“PROTECTING THE RIGHTS OF PERSONS WITH DISABILITIES”
Annual Report 2011
The mission of Michigan Protection and Advocacy Service, Inc. (MPAS) is to advocate and protect the legal rights of people with disabilities.
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Message From the Executive Director
The year 2011 in Review
or the Board of Directors and the staff of MPAS, 2011 was filled with both challenges and
opportunities. Challenges related to increased demand for advocacy assistance and reduced financial resources and opportunities to find new and innovative strategies to address broad systemic failures in the delivery of supports and services to people with disabilities.
To create an “outcome” directed management structure, MPAS tightened up the synergy between:
◆ The agency’s mission,
◆ Setting priorities (listed below),
◆ Defining measurable objectives,
◆ Creating work plans and staff assignments with
in independent residential settings will continue to be a focus in 2012.
In addition, MPAS will continue its work on:
◆ Protection of rights and self- determination,
◆ Guaranteed independent voting access,
Elmer L. Cerano Executive Director
associated costs.
During the course of the year, MPAS management recognized that although counting the number of activities was needed for reporting purposes to the government funding sources, the numbers meant very little when trying to better understand the real impact of the agency’s work on the lives of the individuals served.
In other words, to better manage the limited resources of the agency, MPAS wanted to know the “SO WHATS”
of our efforts. To what degree did our activities have any positive impact on the lives of the people we served?
From the sample cases described below, this annual report is intended to illustrate how MPAS has made a positive difference in the lives of real people. The case examples in this annual report are real; however, the names and identifying characteristics may have been changed to maintain confidentiality.
As we closed 2011, the MPAS Board of Directors and staff are fully aware that although many individual cases have been successfully resolved, many of the systemic issues facing people with disabilities are yet to be resolved. Our work to stop abuse and neglect in nursing homes, schools, psychiatric hospitals, group homes and
◆ Creating incentives for integrated employment
opportunities,
◆ Ending bullying and economic exploitation of people with disabilities,
◆ Assuring access to a full range of needed supports in education and mental health services to enable people with disabilities to live successfully in the community and to divert unnecessary entry into the criminal justice system.
MPAS Board of Directors has, once again, reviewed the input from people with disabilities and their friends and families to identify and approve the MPAS priorities for 2012. With the limited resources available, MPAS will continue to work tirelessly toward its mission of Advocating and Protecting the Legal Rights of People with Disabilities.
Elmer L. Cerano Executive Director
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Michigan Protection and Advocacy Service (MPAS) protects people with disabilities from abuse and neglect – whether in a mental health facility, nursing home, school, group home, homeless shelter, jail, prison or anywhere they work, recreate, or reside.
362 individuals were provided with information and referral 291 individuals received direct representation
Child Caring Institution
hat is Abuse or Neglect? Abuse or neglect includes: verbal, physical, emotional, or
sexual abuse by staff or a peer or inappropriate or excessive use of physical, mechanical, or chemical restraint or seclusion (as described in the Michigan Mental Health Code as Abuse or Neglect I, II, or III).
.
Jail Investigated
MPAS filed a lawsuit against Wayne County jail when authorities refused to release records of an inmate who had committed suicide. The case was submitted to the federal court which ruled in
MPAS’ favor without trial. The county jail has since provided the necessary records, clearing the way for an investigation to begin.
Hospital Investigated
An agreement was struck with Detroit Medical Center in an effort to decrease the use of restraint practices in the hospital’s emergency room. Aside from opening up access to medical records, the agreement provides that the hospital share data with MPAS regarding restraint in emergency rooms and allows us access to the emergency room for monitoring purposes. The agreement also provides that MPAS and hospital staff will participate together in training programs that stress alternatives to restraint in emergency situations.
Investigated
Two years ago MPAS reached an agreement with the Manor, a residential facility for youth in Jonesville, Michigan, to reduce or eliminate the use of seclusion and/or restraint within the facility.
Since that time, MPAS has continued monitoring the Manor and other child caring institutions for compliance and to ensure that children in these facilities are protected from abuse or neglect.
Throughout the year, expert consultants have been working with the Manor to implement the agreement. The experts provided a verbal and written report of their findings and concluded that, while the Manor has made significant progress in reducing the use of restraint and
seclusion by 51% within the facility, there is more work to be done.
MPAS staff continues to meet with residents to identify what further needs to be done to ensure their safety and well-being. During the course of monitoring, it was discovered that a number of residents were not leaving the child caring institution and returning to the
community. We advocated with the Department of Human Services and local community mental health service providers to discharge these children to the community of their choice in a timely and appropriate manner.
MPAS also supports several pieces of legislation expanding protections against abuse and neglect in
the areas of seclusion and restraint in schools, bullying in schools, and more extensive background checks of caregivers. (See page 15.)
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Systemic Changes Take Place after MPcovers Violations at a State Psychiatric Hospital
Residents are Protected from Unlawful Searches
ccording to the Michigan Mental Health Code, residents in a mental health facility must not have their personal belongings searched unless there
is cause or such activity is part of their plan of service. If there is cause for the search, residents have a right to
watch and to have the reason for the search written into
Unfortunately, as a direct result of this neglect, he suffered a heart attack.
MPAS staff investigated the case and filed
their hospital record.
On a routine monitoring visit, MPAS advocates observed that staff at Walter Reuther Psychiatric Hospital had been violating this rule. When asked why unauthorized searches of residents’ personal property were taking place, advocates were told that hospital staff was conducting a monthly search. After advocates interviewed residents, reviewed records, and obtained
a copy of the hospital’s policy regarding searches, they submitted a class action complaint to Recipient Rights, the governmental office responsible for protecting the rights of people receiving public mental health services in Michigan.
The Office of Recipient Rights investigated the charges and found a violation of civil rights against the hospital director. As a result, systemic changes have taken place that include:
◆ Eliminating searches of patients when they return from off-unit visits,
◆ Eliminating searches of patients and their personal belongings without due cause,
◆ Training of treatment teams on these policy changes.
If advocates had not observed these unlawful searches taking place, it may have gone unreported and residents’ rights would have continued to be violated.
Facility Forced to Consider Residents’
Health and Wellness
n another occasion at this same facility, a resident complained to MPAS advocates that hospital staff had been ignoring his complaints of chest pains.
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complaints with the Office of Recipient Rights (ORR)
and the Centers for Medicare and Medicaid Services (CMS). Due to the CMS complaint and the substantiated Office of Recipient Rights investigation, many positive changes have resulted.
Highlights of some of the changes brought about by the complaints include:
◆ Policy was updated and staff were disciplined and properly trained (CMS complaint phone number now posted in hospital and provided to patients upon admission);
◆ Hospital director now provides Medicare recipients with information about MPRO (the federally designated quality improvement organization for Michigan under contract with the U.S. Centers for Medicare Medicaid Services);
◆ Patients are now informed, upon admission, of their right to have an advance directive (living will);
◆ Staff retrained on assessing pain management;
◆ Two levels of supervisory audits were developed;
◆ Clinic referral process revised so appointments are made immediately or within one business day;
◆ Pharmacy procedure revised so expired medications are not used by staff;
◆ Nursing medication administration logs were revised;
◆ As a result of substantiated ORR investigation, staff was disciplined and retrained;
◆ Hospital to revise medical billing policy to ensure patients receive medications before billing for them.
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MPAS Concludes Prison Litigation
PAS has been involved in litigation against the Michigan Department of Corrections (DOC) due to their failure to adequately
identify and provide treatment for teenage and young adult inmates with mental illness.
Following years of corrective measurers and close oversight by MPAS, the case was settled. As a result, incarcerated inmates are now provided mental health screening and, if needed, mental health treatment.
In addition, former practices of placing inmates into administrative segregation and assigning “tickets”
for disability-related behaviors have been replaced by professional mental health interventions.
As a direct result of this litigation, prisoners with mental illness, developmental disabilities, and traumatic brain injury are more readily identified and treatment overall has improved.
Although pleased with the improved mental health interventions, the availability of appropriate
mental heath care in the community remains lacking. Discussions continue on the wasteful expenditures and wasted lives associated with incarceration of people with mental illness or other disabilities. These are Michigan youth who may not have been incarcerated if appropriate identification and treatment had been provided earlier.
MPAS continues to work to divert people with disabilities from the correctional system by advocating for a more responsive mental health system.
Highlights of some of the changes brought about by the litigation against the Michigan Department of Corrections include:
◆ Identification of inmates with serious mental illness has increased from eight percent to 20 percent, meaning that more than 8,000 current prisoners have benefited from improved mental health care;
◆ More than 9,000 prison workers have been trained to identify prisoners with mental illness;
◆ Annual state funding for mental health services within the correctional system has been increased by about six million dollars per year;
◆ The process for requesting mental health services has been simplified;
◆ There are now mental health professionals staffing virtually all facilities;
◆ Youth and those with traumatic brain injury are protected under the agreement;
◆ There are now specialized units for inmates with developmental disabilities and mental illness.
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all the way to the White House
he verbal bullying started when Ian was a middle school student in Homer, Michigan. As he got older, the verbal bullying escalated to physical
abuse. On one occasion, two students dumped him from his wheelchair – one then stepped on the shunt tubing in his stomach while the other pinned him on the floor with the wheelchair.
Outraged, Ian’s father repeatedly tried to contact
the principal of the school but never got a response from him or anyone else regarding the bullying incident.
Following the conference, Ian received phone calls from reporters across the country wanting to hear his story. He was even
contacted by a national TV network requesting a live interview. With help from staff at NDRN, a studio
was reserved and Ian
Ian Forester
On advice from a friend, Ian’s mom called Michigan
Protection and Advocacy Service (MPAS). Advocates at MPAS scheduled an individualized education program (IEP) meeting with Ian, his parents, and school administrators where the bullying problems were discussed and it was further determined what accommodations Ian needed to be successful at school.
In addition, MPAS presented Ian’s case to the national protection and advocacy system, National Disability Rights Network (NDRN). Staff there arranged for Ian and his entire family to hear President Obama speak at the White House Conference on Bullying. While in Washington, D.C., Ian also met and had his photo taken with Congressman Tim Walberg and Senator Carl Levin.
spoke before the NBC cameras.
Ian has since transferred to another school district and is doing very well. Thanks to a unique mentoring program and given the proper supports and services, his grades have improved and he looks forward to going to school again.
In collaboration with other organizations, MPAS
has been working to move Michigan legislation forward that would require school districts to adopt a policy prohibiting bullying. As the end of fiscal year 2011 (September 30, 2011), legislation had not been passed; however, it is expected to be signed into law soon.
On one occasion, two students dumped him from his wheelchair – one then stepped on the shunt tubing in his stomach while the other pinned him on the floor with the wheelchair.