No happy ending yet for Oakwood
Problems persist despite state's assurances
By John Cheves
JCHEVES@HERALD-LEADER.COM
SOMERSET -- Abuse and neglect continue at Bluegrass Oakwood, a long-troubled state facility for mentally retarded adults, even as Kentucky prepares to argue that it's fixed.
In coming months, the state Cabinet for Health and Family Services will urge the federal government to recertify Oakwood for Medicaid funding. Oakwood lost its Medicaid -- most of its $72 million annual budget -- on May 15 because of a terrible safety record. State officials are desperate to reverse that because the state cannot afford the full cost for long.
Oakwood finally is safe, officials told the state legislature's interim Health and Welfare Committee last week.
"Client protection, we feel pretty confident about that," Betsy Dunnigan, the Cabinet's deputy commissioner for mental health and mental retardation services, assured lawmakers.
By many accounts, Oakwood has become a safer place in the 20 months since a Lexington non-profit -- the Bluegrass Regional Mental Health-Mental Retardation Board -- was given the management contract. The previous manager, a company with political ties to then-Gov. Ernie Fletcher, was considered a failure, as was earlier state management, which saw residents die because of staff neglect.
However, "safer" is not "safe."
Documents reveal that some of Oakwood's 221 remaining residents still are hurt by abusive staff, poor medical care and each other. The number of "major incidents" -- including choking, broken bones, falls related to seizures or assaults and injuries that require stitches or staples -- remained about 80 to 100 a month for Bluegrass's first year caring for 221 residents. At least 90 of about 1,200 workers have been fired by the new management, chiefly for misbehavior.
And it's hard to get a clear look at Oakwood.
State inspectors say they've been harassed there and threatened with personal lawsuits by Bluegrass president Joseph Toy and his staff. Toy denies that.
Half of Oakwood's internal investigations of abuse and neglect are flawed because staff fail to examine evidence, talk to witnesses or determine what went wrong, according to a U.S. Justice Department monitor. Oakwood has delayed reporting incidents or written them off as "unsubstantiated" despite videotapes and eyewitnesses proving otherwise.
In at least a few instances, records appear to have been falsified to conceal problems.
Employees say they are ordered not to talk to outsiders about problems.
"When Bluegrass came in, they put emphasis on covering things up. 'What goes on here stays here.' That's what they told us in orientation," said Jerry Haynes of Somerset, who was a foster grandparent at Oakwood -- a paid position -- from 2005 to 2007. "I don't think it's improved at all in terms of incidents."
Toy, leading the new management, strongly disagrees.
"I'm extraordinarily satisfied," said Toy, an aggressive promoter of his agency whose 2006 compensation was nearly $300,000. He brushes aside most criticism.
"Before, you could hardly pick up a newspaper any day without reading some horrific account of treatment at that facility. And it was just happening over and over and over again," he said. "You don't read about the bad stuff in the paper now. It's not because it's concealed. It's because it's not happening."
Falsified logs
While it may be happening less, it is happening, according to state and federal documents, as well as internal reports.
Since Bluegrass took control, Oakwood employees have roughed up residents, hit them and kicked them hard enough to leave shoeprints in the flesh. One employee impatiently broke a resident's finger when he refused to stand up. Another ripped out a resident's fingernails in a careless accident involving a wheelchair.
Oakwood did not give one resident the working oxygen concentrator-humidifier kit she needed. She slumped over at the meal table with a cold, pale face and blue lips. After the local hospital revived her, Oakwood staff insisted on driving her back to the campus without an oxygen bottle, over the protests of hospital medical personnel.
At least twice, Oakwood failed to give residents their anti-seizure medicine. They had seizures and were hospitalized.
Employees have allowed residents to escape the campus and wander up to a mile away along busy U.S. 27. They falsified their security logs at the start of their shifts, to make it appear they were conducting regular checks of residents when they were not. One employee told state inspectors "everyone does it," an allegation his supervisor agreed was true.
Toy said Bluegrass clamped down by eliminating bad workers. Ninety have been fired; 161 more were strongly encouraged to leave and did. Previously, Oakwood's employees had state merit protection, which made them difficult to fire. Usually, Toy said, the state transferred abusive workers to the laundry room for a while.
Under Bluegrass, there is no merit protection.
"We picked up people who had no business ever working in a place like this," he said. "I've seen the criticism from the inspector general, that some of our employees turned out to have shady backgrounds. Well, that's true, but we inherited them. We didn't hire them by choice. And I doubt most of those folks are still here now."
Oakwood, which is Pulaski County's second-biggest employer, carefully hires new people, Toy said. Low-level aides start out being paid from $11.75 to $12.50 an hour.
Ignoring evidence
Toy said he enforces a zero-tolerance policy on abuse and cover-ups.
"We report paper cuts," he said.
Yet under Bluegrass, Oakwood does not always respond as it should, according to records.
Nirbhay Singh is a psychiatrist hired to monitor Oakwood for the Justice Department's Civil Rights Division because of past problems. Singh wrote last December that 17 of 35 recent Oakwood investigations he studied were inadequate. Oakwood ignores witnesses and evidence, such as the videotapes that record activity throughout the campus, Singh wrote. Sometimes residents are hurt but nobody learns why, or reports of abuse to the Cabinet are so delayed that many residents are exposed to the same bad employees before action is taken, he wrote.
An employee smelling of alcohol -- with a history of violent outbursts -- snuck up behind a resident and threw him into a chokehold, frightening him. Oakwood fired the worker, but not until 10 days later, and it gave him two weeks' notice so he continued working with residents until the end of the month.
Confronted about this by state inspectors, according to Cabinet reports, Toy shouted "Regulations be damned!" and declared that he is running Oakwood as he sees fit, like his own private business.
Toy denies saying that. Toy said the inspector general's office has "made up" allegations against him, which Inspector General Sadiqa Reynolds denies.
Toy also blamed Singh, the Justice Department monitor, for not understanding how hard his job is.
"It can take me 10 seconds of watching a tape to say 'They're fired!'" Toy said. "Now, you can criticize me -- if you're a court monitor making a lot of money -- for not acting sooner. But I can't act until they do something and I know about it."
In another case, two housekeepers witnessed employees hitting a resident, who cried out, "No, no! Please don't! I'll be good!" The housekeepers rushed to report the attack to their supervisor, who sent them to the main office, which insisted that they provide separate statements. An hour and 20 minutes passed before anyone was dispatched to check on the resident; he wasn't formally interviewed about the incident for two days.
Uncertain future for all
Oakwood's future is uncertain, even if it passes two rigorous inspections at some point this year and gets its Medicaid money back.
(Cabinet officials say the facility isn't ready for federal review yet, and they can't say when it will be. Without Medicaid, they warn, the place may have to close.)
Founded in 1972 as a long-term care facility, Oakwood changed missions two years ago after settling with the Justice Department over mistreatment of residents. Now it is considered a short-term facility with a responsibility for "transitioning" residents to leave the campus and live in publicly funded community programs, such as shared apartments with aides. In recent years, Oakwood has accepted no new residents; it has shed a quarter of its population.
So in theory, Oakwood will shrink and eventually close as the state moves away from institutional care.
In reality, Oakwood's population skews toward middle-aged -- many residents have lived there for decades -- and severely or profoundly retarded. While some residents can walk, feed and bathe themselves with little help, others need intensive care and supervision for the simplest tasks. The Parent-Relative Organization for Oakwood Families, an advocacy group of relatives, is lobbying the state to keep Oakwood open.
During a recent tour of the Oakwood campus, Toy estimated that nearly 100 of the remaining residents probably could not adapt to living in a neighborhood setting. It would not be safe for them -- or in some cases, for the community, he said. He pointed to a short, wiry man walking past, immediately followed by a tall, beefy aide.
"Jerry there," Toy said. "Jerry can lose his temper and get out of control if you're not watching and prepared for him. He could take all four of us out before we could even react."
Given a continued need for Oakwood, advocates say they hope it becomes truly "safe," not just "safer."
"Are people dying there as we speak? Hopefully not, no. There have been improvements, but more improvements still need to be made," said Marsha Hockensmith, director of protection and advocacy at the state Department of Public Advocacy.
Daniel Dermitt of Leitchfield, whose 30-year-old brother Tim Cox entered Oakwood in 2004, keeps a watchful eye. Cox suffered repeated abuse at Oakwood before Bluegrass took over, including an aide who beat him in the face until his nose broke while calling him "you f-----g retard." That episode resulted in a Type A citation and a pending federal lawsuit by Cox's family against Liberty Healthcare Corp. of suburban Philadelphia, which ran Oakwood at the time.
Bluegrass does seem to be making an honest effort to reform Oakwood, so the place isn't as bad as it once was, Dermitt said. Still, the family wants to remove Cox as soon as it can find a smaller facility closer to home, he said.
"The best I can say is that I'm less nervous now than I was before about the quality of care he receives," he said.
BREAKING DOWN
This is one in an occasional series of stories about the systems, institutions and processes in the state that are barely able to function and are in danger of breaking down. Today's topic: Bluegrass Oakwood mental health facility still has problems.
