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SDC funding in jeopardy

The Sonoma Developmental Center (SDC), long one of the Valley’s largest employers and currently home to a patient population of 517, received a notice from the California Department of Public Health on Wednesday (Dec. 12) that it could lose federal funding for a majority of patients by Jan. 4.

The notice was delivered in person by Public Health representatives at the end of a recertification review that was a follow-up to a July review in which 57 “deficiencies” were identified, including four instances of “immediate jeopardy to resident health and safety.” The July review also revealed six violations of Federal Conditions of Participation, standards that must be met for the facility to qualify for federal funding, which amounts to about $117,000 a day.

When inspectors from the State Facilities Unit of the California Department of Health Licensing and Certification Program returned to SDC this month, they found “dozens more” deficiencies, including some that were termed “immediate jeopardy,” along with continued noncompliance with Federal Conditions of Participation.

Monitoring conducted on Nov. 30 and Dec. 3 documented incidents of abuse that were again considered to pose the risk of “immediate jeopardy” to residents, as well as “actual serious threats to the physical safety of female clients in certain units.” That, according to the three-page letters of determination not to renew the Medi-Cal provider agreement that delivers federal funding for approximately 50 percent of the cost of 290 residents in the facility’s Intermediate Care Facility (ICF).

The ICF serves residents with what are described as “intellectual disabilities” and they comprise more than half of the troubled institution’s patient population.

Losing federal funding for that number of residents could cost the state as much as $43 million a year. The annual operating budget for SDC is approximately $146 million and the average annual cost per custodial patient is about $314,000.

The Glen Ellen campus covers roughly 1,000 acres and employs some 1,400 people.

The Department of Public Health’s determination not to renew federal funding identified five areas where the “Conditions of Participation” have not been met. They include governing body and management; client protections; active treatment services; health care services; and physical environment.

Of the deficiencies in those areas, those listed under “physical environment” were considered the most serious and most urgently in need of correction. “Physical environment” is a catch-all term covering everything from the structural living environment to the quality and kind of care given and the safety the environment affords each resident.

According to records of the Department of Public Health’s Center for Health Care Quality, violations for which SDC has been cited between January and June of this year resulted in a total of $22,000 in fines. That covered “deficiencies” that endangered patients physically, emotionally or financially. Department spokesman Ralph Montano explained that the fines stem from “self-reported incidents” made by clients, their family or staff at SDC, each of which is individually investigated by his department.

Between Jan. 1 and Aug. 7, 2012, there were 89 incidents reported at SDC, down from a high of 297 reported in 2008. The nature of the incidents ranged from “unexplained injury” and “client abuse” to “quality of care” complaints (due to privacy laws, the exact details of each incident are not made public).

Of those 89 incidents, 42 were “substantiated” by the Department of Public Health, meaning that investigators were able to prove the incident occurred. However, that does not mean SDC was at fault. Montano explained, “Say there’s a patient who has a bruise on her leg. We can go and confirm that she does in fact have a bruise, but we don’t know how that occurred. It could have been a fall, it could have been abuse.” Montano said SDC was only fined when the facility did not abide by the law, creating a situation that put clients at risk.

In addition to the 42 substantiated incidents, there were 21 reports that were neither substantiated nor un-substantiated. They include reports of residents being improperly restrained, verbal mistreatment by SDC staff and sexual abuse. Montano explained those cases are either still in progress, or the investigator did not fill out the paperwork correctly. Of the 89 incident reports, a total of 26 were un-substantiated.

According to Kathleen Miller, who has had an autistic son at SDC for more than 10 years, ICF patients include those with “behavioral problems” and are the most difficult to care for and treat.

“It’s the ICF where all the problems lie,” Miller said, referring to recent revelations about a series of abusive incidents including Taser attacks on residents, sexual molestation of residents and, as recently reported by California Watch in the Index-Tribune, the rape of a female patient that resulted in a pregnancy and birth.

Sensational abuses at SDC, and at other institutions under the direction of the California Department of Developmental Services (DDS), have made headlines for months and have surfaced severe criticism of the special DDS police force, known as the Office of Protective Services, which critics charge has failed to pursue competent and conclusive investigations of cases of abuse inside DDS facilities.

The Taser attacks on a dozen SDC patients have never been solved, although an employee found with a Taser and a loaded handgun in his car was subsequently charged and convicted of a misdemeanor concealed weapons violation.

Of equal concern to some current employees at SDC is what they describe as inadequate staffing that results in mandatory double shifts during which some caregivers work 16 hours a day.

SDC employees 562 psychiatric technicians who handle nearly all care outside of direct medical treatments, including daily routines such as bathing and dressing clients, as well as job training and teaching residents how to better function within their environment. During the state budget crisis in 2009-10, funding for psychiatric technicians was slashed, triggering widespread layoffs. Since clients require care around the clock, the remaining technicians are required to fill the void with long shifts and “mandatory overtime.”

“Those issues are definitely continuing. That’s affecting a lot of our members and it’s a huge concern,” said Brady Oppenheim, spokeswoman for the California Association of Psychiatric Technicians (CAPT), which represents more than 7,000 state-employed psychiatric technicians and technician assistants.

Oppenheim was unable to get specific staffing details from SDC by presstime, but reports show overtime for CAPT members reached 29,085 hours in October 2009, costing taxpayers $842,000. Calculated on current staffing rates, that level of overtime amounts to more than 50 hours per psychiatric technician in one month.

“In terms of the staff, it’s simply exhausting. It’s not an easy job, it’s very hard work,” Oppenheim said, adding that the technicians do the best they can for clients. “They’re everyday heroes, they’re always there for their patients. But they’re human … it is tiring to work those 16-hour days.”

Oppenheim said, after conferring with CAPT members at SDC, there has been a recent push to hire more staff and alleviate the overtime requirements. “This is an issue we’ve been trying to draw attention to for a long time. Here we are, facing this concern, with the hopes that it turns around,” Oppenheim said, later adding, “This developmental staff, they are agents of change. I think with this latest information out of Sonoma, they are up to the challenge. They are dedicated to making Sonoma the best it can be.”

Miller, who serves as president of the Parent Hospital Association – composed of parents and guardians of SDC residents – finds the crisis at the Eldridge institution particularly troubling because, she said, “there are so many wonderful, devoted people there doing a great job for the residents. For a lot of residents it’s the best place, and the only place, they’ve got.”

Speaking of her own dilemma, she said, “If we lose our license, my son has to go somewhere else.”

Where that “somewhere else” might be isn’t currently clear. DDS has been implementing a policy of developing smaller group homes in local communities, but not all patients in residential centers can be moved out and away from the more focused and comprehensive health services they provide.

Still, the patient population of SDC has steadily declined for more than 20 years, falling from 1,191 residents in 1994, and some facility staff openly question how much longer the state will be willing to keep the institution open.

By mid-afternoon on Wednesday, DDS responded to the Public Health termination notice with a detailed statement from director Terri Delgadillo, who promised, “We will work with the federal Centers for Medicare and Medicaid Services and CDPH to ensure the Sonoma Developmental Center’s care meets state and federal standards.”

Delgadillo said, “We have removed the executive director and the clinical director and taken disciplinary action against several employees, including job terminations.”

She added that staff is being added on residential units and that DDS is entering into an agreement with the California Highway Patrol to oversee the Office of Protective Services until a qualified commander is hired.

Delgadillo also said DDS will file an appeal of the termination notice, while it develops a “Performance Improvement Plan” to achieve full compliance with state and federal standards. A regulatory compliance expert has also been hired to monitor implementation of improvements, and a “Corrective Action and Quality Assurance Team” of state and national experts is assisting with ongoing improvements.

In addition, a nationwide search is underway to find a new executive director.

That corrective action will have to be substantive and immediate if SDC is to avoid the federal funding guillotine. The Department of Health’s letter of determination not to renew emphatically states in bold print, “A plan for correction at some future date, or evidence of mere progress toward correction, will not be sufficient.”

Signed by John Dexter, Public Health’s chief of Licensing and Certification, the letter states that if Public Health receives “a timely and credible allegation of abatement” a revisit to SDC will be scheduled.

But unless that visit confirms that the “immediate jeopardy has been permanently abated, or if any other immediate jeopardy violations are identified” federal funding will cease on Jan. 4, 2013.

Meanwhile, patient advocate and mother Miller worries that some actions taken to improve SDC problems have created others. She cites the decision to close a unit occupied by “low-functioning” male patients – in part because it was the environment in which the Taser incidents took place – and to subsequently house some of those patients with high-functioning but emotionally-difficult patients in another unit. The two populations did not mix well, which caused further problems, Miller believes.

“They need to slow down, take a deep breath and think this through more carefully,” Miller said.

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Staff writers Emily Charrier-Botts and John Capone contributed to this article.