State institution's Medicaid funding in jeopardy after report / LJWorld.com

Archive for Saturday, September 16, 2006

Department on Aging inspection says safety of clients at risk at Kansas Neurological Institute

September 16, 2006

Kansas Neurological Institute, one of two remaining state institutions for the developmentally disabled, will lose its Medicaid funding unless it stops putting its clients' safety at risk, according to an inspection survey reviewed by the Journal-World.

The Kansas Department on Aging survey, completed late last month and recently made public, found that several clients had suffered injury or neglect because of oversight problems at the institution, which is in Topeka.

"These were situations where people were either put at risk of harm or actually harmed," said Barbara Conant, a DOA spokeswoman. "They are very serious findings."

Among them:

¢ A nurse at the facility "forgot to look" at a disabled client's severely broken arm for one or two days until another staff member reminded her about it. Three months later, hospital X-rays showed the arm still had not healed.

¢ A client suffered injuries, including a broken nose, after the client's wheelchair tipped over on a mall escalator. A staff member had taken the client on the escalator despite warnings banning wheelchairs and strollers.

¢ Two staff members were reported to have laughed at a disabled client after feeding the client a cracker with hot sauce on it. Staff later reported the person had an "allergic reaction to Tabasco sauce" after the client scratched around his or her mouth until it bled.

Most serious

The most serious violations documented by the survey likely stem from a series of problems with the disbursement of medication at the facility, which houses 166 clients.

The state found KNI did not document medication errors - when a client was either given the wrong medication dose or not given medication at all - and even had a policy in place that allowed for these errors, records show.

"The governing bodies' failure to monitor stated events resulted in multiple situations in which clients of the facility were placed at risk for serious adverse reactions," the report concluded.

Officials from the institution turned in a plan of correction to the state late last week.

The plan, submitted by KNI Supt. Ray Dalton, said all staff members involved in the incidents had been disciplined and received training to avoid similar incidents.

Plus, Dalton said, new administrative oversights would insure the problems don't happen with other residents.

"Administrative follow-up will be strengthened to address situations in which appropriate or timely services are not provided," according to the plan.

A separate corrective action report shows that KNI officials plan to change the medication administration system and retrain all staff on giving clients medicine as a physician orders.

The policy allowing for medication errors will also be removed, officials said.

The state was reinspecting the facility late this week. Gary Ingenthron, the director of mental health and residential care facilities at the DOA, said the facility's funding would hinge on that inspection and an annual inspection at the end of October.

KNI received $13,416,318 in Medicaid funding during fiscal year 2005, more than 50 percent of its total funding.

"We're going to be looking for some answers here in the next couple weeks," Ingenthron said.

The results of the inspection should be available in the coming days, he said.

"We're expecting positive results from that survey," Dalton said.

He also said he thought the problems at the institution were an anomaly, and that the facility has a history of providing safe care.

Still, some advocates who champion closing the large hospital and replacing it with more individualized treatment in community settings, said the problems were typical of those found at large, multibed institutions.

Jane Rhys, executive director of the Kansas Council on Developmental Disabilities, said it was part of the federally funded organizations' operating plan that all large state institutions close.

"The council firmly believes that congregate settings are not where people with disabilities should be," Rhys said.

At a Legislative Budget Committee hearing Monday, other disability rights advocates told lawmakers that all large institutions should be closed.

"We believe that Kansas should follow the lead of several other states and set a binding closure date for all large-bed (institutions)," said Catherine Johnson, a spokeswoman for the Disability Rights Center of Kansas.

Johnson said that if SRS were to close KNI, it would allow between $8.7 million and $12.5 million for smaller, community-based services for the disabled.

But state welfare officials said the institutions are still important for some disabled Kansans.

Institutions such as KNI serve clients who suffer from severe disabilities, which many Kansas communities aren't able to care for.

"It really is an issue of community capacity at this point," Dalton said.

The majority of KNI's patients have severe mental and physical disabilities.

Dalton said disabled clients had been moving from institutions to community facilities for years. The number of people in state institutions has declined steadily in the past five years.

Discussion

LJWorld.com doesn't necessarily condone the comments here, nor does it review every post.
Read our full policy. Also, read about banned accounts and harassing comments.

16 September 2006
at 7:28 a.m.

Suggest removal

Permalink

ASBESTOS (Anonymous) says…

good lord! why are those State Employees still on the payroll. Anywhere else this would be simple assualt and battery at the least.

ALL these state agencies that have been in the news are accountable! these employees that are doing prohibited activities, illegal activeties, and THOSE that supervise and MANAGE them are all governed under Chapter 75.—state departments; public officersand employees
Article 29.—civil service.

You can go to the Kansas LEgislature page, go to the statutes and look at ALL the hell that can be brought down on those whos conduct is questionable, and the managers that had the oversight responsibility.

SOme heads need to roll and get off the public till. Let's get rid of these loosers and hire some effective people….in all of our Public State Agencies.
16 September 2006
at 7:38 a.m.

Suggest removal

Permalink

ASBESTOS (Anonymous) says…

PLEASE can we start firing these terrible employees of the State of Kansas????
16 September 2006
at 10:05 a.m.

Suggest removal

Permalink

stops4armadillos (Anonymous) says…

Good luck. They pay these people very little to do very frustrating work. And of course, little pay means people with little education, generally.
16 September 2006
at 12:10 p.m.

Suggest removal

Permalink

ASBESTOS (Anonymous) says…

$11.27 fro a CNA to $17.00 for a LPN. This is plus benes.

I think that is some good coin and better than the private sector.
16 September 2006
at 4:12 p.m.

Suggest removal

Permalink

benfrankln (Anonymous) says…

Looks like fairly forgiveable, understandable, and correctable mistakes to me. The larger issues at homes for people with disabilities, these days, is the paranoia around abuse that undermines anyone's ability to feel at home in places that are supposed to be homes for people, rather than institutions. As long as the focus is on “heads rolling,” these places nor any places like these can be homes for anyone. “Heads rolling” was Stalin's approach to management. And as long as that is the case, these homes become prisons for both clients and staff, which I'm not quite sure is the intent of such efforts.
16 September 2006
at 4:58 p.m.

Suggest removal

Permalink

ASBESTOS (Anonymous) says…

For what is done, it is good enough. True an LPN can make more money, but will have a large increase in demands on their time.

The yearly income average in Kansas is 30 K. The CNA is right at that with the benes figured in which are pretty good. The CNA is not a nurse either, this is a “care sorker”. Getting them in and out of bath tub, cleaning, moving them around etc.

The LPN, would make 35 K then benes would be AFTER that, the 35 K in the State Benes is around 9 K. SO that is about 14 K as a total comp. package.

That is the “Standard” for comparision, remember, they get merit raises too.
18 September 2006
at 10:35 p.m.

Suggest removal

Permalink

tanzer (Anonymous) says…

Are we going to see any articles about the good things these facilities are doing?

20 September 2006
at 10:58 a.m.

Suggest removal

Permalink

jhawk4evr (Anonymous) says…

Talk about “job blurring.” Here the DOA does an “inspection” and finds deficiencies of various magnitudes.

Yet there is no indication that anyone reported possible abuse or neglect to any agency responsible, such as Central Office Abuse/Neglect unit, Attorney General's office abuse investigators (what are the Abuse Hotline phone numbers for?), for investigating allegations of abuse/neglect/medical care laxity.

“Forgot to look” at the healing process progress and 3 months later X-rays show “the arm still had not healed” is more than a simple oversight on everyone's part- especially the physician's!!! That to me would border on sadistic “neglect.”

Where was the Risk Manager during these trying times? Or was there even a Risk Manager? I ask that because around 1990 each institution was to submit (I believe to Central Office - Legal, SRS) an institution's Policy & Procedures Manual (including the risk management procedure) and submit an annual revision - if there had been any revisions to the first Manual.

I'm just wondering who our tax dollars are being paid to, and to do what? The Gov has a Special Counsel investigate the 2-child abuse situation in Wichita and then the DOA does “investigative” work that would seem to rightly fall within the purview of some entity charged with that function. Am I the only one who thinks the world is turned upside down?
23 September 2006
at 1:59 p.m.

Suggest removal

Permalink

jhawk4evr (Anonymous) says…

“¢ Two staff members were reported to have laughed at a disabled client after feeding the client a cracker with hot sauce on it.” Followed by 'Staff later reported the person had an “allergic reaction to Tabasco sauce.”'

asbestos's “Anywhere else this would be simple assualt and battery at the least” comment is somewhat supported by KSA 21-3437 “Mistreatment of a dependent adult.”

But since these victims don't vote why should any government offficial worry?

No one in the health or enforcement field, either in the facility where it was alleged to have happened or in any agency charged with investigating allegations of misconduct or by any law enforcement agency that can invoke that statute, seems to worry or be bothered enough to insist that appropriate charges be pressed.

Makes sense to me that if the Statute has no meaning, get rid of it and don't leave it on the books as if it's real.