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DISABLED SERVICES IN THE DISTRICT OF COLUMBIA: WHO IS PROTECTING THE RIGHTS OF

D.C.’S MOST VULNERABLE RESIDENTS?

HEARING

BEFORE THE

COMMITTEE ON

GOVERNMENT REFORM

HOUSE OF REPRESENTATIVES

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

JUNE 16, 2006

Serial No. 109–158

Printed for the use of the Committee on Government Reform

(

Available via the World Wide Web: http://www.gpoaccess.gov/congress/index.html

http://www.house.gov/reform

(II)

COMMITTEE ON GOVERNMENT REFORM

TOM DAVIS, Virginia, Chairman

CHRISTOPHER SHAYS, Connecticut

DAN BURTON, Indiana

ILEANA ROS-LEHTINEN, Florida

JOHN M. MCHUGH, New York

JOHN L. MICA, Florida

GIL GUTKNECHT, Minnesota

MARK E. SOUDER, Indiana

STEVEN C. LATOURETTE, Ohio

TODD RUSSELL PLATTS, Pennsylvania

CHRIS CANNON, Utah

JOHN J. DUNCAN, JR., Tennessee

CANDICE S. MILLER, Michigan

MICHAEL R. TURNER, Ohio

DARRELL E. ISSA, California

JON C. PORTER, Nevada

KENNY MARCHANT, Texas

LYNN A. WESTMORELAND, Georgia

PATRICK T. MCHENRY, North Carolina

CHARLES W. DENT, Pennsylvania

VIRGINIA FOXX, North Carolina

JEAN SCHMIDT, Ohio

——— ———

HENRY A. WAXMAN, California

TOM LANTOS, California

MAJOR R. OWENS, New York

EDOLPHUS TOWNS, New York

PAUL E. KANJORSKI, Pennsylvania

CAROLYN B. MALONEY, New York

ELIJAH E. CUMMINGS, Maryland

DENNIS J. KUCINICH, Ohio

DANNY K. DAVIS, Illinois

WM. LACY CLAY, Missouri

DIANE E. WATSON, California

STEPHEN F. LYNCH, Massachusetts

CHRIS VAN HOLLEN, Maryland

LINDA T. SANCHEZ, California

C.A. DUTCH RUPPERSBERGER, Maryland

BRIAN HIGGINS, New York

ELEANOR HOLMES NORTON, District of

Columbia

———

BERNARD SANDERS, Vermont

(Independent)

DAVID MARIN, Staff Director

LAWRENCE HALLORAN, Deputy Staff Director

TERESA AUSTIN, Chief Clerk

PHIL BARNETT, Minority Chief of Staff/Chief Counsel

(III)

C O N T E N T S

Page

Hearing held on June 16, 2006 ............................................................................... 1

Statement of:

Bobb, Robert C., Deputy Mayor/city administrator, government of the

District of Columbia; Brenda Donald Walker, Deputy Mayor for Children, Youth, Families, and Elders, government of the District of Columbia; Marsha Thompson, former administrator, District of Columbia,

Mental Retardation and Developmental Disabilities Administration;

Robert M. Gettings, executive director, National Association of State

Directors of Developmental Disabilities Services; Holly Morrison, vice

president and chief administrative officer, the Council on Quality and

Leadership; and Tina M. Campanella, executive director, the Quality

Trust for Individuals With Disabilities ....................................................... 19

Bobb, Robert C. .......................................................................................... 19

Campanella, Tina M. ................................................................................. 105

Gettings, Robert M. ................................................................................... 87

Morrison, Holly .......................................................................................... 99

Thompson, Marsha .................................................................................... 79

Walker, Brenda Donald ............................................................................ 24

Letters, statements, etc., submitted for the record by:

Bobb, Robert C., Deputy Mayor/city administrator, government of the

District of Columbia, prepared statement of .............................................. 21

Campanella, Tina M., executive director, the Quality Trust for Individuals With Disabilities, prepared statement of ............................................ 107

Cummings, Hon. Elijah E., a Representative in Congress from the State

of Maryland, prepared statement of ............................................................ 16

Davis, Chairman Tom, a Representative in Congress from the State of

Virginia:

Prepared statement of ............................................................................... 3

Prepared statement of University Legal Services, Inc. .......................... 6

Gettings, Robert M., executive director, National Association of State

Directors of Developmental Disabilities Services, prepared statement

of ..................................................................................................................... 90

Morrison, Holly, vice president and chief administrative officer, the Council on Quality and Leadership, prepared statement of .............................. 101

Thompson, Marsha, former administrator, District of Columbia, Mental

Retardation and Developmental Disabilities Administration, prepared

statement of ................................................................................................... 81

Walker, Brenda Donald, Deputy Mayor for Children, Youth, Families,

and Elders, government of the District of Columbia:

Information concerning Evans v. Williams ............................................. 26

Prepared statement of ............................................................................... 74

Watson, Hon. Diane E., a Representative in Congress from the State

of California, prepared statement of ........................................................... 136

Waxman, Hon. Henry A., a Representative in Congress from the State

of California, prepared statement of ........................................................... 133

(1)

DISABLED SERVICES IN THE DISTRICT OF

COLUMBIA: WHO IS PROTECTING THE

RIGHTS OF D.C.’S MOST VULNERABLE RESIDENTS?

FRIDAY, JUNE 16, 2006

HOUSE OF REPRESENTATIVES,

COMMITTEE ON GOVERNMENT REFORM,

Washington, DC.

The committee met, pursuant to notice, at 10 a.m., in room 2154,

Rayburn House Office Building, Hon. Tom Davis (chairman of the

committee) presiding.

Present: Representatives Tom Davis, Kucinich, and Norton.

Staff present: Rob White, communications director; Andrea

LeBlanc, deputy director of communications; Victoria Proctor, senior professional staff member; Shalley Kim, professional staff member; Teresa Austin, chief clerk; Sarah D’Orsie, deputy clerk; Tony

Haywood, minority counsel; and Jean Gosa, minority assistant

clerk.

Chairman TOM DAVIS. The committee will come to order.

I want to welcome everybody to today’s hearing on the District

of Columbia’s Mental Retardation and Developmental Disabilities

Administration.

We convene this morning because at a time when so many things

are going right for the District, a longstanding, seemingly intractable problem has painfully reemerged and demands our attention.

The District’s fundamental responsibility to be a humane and

nurturing custodian of those with mental retardation and developmental disabilities is not being met. Some say the situation is irreparable, and the entire function should be taken out of the District’s hands and given to a receiver. But even if that happens, the

District has to find a way to reform the current system and meet

the needs of these most vulnerable citizens.

How did it come to this? The story is a long and sad one. In

1976, after the deaths of two residents at Forest Haven, a facility

for this population, a Federal class action lawsuit was filed against

the District. Today captioned as Evans v. Williams, the case challenged the conditions of the confinement for residents of the institution which was subsequently closed. But the judgment against

the District also imposes continuing obligations, under court supervision, to protect class members from harm and to provide services

in the least restrictive setting for the duration of their lives. Generally, that meant the District should be able to provide community-based living situations in group homes.

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In 1999, the Washington Post chronicled the tragedy of at least

24 deaths of residents in group homes operated in the city agency,

the MRDDA. The articles highlighted chronic abuse and neglect of

developmentally disabled individuals and described profiteering by

some vendors operating group homes. Six years later a day program worker was charged with criminal negligence for burning an

adult home resident. In March 2006, an employee of a day program

for disabled persons pled guilty to charges of sexually abusing a patient. MRDDA made headlines again when the court monitor reported in February 2006 that a woman and three men had died

since November 2004 because of inadequate health care. The report

attributes the deaths to a systemic pattern of negligence in the

homes and lack of oversight. The court monitor said that, ‘‘for a period of over 1 year the District repeatedly failed to notify providers

of the results of mortality investigations conducted by its own reviewer. As a result, corrective actions were never discussed, let

alone implemented or evaluated.’’

Some attribute this lack of accountability to scattered lines of authority in the city government. In effect, MRDDA has the responsibility, but not the authority over key functions required to provide quality care and protect vulnerable lives. Enforcement, personnel, facility licensing and contracting powers are scattered across

disparate city agencies. In that structure MRDDA can achieve

some reform, but not nearly enough to meet the court mandate or

meet the needs of current and future residents. The inability of

agencies with varying levels of responsibility for this population to

communicate effectively has added to the failure to act timely and

decisively.

The bottom line is there needs to be a single point of authority

and accountability, and there must be performance and outcome

measures to gauge the city’s progress.

The committee has conducted oversight of several D.C. agencies

and departments which have been the subject of lengthy lawsuits,

many of which resulted in court appointed receiverships, including

the child welfare system, mental health services and the housing

authority. Five district agencies were placed in receivership in 1999

when Mayor Williams came into office. He made the commitment

to regain control of the agencies and has successfully done so. It’s

past time to bring the same commitment and sense of urgency to

fixing the MRDDA.

Thirty years of court orders, monitors and compliance plans have

not worked to fix a broken approach to this special population.

Today, we need to hear how the District plans to end this agonizing

era of neglect, reform program management, establish visible and

meaningful quality controls, and assume full responsibility for

those who need and deserve the city’s compassion and care.

I like to include in the record a statement by University Legal

Services; and without objection, so ordered.

I would now recognize another champion of the disabled in this

particular city, Ms. Norton.

[The prepared statement of Chairman Tom Davis follows:]

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[The prepared statement of University Legal Services, Inc. follows:]

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Ms. NORTON. Thank you very much, Mr. Chairman.

Mr. Chairman, I really regret that the committee has found it

necessary to hold this hearing on services provided by a local D.C.

agency. And we all know that this Chair does not do so often, and

he doesn’t do it lightly, because he is a strong supporter of home

rule. And this is, frankly, a classic home rule matter that doesn’t

belong in the U.S. Congress. As a matter of fact, Mr. Chairman, I

have a letter coming to you concerning hearings I wanted the U.S.

Attorney, who is unfortunately a Federal official—and on structural deficit, where you promised me a hearing. But I can understand why this caught the attention of the chairman. Congress has

learned that when—the city has learned that when matters that

are quite inflammatory come to the attention of the Congress

through the newspapers it gets congressional attention.

The recent request for a receivership, provided by the Mental Retardation and Development Agency brings this matter too close to

the congressional orbit for comfort because the Federal courts

would be involved or if the D.C. courts were involved, those come

under the jurisdiction of the Congress at this point.

So the death in group homes, the abuse of helpless people making the papers—anybody in this city knows that Congress reads the

papers, too. And of course one doesn’t have to be personally affected to understand why mentally—retarded, and developmentally

disabled residents would catch the attention of this body. These are

our citizens that are often at the mercy of whoever is in charge,

and has the responsibility for their well-being. Well, who has the

responsibility is not the Congress of the United States, it is the society defined as the citizens of the District of Columbia, and of

course the MRDDA. So the concern could not be more well placed.

I raise the issue of whether a Congressional hearing is necessary

or appropriate, not because of the seriousness of the issue—nothing

could be more serious than the issues involving people who can’t

take care of themselves when no one else seems to be taking care

of them. I do note that the hearing is being held at a time when

in the papers there is evidence both of some council leadership indicating that there is oversight in the city which knows the issue

best, and of course where there have been some changes made;

tardy though they were—for example, an experienced and new director on board. The council certainly takes the matter seriously.

They take it so seriously that they have invoked the harshest punishment; denying the agency increases pending improvement. You

couldn’t get people’s attention better than that. And of course it has

a terrible downside that I hope all involved will understand so that

we can quickly get the matter back to some sense of normalcy.

It is an extremely complicated matter. Many agencies providing

the necessary services, or even finding group homes in a city like

this where people are being chased out every day by the cost of

housing, as the market has escalated those costs. Nobody wants a

group home, even for these residents who are helpless. The problem the city has found in getting contractors, people who supervise

these citizens is itself a—who are competent to do so—is a story

all its own. And of course the difficulty is magnified by the fact

that these citizens are not located in one place. They are spread

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across the city, as well they should be because we’re trying to provide a normal environment for them in the least restrictive setting.

So I stress that the only way to get systematic oversight is for

the city to increase oversight, and the alternative to that is not congressional oversight. The alternative to that is something that the

city wants least, and that is third party oversight, like a receiver.

And what a shame that would be, to head back to 5 or 6 years ago

when so many agencies were in receivership. This happens all

across the country in other cities as well. But here was the District,

after the control board period—which literally brought troubled

agencies out of receivership, every last one of them. And as a result, there hasn’t been much said here in Congress because the fact

that they were in receivership brought them right under our nose

and jurisdiction.

It was a great achievement, but in a real sense—it was a great

achievement because it shows that the government was working,

because the courts would not have released these agencies’ receivership if the courts didn’t think that the city could do it. But if the

agencies that have responsibility for these citizens aren’t working,

the conclusion will be the government isn’t working. This is a real

test of whether the government works. I know we don’t want to

head back to 30 years ago, and I really don’t believe that’s where

we’re headed. Those of us who group up in this city remember

Evans v. Williams, the class action that started it all, went on for

so many years, the closing of the old Forest Haven, the move to

group homes for the least restrictive environment.

Given recent responses, what we’re trying to find out is whether

the city gets the point and is on a systemic road, the kind of systemic road it will take to straighten this out before we go all the

way back to control board times when in essence we had a control

board for these agencies.

This hearing is yet another outside intervenor that should get

the city’s attention. The city finds congressional intervenors particularly undesirable, but worse, much worse would be a receivership. I can’t believe, I don’t believe that this administration intends

to come full circle and head back to the bad old days, but I can’t

know for sure. That’s why I will be listening very attentively to the

witnesses today. I welcome them and appreciate their testimony.

Chairman TOM DAVIS. Thank you, Ms. Norton.

I can just say that we didn’t rush into this hearing willy-nilly .

I mean, we’ve been waiting a long, long time for some action. It

just gets worse. And I think I would be not fulfilling my responsibility as chairman to move forward and shed some light on this,

as we have always worked together to try to give the city the resources it needs and understand the particulars of home rule. But

I think this situation has dragged on and on and on, and that’s the

reason for the hearing today.

Members will have 7 days to submit opening statements for the

record.

[The prepared statement of Hon. Elijah E. Cummings follows:]

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Chairman TOM DAVIS. We’re going to recognize our distinguished

panel. Mr. Robert C. Bobb, the Deputy Mayor/city administrator;

Ms. Brenda Donald Walker, the Deputy Mayor for Children, Youth,

Families and Elders, Government of the District of Columbia; Ms.

Marsha Thompson, former administrator for the District of Columbia Mental Retardation and Developmental Disabilities Administration; Mr. Robert Gettings, executive director of the National Association of State Directors of Developmental Disabilities; and Ms.

Holly Morrison, vice president and chief administrative officer of

the Council on Quality and Leadership; and Tina Campanella, the

executive director of the Quality Trust for Individuals with Disabilities.

We may have a vote on the floor between 11 and 11:30. If we’re

not through, it would be my intent at that point to just hand the

gavel over to Ms. Norton, if she has questions, to allow that to happen while I go vote. I regret that she can’t come over and vote on

this resolution and cancel my vote out, but we’re working on that.

But just to kind of keep things going and try to—if we have questions.

It’s our policy that all our witnesses be sworn before they testify,

so if we can have the witnesses come forward. And let me thank

you all for coming today. If you could raise your right hands.

Thank you.

[Witnesses sworn.]

Chairman TOM DAVIS. Thank you very much.

Mr. Bobb, you’re no stranger to the committee, and I’ll start with

you. We have a light in front of you—your entire statements are

in the record. The light will turn green when you start, orange

after 4 minutes, red after 5. Since your entire statement is in the

record and we have some questions we’re prepared to ask off that,

you don’t need to go forward unless you feel you have to. And we,

of course, don’t—if you feel you have to say, we won’t cut you short,

but it makes it go crisper if we can stay within it.

Mr. Bobb, thanks for being with us. And as I said before, this

city is doing a lot of things right. And this is just one area that

we’ve not been able to get our hands around and solve, and that’s

the purpose for the hearing today. But I don’t want to be overly

critical on so many other things that are going right in this city,

and we appreciate you and the mayor’s leadership.

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STATEMENTS OF ROBERT C. BOBB, DEPUTY MAYOR/CITY ADMINISTRATOR, GOVERNMENT OF THE DISTRICT OF COLUMBIA; BRENDA DONALD WALKER, DEPUTY MAYOR FOR CHILDREN, YOUTH, FAMILIES, AND ELDERS, GOVERNMENT OF

THE DISTRICT OF COLUMBIA; MARSHA THOMPSON, FORMER

ADMINISTRATOR, DISTRICT OF COLUMBIA, MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES ADMINISTRATION; ROBERT M. GETTINGS, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF STATE DIRECTORS OF DEVELOPMENTAL DISABILITIES SERVICES; HOLLY MORRISON, VICE

PRESIDENT AND CHIEF ADMINISTRATIVE OFFICER, THE

COUNCIL ON QUALITY AND LEADERSHIP; AND TINA M.

CAMPANELLA, EXECUTIVE DIRECTOR, THE QUALITY TRUST

FOR INDIVIDUALS WITH DISABILITIES

STATEMENT OF ROBERT C. BOBB

Mr. BOBB. Thank you very much. And good morning, Chairman

Davis and Ms. Norton, members of the Committee on Government

Reform.

I’m Robert C. Bobb, city administrator/Deputy Mayor for the District of Columbia, and I’m here today on behalf of Mayor Anthony

Williams.

It is my pleasure to address the committee concerning the work

that has been and is being done in the District to improve the Mental Retardation and Developmental Disabilities Administration.

Mayor Williams and I remain committed to making the necessary

changes to improve this agency.

MRDDA is facing tremendous and diverse challenges. As you are

well aware, MRDDA has struggled for years to improve its service

delivery and to attract and maintain competent providers.

In addition to addressing service delivery concerns, the Williams

administration is working to ensure that the day-to-day management of the agency is strengthened. For the past several months

I have been a regular participant at the weekly meetings with Deputy Mayor Brenda Donald Walker and MRDDA senior management. During our budget review process, we have been working

with the District Council to make certain that the agency is appropriately funded.

In selecting the new MRDDA Administrator Cathy Sawyer, the

Mayor and I sought a strong director with a proven track record

of turning a troubled agency around. A lot can be accomplished in

the next 61⁄2 months, and we are convinced that Ms. Sawyer is the

right person to be at the helm. During her tenure, we will also conduct a search to identify candidates for the permanent director.

In summary, we truly believe that we are laying the right foundation for MRDDA so that it will provide the necessary services

and care that we all want for District residents facing mental and

developmental challenges.

Let me also state unequivocally that we are opposed to the appointment of a receivership. The Williams administration continues

to seek the necessary changes to make MRDDA a better functioning operation. Yes, the task has taken longer than we anticipated;

however, with the concerted attention the agency is under, internally and externally, and with the addition of a nationally recogVerDate 11-MAY-2000 13:07 Oct 05, 2006 Jkt 000000 PO 00000 Frm 00023 Fmt 6633 Sfmt 6633 D:\DOCS\28625.TXT HGOVREF1 PsN: HGOVREF1
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nized expert in these matters, we are convinced that improvements

will be made before the end of the year.

Thank you.

[The prepared statement of Mr. Bobb follows:]

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Chairman TOM DAVIS. Thank you very much.

Ms. Walker.

STATEMENT OF BRENDA DONALD WALKER

Ms. WALKER. Good morning, Chairman Davis and Congresswoman Norton. My name is Brenda Donald Walker, and I am Deputy Mayor for Children, Youth, Families and Elders for the District

of Columbia.

Prior to being appointed Deputy Mayor in November 2005, I was

the director of the Child and Family Services Agency for the District. I was recruited to CFSA as a chief of staff to help guide that

agency through major reforms and transition out of court imposed

receivership. By virtue of a tremendous amount of work, fiscal responsibility, innovative practices and a solid management team, we

were able to create what is now a well regarded child welfare agency.

I offer this history because the challenges facing MRDDA today

resemble very much the issues facing CFSA when I started there

5 years ago.

As you know, MRDDA faces formidable challenges, including

budget, management and service delivery. We have had literally

decades of decay at MRDDA, yet I come before you today to testify

that I believe we are on the right track.

As with our accomplishments at CFSA, MRDDA cannot be transformed in months, but rather over several years. However, the critical foundation—that upon which substantial reform will be built,

can be laid in the next 6 months.

As the city administrator just mentioned, the Mayor recently appointed Cathy Sawyer as the new administrator for MRDDA. Ms.

Sawyer has consulted for the agency since last October, thus developing a working knowledge of the agency, so she will hit the

ground sprinting when she starts on Monday.

In accepting the position, Ms. Sawyer has identified three primary goals for the next 6 months; one, positioning MRDDA to effectively operate within its budget; two, successfully amending the

existing home and community based waiver; and three, establishing a solid organizational foundation to enable MRDDA to function

more efficiently and effectively in its delivery of services.

The coming months will be intense and critical. Everyone who

has met Cathy Sawyer comes away impressed with her confidence,

experience and commitment to improving the lives of persons with

disabilities. I would like to have her brief you and your staff in the

next few months after she has had a little bit of time to begin work

on executing her goals.

Ms. Sawyer represents only one component of our recent efforts.

As I mentioned, a strong management team is essential. We have

also added a Chief Operating Officer, Dr. Heather Stow, who is

here with me today. Dr. Stow has over 20 years of senior management experience in the human services field. We’ve also recently

hired a highly regarded quality assurances manager, a new director of programs, and several other senior staff.

Over the last several months we conducted an organizational and

staffing analysis of MRDDA. And the city administrator and I will

support Ms. Sawyer’s rapid implementation of the critical manageVerDate 11-MAY-2000 13:07 Oct 05, 2006 Jkt 000000 PO 00000 Frm 00028 Fmt 6633 Sfmt 6633 D:\DOCS\28625.TXT HGOVREF1 PsN: HGOVREF1
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ment and organizational changes needed to move the agency forward.

Much of our work at MRDDA since I became Deputy Mayor, and

more intensely in the last 4 months, has been driven by the systems improvement plan that I outlined to address the agency’s

basic structural deficiencies. This plan has seven major components: one, expansion of provider capacity; two, provider monitoring

and accountability; three, contracts management; four, feasibility of

waiver operations; five, improvement in day programs; six, case

management; and seven, training. Through intensive weekly meetings which I chair, we are closely tracking our progress, modifying

things when necessary and, most importantly, remaining focused.

As you are aware, we also face a significant legal challenge to

our stewardship of MRDDA. Counsel for the plaintiffs’ class in the

U.S. Department of Justice filed motions for receivership and contempt in the longstanding class action lawsuit, Evans v. Williams.

I am making available for the committee’s records copies of the

District’s oppositions to those motions, as well as my declaration

submitted to the court on Monday.

[The information referred to follows:]

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Ms. WALKER. Our work over the next few months—over the last

few months and in the 6 months ahead is designed to lay the foundation for long-term systemic reform. With the commitment of the

Mayor, the support of the city administrator and MRDDA’s new

leadership, we are confident that we can finally get this agency on

track.

Thank you for the opportunity to update you on our plans for

MRDDA, and I’m available for your questions.

[The prepared statement of Ms. Walker follows:]

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Chairman TOM DAVIS. Thank you very much.

Ms. Thompson.

STATEMENT OF MARSHA THOMPSON

Ms. THOMPSON. Hello, Chairman Davis and Congresswoman Norton. I’m Marsha H. Thompson, former administrator of the District

of Columbia’s Mental Retardation and Developmental Disabilities

Administration.

I believe that while Mayor Williams may have already made

changes in structure and policy to support the incoming administrator, my sincerest hope is that my comments can contribute to

improving the outcomes for this population, which I tried my very

best to serve as administrator.

I began as interim administrator in May 2005, just in time for

the mid-year budget review with D.C. Department of Human Services. DCDHS is the cabinet level agency above MRDDA.

Former Deputy Mayor Neil Albert and I determined that amending our MRDDA Medicaid waiver to reduce the burden on the local

budget was a critically needed step. I hired a waiver specialist,

formed a waiver work group, communicated budget pressures and

possible solutions to the provider, advocacy and client community,

and began work on the needed waiver revisions.

The parties associated with the Evans court decree insisted that

MRDDA quickly move people from homes fully funded by the D.C.

Medicaid budget, implement a restructure, and provide improved

specialized health care services through private health care practitioners and hospitals. I communicated the increasing spending

pressures to Mr. Albert. He called an all-hands meeting to develop

a plan for funding to continue services during that year, and after

which he determined what should be done to meet the needs in fiscal year 2006. He advised that I complete the amendment for the

current MRDDA waiver, prepare a supplemental budget request to

the Mayor for fiscal year 2006, and collaborate with an expert to

better leverage local funds for the capture of the Federal match in

other ways.

Even though former Deputy Mayor Neil Albert and I had previously mapped out a structure for MRDDA, I was unable to implement it due to funding challenges and the hybrid legal status

under which we were operating. As of June 6, 2006, MRDDA was

in need of internal legal counsel to handle the daily court appearances around client services and many other legal obligations, internal budget staff with adequate fiscal acumen who could directly

access fiscal reports and forecasts, internal contract staff with the

authority to negotiate contracts and monitor performance, an internal human resources office to manage personnel functions. MRDDA

did have an assigned personnel specialist, but the office was not

adequately functioning as of June 6, 2006. Internal information

technology staff with the requisite skills to manage complex information management needs and design improvements for responsive

and comprehensive information.

MRDDA is one of many city agencies that must work closely together to achieve the outcomes required by the Evans plan. These

agencies include D.C. Medicaid, D.C. Office of Contracting, etc. The

coordination and responsiveness of these agencies in support of

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people with disabilities has always been recognized as critical to

meeting the compliance measures in Evans. The Mayor has delegated responsibility for coordination to the Deputy Mayor for Children, Youth, Families and Elders.

The District MRDDA is in need of radical realignment. The replacement of the administrator is, quite frankly, a woefully inadequate step in alleviating the systemic problems of this administration. I submit a few items to be considered and given support to

be implemented: MRDDA needs the undivided attention of executive leadership and should therefore report directly to the city administrator. Mr. Bobb is a well known and well respected administrator.

Consistent budget overruns from a social services program of this

magnitude and with these persistent issues cries out for adequate

funding and appropriate performance measures.

A new Medicaid waiver and the resources to carry out the program’s mandate must be implemented now.

Executive leadership coupled with a legislative committee chair

who will commit the time to understanding the community.

And without the above minimal commitments, the agency should

be immediately placed into receivership.

While the District is moving in a positive direction and I’m sure

will continue to buildupon its accomplishments to date, much is left

to be done at all levels of government. My primary regret is that

I was unable to garner the appropriate level of support to bring

systems change to MRDDA.

Thank you.

[The prepared statement of Ms. Thompson follows:]

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Chairman TOM DAVIS. Thank you very much.

Mr. Gettings.

STATEMENT OF ROBERT M. GETTINGS

Mr. GETTINGS. Thank you, Mr. Chairman.

Mr. Chairman, my name is Bob Gettings, and I am the executive

director of the National Association of State Directors of Developmental Disabilities Services, an organization that represents public

developmental disabilities agencies in the 50 States and the District of Columbia.

I come before you today to discuss my observations concerning

the prerequisites of an effectively managed service delivery system

for persons with developmental disabilities. In drawing together

these observations, I draw upon 40 years of experience in working

with State and local disability officials to improve services to this

population.

You have already heard from the previous witnesses some of the

issues that are faced. I just want to bring it back to this level. Two

of the foundational rules of public administration are that authority must be commensurate with responsibility and public servants

must be held accountable for their performance. I’m pleased to hear

from Mr. Bobb and Ms. Walker that the District is committed to

changing some of the issues, but the truth is that is not the way

in which—and these rules have not been followed in the past.

The Mental Retardation and Developmental Disabilities Administration is responsible under the city code for delivering high quality services to eligible individuals, but because the city is highly reliant, as all 50 States are reliant, on Medicaid as a funding source,

the funding of services are divided between MRDDA and the Medical Assistance Administration, which is the single State Medicaid

agency in the District. As a consequence, funding an administrative

authority for the city’s services are not carried out in a unified

manner.

I think that—and I want to stress that Federal Medicaid regulations allow States, to administer programs in a unified way. In the

District of Columbia prompt steps need to be taken to develop an

effective interagency agreement between the Medical Assistance

Administration and MRDDA, governing the management of Medicaid dollars that support specialized long-term services for persons

with developmental disabilities.

A central aim of this agreement should be to assign clear, unambiguous authority to MRDDA to manage services in a unified manner. That means pulling together all specialized services, whether

they’re derived from Medicaid or non-Medicaid sources. I think you

said it well in your opening statement, Mr. Chairman, there needs

to be a single point of responsibility and accountability within city

government for assuring that services in this population work.

Unlike most jurisdictions, the District continues to rely heavily

on the ICFMR service model as its primary method of drawing

down Medicaid assistance. Over 60 percent of the budget for services in fiscal year 1994 went to payments for ICFMR services, and

only 3 percent went to the home and community-based waiver program.

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You’ve heard from the previous witnesses a commitment to make

the home and community-based service system work. The home

and community-based waiver program has been in existence since

1998, and I think we’re still waiting for those kinds of changes.

At the moment, the District operates one of the smallest MRDDA

waiver programs in the Nation. Expanding and improving the District’s waiver program would not only open a variety of new financing options, but also allow city officials to claim Federal financial

participation in the cost of existing services to Title XIX eligible

persons that are currently being funded fully through city revenues. This potentially could add $30 to $35 million in additional

Federal payments that could be deployed to improve some of the

weaknesses in the existing city infrastructure.

The District really needs to move aggressively to improve the

home and community-based waiver program, but I just would

stress with you that unless existing lines of responsibility and accountability are clarified and a single District official is charged

with assuring that this task is successfully and expeditiously completed, recent history strongly suggests that the waiver renewal

process will remain mired in a sea of bureaucratic infighting.

I want to stress as well that in the 2001 compliance plan

MRDDA is responsible for developing a comprehensive quality

management program, yet at the current time the responsibility for

monitoring and complying with city rules currently rests with the

Health Regulation Administration within the Department of

Health. Because of this division of responsibility and because of the

lack of effective interagency coordination, provider agencies often

receive mixed signals about where their emphasis should lie. There

is an urgent need for the District government to develop a global

plan for monitoring and improving the quality of services.

Within the next 10 months, the city will be responsible for submitting waiver renewal requests to the Centers for Medicare and

Medicaid Services. That request will have to include a comprehensive quality management plan, which is now a new requirement of

CMS. That’s going to take a lot of work. That’s an area that needs

to be given attention.

Faced with the catastrophic consequences of the city’s past failure to protect its most vulnerable citizens from harm, there is, I

think, an understandable tendency on everybody’s part to grasp for

quick solutions. Certainly anyone familiar with the current problems facing the District’s DD service system has to acknowledge

the need for prompt, corrective actions, and a sense of urgency in

implementing them. Immediate steps to stabilize the situation,

however, need to be linked to a broader set of systemic change

strategies aimed at improving the District government’s capacity to

effectively manage services for individuals with disabilities over the

long haul.

One of the central lessons that can be drawn from the sad history of the Evans litigation, and indeed from similar class action

lawsuits across the country, is that deep-seated systemic failures

won’t be resolved by a series of quick overnight fixes. The service

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system needs to be rebuilt from the bottom up, and that requires

commitment and sustained leadership from government officials at

all levels, especially top elected and appointed officials.

Thank you, Mr. Chairman.

[The prepared statement of Mr. Gettings follows:]

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Chairman TOM DAVIS. Thank you very much.

Ms. Morrison, thanks for being with us.

STATEMENT OF HOLLY MORRISON

Ms. MORRISON. Good morning, Chairman Davis and Congresswoman Norton. My name is Holly Morrison, and I’m with the

Council on Quality and Leadership. I’m currently the vice president

and chief administrative officer. It’s a pleasure to be here this

morning.

I think CQL’s experience and history make us uniquely qualified

to discuss performance, measurement and quality improvement for

services for people with disabilities. National organizations founded

CQL as a standard setting body in the field of intellectual disabilities in 1969. CQL has revised and published successive editions of

its standards on a continuous basis in 1971, 1973, 1978, 1984,

1989, 1991, 1993, 1997, 2000, and again in 2005.

CQL remains a private, nonprofit organization incorporated in

the District of Columbia and sponsored by the leading national organizations in the field of intellectual disabilities, including the

American Association on Mental Retardation, ANCOR, which is the

American Network of Community Options and Resources, the Arc,

the Autism Society of America, Easter Seals, Mosaic, National Association of Qualified Mental Retardation Professionals, SABE, Self

Advocates Becoming Empowered, the United Cerebral Palsy Associations, Inc.

Today, I want to focus attention on accountability rather than

specific minimum standards, organizational processes or accreditation programs.

CQL and other leading national organizations in the field of intellectual disabilities define quality in terms of responsiveness to

the individual in addition to compliance with regulations and organizational processes.

Compliance with standards and mandated processes provide uniform and routine performance requirements, but compliance with

standards may not result in personal outcome attainment or performance improvement. Organizations must measure personal outcome attainment, and then constantly adjust standards and organizational processes to optimize outcomes.

Organizational accountability and quality performance requires

outcome-based assessment. Basic assurances in the areas of health,

safety, human security and legal rights require well-defined performance expectations for staff. Quality performance is linked to facilitating the outcomes that are important to the individual, to

their family, to their friends, and the community that supports

them.

Organizations staff professionals and families realize that each

person is a unique sample of one, that each person has unique expectations for such important outcomes as best health, safety, respect, friendship and employment.

The distinction between outcome measurement and compliance

with process is particularly important for service systems operating

under close public scrutiny, government reform initiatives, and

court oversight.

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Standards and organizational processes, policy and procedure

must facilitate outcomes. Public accountability, quality improvement and fiscal responsibility require the measurement of outcomes, not just compliance with minimum standards.

Finally, clear definition of outcomes provides the necessary platform for staff training and board of director education for all service providers. Board of director orientation and staff training are

necessary components for organizational accountability and performance improvement.

Thank you very much.

[The prepared statement of Ms. Morrison follows:]

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Chairman TOM DAVIS. Thank you very much.

Ms. Campanella.

STATEMENT OF TINA M. CAMPANELLA

Ms. CAMPANELLA. Good morning, Chairman Davis.

My name is Tina Campanella, and I am the executive director

of Quality Trust for Individuals with Disabilities, an independent

nonprofit advocacy organization for people with developmental disabilities in the District of Columbia. Thank you for this opportunity

to testify.

Our organization is a product of the 2001 settlement agreement

in the Evans v. Williams class action lawsuit and was created to

represent all citizens with developmental disabilities in D.C., not

only the 665 Evans class members.

The situation for people with developmental disabilities in D.C.

is very troubling. The current structure and framework for services

is not working well at all. The critical question is how to make fundamental changes in the organization and operation of the service

system. Quality trust issues are advocacy experience to inform our

recommendations for change. I have included with my testimony a

4-page working document that describes the broad changes we feel

are needed within the D.C. service system to make services responsive to the needs of the people it supports.

While we recognize and commend the efforts of the D.C. City

Council Humans Services Committee Chair Adrian Fenty and Deputy Mayor Brenda Donald Walker, it is important to underscore

that the D.C. service system cannot be improved without bold and

dramatic action. The difficulties extend well beyond the individual

appointed as administrator. The fragmented structure of the administration, funding and enforcement functions is at the root of

problems with performance and accountability.

Our recommendations target essential elements of a functional

system. These recommended actions will not fix the situation

quickly, but they will advance the dialog about how to bring greater accountability to the administration, funding and oversight of

services and supports to people. Some of these issues have already

been mentioned so I won’t go into detail here.

Obviously we need a comprehensive plan to manage the dollars

that will be coming into the city to fund services to the Medicaid

program, and that needs to cross over agency lines. The waiver application has also been made as a recommendation and a priority

for many people, and we agree that must be made a primary priority.

Additionally, a coordinated strategy to ensure that providers

enter the system with prerequisite qualifications, and that performance over time is tracked to identify areas where difficulties are encountered as needed.

The functions for licensing, certification and quality monitoring

now spread over MRDDA and the Department of Health Regulatory Agency need to be linked and closely coordinated, and again,

as you have heard, preferably with one agency taking the lead.

Case management again is a serious issue. We believe it needs

to be grounded in the tradition of individual advocacy and support

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for people’s right to create lifestyles of their own choosing to the

greatest extent possible.

An additional issue is that D.C. law provides that all individuals

who are receiving residential services are entitled to an advocate.

The structure in process in D.C. to meet this requirement is part

of the D.C. Supreme Court Family Division. This function has not

been implemented as envisioned, and it has no dedicated funding.

Funding for this function has been included in the current budget

request, and we believe must be funded.

And finally, funds and efforts should be devoted to developing a

strategy for working together with families and providing support

to people in their family home. In-home family supports provide an

important alternative to group living arrangements and need to be

part of D.C.’s long-term strategy for services and supports. The

framework for funding exists, but will remain unused without specific efforts to develop the provider capacity needed to develop this

support.

We are encouraged that D.C. has secured assistance from Ms.

Cathy Sawyer. We are mindful, however, that these problems that

she faces are substantial and cannot be fixed overnight through

policy development and planning.

The solution requires everyone to remain clearly focused on the

immediate planning and intervention needed to provide adequate

and reliable supports for people today, while at the same time designing and implementing the structure and capacity needed for

the future.

Further, we see great urgency to move forward quickly to ensure

people with developmental disabilities are protected from any additional harm as they are supported to live full and productive lives.

Thank you again for the opportunity to testify, and I will be

happy to answer any questions.

[The prepared statement of Ms. Campanella follows:]

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Chairman TOM DAVIS. Thank you all very, very much.

I’ve got a few questions. I’m going to start, I think, Mr. Bobb,

with you and Ms. Walker.

Does the city have any plans to regulate case management?

Ms. WALKER. We do have a case management work group as part

of the systems improvement plan, and they’re looking at all aspects

of case management, including some different models. And the subject of regulation has not come up in my conversations specifically,

but we’ll make sure that’s on the table.

Chairman TOM DAVIS. Yeah. I’ll tell you why I say that. There

is a report that’s scheduled to be released on June 22nd, and the

court monitor states there is a lack of standards relating to the

case management in MRDDA and that the individual support

plans fell short of implementation. And that may be where you

start on this.

Ms. WALKER. I was a little confused by your word ‘‘regulate,’’ but

certainly the adoption of standards and case management, monitoring and a whole system is definitely needed and is part of the

short-term plan.

Chairman TOM DAVIS. Now on August 4, 2005, Deputy Mayor Albert notified the court of plans to reorganize MRDDA, and to do so

the parties agreed to the 90-day initiative which was designed to

demonstrate the District’s ability to increase meaningful systematic

reorganization.

Does the District still plan to reorganize MRDDA, and can you

give us a sketch of what you’re looking at?

Mr. BOBB. Yes. MRDDA, this department was part of the larger

Department of Human Services, and so what we want to do is,

make it a single agency itself and give it the independence that it

needs as a single agency. So part of our work this coming Monday

is to look at, although we’ve separated it from the Department of

Human Services, our work is to take it even further in terms of

how we restructure it as a single agency with a lot more independent authority than it currently has, and also to ensure some of the

issues that have been raised with respect to interagency collaboration that’s really needed at the end of the day to make this agency

function even better.

Chairman TOM DAVIS. The city put a lot of effort into regaining

control of the agencies that were in court ordered receivership, a

lot of effort. And of course we worked with the city on that. Mayor

Williams even hired a separate counsel to spearhead the effort. But

back in 2003 the judge in the Evans case found it necessary to

order the city to appoint a Deputy Mayor or other senior official to

coordinate the agencies responsible for various aspects of compliance with the court order.

Does the Mayor plan to appoint a special counsel or other senior

official to reform services for the developmentally disabled?

Mr. BOBB. Yes, one of the discussions—I’ve been involved in the

Jerry Young case, for instance. So in my office I have kind of an

internal receiver that works with me and I work directly with the

plaintiffs in that case; and we’re looking at a similar model with

respect to this agency itself.

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Chairman TOM DAVIS. Do you have any plans to alter the relationship between MRDDA and the Medical Assistance Agency,

which is the State Medicaid agency?

Ms. WALKER. We certainly are looking at that and have that as

a major agenda item, because that is mentioned time and time

again, as it has been today, that it’s important to have some more

coordination if not colonization. I do want to caution the committee,

as I do our team, that at this point MRDDA really needs to focus

on its core mission, and that is delivering high quality services to

the consumers that the agency serves. And certainly we know the

importance of the interagency coordination, and I have found all of

our agencies, including MAA, to be very responsive. And with the

Mayor’s directive and the city administrator’s support, that we—

supporting MRDDA is a top priority where we are certainly going

to be doing that over the next few months while we look at the best

organizational structure. We just have a lot to do over the next few

months.

And I want to add, my former agency, CFSA, did have some

independent authority in certain areas that has been suggested

that might be beneficial for MRDDA, but I also know that it took

3 to 4 years to build that infrastructure, which takes away from

the core services. And so my direction is that we have to focus on

the basics first, while at the same time we’re looking at all of the

structural impediments or opportunities to make MRDDA better.

Chairman TOM DAVIS. Could you elaborate on the systems improvements plan, Ms. Walker? What is the objective of the plan?

And then I’m going to ask anybody else on the panel to comment

on that, if they have a comment on it.

Ms. WALKER. My assessment of the agency is that some of the

basic systems have just not been in place. I think that there has

been a lot of improvement over the last few years in a lot of different areas, but you don’t have the basic infrastructure laid to just

operate smoothly. And so we’re focusing again on a number of

areas, but the provider monitoring and accountability is a critical

area and one that we get criticized, and I think rightfully so, by

the court monitors and others because we don’t have a centralized

system for really evaluating and being able to respond quickly to

problems with our providers or when consumers have problems

with services. We need a centralized system, and we have that, we

developed that for CFSA, and I’d like to look at a similar model.

But basically it’s where all of the information comes together so

that you’re making informed decisions about who is a good provider, who is not, is case management business being done on time,

and while that information comes together, right now it is very

chaotic.

So provider accountability is one key area. Contracts management is another area that goes to our ability to access better services, including the waiver services.

The feasibility of waiver operations, we’re looking at day programs and the whole case management model, as well as basic

training. So we have that, and we have details. If you’d like us to

forward the plan to the staff, we’d be happy to do that.

Chairman TOM DAVIS. Ms. Thompson, the District brought on

two new contractors to take on 16 group homes. Several agencies

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had to help with this transition. Could you walk us through some

of the steps you had to take?

Ms. THOMPSON. Yes, I’d be pleased to do that, sir. Let me start

at the end and work back to the beginning.

The end was having people in place, providing services in legally

licensed safe environments. To get there, each of those providers

had to get an inspection from our Health Regulation Administration, and they had to the get the inspection on the day they were

taking over. It could not be before they took over. That is just our

regulation.

Prior to them getting the inspection, they had to submit a Certificate of Occupancy, which means that they had to go through our

agency that handles the building permits, which is normally a difficult process, but we were able to negotiate that properly.

Before they got a Certificate of Occupancy, they had to have a

signed lease for the facility that they were going to operate. Before

they could have a signed lease, they had to have an agreement

with the District which guaranteed them that they would have

funding with which to pay the lease. To get the agreement with the

District, they had to negotiate a budget and a contract with our Office of Contracts and Personnel.

To negotiate the contract, first they had to respond to a public

request for proposals. So all of this was a tightly organized, quickly

moving train. But it had many, many, many stops it had to make

along the way.

In the end, everything came together well. It took my interagency coordination with the Medicaid Administration, Contracting

and Personnel, Consumer Regulatory Affairs, the Health Regulation Administration, the D.C. Fire Department, MRDDA itself, and

the advocate agencies and the court monitor. And it was a huge job

to get done. And those agencies did a very good job following with

me every single step.

It was a nightmare but it was something that had to happen and

I think the people will be better served by those folks.

Chairman TOM DAVIS. Thank you.

Mr. Gettings, what steps need to be taken, in your opinion, to develop an effective interagency agreement between the Medical Assistance Administration in the Department of Health and MRDDA

in the Department of Health Services that would govern the management of Medicaid dollars for services for the mentally disabled?

Mr. GETTINGS. I think that, first, there are plenty of models

around in other States where that has been done.

But the principles behind this, the management agreement between the two, are that you manage a unified budget across Medicaid and city dollars, that has a single focus on creating a sense of

accountability for how the system is going to operate.

Again, the problem that the District has faced in the past is not

unique. Other States have faced exactly the same problem of saying we have a single State Medicaid agency that manages our Medicaid program, and we have a program agency that is responsible

for making this happen.

The task is to bring those things together and define in clear

terms what the interaction between those two accountable agencies

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has to be, so that there is an absolutely unified approach to developing policy and funding services.

Chairman TOM DAVIS. Thank you, very much. Ms. Morrison. Let

me start with Ms. Bobby Walker. Does the city plan to require accreditation caregivers?

Ms. WALKER. We are looking into accreditation. We have a team

looking at that. Our recommendation is that we do not pursue that

in this next year. That is a very involved process in that it’s very

labor intensive. We can adopt standards and we can—in terms of

our whole QA process we are going to be moving in that direction,

but it’s my recommendation that we not pursue formal accreditation. At least not this year.

Chairman TOM DAVIS. Mrs. Campanella, let me ask you, when

the city meets the court’s requirements in the Evans case, services

to class members will obviously be improved. What do you foresee

the need for reforms that go beyond Evans’ compliance to make

sure non-class members receive adequate care and service?

Ms. CAMPANELLA. Good question. Basically where we are focusing our efforts around quality is not at setting the bar at the floor,

which is what we see the compliance with the Evans plan as defining the minimum standards, but going beyond that to begin to look

at the kind of individually responsive services and individually supportive services that Ms. Morrison described earlier.

So we have begun to focus on the basic assurance areas of health

safety rights, safe environments, and other kinds of supports like

that to really assist providers to think broader than just minimum

compliance.

Chairman TOM DAVIS. Thank you very much. I have more questions. I am going to go—although I may or may not make it back—

I am going to turn the gavel over to Ms. Norton. If I don’t get back,

I want to thank everybody for this. We may have some other additional questions for the record. Again we don’t like to get into these

things, but given what has transpired and the length, and really

the severity of the problem, we are going to continue to exercise

some oversight. But I just want to thank everybody for being here

today and trying to work to get this resolved.

Ms. NORTON [presiding]. Thank you, Mr. Chairman. The chairman does turn the gavel over to me. In the past I’ve always turned

it back. I am kind of like a trustee in the jail. You know, you let

the trustee have greater freedom because the trustee is not going

to break out. One of these days I may have to break out. But because we have a bill pending, maybe that will be unnecessary.

Let me start with what appeared to be a loss of confidence by

the counsel in the ability of the agency to improve itself, taking the

drastic step of denying funding. Was this a denial of increase in

funding? Very harsh step considering the vulnerability of those involved.

One, is this a denial of an increase in funding? And what is the

effect?

Mr. BOBB. Thank you. Well, we stated to city council that we

have several requests them before them. One was a request to address the budget pressures in the current fiscal year, as well as a

request for additional funding in the 2007 budget.

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We also during the course of our budget deliberation, have reduced the budget by approximately——

Ms. NORTON. You wanted funds for this fiscal year plus an increase next year?

Mr. BOBB. That is correct. We need additional funding this current fiscal year, as well as additional funding in the 2007 budget

effective October 1st. And so we have been working through both

of those issues with the city council.

Ms. NORTON. I thought the city council had made a decision. And

what was the decision that was made?

Mr. BOBB. They made one decision last week, which was to provide us with, I think, $10 million of one funding request. And that

decision was made last week.

We still have a decision pending before the city council with respect to the 2007 budget.

Ms. NORTON. So they have, in fact, given you $10 million that

you wanted for this year’s budget?

Mr. BOBB. That’s correct.

Ms. NORTON. And what made them decide to do that?

Ms. WALKER. If I could address that, having had to testify many

times about the budget needs of the agency, the chairman of the

Human Services Committee told us point blank that he withdrew

an opposition to our funding request in view of the management

changes that we made and the systems improvement plan and the

mayor’s and city administrator’s commitment to stand behind the

agency and to drive this reform.

But the $10 million that was improved last week, we still have

another close to $8 million pending before the council for this year.

So, this year there is $18 million——

Ms. NORTON. Why were those funds needed?

Ms. WALKER. Well, there are several reasons. One, the agency received a budget cut last year for fiscal year 2006 and did not adjust

its spending accordingly.

So the budget cut of, there was a budget cut of $5 million——

Ms. NORTON. Is that a budget cut or not as much money as it

requested?

Ms. WALKER. Last year it was a cut as part of the budget process. But going in when you know your budget has been reduced $5

million, then it’s the responsibility of the agency to just adjust its

spending plan accordingly. But that didn’t happen——

Ms. NORTON. Why didn’t that happen?

Ms. WALKER. A management issue. We also had some unusual

circumstances this year. The closure of the local forming group

homes that has been mentioned before, which was written in the

papers, what a bold step and necessary step, and I commend the

former administrator for doing that. What that meant is the providers had a number of homes that were Medicaid-funded homes,

the ICFMRs. When they come in as new providers, they have to go

through the process to get certified again, which meant that for a

period of—we are projecting 90 days and we are close to the end

of the 90 days—to get them certified, then we have to take them

off the Medicaid dollars and they get funded totally with local dollars. So that was another $4 million total for that period of time.

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So that was an unforeseen expenditure but one we felt was necessary due to the performance of those agencies.

And then the other primary driver of the budget issues this year

was that, as Ms. Campanella and other advocates in our Evans

parties push us to do, is to provide placements for clients in the

least restrictive environment, and which we support, but the agency has done that irrespective of the funding available.

And so decisions have been made, policy and practice decisions,

that have not been consistent with the budget authority to fund

them. And so we find that we have more and more clients who are

in apartments, who need a lot of individualized services that our

current waiver does not cover.

Now, those are decisions that, you know, always have to be

weighed out. But certainly if those are the practices an agency is

going to undertake, then it has to have the budget authority in

order to do that. So you have those things running, pushing the

budget into a major deficit this year.

Ms. NORTON. Which brings to us the waiver. If what we are talking about is the Federal Government picking up part of services

that otherwise you would be providing, I can’t think of more of an

incentive to try to get a waiver. What stands in the way of a larger

Medicaid waiver?

Ms. WALKER. Well it’s the process. It is a long and involved

process——

Ms. NORTON. It is not the process.

Ms. WALKER. Part of it is——

Ms. NORTON. It is the same process for everybody in the United

States. So it’s not the process.

Ms. WALKER. The process should have been started a long time

ago. It was started but it was wasn’t completed. Here is where we

are today. We do have the expert consultants on board. We have

signed a contract to take us to the place where we can finally fully

submit a completed application to the Federal Government to expand the waiver and——

Ms. NORTON. So somebody missed the process and the consultants are in the process now?

Ms. WALKER. Yes. Yes. There already has been an application. A

large part of the application has been completed. There are two

sections that have to be done, and that is where we needed the expert consultants——

Ms. NORTON. Are you going to seek this larger waiver or simply

the renewal of the existing waiver?

Ms. WALKER. No. We are seeking a larger waiver that is more

expansive and will cover more services and more hours for the

types of services that our consumers need.

Essentially, right now the local government is paying, like you

said, a disproportionate amount under our current waiver. So we

want to refine that waiver, have that expanded and that will be

part of the renewal application for the waiver, so we would go in

for renewal with the expanded waiver.

Ms. NORTON. I am very pleased to hear that. You owe that not

only to these residents, you owe that to the taxpayers of the District of Columbia.

Ms. WALKER. I totally agree.

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Ms. NORTON. Because they’re picking up the rest. I am interested

in that because I have put in a bill—I have a series of bills called

the Free and Equal D.C. Series. When we got the increase in Medicaid, we still were left paying, as the District of Columbia, a larger

share than any city in the United States, even New York, which

is the only other city that pays 25 percent. We pay 30 percent.

That is much better than before.

But this bill seeks to put the District in the same position that

any city would be in. So it asks that at least part of this be picked

up by the Federal Government, as the quote states.

Now, obviously, if the waiver process in the District is all out of

kilter, that would seriously interfere with Congress, seriously considering my bill.

I haven’t heard anyone—I was out of the room for a moment, but

I understand that no one has advocated receivership. Does anyone

at the table believe that receivership is necessary at this time?

Ms. THOMPSON. I only believe that would be necessary if Mr.

Robert Bobb does not take over the agency and manage it as an

internal receiver, as he has done with DYRS.

Ms. NORTON. Mr. Bobb, do you believe that the agency should report directly to you? MRDDA should report directly to you?

Mr. BOBB. Technically it does.

Ms. NORTON. How technically?

Mr. BOBB. We have the deputy mayors work directly with these

agencies with respect to their daily operations, but at the end of

the day they are accountable to me and the mayor.

Ms. NORTON. They’re accountable, yes. I am now talking about—

would you speak to Ms. Thompson’s notion—is it your belief that

improvements would be made—let me give you some background

here. A number of us have some bills over here involving FEMA,

following the Katrina disaster.

None of them—all of them—they differ somewhat, but all of

them believe that FEMA should report directly to the President of

the United States and should not have to go through any bureaucracy; in other words, if an agency has a mission that is either difficult or important, it may be that what would otherwise make

sense—and here we have the Department of Homeland Security—

would otherwise make sense, may not make sense for this particular agency. Given the long history of problems in this agency I ask

whether or not Ms. Thompson’s suggestion should be considered?

Mr. BOBB. Yes, it definitely has been under consideration. Let me

just say we had a similar situation——

Ms. NORTON. I know that is putting a lot of, I don’t know how

much you can put on one person but you know, that is like saying

I don’t know how much I should put on the President of the United

States. It’s his job to make sure that it works, so.

And I recognize, Mr. Bobb, that you are the real problem solver

in the government. I know from firsthand experience.

So I ask you, not only as a structural matter, I have run a big

troubled agency in the Federal Government. I ask you as a pragmatic matter, is this suggestion feasible?

Mr. BOBB. Yes, it is feasible.

Ms. NORTON. So you are considering doing that?

Mr. BOBB. Yes, we are considering.

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Ms. NORTON. Is it likely to happen?

Mr. BOBB. After consulting with the Mayor we will be able to

say, what we did, just as a point of contact, what we did with the

Department of YSA, the former Youth Services Administration

which has been in receiver for 20-plus years as well, is while that

agency reports directly to the Deputy Mayor, I have an internal receiver that works with me and the Mayor’s personal attorney, executive lawyers for the Mayor. So I have a lawyer that works for me

that helps to move the reforms forward with the director. And then

I meet personally with the plaintiffs in the case.

And so I am directly engaged with the lead counsel for the plaintiffs in the Jerry M. case, for example. So to that extent I am very,

very involved in pushing the reforms in that case. And so we are

looking at a similar model with respect to this agency.

Ms. NORTON. That is very wise if you want to avoid receivership.

Does anyone else believe that receivership is, should or should not

be considered or appointed?

Ms. CAMPANELLA. Ms. Norton quality trust fully understands

why the plaintiff’s attorneys have filed for receivership in this case.

As I stated in my testimony, the situation for people in the city is

very troubling.

There have been continued promises, continued deadlines

missed, and, unfortunately, continued harm that has come to people who rely on the service system here. So while we are very encouraged by some of the things that have happened, the time is

past for when we can actually wait for some sort of a solution. As

we all know, receivership takes time to work through the system.

At such time that considers—receivership is actually considered

by the courts, the substantial administrative changes have been

made by the district, and possibly we can reconsider at that point,

you. But at this point, the needs of people with disabilities in the

District of Columbia are too significant and not being supported

enough for us to say that pursuing receivership is not a reasonable

course of action.

Ms. NORTON. So you favor receivership?

Ms. CAMPANELLA. I favor the course of action in seeking receivership that the plaintiffs have taken.

Ms. NORTON. You favor the shot across the bow in applying for

receivership, in hoping they get their act together so the court will

not have to do so.

Ms. CAMPANELLA. Again, I am going to say based on my 4 years

of experience in the District of Columbia, again, we have worked

very seriously and we are very committed to working in concert

with the District, Ms. Brenda Donald Walker, and at various times

we have seen many players change. I don’t question the earnesty

of any of those folks. But the bottom line and the actual track

record remains that some serious and significant changes have not

been made as evidenced by where we are today with the waiver.

So yes, given the situation as it is today, we do support the filing

for receivership.

Ms. MORRISON. Ms. Norton, obviously from my testimony, I am

here representing an organization that defines, measures, and improves quality for people with disabilities.

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And we would like to say that receivership or no receivership, it

really won’t matter if we don’t start looking at outcomes for individual people, if we don’t look at being responsive to people rather

than layering different levels of organizational process and playing

the compliance game. Bringing in a receiver that would not pay attention to individual personalized outcomes would only add another

layer and make it even more difficult to get things done.

So I think the issue of paying attention to personnel outcomes,

measuring that, and moving forward in designing the system based

around what people with disabilities say is important to them.

Mr. GETTINGS. Ms. Norton, I would just add to that, having

watched situations in which the courts have intervened in such a

radical manner to appoint a receiver, that one of the things that

has to be taken into account is, what is the end gain? Where does

accountability ultimately reside? And serious situations call for serious interventions.

And I agree with Ms. Campanella that if you look at the testimony that is presented to the court, it certainly justifies some radical interventions to correct the situation as it exists for a very, very

long period of time.

At the same time, I don’t think a receivership should be—is a solution, unless you have a very clear plan for how government is

going to reassume responsibility. So the best of all possible courses

of action is that you avoid it. And I think, I hope that would not

happen in this situation because it carries——

Ms. NORTON. Receiverships don’t operate that way. They are

open-ended and they end when the court says they end. And it

could be years and years, and we know because we have been

through that before. I am agnostic on it.

Let me ask the Members of the panel from what you have head

here today, for example, that they have hired a consultant, that

they think they are going to get a comprehensive Medicaid waiver,

does anything you heard here today indicate to you that a receiver

may well not be necessary?

Ms. CAMPANELLA. Again, let me start. I think, again, and I included in my testimony, a commendation for Deputy Mayor Brenda

Donald Walker, because I think she has taken on a very serious

job with a very serious approach and has begun to organize people

in a way that would address some of these significant issues.

I am glad to hear that they have the consultants on board and

they’re going to pursue the new application. But, at best, we are

looking at implementing a new expanded waiver in the fall of 2007.

Ms. NORTON. That would happen whether or not there is a receiver, wouldn’t it? Because if you got to have—the court can’t

mandate or won’t mandate the Medicaid—more comprehensive

Medicaid waiver, it would have to work it through as well in order

to decide, I mean, what I am saying is I don’t see what you are

saying has to do with receiver.

When it would start, when the waiver would start, yes, and over

here it is, here the Federal Government, it’s slow as molasses. But

you have—D.C. hasn’t even gotten it in and the taxpayers of the

District of Columbia are paying for what the Federal Government

should be paying for. And the expanded waiver has enormous implications for the improvements that you are indicating. So the only

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question about the receiver end and Medicaid is whether or not the

receiver facilitates that or not. You could argue that the receiver

delays that, because I can say without fear of contradiction that the

agency is quite unlikely to give a Medicaid waiver while something

is in court.

Ms. WALKER. Ms. Norton, if I could respond to this whole receivership and what we are doing, I ran an agency that had been

under receivership. And when we took over the agency in 2001, it

was after they had negotiated a settlement to end the receivership

and the mayor elevated this to a Cabinet-level agency—we took

over that agency and it was in shambles. There were no structural

foundations. We had to build everything from scratch.

And the same thing is true about the Department of Mental

Health which exited receivership at the same time. So we are vigorously opposing the notion of receivership.

Ms. NORTON. I understand that. But the point is—what my question is, in order to get the comprehensive Medicaid waiver it does

seem to me you would have to show such substantial improvement.

It may even be a proxy for——

Mr. GETTINGS. That is very true, because essentially what the

city——

Ms. NORTON. Proxy for a receiver.

Mr. GETTINGS. Is requesting a special dispensation under Medicaid policy to gain that waiver and, yes indeed—and that is why I

said in my written testimony, there is a lot of work to be done in

order to get to the point where you can do that. I am very encouraged by the commitment that I have heard here today and I hope

we can move ahead rapidly on it.

Ms. NORTON. I don’t see anything inconsistent with what has

been said here. And, Mr. Campanella I don’t know if you had wanted to say something further.

Ms. CAMPANELLA. I would just add I am encouraged by the focus

on the new application. I would encourage, and I have encouraged,

this administration to continue to be focused on what can change

today about how we implement the local rules that govern the

waiver program. Because we believe there is potential there to

make some improvements long before 2007.

Ms. NORTON. In the chairman’s opening testimony, he detailed

some of the abuses that brings a matter like this to the attention

of the Congress, these, of course, are anecdotal but they are so horrendous that even a few of these leads people to believe that there

is something wrong that has not been reported. He spoke about

charges of sexually abusing a patient or burning a patient.

But what was most, most troubling was the part of his opening

statement that said that the monitor had said that for a period of

over a year the District failed to notify the providers where these

residents lived or the results of the investigations, even though

these investigations were conducted by the District’s own reviewer.

And then, of course, he said—here I am quoting the chairman—

as a result—no, no I am not quoting the chairman. He is quoting

the article I think. As a result, corrective actions were never discussed, let alone implemented or evaluated.

Yes, Ms. Thompson.

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Ms. THOMPSON. Congresswoman Norton, in 2004 when I was an

employee of MRDDA, my job at that point was to work with the

Evans compliance piece. And I followed a committee called the

Mortality Review Committee, which began at that time to share

those evaluations and recommendations and the actual reports

from Columbus with the providers, the hospitals etc.

I was moved from that position to work for the deputy mayor to

oversee the health care plan.

In late April, early May, I was sent back to MRDDA as the interim administrator, at which time, by the way, we only had about

a month’s worth of funding in the pot. When I got back there, there

were so many things to fix that it took me a few months to recognize that the committee had stopped meeting when I left.

So I reinstituted it in November 2005 and broadened it to include

the monitor staff, case management staff, the quality trust, and

many others. So we put a process in place to ensure that these recommendations and reports were distributed appropriately to everyone who touched the client at the time.

So that has restarted——

Ms. NORTON. You are telling me that these reports are now always made available?

Ms. THOMPSON. Now they are. Now they are.

Ms. NORTON. All right. Let me go to what is my real concern

here. You would think that is the least that could be done.

I noticed that in Ms. Campanella’s testimony—I am not interested—of course, I am interested in finding out what happened and

preventing it and so forth. But you see it should be, if somebody

has been seriously hurt you wonder how, what the agency is doing

to make sure that doesn’t happen. And she says in her testimony,

she speaks about the advocate. ‘‘Each person by law is entitled to

an advocate,’’ and says that there is no dedicated funding, although

funding has been included in the current budget request. Now, let

me ask, because the point here is to have somebody who will watch

over me, as they say, ‘‘somebody to watch over me.’’

And very often there is no relative, and even if there is somebody, the relative may not feel it is his responsibility to perform

this function.

Is the advocate the best way to prevent this kind of abuse, the

fact of actually going and monitoring the residents often? Is there

now dedicated funding? Does every resident in one of these group

homes have an advocate?

Ms. THOMPSON. Ma’am, the answer to the last part of your question is no. Every person in those group homes does not have an advocate. A critical function that I think when we are really sort of

dancing around the edges is the role of active and advocacy-based

case management where the intent of case management is around

advocating for the client as though that person is your best friend

or your family member.

And until that intent of case management is properly

developed——

Ms. NORTON. I am not talking about intent of case management?

Are you talking about case workers?

Ms. THOMPSON. Yes, I am.

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Ms. NORTON. Are there sufficient case workers? Once I hear you

talk about case workers, my eyes really begin to roll, because it’s

so hard to find people to deal with people in many different kinds

of situations. So, is the answer that every person should have a

case worker that comes so often that, in fact, burning somebody or

sexually abusing somebody is deterred?

Ms. THOMPSON. I think that is part of the answer, Ms. Norton.

Ms. NORTON. How often do case workers——

Ms. THOMPSON. They are supposed to see people as far as I know

now, at least once per month. But that is the floor. That is not

what real case management advocacy is about.

Ms. NORTON. What is real case management advocacy about? I

am interested in somebody watching over. I only have one question.

If they know somebody is, if they knew I was going to come in

there very often, they are less likely to harm the person I am coming to see. And all I am asking is, and when you tell me about case

management and case workers, then I really get scared because we

have had hearings on foster children, we know nobody is going into

social work. I don’t want to go through that one again.

So, I was caught by this notion of an advocate because I can’t ask

the District to do the impossible.

Mr. GETTINGS. There are several issues that are being raised

here. One of them is the issue of an individual legal advocate. That

is through the Superior Court.

That’s not budgeted as part of the city’s budget, and when Ms.

Campanella talks about a budget request there is a budget request

that has gone forward to the superior court to put in funding for

those advocates. That is an act of Congress. It is not an act of the

city government, by the way.

Ms. NORTON. But what does the advocate do and how often does

the advocate come?

Ms. CAMPANELLA. The court-appointed advocate would work

under the supervision of the D.C. Superior Court Family Division.

And the idea in their volunteer advocacy program is that it would

introduce into the lives of people with disabilities, who may not

have family, someone who is committed to going and visiting that

person and staying involved in that person’s life, over time.

Ms. NORTON. Mr. Bobb, please. I am trying to get, how many advocates do we have? And how often do you believe the advocate

should come in order to have at least a deterrent effect on abuse?

Ms. CAMPANELLA. Again, my best estimate at this point is for an

estimate of 1,200-plus people who should be accessing an advocate.

There are around an average of 200 advocates available.

So they assess AREAs. Any people that don’t have an advocate.

The advocacy program, as it currently exists, is not supervised.

It has a half-time clerk assigned to it, and it is not really staffed

to oversee any of the recruitment and supervision activities that it

would need to make it a functional program.

Ms. NORTON. Now let’s get to the funding. You say in your testimony that there hadn’t been dedicated funding in the budget request. Mr. Bobb or Ms. Walker or Ms. Thompson, again, is the

money—budget—has this been approved in a budget which, by the

way, is already over here? Then, Bob, the answer to the question

is no. We don’t have this as a ‘‘be candid,’’ this is the first time I

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have known, seen this D.C. law. You know this particular code.

And I don’t know that if this is a requirement if it’s a requirement

that the D.C. government, and no one has called this to my attention, if it is a requirement of the courts. And we should be advocating with the court to provide this funding.

Ms. CAMPANELLA. Again, Ms. Norton, just to clarify, we have

been advocating over the past 4 years with the D.C. Superior Court

to acknowledge and figure out how to address and implement the

responsibilities associated with this.

It is my understanding that Judge Rufus King in the D.C. Supe- rior Court has included just under $1 million in the budget request

that was sent to Congress for the superior court.

Ms. NORTON. In the court budget.

Ms. CAMANELLA. The court budget. Yes, because this was supervised and overseen by the D.C. Superior Court.

Ms. NORTON. And these are volunteers?

Ms. CAMPANELLA. It’s a volunteer advocacy program. Again it

was designed back in, I believe, 1978 when the law was designed.

The local D.C. law is the Citizens with Mental Retardation Rights

Act of 1978, I believe. And it defines individuals’ rights to have access to an advocate to help them understand what’s happening to

them. And when this program works well, and as we have seen at

least in a few individuals, it introduces again into the person’s life

somebody who is there, that cares about them, and who will ask

the hard questions not because they’re paid to, but because they

just care about the individual. Which is a significant safeguard.

Ms. NORTON. I want to know where we have something involving

Federal funding, I do wish people would be in touch with me. I am

very pleased that the court, the court has been very vigilant now,

particularly now that we have done that court, put a lot of money

into that court. But I had no idea, and I am very pleased that

Judge King has indeed put this in. But I didn’t even know about

it.

This is the best way, short of the complicated notion of case management that the District still has to do to assure somebody will

be there for the advocate, and perhaps we can prevent some of the

incidents that have been in the paper and that were——

Mr. GETTINGS. It’s a piece.

Ms. NORTON. I am not suggesting—look, we have discussed the

whole—excuse me—darn thing. And you know, it’s very nice for us

to talk about structural stuff. I am trying to deal with the fact that

these people need to be taken care of right now.

So while they’re getting their act together—and nobody suggested an advocate or even a case worker can do this job—but

meanwhile people are sill sitting in these group homes now. And

I picked this up, really, from Ms. Campanella’s testimony, because

it seemed to me that even what you’ve described, Ms. Thompson,

going in and catching it, going back and evaluating it after it’s

done, is a terrible thing to have to do. There should be very few

of those.

So what’s the answer? The answer is I am at the mercy of this

group home, with nobody to watch over me. Then of course, I have

no confidence in myself that there will not be some minimum wage

person untrained or whatever, who may abuse somebody.

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But, let me ask you, is there another way—other than the advocates or redoing the whole case management which they are in the

process of doing—is there another way, other than the advocate to

get this kind of frequent oversight by one person dedicated to the

client—or is this really the best way to do it and deter it? Because

if there is another way, I want to know about that other way, too.

But if it’s let’s reform the system, yes, of course. But meanwhile

there are people that could be abused today, tomorrow, and the

next day while you’re reforming the system which hasn’t been reformed in a very long time.

Ms. THOMPSON. In today’s terms I think that is probably the very

best way to go right now.

Ms. NORTON. Let me tell you one thing. That’s a Federal matter

because the courts come under us. I am going to be in touch with

Judge King. They have run their programs well. Do you believe

this $1 million funding would be enough for every resident in a

group home to in fact have an advocate?

Ms. CAMPANELLA. Again, based on what I’ve seen, I don’t know

if it is totally enough but I think it’s a good—it provides a good

foundation and starting point.

Ms. NORTON. I’m going to call Judge King and ask him. And if

it’s not enough, the budget has beautifully gone through the House

without any attachments. When they were cutting to smithereens,

we were able to keep things from being cut that were critically

needed. But the budget has not yet gone through the Senate.

So I would like you to—this is my counsel. I would like to know

by the end of the day from Judge King, whether or not the million

dollars is enough to cover an advocate for each of the clients? How

many are there, please?

Ms. CAMPANELLA. Approximately 1,200 people that we estimate

need an advocate.

Ms. NORTON. That would be the total pool.

Ms. CAMPANELLA. There is approximately just under 2,000

served by MRDDA Service System but I think it is only certain

people that are in residential services that need the advocacy.

Ms. NORTON. But Federal funds a lot of this may have happened,

and I am just pleased to know about it. I understand that there

is a consulting firm that investigates these deaths. But the district

has been hammered because these reports are not made public. I

don’t understand what the, ‘‘privacy concerns’’ would be. Somebody

has been killed while literally a ward of the State. That is the

worst intrusion of privacy I ever heard of.

But I don’t understand the privacy concerns. Once there is a

death, that is a matter of public record, I thought. No matter who

it was, there is a death. So I want to understand why it is that

this is not routinely disclosed; if it would be disclosed with, for example, the investigative work that Ms. Thompson has described,

and what is the state of that?

Because that makes a city look worse than ever, if the people get

killed or abused and get investigated and then nobody is told. Then

you get the press going after you, and you get people no longer having confidence in you because you don’t report things that are—

that have happened are untold. Look, something is going to happen

that is untold. This is not a perfect world. And it’s been invesVerDate 11-MAY-2000 13:07 Oct 05, 2006 Jkt 000000 PO 00000 Frm 00132 Fmt 6633 Sfmt 6633 D:\DOCS\28625.TXT HGOVREF1 PsN: HGOVREF1
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tigated and you can then at the same time talk about what the investigation shows and what you have done. I don’t see that the city

is going to be held to the standard of perfection. It is held to that

standard though when people only find, when the press or somebody else hammers them. So I would like to know if there is a systematic way to report the deaths, particularly the deaths or other

such concerns along with what the city is doing to correct it.

Ms. WALKER. The answer is, yes, Ms. Norton. There is a systematic way. There is a citywide fatality review committee. The debate

about the records is the amount of redacting or protecting the confidentiality that is tied into a lot of other legal issues such as

HIPAA, the family members. And I think, though, that we can certainly respond more openly with the council and our other stakeholders in this, even though you can redact and protect an individual’s confidentiality, we certainly need to be held responsible for reporting on what the findings were, what we have done in response,

and if there are certain providers where you have multiple occurrences, then we have to be forthcoming with that information. And

we are still working through that with the city council as far as

the level of information that is provided. It is pretty much of a

legal battle.

Ms. NORTON. Well, if it’s a legal battle, then of course, what can

be reported should be reported.

Ms. WALKER. Correct.

Ms. NORTON. The public has a lot more confidence when the government comes forward and reports on it itself than it does when

a FISA or something has to be filed by the press, who can always

then find out. And apparently the press has found out. So I don’t

know what these privacy concerns are if the press can find out.

Let me close with this hearing, I am very pleased with the notion

of this advocate, that restores some confidence in me that a system

that is spread all out in the city, nobody can possibly know what

is going on every moment, the best you can do is to try to deter

it. And if you know that somebody is coming in there, it does seem

to me the deterrent effect can be extremely important here.

There was a report from a hearing, a recent hearing, that 47 out

of 1,800 patients get the, ‘‘requisite monthly visits each year.’’

What is that about? Is that about the case management system?

Ms. THOMPSON. Yes, ma’am.

Ms. NORTON. Is that, in turn, dependent upon hiring more case

workers? Are we back into the revolving issue that has never been

solved and I am convinced will never be solved? Unless we can get

to the point where we can get something like what we have in the

school system, paraprofessionals or something, you will never convince women—and that is who you are talking to—who can now be

anything they want to be, that they ought to take the low pay that

goes along with being a case worker, which means you have some

sort of social work background, rather than using that same background on something that pays better.

So I would like to know what you are going to do about the case

worker personnel problem. Or is there one? Maybe you don’t have

that problem.

Ms. WALKER. I think it’s a matter of training accountability, and

effectively——

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Ms. NORTON. I am asking one question so we won’t go on. The

chairman is back. He said my 5 minutes were up.

The CHAIRMAN. Almost. Almost.

Ms. NORTON. I am asking—I am talking about one visit, 47 out

of 1,800 patients got the required one visit per month. Now I am

trying to deal with part of this through the advocate.

But if we are talking about case workers, then my question: what

are we talking about, case workers?

Ms. WALKER. Yes. We are talking about staff case workers from

MRDDA.

Ms. NORTON. If we are talking about case workers, then unless

you have had something to happen to the District that has not yet

been reported, there is a severe shortage of case workers.

Ms. WALKER. MRDDA actually has an adequate number of case

workers.

Ms. NORTON. Who, in fact, visit once every month.

Ms. WALKER. Yes. Their caseload ratio is among the lowest in the

country.

Mr. GETTINGS. Absolutely.

Ms. NORTON. Go right ahead.

Ms. WALKER. This is why I get to accountability and training and

oversight——

Ms. NORTON. Training? Just going out there once a month?

Ms. WALKER. Maybe it’s accountability and oversight. And I understand the issue about not having enough case workers and social workers. I have had that with CFSA. That’s not the case here.

Ms. NORTON. Are these trained social workers, do they have to

have a college degree?

Ms. WALKER. No. But they do have a college degree. No.

Ms. NORTON. They don’t have to have a college degree, it seems

to me. That is why I talk about paraprofessionals or something——

Ms. WALKER. I believe they fall in that category. Ms. Thompson

would know better about the requirements.

Ms. NORTON. You think the reason they have not been going out

once a month, if they had been going out once a month maybe we

would have less of what was in the chairman’s testimony. But between the caseworkers going out once a month, and we got enough

case workers, and the advocates going and spelling when they go

out does seems to me to go a long way toward preventing abuse

and deaths.

Why have they not gone out? That doesn’t take training. It just

says go out there and report whether you have gone and sign this

thing here that you have gone out there.

Ms. WALKER. I have to turn it over to Ms. Thompson.

Ms. THOMPSON. Basically I think the reason, I think what is two

things: you have somebody go out and come back and don’t report

that they have been out. I have run into that myself in the homes.

And then I go back and I check on the internal information management system and they haven’t put their notes in. And then the

other issue is the ones that just don’t go out. And they don’t go out.

It was the building was wrong or they didn’t know who they were

supposed to see, or they had no way of getting there because

MRDDA doesn’t provide the transportation.

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There is, again, the issue of caring and intent, and understanding what case management is supposed to be about and wanting

to do that. And wanting to have a good government job is one

thing, and wanting to be a good case manager is, say, a separate

thing. And those two just don’t meet right now in MRDDA’s case

management work force.

However, when I left I was hopeful, because I was beginning to

see the turnaround, the change, in case management interest. They

were beginning to want to go out, and I mean, that is where it

comes down to.

Ms. NORTON. Maybe that is what Mrs. Walker meant when she

said training and, of course, accountability.

Let me ask one more question. This comes from Ms.

Campanella’s testimony. I am very leery of anecdotal evidence but

they do tell us things. And she spoke about a woman who was

found living in a dilapidated apartment, so dilapidated her health

was threatened. And then she says that despite intense efforts by

the advocate and the personal intervention from the court monitor

and the administrator of MRDDA, it took nearly 7 months to successfully transition this woman into a new living arrangement.

Are you talking about somebody who was going to be put into a

new apartment?

Ms. CAMPANELLA. Yes, ma’am.

Ms. NORTON. That may explain it all, Mrs. Campanella, because

if you are trying to find a new apartment for anybody in the District of Columbia, the average person in the District of Columbia,

good luck. Because at least I think MRDDA may be willing to pay

rents that the average person here can no longer afford.

And then you are trying to place somebody in an apartment who

is so troubled that she was living mired in health risk in her own

apartment. How do you find apartments for people like that in the

District of Columbia?

Ms. THOMPSON. Ma’am, let me respond a little. This person apparently has lived on her own with her husband for a number of

years. Their living situation was deplorable from what I found myself. I think that there was some communication issues back and

forth between what they felt they would be obligated to submit to

intrusiveness as opposed to their choices to live the way they were

living.

And it was a matter of education and urgency and diplomacy on

the part of case management at MRDDA. And when Mrs.

Campanella’s staff and the court monitor staff brought it to my attention—I worked with Mr. Brian Willbom and we were quickly—

when we had our hands around it—we were quickly able to convince them, yes, you don’t want to live there when you could live

here.

And guess what——

Ms. NORTON. You were able then to find—it was a question of

them not wanting to live——

Ms. THOMPSON. Yes, it was a communications issue, I really believe, but it was resolved.

Ms. NORTON. I was concerned about that because if in fact this

so troubled a person anywhere she lived, might in fact get her in

the same situation. I think it would be hard to find a living arVerDate 11-MAY-2000 13:07 Oct 05, 2006 Jkt 000000 PO 00000 Frm 00135 Fmt 6633 Sfmt 6633 D:\DOCS\28625.TXT HGOVREF1 PsN: HGOVREF1
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rangement for her in her own apartment even if she were able to

take care of herself. But then maybe somebody coming in and helping her would be all that was needed.

Ms. CAMPANELLA. It underscores and illustrates many of the

things that have been discussed here this afternoon that need to

be urgently addressed about case management and communication.

Ms. NORTON. I compliment Mrs. Thompson that she was willing—they went all the way to the top and she was willing to step

in.

Ms. CAMPANELLA. We do too.

Ms. NORTON. Testimony, very, very helpful. You heard from the

Congress; I am sure you don’t need to hear from us again. Thank

you very much, Mr. Chairman.

Chairman TOM DAVIS. Thank you all very much. I want to thank

you for being here we look forward to working with you as we try

to get this program in shape. This hearing is adjourned.

[Whereupon, at 11:55 a.m., the committee was adjourned.]

[The prepared statements of Hon. Henry A. Waxman and Hon.

Diane E. Watson follow:]

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