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Monday, April 20, 2015
From: Sabrina Steketee
TO: Dear Representative:

I have received the details of each of the 8 substantiated abuse staff-on-client incidents for 2015, January through April. I think you will be shocked by what you read so I hope you take the time to read this. When I say shocked, I mean shocked that these are the incidents referred to by those trying to close MDC when they say there is endemic, terrible, vile horrendous abuse at MDC. I hope you will be so shocked that you will vote against SB 411 on third reading today.

1. Staff commented in the secure unit in front of one client about another client not present that the not-present client would never get out of MDC because of the non-present client’s behavior. This was substantiated as “neglect.”

2. Client asked by staff to stop tickling another client while the clients and staff were playing a board game. Client did not stop. Staff asked client to sit separate from the client being tickled. Client did not stop. Staff said that if client did not stop tickling, then the game would have to be put away. Client used profanity and went to their room. Client returned few minutes later, walked up to staff person and punched staff in the stomach. Staff pushed the client aside to get away from the wall and asked client to stop. Client attempted to punch staff again, was again asked to stop. Client moved aggressively toward other client. Client began ripping things off walls, tearing up game. Staff was able to redirect client outside where client screamed and yelled for some time. This incident was substantiated as staff “physical abuse.”

3. Client A yelled at Client B to pull up her pants. Staff yelled at Client A to stop yelling at Client B. This was substantiated as “verbal abuse.”

4. Staff were to check on a client every 15 minutes and failed to check at one interval. At the next interval, the client was not in the room. Staff reported to supervisors that they couldn’t find the client. A search was conducted and client was found hiding in the room’s closet. This was substantiated as “neglect.”

5. An announcement was made over the PA system for a client to report to a location. A staff member, in the classroom with the client and others at the time, commented that the client should not be at MDC because he is so physically aggressive and he should be in Warm Springs instead. This was substantiated as “verbal abuse.”

6-7-8 A female client was asked to give a staff member the book she had been reading because while on suicide watch a client may not have items in their room at night. The client refused and at some point the staff member jerked the book out of the client’s hands. The client became upset and began to hit, spit on and yell at the staff person and began hitting and biting themselves. The staff person used a towel on the client’s head to stop the spit. Something about how the towel was used was not the proper technique (I think because it should not have touched the client’s face). The staff person also used a “Mandt” hold, a kind of hug around the person that staff is trained to use to restrain and help diffuse a situation. Ideally the hold should not result in the client going to the ground but in this case it did and the client hit their knees. Some of the staff person’s language toward the client was determined to be disrespectful. Earlier in the day, in another situation, the client had been placed in a restraint chair for another physical outburst. The DOJ report says that this client has resisted use of restraints before and that the client has significant bruising and abrasions from self-injury so they cannot determine if the bruising she had was from the current Mandt hold or restraint, from previous resistance to restraint, or from self-injury. This incident resulted in three substantiated claims, physical abuse, mental abuse and neglect.

I want to also point out that the last one, 6-7-8, are the three substantiations that resulted in the order you may have seen in the newspaper last week to not accept clients in to the secure unit. This single incident.

These are all the staff-on-client substantiated claims for 2015. 37 claims were made and these 8 are the sum of what has been substantiated by the DOJ. I am shocked and I hope you are too that this is what is being portrayed as the endemic, vile, horrendous, demonic, abuse going on at MDC.

There is such a concerted, deliberate campaign to paint MDC in the worst possible light. Who is doing this and why? As is said so often these days, “Follow the money.” Who stands to gain by placing these high-treatment-dollar people out in the community? Who will have tremendous leverage to raise rates in group homes because we no longer have a state-run safety net? Did you know that since 2013, 51 people have been discharged from MDC but 53 have been returned by the community provider???

The above list is all I have new today but I want to re-iterate the things that are bad about this bill, the misinformation that is out there about this bill and what it does:

1. SB 411 closes MDC before there is a plan in place for how and where we will serve its current and future clients. It is getting the “cart before the horse.” It is essentially saying to the residents of MDC now and in the future, “You can’t go home but you can’t stay here.”

2. After 35 years spent transitioning people in to community-based settings, only 12 states have completely closed their state-run facility. So even as Representative Harris and others try to describe the MDC facility and programs as a “dinosaur,” this means 38 states, a great majority, disagree. From those I have talked to in other states, this is a recognition of the fact that we need a state-run safety net. First, because we cannot force private providers to take all clients. Second, because community providers return people to MDC at a high rate. Third, the criminally convicted may wind up with nowhere to go other than prison. And, fourth, those in crisis will not have a place with the full array of stabilization services that MDC offers. Without MDC, where would all these people go?

3. If these folks wind up in prison, their fate is really terrible. Here is an excerpt from the lawsuit Disability Rights Montana filed against the prison system just last year:

a. "Prison staff engage in a pattern of cruel and unusual punishment of prisoners with serious mental illness, including: routinely keeping prisoners with serious mental illness locked in solitary confinement 22 to 24-hours a day for months, and in some cases years, which makes their illnesses worse and leads to a cycle of misbehavior and further punishment; depriving prisoners with serious mental illness of clothes, bedding, proper food, and human contact as part of so-called “behavior management plans” that punish prisoners for behavior resulting from their mental illness; deliberately refusing to diagnose prisoners as suffering from mental illness despite clear evidence supporting such diagnoses; deliberately discontinuing prescriptions for necessary mental health medications; and failing to provide any meaningful treatment and therapy for the vast majority of prisoners with serious mental illness."

4. SB 411 as written does not leave the 12-bed secure unit open past 2017 despite repeated public statements and assurances to the contrary. The Governor’s Budget Office has confirmed that the bill would need to be amended to provide for this and there is no funding in the fiscal note for continued operation of the secure unit past 2017.

5. The state has tried twice in recent years to get private providers to build 16-bed units and no one will do it. The Governor’s Budget Office has stated that they are not aware of any provider in the state currently willing to construct a 16-bed secure facility.

6. The bill as written removes Board of Visitors oversight of the new community-based residential facilities. If we have determined that this level of oversight is needed for this population now, why would we remove it at this critical time of changing how they are served? Wouldn’t we want even more oversight at this time?

7. The bill as written requires the Department of Justice to investigate reports about MDC but not about the new residential facilities. Again, why lower the oversight we determined was necessary for these folks?

8. MDC did not return $1.7 million of funding to Medicaid. This was money set aside for community placements that community providers never took and so it was moved to other Medicaid programs, not MDC.

9. Information on abuse allegations referred to the department of justice are made available to Disability Rights Montana but they are selective in what they share about these reports and give an incomplete sense of what the concerns are. I have tried for several weeks to get the detail on the abuse and neglect allegations. I have been told anecdotally that the majority of these allegations are very, very small such as one client calling another resident a name or a staff member placing their hand on a client’s arm after trying two or more other interventions to change a client behavior or restricting a client to the use of a spoon because they stab people when given a fork. Every allegation is important but we should have a complete sense of what the allegations really are. Once we have the information, if it proves the allegations are horrendous, let’s deal with that. But we should not make a decision to close MDC before we really know.

10. Center for Medicaid Services (CMS) reviews for the recent years are good and consistently improving. To say that MDC has not improved is false and misleading. Despite dramatic speech on the House floor that MDC has had six “immediate jeopardy” findings, you have to go all the way back to 2003 to get that many and there has not been an immediate jeopardy at MDC since 2011 when the administration at SPHHS and at MDC was changed. In addition, I reviewed the CMS inspection reports for several similar institutions in other states and Montana’s recent report was shorter than any others I found.

11. It has been said that the bill does not close MDC before the next legislative session and therefore we have time to see how this goes. I think this is really wrong. As soon as the bill passes, MDC will lose people and will have a tremendous difficulty in maintaining staffing levels.

12. The community of Boulder and surrounding communities have served MDC for over 100 years and yet this bill does not even mention mitigating the impacts of closure on these people and communities. Your decision should not be based on the impacts but this bill should make some attempt to address the impacts.

13. Two legislative interim studies of MDC from the last sessions and a study of the Dual Diagnosis Task Force done during the same time did not recommend closing MDC. Each of these were in-depth looks at this very complex issue. We should follow their recommendations to do more real planning and improvement and expand community based services but not close MDC.

In conclusion, this is a poorly constructed bill and plan that jeopardizes the safety and health of our most vulnerable citizens for years to come. It is being promoted by a person that has tried for years to close the facility despite multiple studies and reports that do not recommend this and despite great progress at MDC over the past years. The information you have been selectively given has been designed to present MDC in the worst possible light. If we want to move more people in to the community, kill this bill and work to make it possible in a planned, effective way and let MDC die a natural death if over the years their services are no longer needed.

Sincerely,

Sabrina Steketee
PO Box 566
Boulder, Montana 59632
Cell: 406-431-1285

This email will come from my work account, to reply to me at home, please reply to sabrina@bouldermt.com
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Service-Learning Activities for Childhood Hunger Week 4/13-4/17/15
April 13 - Food drive from 3:30-5:30pm at L&P Grocery
April 14 - Assembly from 1:30-2pm at Boulder Elementary School Gym
April 15 - Community Potluck from 6-8pm in the Jefferson High School Cafeteria (bring a dish). Prizes for the top 3 best tasting food dishes.
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