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SDC receives termination notice

State gives facility 23 days before federal funding is lost

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 this morning (Dec. 12) that it could lose federal funding for a majority of patients by January 4.

The notice was delivered in person by Public Health representatives at the end of a facility review that found the troubled institution out of compliance with what one source described as 10 conditions involving governance, client protection, active treatment and the physical environment.

According to a source, the most serious area of non-compliance involves the physical environment, and if identified problems are not remedied by Jan. 4 the facility would be decertified and would lose federal funding from the Medicaid program. Those funds reportedly cover 50 percent of the cost of patient care in the Intermediate Care Facility (ICF), which houses 290 members of the patient population.

The ICF serves residents with what are described as “intellectual disabilities.”

According to Kathleen Miller, who has had an autistic son in the facility 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.

The Public Health action came in response to findings that SDC had failed to “correct problems, comply with state regulations or satisfy federal standards set by the Centers of Medicare and Medicaid Services.”

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.

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.

State figures reveal that the average annual cost for each custodial, developmentally disabled patient is $314,000. That would put the yearly cost of maintaining SDC at more than $163 million, although the actual figure is probably higher given the size and complexity of the facility.

By mid-afternoon on Wednesday, DDS had 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 are assisting with ongoing improvements. In addition, a nationwide search is underway to find a new executive director.

Meanwhile, patient advocate and mother Kathleen 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.