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Good afternoon
Councilmembers Allen, Patterson, and other members of this combined committee on the
status of the Department of Human Services' Mental Retardation and Developmental
Disabilities Administration (MRDDA). I am Carolyn N. Graham, Deputy Mayor for Children,
Youth and Families, and Interim Director of the Department of Human Services. I am joined
today, by Dr. Abdusalam Omer, Chief of Staff, the Executive Office of the Mayor, and Mr.
Norman Dong, Deputy Mayor for Operations/City Administrator. On behalf of Mayor Anthony A. Williams, we are pleased to come before you today, to present testimony on behalf of the executive branch of the government at this the conclusion of your intensive review of senior administrators' roles in the conduct of business associated with managing urgent and emergent issues of the mental retardation and developmental disabilities administration. And coincidentally, at the near conclusion of the Williams' administration's own multifaceted assessment of the entire system of services for persons with Mental Retardation and Developmental Disabilities in the District of Columbia. Upon Mayor Williams' assumption of office in January 1999, he stated his unwavering commitment to making the government of the District of Columbia responsive to the needs of the most vulnerable of our citizens. It is no mystery to anyone that the Williams' administration inherited a government that was almost completely decimated as a result of years of disinvestment, mismanagement, and poor performance. Upon assuming responsibility for this government, Mayor Williams gave agency leaders the opportunity to begin the organizational restorative process by implementing a series of short-term action initiatives aimed at meeting the needs of District of Columbia residents being served. The Director of Human Services showed a commitment to serious reform efforts. She embraced Mayor Williams' call for accountability and results, and she showed a sense of urgency about improving services to vulnerable people. The Director of Human Services delivered results in 1999, by achieving many of the short-term targets identified as making a difference in the quality of government, and the quality of life of the District's residents. The Executive Office of the Mayor supported the Department of Human Services on a path to accountability and excellent customer service, and helped the agency when problems arose. Issues raised by the leadership in the Department of Human Services indicated that although problems existed in MRDDA, and in other administrations in the organization, Director Williams was on top of them, no threats to life or safety of individuals in government care were identified, and all situations in the Department were under control. There were multiple mechanisms for communication between the Executive Office of the Mayor and agency directors. Agency directors attended weekly cabinet meetings with the Mayor, the Deputy Mayor for Operations/City Administrator, and the Chief of Staff where they could raise concerns both within their own agency and across-agencies. Another way that agency directors discussed problems and their strategic plan was through monthly meetings with the Deputy Mayor for Operations/City Administrator. Also, if agency directors felt that they were not getting sufficient response to serious problems, they could reach the Mayor directly, 24 hours a day, seven days a week, by contacting the Mayor's Command Center. Since these mechanisms were not used to convey issues emerging in the Department, there were no indications that would lead the Executive Office of the Mayor to doubt the Department's leadership, given its performance on major initiatives accomplished and its demonstrated commitment to government reform. The Department of Human Services (DHS) reported to the Executive Office of the Mayor (EOM) that to the extent problems existed in MRDDA, they were under control:
However, when the EOM learned of serious MRDDA issues, EOM took immediate action.
Upon learning that problems were even more egregious than originally and subsequently described, the EOM again took immediate actions to address MRDDA health and safety issues. The public record establishes that during 1999, the U.S. Department of Justice was investigating MRDDA and had issued a report raising health and safety concerns about several class members. In addition, the Office of the Inspector General was asked by the DHS Director to perform an audit in 1999 concerning health and safety of clients. The Director of DHS and her General Counsel were fully aware of these investigations but did not inform the Executive office of the Mayor. In December, 1999, the EOM assembled a team to aggressively review the MRDDA service delivery system including the Department of Human Services, Department of Health, and all licensing and regulatory agencies. A January 21 memo transmitting the preliminary report recommended further investigation of various governmental entities, including the Executive Office of the Mayor, the Office of Communications, the Office of the Inspector General (OIG), the Department of Health (DOH), the Department of Human Services, Metropolitan Police Department (MPD), Office of the Chief Medical Examiner (CME), D.C. Public Schools (DCPS), employees currently on administrative leave pending further evaluation, and the City Council. The report suggested that the entire mental retardation and developmental disabilities system was fundamentally unable to deliver even the must basic services. The team's report helped in the development of the MRDDA 90 Day Plan to Build a Comprehensive and Competent Developmental Disabilities Service System. As we work to build a new system, it is important to understand why and how the old system failed. We began with a thorough examination of: the philosophy of service, our methods of doing business, our system of procurement and the capabilities of our provider agencies and their staffs, the ability and training of government workers, our approach to quality assurance, service coordination, monitoring, tracking and other issues. Based on our work over these past 90-days, we can say fairly definitively that the current system failed because of a poor design and years of neglect and disinvestment by a community and a government that found it easy to forget those who were voiceless. The system intended to address the needs of those with developmental disabilities suffers from fundamental problems that must be remedied immediately:
Madam chair, some have said that the involvement of many agencies in this work is what has led to the management breakdown. I would suggest to you today that the very nature of human services requires the involvement of multiple agencies working together. The MRDDA function is no exception. What we have accomplishedOver the last 90 days, we have mounted an aggressive, rapid effort to improve the MRDDA system and remove imminent threats to life and safety. While the system requires a major overhaul that will not happen overnight, we have already made major progress in three areas:
Let me give you a few highlights in each of these areas. A. Stabilization and Reduction of Risk to Individuals in the System:
While we have accomplished much over the last 90 days, far more remains to be done. We have already begun a new system of services. It is a system that will work and will give us the outcomes that we desire as a community for persons with disabilities: dignity, productivity, independence, self-determination, and inclusion. Based on recommendations from a number of sources: the Evans Exit Planning Committee, the MRDDA Internal Coordinating Committee, an understanding of best practices in New York State, Maryland, Michigan and Minnesota, we've begun to lay the foundation for this new system whose tenets will be, at a minimum, based on some of the following principles:
Funding of the new system will use both federal and local resources to fund individuals rather than "slots" or beds in the system. A growing share of the system's costs will be underwritten by federal dollars through the use of the Medicaid Home and Community Based Waiver for which we have applied. We are now working with the Department of Health and Human Services to structure the waiver so it meets the discrete needs of persons with disabilities. The District's Waiver Request has been designed to include occupational and physical therapy, nursing care, assistative technology, family training, adaptive aides, and companion services. Within the next week, the Mayor will send legislation to the Council create an independent quality assurance monitoring commission as well as legislation to fundamentally change the governments role in the MRDD system. The independent monitoring commission will have broad oversight responsibility over the entire system of services, including government and the private sector. It will be a 501 (C) 3 whose members are appointed by the Mayor and confirmed by the Council. The commission has three functions: monitoring, advocacy, and planning and research. First, the Commission will serve as an independent quality of care monitor, conduct investigations as it sees fit, and aggressively press for equity, fairness, the protection of individual rights, and quality in all services. Second, the Commission will be empowered and staffed to protect the rights of people with developmental disabilities through both a Lay Advocacy branch and a Legal Advocacy branch. Third, the Commission will be charged with gathering information and planning for future needs of the population with mental retardation and developmental disabilities. It is our belief based on anecdotal data - that the MRDD population will grow substantially over the next ten years. Within the next week we will also send legislation to the Council to expand our authority to outsource or use managed competition for most of the services in this area that government does poorly. Painful experience has taught us that government currently lacks the capacity to adequately deliver these services. As the legislation moves forward, we will closely consult with all of the appropriate stakeholders, including organized labor, to ensure that they are part of the decision making process. We will radically redefine and reduce the government's role, focusing our efforts on expanding options for individuals and their families, and providing the proper oversight and enforcement that we need to protect the health and well-being of our people. Moving forward, government will do three things: First, we will create new alternatives to group homes, providing individuals and their families with a full range of options. We will give them the freedom to choose services for themselves. The Medicaid Waiver program and the flexible funding strategies it allows will help the District to move down that road. The system works best when funding follows people not institutions Second, we will establish strong and effective legislation and regulation to provide quality oversight for people in our care. We must ensure that residents are safe and that providers follow national best practices. And third, we must enforce our laws. Threats to life and safety must be met with strong investigation and intervention. We must live up to our legal and moral obligation to protect our vulnerable citizens. Obviously, our approach requires a renewed public-private partnership to reinvigorate our service system. By the end of this month, under the master services agreement, we will launch a solicitation to dramatically increase the number of private sector partners who can provide a variety of high quality services. We want the city's best providers to offer new services that meet needs and lead to desired, measurable outcomes. The new system of services cannot be designed without the active involvement of those it will serve: individuals with disabilities and their families. We are committed to this principle. Finally, others from the private sector must be involved in making the District home for people with developmental disabilities and their families. A true partnership must include educating the next generation of leaders and direct support professionals who will work in this system. The business community must provide more jobs and more opportunities for promotion. Housing developers and lenders must assist in providing low-cost, safe housing for all members of our community who desire to live in their own home. And of course, elected and appointed officials must work together toward one goal of a new commitment to our most vulnerable citizens. This now concludes our testimony. We will be happy to answer questions at this point. |
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