Annual Report 2012
“Protecting the Rights of Persons With Disabilities”
The mission of
Michigan Protection and Advocacy Service, Inc. (MPAS) is to advocate and protect the legal rights
of people with disabilities.
Message From the Executive Director
The Year 2012 in Review
am happy to again report that the State of the Organization is both fiscally and programmati-
cally sound. As we close another fiscal year, I am pleased to report to the Board of Directors and to the public, that the financial and programmatic integrity of Michigan Protection and Advocacy Ser- vice is accurate and in compliance with the mission and all applicable laws, rules, and regulations.
Although we have been able to manage the very limited and decreasing financial resources of the organization, we find that the need for effective advocacy is increasing. To address some of the mul- tiple issues facing people with disabilities and their families we have tried our best to do more with
less, but we are finding this task overwhelming. The need for advocacy is on a faster track than our
We have attempted to do this in our work to:
◆ Eliminate abuse and neglect in Michigan nursing homes
◆ End the unbridled use
of restraint and seclusion in schools
◆ Assure people with disabilities prompt and appropriate
access to needed services
Elmer L. Cerano Executive Director
resources can accommodate.
We have learned that change is inevitable – sometimes change is good and other times it simply makes things worse. We learned that we can op- pose change but soon find ourselves swallowed by the currents. We can accept change and simply try to find where people with disabilities will fit in with the new order of things. OR, we can lead the chang- es that are needed.
◆ Protect against employment discrimination
◆ Promote the full inclusion of people with disabilities into the fabric of society
The future will unfold without us if we allow it. We have an obligation to those we represent to speak up and make sure that people with disabili- ties have a voice and a role in designing the world of the future. There is so much more yet to be done.
It is my honor and privilege to serve as the Executive Director of this terrific organization.
Elmer L. Cerano Executive Director
2 MPAS 2012 Annual Report
Thousands were Served with Information and Referral Services
nformation and referral (I&R) advocates take incoming calls from the public and offer short-term assistance to people
calling the agency. Staff provides technical assistance literature, advice and counseling, referral to other agencies that can more appropriately meet callers’ needs, and help in drafting letters or completing forms, among other services.
I&R advocates answered disability-related questions on a wide variety of issues. Some of the most frequently asked ques- tions dealt with:
◆ Discrimination in education, employment, housing, and accessibility to public places
◆ Special education supports and services
◆ Abuse and neglect
◆ Social Security benefits, Medicaid, Medicare, and other insurance
◆ Vocational rehabilitation
◆ Voting rights
Information and referral advocates offered information or short-term assistance to 7,976 clients.
“Thank you for being so helpful and letting me know I have some rights.”
“I talked with a very nice person who gave me GREAT advice and sugges- tions that I’ve gotten results from already. Thank you!”
“Keep doing what you do one client at a time; it will add up and make changes.”
“I was able to assist a client I was working with more effectively with the information I received from you.”
“I feel like I have a person on my side.”
“The advocate was great – she lis- tened and then gave advice. I be- lieved in her voice and what we talked about, she was truly concerned and trying to help.”
“Best advice yet out of 12 agencies contacted.”
“The person at the end of the phone was extremely helpful, sincere, and listened well. Thank you so much.”
“Very nice and very helpful. I would use your services again and tell oth- ers about you all.”
“Thank you! Don’t have a clue what I would do without the resources and support you all provide!”
MPAS 2012 Annual Report 3
PAS works to keep people with disabilities safe from
abuse and neglect wherever they work, recreate, or reside. That includes nursing homes, mental health facilities, schools, group homes, homeless shelters, jails, and prisons.
MPAS staff conducted more than 75 investigations of seri- ous physical abuse and neglect in facilities where people with disabilities reside and/or receive services. In addition, staff regularly monitored five state psychiatric facilities. Staff also monitored group homes and provided assistance to residents.
MPAS Report Shows Abuse and Neglect in Nursing Homes Across Michigan
major initiative undertaken by MPAS in fiscal year 2012 involved the abuse and neglect of
nursing home residents.
After reviewing nursing home surveys collected by the Department of Licensing and Regulato- ry Affairs (LARA), MPAS found that many nurs- ing home residents had experienced severe neglect and abuse – sometimes resulting in death.
One survey in Washtenaw County described how a female resident was found with maggots infesting in and around her catheter area. The registered nurse manager on duty was instructed
by clinical corporate staff to document the discovery as debridement (dead tissue) rather than maggots.
A similar survey from a nursing home in Oakland County reported that emergency medical services were called to suction maggots from a resident’s trachea.
MPAS went public by contacting media
penalized and required to bring their facilities into compliance.
MPAS responded that paying fines and re-train- ing personnel is not enough to ensure patient safety and quality of life. The problem of substandard care is system wide and extends beyond one or two facil- ities. The current regulations and laws (mandatory reporting) already in place need to be enforced on a consistent basis and to the fullest extent. All par- ties should be held accountable and, if the infrac- tions rise to the level of criminality, they should be reported to law enforcement and prosecuted just like any other crime.
In addition, MPAS insists that nursing home owners and operators of poor performing facilities be banned from doing business in Michigan. While LARA is working within the present system – in- vestigating, requiring a plan of correction, and follow-up visits –
throughout the state.
LARA responded by saying that the department was aware of the maggot cases due to complaints filed by the Bureau of Health Systems. Accord- ing to LARA, the nursing homes have been fined,
HIGHLIGHT
the current system
does not address the failures of safety nets that should be in place to prevent abuses.
506 individuals received
information and referral services
74 individuals received direct representation
PAS filed a complaint with the U.S. Office for Civil Rights (OCR) challenging the
use of prone restraint practices in a Michigan school district. The complaint alleged that the district’s use of prone restraint, an especially dangerous form of physical restraint, violated state and district policies and therefore was
4 MPAS 2012 Annual Report
discriminatory under Section 504 of the Fed- eral Rehabilitation Act. After an investigation, OCR agreed and ordered the district to correct its practices to conform to its own policy. This finding could lay the groundwork for further challenges to restraint and seclusion practices in other districts.
What is MPAS doing to Protect Nursing Home Residents?
ome of the legal strategies that MPAS has put in place are:
◆ referring nursing home administrators who attempt to cover up abuse/neglect or who retaliate against employees who cooperate with state inspectors to law enforcement for prosecution;
◆ referring cases of abuse/neglect by facility staff to law enforcement for prosecution under the Vulnerable Adult Abuse Act;
◆ monitoring those prosecutions to make certain that charges are brought forth;
◆ filing complaints against the professional licenses/certificates of nurses, doctors, aides,
and others who abuse, neglect, or mistreat residents;
◆ referring cases of abuse,
neglect, and mistreatment to attorneys experienced in litigating against nursing homes;
◆ advocating for expanded MiChoice services to allow people who need nursing or home care to get it in the community;
◆ educating policy makers;
◆ examining the current oversight process to identify deficiencies and advocating for changes within the system to end abuse, neglect, and mistreatment.
MPAS is also Pushing for Laws that Protect Against Abuse and Neglect in Nursing Homes
ichigan currently has a background check pro- cess for all nursing home employees who have
been convicted of abuse, neglect, or exploitation of residents within those facilities. The current registry is not effective, however, because not all
employees who should be reported for violations of
abuse, neglect, or exploitation and are still working within nursing homes. MPAS is working to close that loophole in the law by supporting a series of bills that would expand the background check pro- cess.
Protecting Against Abuse and Neglect in Schools and Child Caring Institutions
PAS monitored and brought a series of li- censing complaints against a child caring
institution with an excessive rate of restraint and seclusion. As a result of the complaints, the state Bureau of Child and Adult Licensing (BCAL) moved to revoke the license of the facility.
Other monitoring visits have provided support to youth within child caring institutions and iden- tified referrals for MPAS’ special education efforts. Individuals in institutions are receiving the ser- vices they need to move toward discharge into the community. In some cases, discharge is accelerated through MPAS involvement. In addition, areas of concern are shared with policy makers and other investigators, helping MPAS and others develop and improve accountability strategies.
As in years past, MPAS provided support to the Michigan Legislature through the continued main- tenance of bills that would reduce or eliminate the use of dangerous restraint and seclusion practices in schools. U.S. Senator Harkin introduced the Keeping All Students Safe Act in December 2011.
The bill prohibits the use of seclusion, mechanical and chemical restraint, aversive behavioral inter- ventions and physical restraint that is life-threat- ening.
Several national reports were issued on re- straint and seclusion in schools including reports from the National Disability Rights Network, TASH, National Alliance on Mental Illness, Con- sortium of Citizens with Disabilities, Coalition of Parent Advocates and Attorneys, and the American Association of School Administrators.
Raising the visibility of school bullying as it affects students with disabilities has been a long- standing effort. With the support of MPAS and others in the community, the Michigan Legisla- ture passed an anti-bullying bill requiring school districts to adopt anti-bullying policies, including policies to address bullying of students with dis- abilities. Attention is now turned to passing an anti-bullying bill at the federal level.
MPAS 2012 Annual Report 5
PAS continued to advocate for effective sys- tems and proceedings to safeguard the rights
of people who have guardians. One way MPAS did this was by supporting legislation to require in- creased financial reporting by guardians to protect against financial exploitation.
HIGHLIGHT
well-being. Examples of this include medical neglect or exploitation, undesirable mental health treatment including electrocon- vulsive therapy (ECT), substandard or restric-
787 individuals received information and referral services
18 individuals received direct representation
n 86-year-old man had been placed under
a guardianship order. Although he had the capacity to make personal decisions and only re- quired minimal assistance, his corporate guardian was overly controlling and demanding. MPAS ne- gotiated an agreement allowing the client’s guard- ian to resign and be replaced by a family member of his own choosing.
MPAS helps assure that people with disabili- ties who are subjected to guardianship have their rights protected by seeking court protection when guardians are abusive or neglectful to the point where it affects their physical or mental health and
HIGHLIGHT
uring a routine monitoring visit at a state psy- chiatric facility, an advocate was stopped by a
resident who complained that the facility’s vend- ing machines were poorly stocked and inconsistent in reimbursing change. After several unsuccessful attempts to get the facility director and recipi-
ent rights officer to resolve the issues, advocates contacted the vendor, and the resident was reim- bursed for the money he had lost in machine.
A number of systemic changes also occurred affecting more than 250 residents, including: re- placing and upgrading vending machines, having money automatically returned from the machine if a selection is not available or it takes too long
to make a selection, getting reimbursements from the operator every seven days, and adding healthy snacks to the selections (e.g. baked chips, nuts) so all residents, regardless of dietary restrictions, can use the vending machines.
6 MPAS 2012 Annual Report
tive living conditions, or having a guardian who
acts outside the scope of their legal authority.
One of the most important rights protections systems for vulnerable individuals is the state’s Bureau of Child and Adult Licensing (BCAL). This is the agency that inspects adult foster care facilities and child caring institutions. BCAL also responds to complaints from residents and others about conditions, incidents of abuse/neglect, and rights violations. After an extensive investigation of the treatment of a resident at an adult foster
care facility, BCAL began proceedings to revoke the license of the operator. The decision to revoke the license was upheld by the administrative law judge, but the local Circuit Court reversed that decision. BCAL has asked the Michigan Court of Appeals to uphold its original decision to revoke the license.
Because MPAS sees this as such an important case, we made the decision to file what is called
an amicus brief. Basically, MPAS is agreeing with BCAL and asking that the revocation stand. Our brief details the sad history of abuse, neglect, and rights violations in institutions and emphasizes the importance of an effective rights protection system, such as BCAL.