meeting of the parties e.h. v matin november 28, 2016 · 11/28/2016 · e.h. v matin november 28,...
TRANSCRIPT
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Meeting of the Parties
E.H. v Matin
November 28, 2016
David Sudbeck: Alright, I think we’ll get started. Jenny, this is David Sudbeck and I think
we probably should do introductions since there are quite a few new
faces around the table.
Kyle Blackburn: Kyle Blackburn, Assistant to the Court Monitor.
Chuck Bailey: Chuck Bailey, outside counsel for DHHR.
Kelly Morgan: Kelly Morgan, outside counsel.
Vickie Jones: Vickie Jones, Commissioner for the Bureau for Behavioral Health and
Health Facilities.
Andrew Dornbros: Andrew Dorbros, Assistant AG for the Bureau for Behavioral Health and
Health Facilities.
Vaughn Sizemore: Vaughn Sizemore, Assistant AG.
Bill Hicks: Bill Hicks, Acting General Counsel.
Cindy Beane: Acting Commissioner for Bureau of Medical Services.
Shawna White: I just started with West Virginia Advocates this morning.
Erin Snyder: I also just started with West Virginia Advocates.
Chuck Bailey: I’m sorry, your name is?
Erin Snyder: Erin Snyder.
Chuck Bailey: Erin?
Delcie Gorum: Delcie Gorum with West Virginia Advocates.
Jeremiah Underhill: Jeremiah Underhill. I am the Legal Director of West Virginia Advocates.
Susan Given: Susan Given, Executive Director of West Virginia Advocates.
Lydia Milnes: Lydia Milnes of Mountain State Justice.
David Sudbeck: We usually start by scheduling our next meeting and instead of doing that
today, I’d like to see what falls out on Wednesday at the hearing so we
can make a decision on whether we want to meet in January or early
February. So, I’ll make that decision after the hearing on Wednesday. Are
there any additions to the agenda? First issue under my report is…First
of all, I should say, Jenny, that there were no grievances filed in my office
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since we last met. On Potomac Center, you have received a copy of the
letter that I received from Kim Helmstetter regarding three children that
are approaching…one has approached the 24 month period, two others
are soon approaching the 24 month period. Kyle, do you want to hand
that to Kelly and I’ll get one over here to Lydia. I redacted the names. I
didn’t want those names to be out in space. So, you are now getting a
copy of the three named individuals that are approaching the 24 month
period. And, I guess I would just like to have some discussion on what are
the statuses of these three children? I know that there was a meeting
with Potomac Center a couple of weeks ago. I was not invited to that
meeting, I know it happened within your Bureau, I believe, Vickie. Were
you at that meeting?
Vickie Jones: I was not.
David Sudbeck: Are you aware of these three children?
Vickie Jones: I was aware that there were three children and it was requested that they
had difficulty in placing. I am not aware of the plans moving forward. I
wasn’t aware that we were going to discuss that. I thought it was just
going to be about this [inaudible] and whether or not they would
approved to stay longer, to be honest. I can’t [inaudible], but I was not
aware that we were going to get into this.
David Sudbeck: Did you not see the letter?
Vickie Jones: I did see the letter but I thought it was just to discuss whether you would
approve them to stay there. I…
David Sudbeck: Well, Kim called me on their way down here before that meeting and she
was concerned that the State might place these children on a stay. I was
concerned about that and she told me that these children are still
benefitting from their services and…
Vickie Jones: Right.
David Sudbeck: Well then, you know, I would support them staying.
Vickie Jones: And that’s all of what I thought we were going to be discussing here
today. I apologize. I can find out more if you would like to……
David Sudbeck: I do want to know…
Vickie Jones: [inaudible]
David Sudbeck: Well, I do want to know kind of what long range plans are being talked
about for these three children because they all three reached the 24
month period. So, I’d like to know what the long term plan is for the next
three months.
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Vickie Jones: I know…
David Sudbeck: Well, the next six months. I mean, what has the treatment team has said
about how much longer they will be there.
Vickie Jones: And I know that you had asked them to provide you with a report every
60 days, that would be due in December….
David Sudbeck: Right.
Vickie Jones: And that will be coming to you in late December. So….
David Sudbeck: Maybe you could attach the long range plans for those three children.
Vickie Jones: I would be glad to.
David Sudbeck: Do you have anyone up there at Potomac Center or is it just Legal Aid?
Susan Given: No, we don’t have that contract anymore. No [inaudible] wants to keep
it staffed.
David Sudbeck: Uh-huh. So, maybe mid to late December I could get a report?
Vickie Jones: Oh, sure.
David Sudbeck: Alright, any other discussion from anyone else?
Lydia Milnes: Just a quick question. What is the…how many children total are at
Potomac Center?
David Sudbeck: 24. There are three group homes on campus. Eight beds each. I have not
brought this to the attention of the Judge and I will not do that until I see
what your long range plans are because, at some point, I have to let him
know that an order is being violated or not being followed. So, I will do
that. I won’t have that discussion with him until after I see what the long
range plans are for the three children.
Chuck Bailey: Maybe for my edification, the first time I seen the letter, I don’t see any
criticism of DHHR in here. I simply see that….
David Sudbeck: No. There isn’t.
Chuck Bailey: …they’re asking a, to whether or not these children can stay at Potomac
Center. Inc. So, I am not sure what the controversy is. Is the controversy
is there is no suggestion by somebody that they were going to be placed
elsewhere, or what?
David Sudbeck: No. The controversy is that, I am trying to think, that Order was signed,
God, the Potomac Center Order…the Judge came in in 2000. I think it was
2002. Since 2002, that Order has been always followed. On rare
occasions, has any child stayed more than 24 months. So, now we’ve got
three and that’s the issue, Charlie.
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Chuck Bailey: Ok.
David Sudbeck: That’s the red flag in my mind.
Chuck Bailey: Ok. So we are bucking up on this 24 month timeline and a decision has to
be made with regard to that. Ok. Thank you. I just needed to understand
that. Thank you.
David Sudbeck: Do you know, Vickie, if there has been any discussion on placement of
these children out of State?
Vickie Jones: I am not aware of discussion being placed out of State, but, to be honest,
that’s [inaudible] had these discussions with the Potomac Center and….
David Sudbeck: I haven’t heard anything from Legal Aid.
Vickie Jones: I have not.
Chuck Bailey: Well, apparently, the letter says placement has been pursued for these
two children. No success. So, apparently, placement options have been
sought for these children without success. So, obviously, placing these
children by the Potomac Center was met with little success. So, what we
need to do is to determine what their status is going forward, correct?
David Sudbeck: Well, what providers are being approached and why are the providers
saying No. You know, I have not met these children, but, I may have to go
out there and meet them and to nudge this process on a little bit. But I
will wait until I see your report. I hate traveling in that part of the country
in the winter.
Vickie Jones: I understand and I will try to learn more detail and provide that to you….
David Sudbeck: Well.
Susan Given: Is it special funded?
David Sudbeck: I don’t know what their status is funding wise, if they’re on waiver or not.
Do you know, Cynthia?
Cynthia Beane: If they do [inaudible] for months, they are not waiver. They’ve lost it.
Susan Given: They’re not on waiver.
David Sudbeck: Did you have anyone at that meeting? The Potomac Center meeting?
Cynthia Beane: No. Not that I’m aware of.
David Sudbeck: Ok.
Vickie Jones: Some of these children, just so you’re aware, are really under parental
placement and some are under the jurisdiction of the court, and
so….there is not a special funding [inaudible]
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David Sudbeck: Do you know who in your department called this meeting. I mean its like
a phantom group. Who are these people? I mean, that met with Potomac
Center? That met with Rick and Kim? Was it Beth Morrison?
Vickie Jones: Well, there is [inaudible] group with children’s family and [inaudible]
parental placement and DHHR guardianship and so, [inaudible] regarding
these children and we’ll work with [inaudible] to try and find a placement
with them, so, I can find out more specific details. To be focusing
[inaudible] I wasn’t like thinking….
David Sudbeck: Are you familiar with the orders?
Vickie Jones: I am familiar with the orders and I just thought we were going to be
discussing whether or not you would give approval for them to stay
beyond that order. I will find out….
David Sudbeck: Well, see, I am trying to get out of this situation. I don’t want to be the
person, well sure, let them…….
Vickie Jones: I don’t know how I got involved in it.
David Sudbeck: Where’s the treatment team? Those are the people that should be
making the decision on whether or not this person is still benefitting from
this program. Can they stay, should they stay in….
Vickie Jones: [inaudible] be in the Potomac Center.
David Sudbeck: Absolutely.
Vickie Jones: Ok.
David Sudbeck: Yeah. But, also a part of that team is some people out of Bureau of
Children and Families use to sit at that group. Somebody’s alleged
advocate is at that group meeting. Education is at that group meeting.
Vickie Jones: That’s my understanding.
David Sudbeck: But those are the ones that should be making the decision on whether or
not the child should stay.
Vickie Jones: Right.
David Sudbeck And if providers are being approached, why are they saying no?
Vickie Jones: That’s what I can find out..
David Sudbeck: Yeah, ok.
Lydia Milnes: It looks to me like there are already two that have exceeded the 24
months plus three approaching it. Then we’re looking at a 1/5 of the
population there being outside the order, which is, you know, pretty
extreme.
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David Sudbeck: That’s why I’m having this discussion. I’m concerned. I mean I used to go
up there every eight weeks and conduct this group meeting. I have since
not done that since they lost their license. What was that, last year?
Cynthia?
Cynthia. I…
David Sudbeck: I think it was, early last year.
Cynthia Beane: [inaudible] Its been a while.
David Sudbeck: They lost their license and a bed sat empty for about a year and a half.
So, I mean, there was no reason for me to go up and conduct a meeting,
and then they got their license back, oh, well, about 24 months ago. Some
of these children are past the 24 month period. But in that time frame
that I’ve been conducting these meeting for 15 years, we have never had
this. I mean, children were going through that program like it was meant
to be, a transition facility. So…
Vickie Jones: So, can I ask a question?
David Sudbeck: Sure.
Vickie Jones: Are you planning to start those meeting out? Are you expecting…
David Sudbeck: I’ve asked this…I’ve asked the parties whether they want me to go up
there and do this and they basically said no. You’ve really haven’t, but
over here you have. So, I haven’t been doing them. And I don’t need your
approval to do that.
Vickie Jones: I understand.
David Sudbeck: And based on what your report in mid-December tells me, I might look at
the Judge and say “Judge, I’m going back out there. I’m going to, you
know, pull that group together again.”
Jeremiah Underhill: This is Jeremiah speaking. I know we don’t have any people that are ours,
but I think it would be a wise decision for…
Susan Given: They’re all ours.
Jeremiah Underhill: Ok…
Susan Given: [inaudible]
Jeremiah Underhill: Because it sounds like it’s not transitioning the way it’s supposed to. So I
think it would be in the best interest of those kids to have you go back up
there.
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Chuck Bailey: The letter says placement has been pursued for these two individual
children with no success. That’s pretty blunt. Clearly they tried to place
them…
David Sudbeck: But they….
Chuck Bailey: without success. So, rather than beating this dead horse, why wouldn’t
you determine why there’s no success.
Susan Given: I believe that’s what David was asked to do…
Chuck Bailey: That’s what we’re going to do but I don’t understand…I get the letter, I
just reviewed it, it sounds to me like they are benefitting from a
structured environment consistent with [inaudible] strategies and they
are still benefitting. The question is why these children haven’t been
placed with no success. So, we’re going to find out why they have never
been placed with no success and report back to Mr. Sudbeck as soon as
possible. Is that satisfactory, David?
David Sudbeck: Absolutely.
Chuck Bailey: Thank you.
David Sudbeck: You know, it simply could be a funding issue too.
Susan Given: I think it’s a funding issue as far as the [inaudible]. I mean there
[inaudible], so they were all perceived by [unknown] waiver, but they all
qualify based on their [inaudible] personal care [inaudible] They would
probably be on a wait list for waiver. They would certainly have funding
for in home care.
David Sudbeck: And what’s your wait list again? Is it a thousand? Two thousand?
Cynthia Beane: I don’t know. I mean I don’t know. I don’t have the exact number off the
top of my head. [inaudible] It grows everyday so.
David Sudbeck: Yeah,
Cynthia Beane: I would have to go back and [inaudible]
Susan Given: Does that team have…they could place these children out of state?
Vickie Jones: They….
David Sudbeck: In my involvement in 15 years with this group, we’ve never had to do
that.
Susan Given: We just became aware of a couple of teenagers that are out of state and
there was no interstate compact, and they’re out of state and a place
we’re going to be doing some investigation into and it’s like nobody really
knew they were there.
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David Sudbeck: Alright, Vickie, we look forward to your report. Will you also share that
with petitioner as well?
Vickie Jones: Oh, sure.
David Sudbeck: Ok. Before we talk about the American Medical Foundation report, let’s
talk about the SUD waiver discussion, Cynthia?
Cynthia Beane: I don’t have a lot more. I just made my normal amount of copies. So,
certainly we can get some more copies.
David Sudbeck: Maybe we could get someone to make some more copies?
Cynthia Beane: It’s just a [inaudible] of what services are going to be in the SUD waiver.
It’s a basic handout and [inaudible] as far as the application. So, Betty
[inaudible] Samples told me at the meeting of the [inaudible] that I
attended there were some [inaudible] about the waiver and wanted an
explanation of what that is. First of all, I want to explain what it is that
West Virginia is applying for. It is an 11-15 waiver, which means it’s a
[inaudible] waiver. West Virginia has never applied for a true 11-15
waiver before. We have some 11-15 waivers [inaudible] as far as eligibility
and enrollment, but they weren’t true 11-15 where you have to be
[inaudible]. So, this is a first for West Virginia. We’re really excited about
it. CMS about a year or so ago gave the State the flexibility to [inaudible]
the 11-15 waivers for substance abuse disorder population, so, I don’t
have to tell probably anybody who is here what is going on in our State
with regards to substance abuse disorder and the epidemic that West
Virginia is in and the [inaudible] that we’re in as far as being number one
[inaudible] so, that is what [inaudible] Governor Tomblin is definitely on
board with making sure that we get this application in as quickly as
possible. So, what you have in front of you is the expanded services that
West Virginia Medicaid cover under the waiver, so, basically what you
have is services that we are going to add to our continuous care and
behind that is just an explanation of each of those services so that they
can [inaudible] waiver its basically billed at continuous care. A lot of times
you’ll have [inaudible] substance abuse disorder that wants treatment
and cant access treatment because [inaudible] so what we found is that
in certain areas of the State there is a lot of treatment centers at the State
but not very much treatment at all. So, this will provide Medicaid funding
for all of these services. So, any individual who is Medicaid eligible will
be eligible for these services. That is really quick and dirty. We will need
to describe some of the services.
David Sudbeck: Let me ask you this question. How many….is there a limit on enrollment.
Cynthia Beane: No. So in our 11-15 waiver there is no, like, [inaudible]. So, like, I know
we’re used to talking…
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David Sudbeck: Sure.
Cynthia Beane: …talk about this [inaudible] waiver a little bit and any of our waivers
there’s slots that basically, in order to be eligible for this waiver, you’re
going to have to have a diagnosis of substance abuse disorder and be
Medicaid eligible. And so, if you have those two things, and require this
level of treatment, which the level of treatment runs the gamut from just
screening and assessment and supervision to actually the patient
treatment. So, as a whole, its spread over a continuum if you qualify for
these services.
David Sudbeck: The reason why I wanted to talk about this is basically I wanted to
congratulate the Department. I mean I was shocked. I did not know that
this was happening and I think when the State’s doing something good
that they should let the Court know and that’s why I wanted us to have
this discussion today and also when the minutes go out we’ll attach this
so the Judge will actually see this as well. Ok.
Cynthia Beane: So [inaudible] pulled. [inaudible] has our draft now. We’re going to pull
that. We’ll get the official submission in, hopefully sometime this week
and then, once you get that in, with this waiver, [inaudible] 90 day on the
spot, there is negotiations and terms and conditions with BMS and the
dollars so those negotiation will start so this will be beneficial….
David Sudbeck: So, what are you hoping…
Cynthia Beane: They will actually do…we’ve had it up for our 30 day comment period.
We’ve had two public forums. Then BMS will have to actually perform
two [inaudible] for a nationwide public comment period for 30 days as
well.
David Sudbeck: When do you hope to have it up and running?
Cynthia Beane: January of next year.
David Sudbeck: Oh my.
Cynthia Beane: and that give you time, because, like some of the services….
David Sudbeck: January of 2018?
Cynthia Beane: Yes. Because on some of the services, because we will have to change
policies and procedures to meet [inaudible] level of care and then we’ll
have to build some of the service capacity as well. We only have so many,
you know, we don’t have the [inaudible] people to [inaudible] or 30 day
program. We don’t have a whole lot of those around the State.
David Sudbeck: Vickie, are your provider community, are they excited about this
expansion?
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Vickie Jones: They are. They actually provided comments and we’ve had many
discussions with them and they’re excited to be able to have
opportunities to not only increase their treatment, primarily the
treatment from Potomac, but to be a part of, you know, providing info
for the application itself. So, they’ve been really good about helping us
out and getting us feedback on it.
David Sudbeck: All right, are there any questions? All right. Let’s go to American Medical
Foundation Report. Have you ever had one of those nights where you
wake up and good God you just can’t go back to sleep?
Vickie Jones: Every night.
David Sudbeck: Every night? That happened to me a couple of days after this report came
out and I got up at 1:30 and stood in my kitchen and read this thing until
4:30 and I guess I’m not use to standing that long at one time, but I do
have to say, I mean I have a lot of respect for this group. A lot of respect.
This is the most in depth report I have ever seen. I’d like to know what
the parties thought of the report.
Lydia Milnes: From my review, I also agree that it seems like a very thorough report and
it seems certainly I didn’t have any questions about the competency of
the evaluators or anything along those lines. I felt like there was a mixture
of positive things that seemed to be happening as well as some things
that raised some very serious concerns. You know, essentially each of the
individuals that reviewed files noted some consistent problems with the
way the PRNs are written. Specifically, that there would be a number of
PRN medications prescribed for the same set of symptoms with no
directions to the nursing staff on which PRN to use on which occasion or
which one to use first or how long to wait between. I know there were at
least a couple of occasions where they seemed to give multiple PRNS
without waiting a sufficient period of time between them and then the
use of the injections into muscle as opposed to offering PRNs orally. It
appears that sometimes they are offered orally, sometimes it is just
simply unclear from the notetaking if they were or not and then there
was a number of occasions when there was no oral PRN written and it
was the reviewers tend to believe that there could well be an oral PRN
and it was just written in a way that only allowed the injection, which
obviously is concerning for the individuals. So, you know, to me it seemed
like a very thorough and well documented report and, you know, its
positive that it appears that they were not using the PRNs as chemical
restraints and, but it certainly raised some other issues about the way
that they are being administered.
David Sudbeck: One of the things that, I mean, it was clear that they don’t believe that,
we’re all hoping that they would not find that drugs were being overused.
I think that was clear. They indicate on page 3 that’s not to say the agents
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used, and the way in which they were used in some patients, did not
invite scrutiny. And on page 8, there was a word that stuck out and I
highlighted it….more medication was, it says “appears to be forced.”
Another thing….word…that came up a lot throughout the report, and this
is one psychiatrist basically critiquing another psychiatrist’s actions. The
word “concerning” comes up a lot in the report. And I thought of you a
lot Vickie when I was highlighting that word because these are your staff.
This report could be really helpful in addressing some of the issues that
they saw that were concerning. So, I mean it’s a very good tool for you
and your administrators and I don’t know if they had the opportunity to
review it, but boy if I was a CEO of Bateman or Sharpe, I would want to
see this and I would to use this as an education tool for these doctors.
Vickie Jones: And we will [inaudible].
David Sudbeck: and you know….
Vickie Jones: They have not seen the report as of yet.
David Subeck: What’s your intention as far as Court. I mean, the Judge has received a
copy of this. Are you planning on any videoconferencing or for testimony,
I mean, what do you plan to do? Anything at all? Have you thought about
it?
Vickie Jones: For Wednesday?
David Sudbeck: Yeah.
Chuck Bailey: I think the plan is, and you kind of hit on it, I was asked my opinion on this
and not to get too detailed, but I think that now that we digested your
report, we were thinking to talk to the Secretary about providing copies
to the administrators for their thorough and complete review and then
sit down and taking a look at the positive things and those things that
could be improved and put together a plan wherein to the extent that
our psychiatrists and our professionals agree to probably try to see how
those comments could be integrated with the system. I purposely told
them not to share this with the administrators because I didn’t want any
kind of leaks, or you know how….
David Sudbeck: Sure.
Chuck Bailey. …things go out there so I thought it was best that we first, number 1, I
want to hear what you thought about it, David and I heard you and I agree
with your comments, so, having heard from you, and I’m sure the Court
will have some comments and once we absorb those two comments then
we can begin the process, but I agree with you that there are some things
in there that need to be taken to Court to approve patient care.
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David Sudbeck: Well, if I was the CEO of Bateman or Sharpe, I mean, I would just like to
sit my clinical director down and say read this thoroughly and come back
and tell me what you think.
Chuck Bailey: Yeah, I mean, as a manager of a law firm, if someone did that kind of
scrutiny of my law firm, went through every file, I’ve had files audited
before, I’ve had files audited by some of the clients, they come in and
give you scrutiny and I look at it in a very positive way, and [inaudible], so
I think I agree with you on that. There’s no disagreement on that. I just
asked them not to share it yet, because I wanted to hear your comments
first and then the Court’s so if there’s a direction to go in, we’ll all be on
the same page.
David Sudbeck: I don’t know how the Judge is going to react. I mean, I don’t know what
he’s expecting either. I mean, is he expecting any kind of testimony
regarding this report.
Kelly Morgan: No testimony has been up yet. I mean, I wanted to raise the issue of the
invoice for this, as seen in the initial budget that we initially planned on.
David Sudbeck: We originally talked 40, how far did we go over?
Kelly Morgan: I don’t have an actual copy of the new summary but it was somewhere
right around 50 some. But, any, you know, testimony that the Court
would want or anything like that, I mean, of course it’s all per hour and
scheduling…
David Sudbeck: Sure.
Kelly Morgan: …you know, we didn’t set any of that up yet.
David Sudbeck: Well maybe, let’s see how, let’s see how he reacts to it and he may want
to take in some kind of evidence regarding this report from these people
and that would just be another hearing.
Kelly Morgan: Yes.
David Sudbeck: that we would have to schedule.
Kelly Morgan: Yes. Yes, right.
Charles Bailey: I think that…
David Sudbeck: So let’s just see how he reacts.
Kelly Morgan: Sure.
Chuck Bailey: He might not want to hear anything…if he does.
David Sudbeck: True.
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Chuck Bailey: I want the comments back from our professionals as well. I think that’s
important that we get that, once they review it.
David Sudbeck: Yeah…
Chuck Bailey: …to see their comments as well because, again, you got one psychiatrist
reviewing another and….
David Sudbeck: And you might want to even bring them in if there was a hearing needed
on this particular report.
Chuck Bailey: I’m not going to pursue one if Judge Bloom wants to do it or not.
Hopefully, he might be just satisfied with the report and our
representations that we are going to provide copies to administrators
and work with them to look at those issues and report back. I’m not going
to presume what Judge Bloom does.
Kelly Morgan: The only reason I brought up the invoice issue with testimony and all that
is that it’s just official costs.
David Sudbeck: I know.
Kelly Morgan: We’ve already depleted the budget and, so…. We already had that one
order that set forth, that [inaudible] that certain price. We’re going to
have to enter another order in order to get that paid but, so anything on
top of that.
David Sudbeck: Well that’s the reason why we can explain to the Judge why there is no
one here today.
Kelly Morgan: Right. Exactly.
David Sudbeck: But if he wants to go further into this, then we have to go for more
money. But, I’m sorry, Susan, did you have something?
Susan Given: I had our advocate who monitors the state hospitals to take a look at that
and here are some of his remarks. Just a little less than half of the cases
reviewed for this report, the individuals had some combination of border
line intellectual functioning, mild intellectual functioning, mild moderate
developmental disabilities, um, tbi’s.
David Sudbeck: Uh-hum
Susan Given: So, I think that’s important to note that perhaps they may be used more
in that population because they are being harder to deal with due to their
[inaudible]. I would be something to think about, to look at. He felt there
was poor documentation in general to substantiate need, hierarchy of
choices, um.
David Sudbeck: Well, if you look at page 70, the first paragraph, the last sentence there
is “There is no documentation that oral medication was offered prior…
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Susan Given: Right…
David Sudbeck: …to IM administration.” Basically, what you are saying.
Susan Given: Right. Poor documentation or instructions to nursing. Um, but I will
just…he also noted that for [inaudible] with developmental disabilities,
there was no [inaudible] or support plans.
David Sudbeck: On page 70 Vickie, if you look at, they said was the patient subjected to
chemical restraints and they say no. While there are concerns about the
patient receiving IM medications without being offered PO medications.
The medications were administered based on his symptoms of agitation
and threats to harm staff, so, they see no evidence of chemical restraints
but there is the concern about that one particular issue. I think it would
be very useful, this whole document, you know, I know its $50,000 but
damn, this is a good education document for doctors.
Susan Given: And without positive behavior support plans, hospital rules really don’t
mean anything to a person with a developmental disability per se, um, so
you have to go...take more steps to try and deflate a situation, I think,
with those individuals.
David Sudbeck: You know the other thing that slapped me in the face when I was reading
this in the middle of the night was the population we’re dealing with.
We’re dealing with a very, very seriously ill people and you read their
stories and you can’t help but get emotionally involved in their life and
their experience that they are having at this hospital. It’s sad.
Chuck Bailey: Early in my legal career, you know, like all lawyers struggling to get going,
you [inaudible] the mental hygiene and criminal defendants and absolute
psychotic thing and I told the judge once, I said I didn’t major in
psychology. I majored in journalism and I was ill equipped as an attorney,
especially juveniles. I was ill equipped as an attorney to deal with the
psychological and emotional problems that many of the children I dealt
with and juveniles came from homes that are really rough. So, it’s a long,
long travail.
David Sudbeck: And so many of the patients, the history of sexual abuse, is just,
throughout this report, is just…
Chuck Bailey: I was involved in several cases in Nicholas County. I remember one night
just putting down the file and I started crying as a grown man at 35 years
old. I was stunned. I was stunned that anyone could do that to a child.
David Sudbeck: Yeah.
Chuck Bailey: And this child had grown up to be an absolute, and I can understand….
15
David Sudbeck: We lucked out when we chose American Medical Foundation. I don’t
know who to give the credit too, but I guess it goes to Kelly and Charlie
and the Department because I don’t know how you found these people,
but I’m sure glad I know that they’re out there, if I need to use them
again.
Chuck Bailey: They’re very thorough.
David Sudbeck: And they did this all without coming into the State.
Lydia Milnes: I just raise one other issue that I suspect the Judge might ask about, which
is if we go back to the beginning of what caused him to ask for this audit
to happen in the first place. It was the question of whether the
understaffing problems at the hospitals were leading to what he called
and has been referred to as chemical restraints. Um, that…that issue isn’t
analyzed in this report. Um. I don’t know how it could have been because
I doubt that…I mean certainly they weren’t provided with like staffing
level stuff, but so there’s still that open ended question of the incidences
of um agitation and aggression, etc., whether they are in any way
connected to staffing. I’m not suggesting they are not, and I think
certainly some of them is pretty clear that the persons coming into the
hospital in a state of…of… you know, a situation in which they are already
agitated, etc., but umm, I just raise that since that is what the Judge was
questioning when he ordered this report, and I don’t think that, um, that
specific question, um, gets determined by the report.
Chuck Bailey: You know you were invited to participate in protocols and testing and
chose not to get involved.
Lydia Milnes: I am…I’m not suggesting.
Chuck Bailey: No you are suggesting. That’s just typical of how this goes [Inaudible] the
report. It’s 70 pages or more, analyzing every aspect of it. Rather than
keeping a positive influence, which there is no issue of staffing, so let’s
take a [inaudible] approach.
Lydia Milnes: With all due respect, I was trying to give you all a heads up as to an issue
that I suspect the Judge may ask himself given that he is the one who
asked for this report to begin with.
Chuck Bailey: He has to determine whether or not they were using chemical restraints
and the answer was no. So I hope that will satisfy the question.
David Sudbeck: Well, he keeps bringing up though in some of our hearings and I know
this is always in his mind. There is testimony admitted into the record
from the medical director of Bateman Hospital that medication was being
abused. And that…it was directly related back to the staffing [inaudible].
He has that in testimony and that’s why I think that what Lydia is saying
16
is that be prepared, he may go there. I’m not going to bring it to his
attention, but you know him. He asks a lot of questions.
Chuck Bailey: My recollection is that the study and the protocols were completely
noted by all parties so that is what [inaudible]
David Sudbeck: Well, Kelly, can I thank you for finding these people and Charlie for
bringing them on board and working with them because they produced
quite a document here and will you tell them that on my behalf.
Kelly Morgan: Sure.
David Sudbeck: Ok. Are there any other questions on this report? Susan, do you have
anything else? Who is the advocate it was looking at?
Susan Given: Ed West.
David Sudbeck: Oh.
Chuck Bailey. What’s his name?
Susan Given: Ed West.
Chuck Bailey: How do you pronounce…spell his last name?
Susan Given: W-E-S-T. West.
Chuck Bailey: West.
David Sudbeck: There’s a name [inaudible].
Susan Given: He’s been around for a long time.
David Sudbeck: I met him about 28, 29 years ago. And no, I’m not 50. But anyway.
Chuck Bailey: Who else was the report shared with? Anyone else?
Susan Given: Just the legal staff. Ed West, because he monitors the hospitals.
David Subeck: He monitored both of them? You said one for Bateman and one for
Sharpe, didn’t you.
Susan Given: Uh-huh.
David Sudbeck: So he combined that into one. Where is he based at?
Susan Given: The Clarksburg office.
Chuck Bailey: The reason why I asked. I am terribly concerned about confidentiality
issues so I think that is my only concern. Certainly sharing with Mr. West
is fine. I just think we have to be very circumspect with regard to this
report until we get some guidance from Judge Bloom or otherwise…
David Sudbeck: The only person I sent it to was the Judge and I had asked Kelly…
17
Chuck Bailey: No, no, I get that, I just when I read the report, I wasn’t sure if I was
reading it outside that I could probably recognize a brother or sister….
David Sudbeck: Oh, yeah.
Chuck Bailey: …cousin. Certainly wouldn’t want to be reading that in the, [inaudible]
concern. I just, I was very careful in our office how everything is going to
be sealed and taken care of because I didn’t want people reading it other
than the people that should be.
Susan Given: Will he have access to those records?
Chuck Bailey: No. No. I have no issue with Mr. West. I’m sorry. I just didn’t know who
he was and [inaudible] when I heard it was reviewed by someone else
and I had kind of refrained from doing that so far. It’s fine, no issue.
Kelly Morgan: And David, I’ll say, you know, you sent it to the Judge, not formally filing
it, so, it, and I don’t see any reason why it should be formally filed, but if
it would be, it would need to be sealed and everything, but since it hasn’t
been.
Lydia Milnes: Just for the record, I actually don’t know that I agree that it should be
confidential. I mean, I believe that this would be information that would
FOIA able. I don’t see why…you know, we took steps to…
Chuck Bailey: Well, if you want to…
Lydia Milnes: …the ways we set it up…
Chuck Bailey: deal with the lawsuits that will be filed over the breach of confidentiality
by persons who could be recognized, that is fine with me.
Lydia Milnes: With all due respect from Legal Aid, the portion of the audit that they did,
they took all these steps to eliminate individual’s names from there, from
the portion that they did. I understand that we have ended up with initials
here, and certainly I would, you know, have no problem with something
like that being redacted, but I don’t…I don’t see a basis for keeping it
confidential if given appropriate redactions are made to protect any
possible…
Chuck Bailey: I didn’t suggest a broad issue. What I was suggesting in here today was
that it not be released in any matter absent some guidance from Judge
Bloom and a careful consideration of the privacy interests of those people
described in there because I can guarantee that someone sitting in
Clarksburg who would read that report might say that’s my brother. Ok?
So, I think…that’s my issue. We’re all talking about patient rights and
people’s rights so I’m trying to advocate for that. At some point, Judge
Bloom will make a decision I’m sure on what, if anything, should be
released in this matter. We just have to be careful at this point.
18
Lydia Milnes: I don’t disagree.
Chuck Bailey: Good.
David Sudbeck: All right. Well, let’s see how the Judge reacts on Wednesday and then we
can always come back and revisit this and how we want to use this
document for your purposes of education and training.
Kelly Morgan: I presume Lydia and David, that you wouldn’t have any objection into
entering into some sort of agreed order to extend the budget on that to
supplement the initial one and have it, maybe, for the judge…
Lydia Milnes: That’s fine.
David Sudbeck: What was that first order? Was it 40?
Kelly Morgan: I want to say 36.
David Sudbeck: Oh, yes.
Kelly Morgan: 35 plus a $1,000 administrative fee. So I believe it was like 36 and I want
to say we’ve reached like 55, so we’re talking about 20 some over. Of
course, that was based on an estimation that they had given me of like, 2
to 3 hours per file, and…
David Subeck: Yeah.
Kelly Morgan: And they estimated it was like 4 ½ per file on average, some were more,
some were less.
David Sudbeck: No. I don’t have any problem with you entering.
Kelly Morgan: I’m just saying we need…we will need to provide the Court with a
supplemental agreed order.
David Sudbeck: Sure.
Kelly Morgan: In order for that to be paid.
David Sudbeck: I know all the costs…
Kelly Morgan: I assume you don’t have any objections.
David Sudbeck: No. Ok. Anymore on this? I’d like to hear from every one of these new
people on this report.
Shawna White: It’s my first day.
David Sudbeck: I’m not going to make it easy on you just because it’s your first day. Or
your first meeting. Ok. BHHR report.
19
Vickie Jones: I know that you are wanting to ask some general questions about
[inaudible] and I really haven’t even been to court per se, but if you have
specific questions you…
David Sudbeck: I think you brought up the issue.
Lydia Milnes: Briefly just in anticipation that it is generally a question asked by the
Judge, so I thought if there was any issues, it might be helpful to discuss
today. I heard about a month ago that there were problems at Sharpe
where [inaudible]. I don’t know if that’s continuing. I just thought I’d raise
it today so there wasn’t, you know, any surprises at the hearing on
Wednesday.
Vickie Jones: Let me kind of start with Bateman. There were no issues at all with
Bateman and having a meeting [inaudle] tomorrow to just be prepared
for a maximum limit question for [inaudible]
David Sudbeck: Sure.
Vickie Jones: For Sharpe, they do do the [inaudible] where classrooms, visitor rooms
on occasion. The census says they’re pretty good since November 2nd, I
believe, [inaudible]. However, there are times when we have, and I think
I testified to all of this, so there are times when there might be a locked
room, for instance, when a female might have one of the beds and you
have to have another female so it is locked for a female admission. To get
male admission, a female can’t go in there [inaudible]. There needs to be
someone who gets admitted in the middle of the night, and other than
wake a person up, you ask the person if we can put you in there for the
night [inaudible] back to the morning when everybody is awake. I
[inaudible]…
David Sudbeck: Un-huh.
Vickie Jones: There’s also some reasons for medical capacity. We’ve talked about those
before. And then there are times when someone may have a psychotic
episode and for the roommates safety purposes, we will move them out
for a [inaudible] so that person can become stabilized again. So there is,
there are uses of those rooms that I can talk about more specific in terms
of anything you might have that [inaudible] complains still concerned
about. But that does continue [inaudible].
David Sudbeck: I am not getting any complaints from patients.
Vickie Jones: Well, we have a
David Sudbeck: ..and I’m not hearing…
Vickie Jones: We haven’t received any complaints or grievances but I wasn’t sure if
there was anything that you had.
20
Lydia Milnes: Like I said, a month ago I heard it was up but I hadn’t heard there were
any problems.
Vickie Jones: And I…and I can, you know, when all of the decision that are made like
that is something that the treatment team usually [inaudible] to the
next day, even if they [inaudible] for short term stay, must get medical
reason [inaudible] what the doctor says this person needs to be here
[inaudible].
David Sudbeck: It’s not like 2008 when we were using the rooms because there were no
beds available.
Vickie Jones: It was not like that…
David Sudbeck: Well, it’s just basic common sense actually in some of these cases where.
Vickie Jones: It is.
David Sudbeck: …where, you know, do I want to wake up this other female patient to
admit someone at 2 in the morning.
Vickie Jones: Yeah, and that actually, because that could actually agitate the individual
David Sudbeck: Oh, sure.
Vickie Jones: [inaudible]
David Sudbeck: And with agitation comes PRN.
Vickie Jones: There, I think there is more knowledgeable decisions that are being made
and, um, and more care and careful decision as opposed to back in 2008
and 2009 when things were more challenging and difficult. But again, if
anything ever raises your concern or specific issues, I am more than glad
to receive a contact from anyone in the room and we will look into it right
away and deal with that [inaudible].
David Sudbeck: Ok. Vickie do you want to talk about the provider meeting we had? Which
I thought was quite successful.
Vickie Jones: We’ve actually had a couple provider meetings.
David Sudbeck: We had three actually.
Vickie Jones: And you’re inferring to the letter that was sent?
David Sudbeck: Right, in December. Yes, 2015.
Vickie Jones: So, in….
David Sudbeck: December 2015.
Vickie Jones: In December 2015, there was a letter that was sent to Judge Bloom by
the providers….
21
David Sudbeck: It was sent to me.
Vickie Jones: Oh, I’m sorry. It was sent to David where there were concerns raised by
the providers association. The providers association for those who may
not know, is an association that represents all of the comprehensive
providers here in West Virginia. There are 13 of them. There’s a few
others that are involved as well under that association, but they
represent the comprehensive [inaudible] health providers that are
community based providers in West Virginia. And they have raised some
concerns primarily related to BHHF and [inaudible]. And then involved
around the [inaudible] back in 2009.
Lydia Milnes: An email was sent out of [inaudible].
Vickie Jones: They actually request there be meetings that were set up and we all met
on different occasions, and each time…
David Sudbeck: The judge asked that I get involved and pull the group together…
Vickie Jones: Yes, to resolve any outstanding concerns….
David Sudbeck: Right. Right.
Vickie Jones: …that the providers might have had. And, we met and discussed all issues
that they had raised in the letter, as well as a think a few others and I
think that as of right now, there has been no other issues raised by the
providers and we have not had another meeting scheduled to address
any of these. The meeting went very well on all sides, I think.
David Sudbeck: Well, the providers felt and believed that their issues were kind of like a
moving target. So that is why we kept meeting on every two or three
months.
Vickie Jones: Right.
David Sudbeck: But after our last meeting, was it in November?
Vickie Jones: Yes. It was.
David Sudbeck: Yeah. We decided to just call the group together only on an as needed
basis. So there is not another meeting scheduled. I really think those are
some of the most productive meetings that I’ve ever been involved in and
I have sat in a few meetings in my lifetime.
Vickie Jones: Very productive. We learned a lot, I think.
David Sudbeck: Yeah.
Vickie Jones: as to what the concerns were, how to resolve them, and what we were
going to report.
22
David Sudbeck: I learned a lot about how the system is operating now under managed
care. And how….
Vickie Jones: Actually I…
David Sudbeck: …and how in some areas, you know, in some areas not so well and other
areas, not bad at all, but I remembered Karen Neal talking about that $1
million dollar she had in invoices.
Vickie Jones: I think even in the areas that they had concerns, um, one of the things
the providers did comment on was that the managed care companies
were all willing to meet with them to walk through this.
David Sudbeck: Yeah, that was the common theme…
Vickie Jones: The [inaudible] that came up, the managed care companies were ready
and willing to do their best to adjust their [inaudible]
David Sudbeck: Yeah. There was no one provider in that room that talked negatively
about the care providers. The managed care providers. In that, they
always seemed to be in this open dialogue and wanting to sit down to
meet to resolve their issues. That was very impressive for me.
Vickie Jones: I thought so too.
David Sudbeck: All right.
Vickie Jones: I think we were all pleased with the outcome of those meetings and
should there be a need for another one, I am confident that could
probably be arranged.
David Sudbeck: The only thing that I think I could probably pull the group back together
again is the election. I mean, and in just a few weeks from now, we may
be looking at all different people, you know. I don’t know how many of
you people are going to be in this room. I probably will be, but I don’t
know who else will be because it’s been my experience after an election,
the faces of the meeting of the parties change considerably. Legally,
professionally within the Bureaus, within the Secretary’s office, so a
change is coming and with changes comes fear and with fear comes
maybe another letter to me from the provider community outlining a
whole another set of issues based on decisions being made by a new
administration. I’m just saying.
Vickie Jones: I will say that I think we have established a good working relationship with
them so that even if change does occur, I think there is enough of a
relationship at lower levels of individuals that are not in this room that
are not parties to this conversation [inaudible] just working that I’m
hoping that that relationship will carry forward and keep on moving
23
forward because I think that’s what everybody wants. I think we’re in a
good place for that.
David Sudbeck: Well, and I think Mark Drennan is kind of the pulse for that group, which
I think is positive….
Vickie Jones: Yes. He is …..
David Sudbeck: …for us and for the Department. Yeah. Good guy. Alright, anything else
Vickie?
Vickie Jones: I don’t think so.
David Sudbeck: Petitioners Report.
Lydia Milnes: I think the one thing that I wanted to follow up on is we had a couple
email exchanges following the last meeting regarding the advocacy
services provided at hospitals with diversion patients. And, if I recall
correctly, Chuck, you were going to talk with Vickie and get back to me,
and I, I don’t believe I’ve seen that follow up.
Chuck Bailey: Well, I asked Vickie to re-insure, I call them outside vendors, to make sure
they are respecting the advocacy program and I think you spoke with
them?
Vickie Jones: Well, I have spoken with the CEOs and they are planning, they were
contacting all of the diversion hospitals as a reminder to them that
advocacy services were required, um, some [inaudible]. The advocacy
services are provided through inpatient hospitals [inaudible]. So
advocacy services are provided. We’re not aware of any hospital that
doesn’t have advocates, as well as West Virginia Advocates are able those
services to the hospital.
Chuck Bailey: What I asked Vickie to do and she did to is ensure that the CEOs or
someone contact each one of these facilities and make sure that they
understood that the patient’s rights, the right to advocacy and the right
to an advocacy center and remind them that that is in place so if there is
an issue arising, they’ll remind them of their responsibilities. The have a
contractual, I did look at that, they do have a contractual obligation to
fulfil that as well. So, I think that at least satisfies in my mind that if an
issue arises that it would be taken care of appropriately. If an issue arises
where a patient wants an advocate and for some reason falls across the
cracks [inaudible]
Kelly Morgan: Lydia, just real quick…you said you hadn’t heard back from us. I sent you
an email on October 28th following up on this specific issue again advising
that we had spoken to Commissioner Jones outlining the [inaudible]
advocates regulations.
24
Chuck Bailey: Well, I take it, we did. but I think what Lydia had a fair question and I
probably didn’t respond and confirm that we did what we said we would
do and I will confirm we did. We’re going to do it and confirm we did. At
least what I directed the parties to do. I just, David, I want to make sure
that any divergent facility persons, CEOs, etc. are fully aware of the rights
of these patients of being in divergent facility. I don’t know if they need
to be reminded but they got contractual obligations to us as well. They
have JCO responsibilities as well, so, it’s in place and plan there and you
know, someone falls through the cracks or something happens, I would
be glad to address it.
David Sudbeck: Yeah, Kelly, I also remember.
Chuck Bailey: You’re right. I should have responded back to you and said
David Sudbeck: Did you see…
Chuck Bailey: they have done this correctly.
Lydia Milnes: I’ll have to…I’m trying to search, but I’ll have to pull it up at my office.
David Sudbeck: Yeah.
Susan Given: I have another question, just on that matter. I can’t search my emails but
we just got an email not very long ago from Ed West saying that Highland
Clarksburg just hired their first patient advocate.
Vickie Jones: Actually, he’s the one that just got the [inaudible] advocacy.
Chuck Bailey: They have a habit of some services under their agreements, etc. They may
have…
Vickie Jones: You mean they just hired someone on the staff….
Susan Given: internal.
Vickie Jones: He probably had contractual….he is the one who testified that, he said
before Judge Bloom….
David Sudbeck: Yeah.
Chuck Bailey: They all have to comply with joint commission of hospital accreditation
and patient rights. Highland is probably taking the step to hire an in-
house advocate as well for that issue because they probably have….
Vickie Jones: Well they just increased their census….
David Sudbeck: Right.
Vickie Jones: And so they each have 50
Chuck Bailey: Given the number of patients.
25
Vickie Jones: [inaudible] their census now.
David Sudbeck: 75 isn’t it?
Vickie Jones: Well.
Chuck Bailey: Which is what Judge Bloom wanted so, the divergent issues….
Vickie Jones: but they now have 70
David Sudbeck: 70?
Susan Given: It seemed like it was a new event. I only got that email.
Lydia Milnes: This is the issue that I’ve been trying to get to it…
Chuck Bailey: We are not going to hire…We are not going to require our divergent
facilities to do what Highland…they don’t have the contractual room to
do that. It’s not required. What is required is that they comply with the
law and to the extent that they are complying with the law so you have a
complaint that’s working and if Highland wants to hire a new patient
advocate the way they’ve done because of their census, that’s fine.
Lydia Milnes: I was going to explain the question that I have been trying to get to, which
is that my reading of Title 64 indicates that patients in DHHR custody are
entitled to an advocate who is not part of the hospital administration.
And it is my understanding that the divergent facilities, the advocates
that you all have been referring to, that they are required to have like a
JCO or whatever, are frequently employees of the hospital, um, nurses,
or other people on staff at the hospital. They are not individuals that are
separate from the hospital the way the advocates at Sharpe and Bateman
are. And the question that I have raised several times now is whether
that complies with Title 64.
Chuck Bailey: It does. We are complying with the law. If you believe that it’s wrong, we
can deal with it legally. I disagree with you vehemently. If you read that,
the bottom line of it is they, those divergent facilities have multiple
requirements on various statutes, rules and regulations to provide
patient advocacy. If they fall short of the patient advocacy roll, I can
guarantee I will take care of it. But the bottom line of it is if you think that
the DHHR is going to fund persons like they do at Bateman, etc. that’s not
going to happen.
Lydia Milnes: Ok. And the reason I’m bringing it…you said I can deal with it legally as
well, this is me attempting to deal with it legally, without making more
issues…..
Chuck Bailey: Well you’re asking us to hire people [inaudible]. That’s not going to
happen.
26
Lydia Milnes: So, I have never made that request.
Chuck Bailey: Well, what are you asking? That’s what you’re asking. You’re asking that
the DHHR hire persons or someone to go in there and serve as special
advocates for these patients. Is that what you’re asking?
Lydia Milnes: I am asking what is the current system. This is how this all started,
remember? I asked…I didn’t know…
Chuck Bailey: It’s been explained in three emails to you…
Lydia Milnes: Excuse me. If you’ll let me talk, please. I’ve let you talk a lot. The questions
that I have asked over the past couple meetings now were me trying to
understand the current system. I didn’t want to jump to conclusions. I
wanted to try and get a sense. One of the questions I was going to ask is
whether the advocates at the divergent hospitals have been specifically
trained in Title 64 and patient rights under Title 64. When you said that
Becky had asked the CEOs to contact the divergent hospitals, I didn’t
know if that was one of the issues being raised or not. That was a question
I was going to ask. I have not made any specific requests or demands. I
have been trying to understand the system as it stands. I’ve been trying
to understand the details. I, you know…
Chuck Bailey: I think…I think Kelly gave you a very lengthy and elongated email with
regard to the system. If you are questioning is what training it may receive
with regard to that, I think that’s a fair question and I will find out.
Lydia Milnes: Ok.
Chuck Bailey: Because that’s a fair question. I mean, there is no disagreement. They
need to be perfectly trained in methods to deal with any form of patient
advocacy whether it be someone in divergent care or not. There is no
question about that. I don’t believe that there is any issues since we
received zero complaints about it that given the fact that you want to be
[inaudible] about It, I will work with Vickie to make sure that I think my
message was clear that it may need to be clear enough to make sure that
any patient advocate in any of these facilities, divergent or otherwise,
understand the rights of the patients they receive from our facilities. I
think that’s a fair question and something that should be done. That’s
just common sense.
Kelly Morgan: During the last meeting, Regina verified that West Virginia Advocates
[inaudible] doesn’t need an advocate and they did have advocates who
were able to go to the facilities. I’m not aware of any conflict.
Chuck Bailey: Well, the issue is…ok, you want me to make…if you want the issue to be
addressed of what training should be provided, I will look into that and
do my best to make sure that everybody is on board with that.
27
Kelly Morgan: Susan, you might have the answer to this, I mean, I presume West Virginia
Advocates is training their own advocates.
Susan Given: Oh, we have not had an access problem at the diversion hospitals. I don’t
think that’s what she’s getting at though. You know, we have one person
who monitors the state hospitals and diversions, so, he may only be there
once a week or twice a week as opposed to advocates who are at Sharpe
and Bateman and are there every day for legal aid advocate. I think the
question, as I understood it, was does Title 64 extend to the people who
are in state custody who are at the divergent hospitals, if they have the
same access to advocates as people who are at Sharpe and Bateman. We
do go there and we’ve had no access issues. They are very good at, you
know, we have access.
Kelly Morgan: The patients are able to contact your advocate.
Susan Given: We have posters up and we have an 800 number so they can contact us.
Kelly Morgan: And you say they’re there at least once a week.
Susan Given: I’m just saying they’re monitoring all of the hospitals, so I’m not sure if
he’s there once a week or not. It’s just, he’s there, he’s not there every
day.
Kelly Morgan: What’s his name?
Susan Given: Ed West.
Kelly Morgan. Oh, ok.
David Sudbeck: And that’s basically the outside source that you’re looking for, is it not?
In my mind it would be. I mean, we did ask them specifically. I, I think I
asked the question, is your agency name and telephone number posted
in the hospital and they said yes.
Lydia Milnes: I don’t believe that necessarily meets the requirements….
David Sudbeck: 64?
Lydia Milnes: of Title 64 and I think that we probably have a different legal view on that,
and I’m not, at this point, if I decide that we have reached a standpoint
but we can’t agree and there is something more needed, I will file an RFR.
I’m hoping that, you know, that it appears that there is appropriate
advocacy services in place and appropriate training of the advocate and
as I mentioned previously, I have received complaints from divergent
hospital patients. I haven’t received one recently so I don’t know, maybe
things have gotten better. I’m not trying to rush into anything, I’m just
simply trying to understand that…..
28
Kelly Morgan: Are you now willing to share that information of the patient or the person
who was concerned enough.
Chuck Bailey: She said she, she said she hadn’t had one in a while.
Lydia Milnes: And as we were talking about before, I don’t disclose individual’s names
without their permission.
David Sudbeck: Alright, anything else?
Chuck Bailey: I may ask you this, and I may say, talk about some additional training,
David would have to call Mr. West to make sure that he would want to
buy any time to work with training at the hospitals. I mean, since he is the
one knowledgeable on behalf of the advocacy program, he’d be the one
I’d think would do the training.
Lydia Milnes: Seems like he would need a contract.
Chuck Bailey: Yeah, we’ll work that out. My question posed is, since you raised the
issue, is that Mr. West seems to be the one qualified. He’s been here 30
years, I would say?
Susan Given: Oh, he’s been around for 30 years. He’s been around for a long time.
Chuck Bailey: So, therefore, I mean, he’s been paid by [inaudible], I was just saying that
my question only who is might be a person or resource to tap into.
David Sudbeck; Anything else, Lydia?
Lydia Milnes: I would just suggest that hospitals should have plenty of individuals well
versed in Title 64 that could provide training.
Chuck Bailey: It sounds to me that Mr. West is the most qualified person. That’s who
I’m looking for.
David Sudbeck: Well, currently, legal aid does that training in the hospital.
Lydia Milnes: Yeah.
Chuck Bailey: You got legal aid, you got lots of people to do it. Just find the most
qualified person or [inaudible]. I’m not going to ask DHHR to reach into
its pocket for another $54 million dollars to be tucked into the budget to
do that.
Lydia Milnes: Well, DHHR is responsible for the care and protection…
Chuck Bailey: Well, they’re going to take care. You haven’t gotten any complaints, have
you? No. The one complaint you had, you won’t disclose. But anyway,
I’ve heard what you had to say. I think there should be training. I just
suggest that Mr. West, who I have a note here who had been here for a
29
long period of time, seems heavily qualified, maybe he’ll assist us. Is that
a fair question or not? I’ll make the request once I dig into it. Thank you.
Lydia Miles: Do you all have any issues [inaudible]
Susan Given: What about there’s no programing on the weekends?
David Sudbeck: Jenny, this is Susan Given talking.
Susan Given: That’s uh…
David Sudbeck: That will help her…
Susan Given: Sorry. That’s something that Ed also noted on the weekends, there is no
programing. There is no nothing. They could go to church. They could…
Chuck Bailey: Is this diversion or at Bateman?
Susan Given: No, this is at Bateman and Sharpe. You know, there is, they could go to a
movie and have popcorn. They can go to church on Sunday. There is no
structure programing even no AA/NA meetings. Nothing takes place over
there on weekends. And idle hands and bored people…
David Sudbeck: I mean, you have a physician at both hospitals. I forget the title that
coordinates all of the outside activities. But you are saying they are not
happening.
Susan Given: Well, I am saying there is no treatment that happens on the weekends.
Chuck Bailey: We just talked about popcorn.
Susan Given: Well, he was saying that the activities on Saturdays and Sundays is, they
have the choice of going to a movie if they want to, or they can go to
church on Sunday if they want to, but there is no treatment that happens.
There is no, I guess Monday through Friday there are groups, there is this,
there is that, and none of that happens on the weekends.
David Sudbeck: Is that a change, Vickie?
Vickie Jones: I have to ask the person from the [inaudible].
David Sudbeck: I’ve never seen it as an issue either. I do know.
Vickie Jones. It’s the first I’ve heard of it [inaudible].
David Sudbeck: Well, sometimes the outside activity is a part of treatment.
Vickie Jones: Its, it’s to try to [inaudible]…
David Sudbeck: Yeah.
Vickie Jones. There’s lots of different clinical decisions that are made [inaudible]. I
wasn’t even aware [inaudible].
30
Lydia Milnes: There’s technically a number of individuals who are not eligible for
community integration activities so for them these [inaudible] are going
to not be an option on the weekends. So it would be a question as well
for them if that means that there is nothing occurring or if there is, and
obviously, I mean….
Vickie Jones: [inaudible] 24 hours a day. I don’t see.. I’ll have to ask. I’m not sure. What
I don’t…what I really don’t what [inaudible] clinical decisions [inaudible].
David Sudbeck: Right.
Vickie Jones. I mean…
Lydia Milnes: I doubt there is a clinical decision that having activities on the weekend is
bad for somebody. I don’t think that’s the issue.
Vickie Jones: I’m not suggesting it is. I just want to make sure [inaudible].
Lydia Milnes: No, of course not.
Chuck Bailey: No. the meeting is…I’ll keep my comments to myself.
Lydia Milnes: The meetings are to raise new issues between the parties and an
opportunity to address things that…
Chuck Bailey: The only thing left on the agenda, I don’t see that on the agenda. That’s
my problem, is that it’s hard for me to prepare for something or
understand something that I don’t know when I’m going to discuss. If you
brought this situation to maybe why some people are not participating in
movies or church or other issues, then it could be addressed. I just think
it’s just weird…
David Sudbeck: I think that, to be fair, this is something that we need to follow up on at
another meeting of the parties. I think we need to allow Vickie to go back,
talk to her CEOs and find out what is the structured activity, on what days
does it happen, if it doesn’t happen on the weekend, why does it not
happen. That kind of thing.
Vickie Jones: Now, just for clarification, this is at Bateman and Sharpe?
Susan Given: As I recall. As I recall.
David Sudbeck: It was only at Sharpe?
Vickie Jones: [inaudible]
Susan Given: It was at, um it was at both hospitals.
Vickie Jones: Ok.
Susan Given: That they’re, his comment was that there was no treatment on the
weekends.
31
Vickie Jones: No treatment…
Susan Given: No treatment on the weekends.
Vickie Jones: Ok, I will have to go through…
Susan Given: There are no groups, there are no AA meetings, NA meetings, none of
that.
Vickie Jones: I’ll ask the [inaudible]
Susan Given: Ok.
Vickie Jones: And I’ll,,,
Susan Given: Ok. And maybe Ed should be coming, kind of providing those…
David Sudbeck: I don’t want to expand this group anymore.
Susan Given: Well, I’m not, I probably won’t be here anymore and certainly our 4
attorneys.
Davis Sudbeck: Well, make sure your issues are shared with Lydia or bring them or when
we send out the agenda, I think we always say if you have anything to
add, add it.
Lydia Milnes: One thing I suggested, I think I asked a couple times, but advocacy
included on the emails but there are still most of the emails getting
circulated, they are not include on and sometimes I remember to forward
to them, and sometimes I don’t, but I think we just need to as a policy,
should it be [inaudible] included in all of the emails that would normally
go out on any kind of issue and hopefully that will…
David Sudbeck Well, we’re trying to get away from this gotcha kind of moment. We need
to be more planned and structured on the issue that we bring before…
Lydia Milnes: I’m not trying to be…
David Sudbeck: I’m not looking at you. I’m talking about other issues that we’re trying to
discuss here now that’s not on the agenda.
Lydia Milnes: Sure.
David Sudbeck: It’s not fair to the respondents at all. All right. So, let’s do a follow up on
that.
Vickie Jones: Yes. I’d be glad too.
David Sudbeck: Jenny, make sure that gets included in the minutes, that we are going to
follow up on the schedule issues at both Sharpe and Bateman hospitals
at our next meeting of the parties. Thank you. Lydia, do you have
anything else?
32
Lydia Milnes: No.
David Sudbeck: Ms. BMS?
Cindy Beane: [inaudible] We have all of the [inaudible]. We have 8 people currently
waiting. [inaudible] We do have some [inaudible] and what we’re going
to do is just, since we only have [inaudible] for a waiver getting [inaudible]
so we will look at those slots. We had actually 8 slots right now for any
[inaudible] person. [inaudible] people in the pipeline, [inaudible]
meaning somebody who has [inaudible] in a nursing home that they are
looking at possibly moving out and then those slots will be probably used
more than likely by people in the mla {inaudible]. I think last year, we
moved out two people for [inaudible]. That’s where we’re at.
David Sudbeck: What’s your budget for this program? I know I’ve asked in the past.
Cindy Beane: A million dollars.
David Sudbeck: How much?
Cindy Beane: A million but with the match.
David Sudbeck: Ok. So, it’s about $4 million dollars?
Cindy Beane: Yes.
David Sudbeck: the program. Is the…
Cindy Beane: I’m rounding… I mean, I could.
David Sudbeck Right. No I don’t need. That’s fine. Round off is fine. Is your…do you
waiver? What’s the budget on it?
Cindy Beane: [inaudible] That’s why when we talk about the SUD waiver, one of the
things that I think, people were like, you’re applying your applications
were given and you’re not going to start from a year now. The budget
negotiations were [inaudible] from an SUD waiver. Historically had taken
the state almost two years, we are pushing it to get EMS to agree for us
to start in January. In fact, most states give their application to the point
we are in it usually takes two years up and running to get it within six
months.
David Sudbeck: you know….
Cindy Beane: So it’s a very tight timeframe with [inaudible] because it was taught to
them and because the West Virginia academic is so huge right now in our
state, we are probably one of the hardest hit states across the country,
that we are pushing them as much as we can [inaudible]/
33
David Sudbeck: Do you think the election, Cynthia, will have an effect on this program?
Because I know the current Secretary of Health and Human Resources at
the federal level is from, is a native West Virginian.
Cindy Beane: Yeah. I still, [inaudible[ that is why our push was to get our application
submitted prior to the administration change, which we will accomplish.
So, say at CMS, much like you said here, at the federal level, all the players
change, and so, it’s not just the players of the Secretary at FEMA, but it’s
on down, they are appointed positions themselves, like [inaudible] is who
I talk to a lot at CMS, since they [inaudible] FEMA program. She will turn
in her resignation and accept [inaudible] like the federal employees who
are appointed and so I don’t know who the new administration will
appoint and how that will work out, you know…..
David Sudbeck: Yes.
Cindy Beane: We just hope it all works out well for West Virginia.
David Sudbeck: I don’t think.
Cindy Beane: [inaudible]
David Sudbeck: I don’t think President Elect Trump has given any indication for that roll
in his administration to this point anyway.
Cindy Beane: I haven’t heard anything as far as the Cabinet Secretary for Health and
Human Services. I do assume to indicate it will definitely change and
[inaudible] Secretary for a while, but I have no idea who he might appoint
and, so the only thing that I have heard with regard to that was that her
state would not be in favor of [inaudible].
David Sudbeck: Hmm.
Cindy Beane: So I would not be in favor of that or several other states. [inaudible]
David Sudbeck: Yeah. What is it? 73? 74?
Cindy Beane: Yeah, it’s like 72. Something. Every point something [inaudible] So, I
mean, Medicaid in West Virginia is $4 billion dollar program so [inaudible]
David Sudbeck: Well, this administration. I think I read in the paper, was it 20, no I didn’t.
I got this out of that meeting, Vickie, that you and I are were in. Was it
$25 million dollar deficit in Medicaid or was it $50?
Cindy Beane: A quarter at a deficit every year so last year…I mean, two years ago we
had to get $100 million dollars from the rainy day fund for the budget last
year, it was [inaudible].
David Sudbeck: There’s not much left in the rainy day fund either. Anything else for
Cynthia? Cynthia, thank you for your report. There is no other. So, I’d like
to thank everyone.
34
Susan Given: Do you want to follow up where it was in the paper about the patient at
Sharpe who assaulted staff and their names were named and it said they
were patients.
David Sudbeck: Well, we had a lengthy discussion with Regina and Teresa on that issue
and I think Charlie, refresh my memory, but I think we put that back on
you.
Susan Given: Well, I was just going to tell you what we’ve done so far. [inaudible]
Maybe you might want to tell them.
Jeremiah Underhill: Yeah, I mean I reach out to the publication, write a letter and explain to
them the statute that covers this and they can’t release that type of
information in the future and make sure that what we have in reports,
basically writing up the police blotter for the paper, that they don’t
include the names or location of the state hospital. I mean, I get it, the
reporter, you know, it’s a rough job to go in and do this and try and
sensationalize it and put a headline that Sharpe patient. They received a
letter and we also notified the Public Defender’s Office in respective
areas for this hospital and ask that in the future if you can’t ask for a
sealed court room when you are dealing with individuals who are patients
of Sharpe or Bateman.
David Sudbeck: Could you make sure that we get a copy of those letters?
Jeremiah Underhill: Sure.
David Sudbeck: Because that would be helpful for us since the discussion started and it
was initiated here.
Lydia Milnes: Did they respond?
Jeremiah Underhill: No. Nobody responded
Lydia Milnes: Ok.
David Sudbeck: Did you ask for a response?
Jeremiah Underhill: I told them to contact me if they needed further clarification on the issue.
Chuck Bailey: And I would make one other recommendation. You might want to send
to the Prosecutor’s Institute here in Charleston. I can email you their
address.
Jeremiah Underhill: Ok
Chuck Bailey: They have a responsibility for all prosecuting attorneys to kind of, you
know, give out that kind of information and predominately know its
Cabell, but we can begin with Cabell and Harrison County, and those are
tough places, but anyway, I will get your email, I will send you an email. I
35
know that the person who, I know the person who runs that, and he can
back you up on that and educate the prosecutors on that
Jeremiah Underhill: Yeah, I’m sure the prosecuting attorneys, they probably have no idea that
the information was let out.
Susan Given: It was just really shocking.
David Sudbeck: Yeah, it is.
Jeremiah Underhill: It’s what happened when a woman was visiting a hospital and he noticed
it.
Chuck Bailey: Well, I…
Jeremiah Underhill: Hopefully it doesn’t happen in the future.
Chuck Bailey: So, yeah, one thing that would be nice, all of the new faces here, rather
than inundate, send an email to Kelly with your name, email address, and
all that, because we have a computer system set up where we put
everybody’s name and contact and her email, Kelly Morgan, is
[email protected] and Wyant is spelled W-Y-A-N-T. Kmorgan,
Kelly Morgan, [email protected]. Send an email to Kelly and
we’ll put you in the system as the need arises and for you, I will support
you in talking to the Prosecutor’s Institute about that issue. I think that’s
a fair issue.
Kelly Morgan: Just to clarify. Delcie, you’re the primary….
Delcie Gorum: Yes.
Kelly Morgan: Should we also include you Susan, or no?
Susan Given: I don’t… I don’t need to know.
Delcie Gorum: Yes. I get [inaudible]
Susan Given: Yeah in going forward, Delcie is going to be the one representing us.
Kelly Morgan: Gotcha.
Jeremiah Underhill I just brought them in here because I wanted to [inaudible]…Orientation
day.
Chuck Bailey: Welcome. We talk about change. We already got radical change. I’m
almost becoming an oldtimer. We got Vaughn though.
David Sudbeck: What happened to Chris? Did he go to a different…
Vaughn Sizemore: He’s in Cleveland.
David Sudbeck: He’s in Cleveland? He moved?
36
Vaughn Sizemore: He joined one of those mega-firms?
David Sudbeck: Really? Where did Karen go? KVM? Where did she go?
Vaughn Sizemore: Part of the change in the administration.
David Sudbeck: Did she go into another…
Vaughn Sizemore: I’m not sure where KVM is right now.
David Sudbeck: So, she didn’t stay in government? Ok.
Chuck Bailey: Of course she’d planned that for a while. It wasn’t’ sudden.
She...everybody knew. I mean, had it inside. KVM said she would spend a
certain time helping the Department.
David Sudbeck: Wow.
Chuck Bailey: She [inaudible] herself.
David Sudbeck: Well, I’ll see some of you on Wednesday and thank you for coming. It was
nice meeting the new people and Happy Holidays to everyone.
Do you want to cut this off?
Chuck Bailey: Yes. Thank you.