems at the center.

However, he also said state officials had taken steps in the right direction, including their response to an order to remove residents with serious health complications. A total of 47 people were moved, most to hospitals.

Dr. Joanne Schaefer, the state medical director, issued the order after Manes’ death.

“Although it was most unfortunate and a demonstration of being out of compliance in terms of health care at BSDC that an emergency medical order had to be invoked,” McGee said, “the state showed leadership, creativity and courage in following the Feb. 2, 2009, order.”

The report is the second issued by McGee, who was hired to oversee the agreement between the U.S. Justice Department and the Nebraska Department of Health and Human Services.

The agreement was reached in June 2008 to stave off a federal lawsuit over conditions at the state institution, which is for people with mental retardation and other developmental disabilities.

A Justice Department investigation had concluded that conditions and practices at the center violated residents’ constitutional and legal rights and showed a “cultural undercurrent that betrays human decency at the most fundamental levels.”

The agreement gives Nebraska four years to ensure that center residents are safe, that they get care and services to meet their needs and that their constitutional rights are protected. However, the agreement calls for the state to meet several earlier deadlines on specific changes.

Jodi Fenner, HHS legal counsel and interim director of developmental disabilities, said Wednesday that she was still reviewing the findings of the report. As interim director, she replaces John Wyvill, whose last day is today.

Fenner said the state has made progress since McGee’s team visited the center. She said the institution has more medical and therapy staff, less employee overtime and an improved process for transitioning residents to community settings.

McGee’s report also found that the number of reported cases of abuse and neglect has declined this year from 2008. The report attributed the change to recent staff training, the smaller number of residents at the center and reductions in mandatory staff overtime.

Among concerns raised in the report:

Ÿ Moving people out of the Beatrice center into nursing homes or other institutions is “worrisome” and might put the state out of compliance with the settlement. Of 166 people who have left the center since October 2007, 54 are in nursing homes and 15 in hospitals. As of June, 179 people remained at the center.

Ÿ A more careful process of approving do-not-resuscitate orders should be adopted. Medical reviewers raised concerns that parents and guardians were being asked to make such decisions in times of crisis and without sufficient information.

Ÿ The amount of restraint use increased this year, after being reduced significantly in the last three months of 2008. Ten residents accounted for 179 incidents of mechanical restraint use from Jan. 1 through March 31. Many of the same residents were subjected to physical holds, as well. “The trend reflects a lack of positive behavioral support, appropriate and adequate psychiatric services and staff training and mentoring.”

Ÿ A number of serious incidents have been reported among former center residents now living in the community. From April 7 through May 31, there were 11 incidents involving nine former residents. Three involved police intervention, including one in which the former resident was Tasered.

In addition to the Justice Department concerns, the Beatrice center has lost its Medicaid certification because of continued care problems. The state expects to lose about $25 million in annual Medicaid funding for the center.

Contact the writer:

402-473-9583, martha.stoddard@owh.com