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Archive for the ‘DHH’ Category

By Robert Burns

After Louisiana’s FYE books were closed on June 30, 2013, the Jindal administration touted the fact that 2,340 hospital employees had been laid off during that fiscal year. Nevertheless, one hospital, the Huey P. Long Hospital in Pineville, was proving particularly vexing for Jindal’s administration.

With much fanfare, Jindal’s folks called a news conference to announce that the hospital’s operations would be transferred to England Airpark with an estimated $30 million required to renovate the facility which was closed in the early 1990s. The money was said to come from $5 million pledged by the England facility and the remainder from state-issued capital outlay bonds issued during FYE ’13.

Despite all of the hoopla associated with the announcement of the transfer, the proposal ended up fizzling out, and Jindal’s administration had to conjure up a “Plan B.”

That turned out to be another iteration of the public/private partnerships for which the Jindal administration essentially could have qualified for a patent on crafting such arrangements. In this instance, the public/private partnership would entail Rapides Regional Medical Center and Christus St. Frances Cabrini Hospital taking over much of the workload of Huey P. Long.

Of course, the whole proposal had the

gnawing obstacle that it needed approval from those darn folks at the Legislature, and that’s where things got interesting.

To accomplish the goal, Senator Gerald Long obediently introduced

Senate Concurrent Resolution (SCR) 48 in the regular session of the 2014 Legislative Session. On March 31, 2014, the Senate Committee posted an agenda for its meeting of April 2, 2014; however, that agenda was devoid of any reference to SCR-48.

On April 1, 2014 at 4:07 p.m., a revised agenda was posted in which SCR

-48 was posted and itemized to include a notation entailing its subject matter: “creating a new model of health care delivery in the Alexandria and Pineville area.” Amendments were added to SCR-48, and it ultimately passed both the House (66-28) and Senate (26-11).

Baton Rouge attorney Arthur Smith, III,

filed litigation on behalf of affected employees of the hospital and others alleging violations of Senate Rules of Order 13.73 and 13.75.

Also alleged was a violation of Louisiana’s Open Meetings Laws

, and relief was sought to have SCR-48 declared null and void (a relief available under Louisiana’s Open Meetings laws) based on that violation and also an assertion that SCR-48 was unconstitutional. A preliminary injunction was also sought to block the closure of the hospital with the ultimate goal of obtaining a permanent injunction.

The trial court granted the preliminary injunction, but it simultaneously suspended enforcement of the

preliminary injunction upon the defendants (the Louisiana Senate, LSU, and the State of Louisiana) perfecting an appeal.

It was initially believed that the Louisiana Supreme Court (LSC) would decide the matter because of the issue raised of the constitutionality of SCR

-48. However, the Supreme Court quickly refused to hear the matter in stating that it was “not properly before this Court.” The Supremes (no, not the singing Supremes) elaborated by ruling that it could consider only matters which had been declared unconstitutional in a court of law.

Since the trial court’s reasons for judgment only made reference to the

potential unconstitutionality of SCR-48 without making a definitive declaration that it was unconstitutional, the Supreme Court denied writs.

Meanwhile, the hospital was closed, and Smith took his case to the First Circuit Court of Appeal. That appeal was dismissed based

upon the fact there was no active injunction to prevent the hospital from being closed. That was the case because, expecting (wrongly) the Supreme Court to rule on the matter, Judge Robert Downing suspended the preliminary injunction. With no injunction in place to prevent the closure, the hospital was padlocked.

The First Circuit issued its decision on September 15, 2015. That ruling notwithstanding, the

declaratory judgment aspect of the lawsuit could proceed forward, and that led to a hearing in 19th JDC Judge Don Johnson’s courtroom on Monday, June 13, 2016.

During that hearing, much of what has been elaborated above was rehashed, but then co-counsel for the day’s proceedings, Chris Roy, Sr., of Alexandria, took center stage and converted what had been basically a snooze fest into a fireworks display.

Prior to Roy beginning testimony, Judge Johnson interjected a few points of his own into the arguments. First, Johnson indicated that, while he was a student at Southern University, he experienced a significant health issue and went to Baton Rouge’s local charity hospital

, Earl K. Long, and he said, “I sure was glad it was there to treat me.”

Earl K. Long was also shut down by the Jindal administration and subsequently demolished. Emergency room treatment of indigent patients was initially taken over by Baton Rouge General Midtown. But Baton Rouge General closed its emergency room more than a year ago. That forced low-income charity patients in the northern part of East Baton Rouge Parish to travel a much further distance to Our Lady of the Lake Medical Center in South Baton Rouge for treatment. That point was not lost on attorneys for the defendants who claimed that care would continue to be provided for the underprivileged, but such care would simply now take place under the new public/private venture.

Roy said that the closure of the

Huey Long Charity Hospital caused an enormous level of anxiety among the community’s population and also with the employees of the hospital. Johnson acknowledged that fact and said, “I’m aware of that fact. They didn’t like it at all.” Roy stressed that “125 employees lost their jobs and $11 million in wages were lost as a result of this episode.”

Roy focused most of his arguments on the fact that, contrary to defense attorney claims, the whole issue

of SCR-48 is not now “moot.” He emphasized that ordinary citizens are provided with only one mechanism for making their sentiments known about proposed legislation and that is through “showing up and testifying at committees and subcommittees of the Legislature.”

Roy then rhetorically asked how they were supposed to do that w

hen the Senate would engage in such a “flat-out violation” of posting an addition to the agenda at 4:07 p.m. the day before a hearing when the clearly-established deadline was 1 p.m. for such an addition. Roy then stressed his age, and even poked fun at the relative youth of one of his opposing counselors (who appeared to be in his late 20s at most), in indicating that he, Roy, was one of the participants in the formation of the present Louisiana Constitution.

Roy said, “One of our main objectives was to try and make everything as transparent as possible because there had been a prior governor, whom I won’t reference by name (a thinly veiled reference to Huey Long), who sought to keep the public from knowing

anything that was transpiring.” The irony of the subject matter of the suit being the closing of a hospital named for him seemed not to be lost on anybody in the room.

“Your Honor,” Roy continued, “the Senate basically said ‘to hell with the Constitution. We are the Senate of the State of Louisiana, and we decide what we will do and won’t do.’” Roy then emphasized that opposing counsel could not simply argue that the whole matter was “moot,” and assert a defense along the lines of “we won’t do it again.” Roy then emphasized that Louisiana Senate President John Alario is a good man with integrity and a close personal friend of his, but he then asserted that what Alario allowed to transpire in this instance was just “wrong.”

The State sought the granting of a Motion for Summary Judgment (MSJ) to dismiss the case, and the plaintiffs sought the granting of an MSJ declaring SCR-48 to be null and void. In the battle of the MSJs, Johnson ruled in favor of the plaintiffs: “SCR-48 of the 2014 Regular Session is declared to be Null and Void. The Plaintiff’s may seek attorney fees, costs, and expenses through post-hearing motion. The Joint Motion for Summary Judgment filed by defendants is denied.”

Now all that remains to be seen is whether the state will have to pay salaries and benefits retroactive to the hospital’s closing date to those 125 employees (the amount given was $11 million saved by closing the facility) or if there will be yet another appeal of a 19th JDC judge’s ruling to the First Circuit.

The smart money is on an appeal.

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The timeliness of Tuesday’s observation about holding our public officials accountable has come into play less than 24 hours after the post went up.

Today’s (March30) Baton Rouge Advocate revealed that only two of Bobby Jindal’s nine public-private partnership hospital contracts will be funded in the next fiscal year, a move that is certain to adversely affect low-income residents seeking medical care. http://theadvocate.com/news/15333761-70/seven-out-nine-public-hospitals-unfunded-in-next-years-budget-including-baton-rouge-and-lafayette

As severe as the projected cuts are ($58.4 million to Our Lady of the Lake Medical Center in Baton Rouge and $51.2 million to Lafayette General Health Center alone), Gov. John Bel Edwards appointee Department of Health and Hospitals Secretary Dr. Rebekah Gee has been AWOL at hearings before the House Appropriations Committee and the Joint Legislative Committee on the Budget.

The latest crisis is, of course, directly attributable to the short-sightedness of Bobby Jindal and his obsession with privatizing everything in state government that moved—even to the extent of having his lap dog LSU Board of Supervisors approve a contract turning over medical facilities in Shreveport and Monroe to private concerns which contained 50 blank pages.

As things now stand, it appears the only hospitals to be spared the knife (if you will pardon a terrible pun) are the LSU Medical Centers in New Orleans and Shreveport and they survived only because they house LSU medical schools.

The fiscal year 2017 budget calls for a 10 percent funding cut for DHH. That comes to $283 million right off the top but the number escalates to $750 million when the loss of federal matching funds are factored into the equation.

Besides OLOL in Baton Rouge and Lafayette General, other public-private hospitals impacted by the cuts include those in Alexandria, Monroe, Houma, Bogalusa and Lake Charles.

LSU Health Sciences Center Chancellor Dr. Larry Hollier testified that he was worried about the prospect of seeing the public-private arrangements go belly up. OLOL, he said, has 150 residents in training and Lafayette has 82. In all, LSU has about 800 residents scattered about the state.

State Rep. Ted James (D-Baton Rouge) noted that residents of north Baton Rouge, a predominantly black area, have lost both inner community hospitals when Earl K. Long was closed and later torn down and when Baton Rouge General-Mid City closed down its emergency room a year ago Thursday (March 31).

So with all this bad news swirling about, where was the DHH secretary?

Sure, DHH Undersecretary Jeff Reynolds testified but was unable to give clear cut answers to legislators’ questions about how funds saved from Medicaid expansion might be used to offset the DHH shortfall.

But Gee was still MIA. Reynolds said she was absent because of personal issues but that lame excuse was quickly shot down by DHH spokesperson Bob Johannessen told LSU’s Manship School News Service that Gee was spending spring break with her family.

Johannessen’s candor could get him in hot water. The boss never likes it when a subordinate reveals something that puts him or her in a bad light. And face it, this is a pretty bad light. He did recover some lost ground, however, when he added that legislators who were critical of her absence were “grandstanding.”

Well, yeah. That’s what politicians do. So why make it so easy for them?

Rep. Bob Hensgens (R-Abbeville) said he doesn’t recall seeing Gee at any Appropriations Committee or Joint Legislative Committee on the Budget meetings.

Rep. John Schroder (R-Covington) was even more critical. “It’s getting a little troublesome that the secretary doesn’t come,” he said. “The taxpayers want to hear from the boss when we start talking about these kinds of dollars.” http://www.thenewsstar.com/story/news/local/2016/03/29/millions-dollars-cut-state-hospitals/82402336/

Spring break? Whiskey Tango Foxtrot? (the new polite way of saying WTF?)

Edwards appointed Gee, a professor of health policy and management in obstetrics and gynecology at LSU, to head DHH in early January. http://new.dhh.louisiana.gov/index.cfm/page/7/n/55

We just had a DHH secretary (Kathy Kliebert) whose brother-in-law got into hot water with the Louisiana Board of Ethics (does anyone have any idea how difficult that is to do after Jindal revamped the ethics board in 2008?) because he failed to disclose his employment by state Medicaid contractor Magellan Health Services. http://www.theneworleansadvocate.com/news/11707352-123/brother-in-law-of-state-health-secretary

We just got rid of a governor who for eight years steadfastly refused to be held accountable for his action (or inaction, as the case may be).

Her appointment was described as “among the most important appointments Edwards will make in his new administration” by NOLA.com back in January.

At the time of the announcement of her appointment, she said, “I pledge to you I will use all of the skills I’ve used as a physician, a patient, a parent, and a policymaker to do everything I can to improve the lives and health of people in this great state.”

http://www.nola.com/politics/index.ssf/2016/01/john_bel_edwards_dhh_secretary.html

Dr. Gee, those noble words might mean a little more to the taxpayers of this state if you would take your position more seriously and appear at important committee hearings. A public face on an agency in crisis mode is more than important: it’s critical.

It’s all about accountability.

We’ve already had one agency head (Kristy Nichols) to duck out on a committee hearing to attend a boy band concert in New Orleans. We don’t need an encore of that performance. https://louisianavoice.com/2014/10/06/kristy-kreme-knows-one-direction-ducks-out-on-legislative-committee-for-boy-band-concert-at-n-o-smoothie-king-arena/

Going on spring break at a time when the low-income residents of this state are staring at having to overcome even greater hurdles to obtain decent health care sends the wrong message—a message that we’ve become all too familiar with over the past eight years.

And that message is arrogance.

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On Feb. 15, an arrest warrant was issued for a north Louisiana employee of the Louisiana Department of Children and Family Services (DCFS) following an investigation of more than two months by the Office of Inspector General.

Kimberly D. Lee, 49, of Calhoun in Ouachita Parish, subsequently surrendered to authorities and was subjected to the indignity of being booked into East Baton Rouge Parish Prison on Feb. 17 after being accused of filing false reports about mandatory monthly in-home visits with children in foster care.

As is often the case, however, there is much more to this story.

A month earlier, on Jan. 10, LouisianaVoice received a confidential email from a retired DCFS supervisor who revealed an alarming trend in her former agency:

“I served in most programs within the agency, foster care, investigations, and adoptions,” she wrote. “Over my career I witnessed the eight years of (Bobby) Jindal’s ‘improvements.’

“Those ‘improvements’ endanger children’s lives daily. The blight is spread from the Secretary to the lowliest clerical worker in the agency. People are overworked and underpaid but it’s not just that. People are so distraught from the unrelenting stress that children are in danger. Add to that the inexperience of most front line workers and their supervisors’ inability to properly train new staff.”

She then dropped a bombshell that should serve as a wake-up call to everyone who cares or pretends to care about the welfare of children—from Gov. John Bel Edwards down to the most obscure freshman legislator:

“In the Shreveport Region, the regional administrator (recently) told workers that they may make ‘drive-by’ visits to foster homes, which means talking to the foster parents in their driveway. Policy says that workers will see both the child and the foster parent in the home, interviewing each separately (emphasis added). A lot of abuse goes on in foster homes. Some foster families are truly doing the best they can but they need counseling and guidance from their workers. The regional administrator’s answer to that one? Have the foster parent call their home development worker—another person who can’t get her job done now.”

She wrote that she had heard of two separate incidents “where a child new to foster care was taken to a foster home and left without paperwork, without contact information for the person in charge of the case and without knowing even the child’s name.”

Moreover, she said, vehicles used in the Shreveport Region “are old, run-down, and repairs are not allowed. The last time new tires were bought was in 2014. When one (of the vehicles) breaks down, they just tow it away. No replacement is ordered.”

Could those factors have pushed Lee to fudge on her reports? Did the actions attributed to her constitute payroll fraud or did budgetary cuts force her into cutting corners in order to keep up with an ever-increasing caseload? Lee says yes to the latter, that she was told by supervisors to get things done, “no matter what.” Child welfare experts said her actions and arrest shone a needed light on problems at DCFS: low morale, high turnover, fewer workers handing greater numbers of caseloads, and increasing numbers of children entering foster care.

http://theadvocate.com/news/14909284-31/louisianas-child-protection-system-understaffed-and-overburdened-after-years-of-cuts-child-advocates

To find our own answers, LouisianaVoice turned to a document published on Jan. 5 of this year by the Child Welfare Policy and Practice Group of Montgomery, Alabama.

The 77-page report, entitled A Review of Child Welfare, the Louisiana Department of Children and Family Services, points to:

  • A growing turnover rate for DCFS over the past three years from 19.32 percent in calendar year 2012 to 24.26 percent in 2014;
  • A 33 percent reduction in the number of agency employees to respond to abuse reports;
  • A 27 percent cut in funding since fiscal 2009, Bobby Jindal’s first year in office;
  • An increase in the number of foster homes of 5 percent;
  • An increase of 120.5 percent in the number of valid substance exposed newborns, from 557 to 1,330;
  • A trend beginning in 2011 that shows 4,077 children entered foster care but only 3,767 exited in 2015;
  • A 19 percent decrease in the number of child welfare staff positions filled statewide from 1,389 in 2009 to 1,125 in 2015.
  • Of the 764 caseworkers, 291, or 38 percent had two years’ experience or less and 444 (58 percent) had five years or less experience.

Moreover, figures provided by the Department of Civil Service showed that of the agency’s 3,400 employees, 44.5 percent made less than $40,000 a year and 19 percent earned less than $30,000.

In 2014 (the latest year for which figures are available), the median income for Louisiana for a single-person household was $42,406, fourth-lowest in the nation, as compared to the national single-person median income of $53,657.

http://www.advisorperspectives.com/dshort/updates/Household-Incomes-by-State.php

“The stresses within the system are at risk of causing poorer outcomes for some children and families,” the report says in its executive summary. “…Recent falling outcome trends in some of the areas that have been an agency strength in the past are early warnings of future challengers.”

Despite years of budgetary cuts under the Jindal administration, Louisiana has maintained “a high level of performance in achieving permanency for children in past years and currently is ranked first among states in adoption performance,” the report said.

The budget cuts, however, “have negatively affected the work force, service providers, organizational capacity and increasingly risk significantly affecting child and family outcomes” which has produced a front-line workforce environment “constrained by high caseload, much of which is caused by high turnover and increasing administrative duties and barriers that compromise time spent with children and families.”

And it is that threat to “compromise time spent with children and families” that brings us back to the case of Kimberly Lee and to the email LouisianaVoice received from the retired DCFS supervisor who cited the directive for caseworkers to make “drive-by” visits to foster homes, leaving children with foster homes with no paperwork, contact information or without even knowing the children’s names, and of the state vehicles in disrepair.

It’s small wonder then, in a story about how Jindal wrecked the Louisiana economy, reporter Alan Pyke quoted DCFS Secretary Marketa Garner-Walters as telling the Washington Post if lawmakers can’t resolve the current budget crisis, many Louisiana state agencies will see budget cuts of 60 percent. http://thinkprogress.org/economy/2016/03/07/3757416/jindal-louisiana-budget-crisis/

As ample illustration of Bobby Jindal’s commitment to social programs for the poor and sick, remember he yanked $4.5 million from the developmentally disadvantaged in 2014 and gave it to a Indy-type racetrack in Jefferson Parish run by a member of the Chouest family, one of the richest families in Louisiana—but a generous donor to Jindal’s gubernatorial campaigns and a $1 million contributor to his super PAC for his silly presidential run.

Well, thanks to the havoc wreaked by Jindal and his Commissioner of Administration Kristy Nichols, the legislature did find it necessary to pass the Nichols’ penny tax (not original with us but the contribution of one of our readers who requested anonymity) to help offset the $900 million-plus deficit facing the state just through the end of the current fiscal year which ends on June 30.

Were legislators successful? Not if you listen to Tyler Bridges, one of the more knowledgeable reporters on the Baton Rouge Advocate staff. “Legislators were neither willing to cut spending enough, nor raise taxes enough nor eliminate the long list of tax breaks that favor one politically connected business or industry over another,” he wrote in Sunday’s Advocate (emphasis added). http://theadvocate.com/news/15167974-77/a-louisiana-legislature-that-ducked-tough-budget-decisions-during-its-special-meeting-convenes-again

As is all too typical, most of the real “legislation” was done in the flurry of activity leading up the final hectic minutes of the special session, leaving even legislators to question what they had accomplished. In military parlance, it would be called a cluster—.

But that should be understandable. After all, 43, or fully 30 percent of the current crop of legislators, had to work their legislative duties around their busy schedules that called upon them to attend no fewer than 50 campaign fundraisers (that’s right, some like Neil Riser, Katrina Jackson, and Patrick Connick had more than one), courtesy of the Louisiana Oil and Gas Association, the Beer Industry League, CenturyLink and a few well-placed lobbyists. http://www.nola.com/politics/index.ssf/2016/03/louisiana_special_session_fund.html

It is, after all, what many of them are best at. (Seven of those were held at the once-exclusive Camelot Club on the top floor of the Chase Bank South Tower. We say “once-exclusive” because last week the Camelot announced that it was closing its doors after 49 years. Restrictions on lobbyists’ expenditures on lunches for legislators was given as one cause for the drop in club membership from 900 to 400. Not mentioned was the fact that Ruth’s Chris and Sullivan’s steak restaurants in Baton Rouge have become favorite hangouts for legislators and lobbyists during legislative sessions. One waiter told LouisianaVoice during the 2015 session that one could almost find a quorum of either chamber on any given night during the session—accompanied, of course, by lobbyists who only wanted good government.) https://www.businessreport.com/article/camelot-club-closing-afternoon-can-no-longer-viable-club-owner-says

LEGISLATORS’ FUNDRAISERS

Bridges accurately called the new taxes that will expire in 2018 “the type of short-term fix” favored by Jindal and the previous legislature “that they had vowed not to repeat.”

Can we get an Amen?

In the meantime, he observed that Gov. John Bel Edwards and Commissioner of Administration Jay Dardenne, because the legislature still left a $50 million hole in the current budget, will have to decide which state programs will be cut—again.

Emphasizing the risks to children, Garner-Walters told legislators in a committee hearing during the just-completed special session that state DCFS staff numbers 3,400, down a third from the 5,100 it had in 2008. “You can’t just not investigate child abuse,” she said.

Former Baton Rouge Juvenile Court Judge Kathleen Richey, now heading up Louisiana CASA (Court Appointed Special Advocate), a child advocacy non-profit, has expressed her concern over the budgetary cuts that make DCFS caseworkers’ jobs so much more difficult.

“Our political leaders need to understand that while infrastructure represents a physical investment in our future, our children represent an intellectual investment in our future,” she said. “We have to protect innocent children who have no one else to stand up for them.”

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Bobby Jindal: the gift that keeps on giving.

It’s bad enough that colleges and universities are facing the threat of temporary closures, cancellation of summer school, and loss of accreditation. But coupled with the bad news on higher education is an equally grim outlook for health care.

A sample of the legacy left us by Jindal’s hospital privatizations and closures:

In Baton Rouge, the closure of Earl K. Long (EKL) Medical Center had a ripple effect on the low income residents of North Baton Rouge. The emergency room patient care shifted onto Baton Rouge General Regional Medical Center Mid-City became such a money loser that it closed its emergency room on March 31, 2015. That moved emergency room care 30 minutes further away to Our Lady of the Lake (OLOL) Medical Center, located in largely white South Baton Rouge. One emergency room doctor confided to the author that it was his feeling that Jindal wanted to create “a medical wasteland north of Government Street.” Government Street, which traverses Baton Rouge in an east-west direction is a roughly-defined dividing line between South and North Baton Rouge.

Mid-City was hemorrhaging $2 million a month through its emergency room because Jindal refused to expand Medicaid and rejected any idea of putting up state money to keep the facility open. With the closure of its emergency room, residents of North Baton Rouge, which is largely low-income black in its demographic makeup, had few medical choices. With Our Lady of the Lake so far away, the alternatives were two urgent care clinics operated by the partnership of LSU and Our Lady of the Lake. The clinics were located on North Foster Street and Airline Highway. The North Foster clinic has no onsite doctor and the main Airline High clinic has a doctor onsite only until 7:00 p.m.

The same emergency room doctor who related the “medical wasteland” story told of the tragic case of an elderly African-American couple. “I felt sick reading this report,” he said. He said it involved “an old black couple who were paying $40 per month on their existing medical bill” to another Baton Rouge hospital.

The report read said the decedent was found “supine on bedroom floor. His wife told EMT personnel that her husband had congestive heart failure and that fluid had been building up. He did not go to the emergency room because the couple owed money to the hospital. She said he had been short of breath through the night and when she awoke, he was not breathing. CPR and advanced cardiac life support were initiated but were terminated after no response. “If he had gone to the LSU urgent care center, likely as not, no doctor would have been on duty,” the ER doctor said.

The closure of EKL and the decision by Baton Rouge General Mid-City to close its ER necessarily imposed a heavier workload on OLOL which entered into a partnership with the state for treatment of Medicaid patients. That increased workload has understandably also produced greater pressure on doctors and staff which in turn has apparently led to lapses in quality of care.

Consider the following brief email thread:

“Please see the email below sent from one of vascular consultants to our Associate Chief Medical Officer Dr. (redacted). My purpose for forwarding this email to you is not to criticize anyone nor is (it) to elicit a string of email responses. The sole purpose is to make all of us aware of the perception some of our consultants and primary care teams have of us. Increasingly of late, I am getting this type of feedback, be it real or otherwise.

“Doctors, we must elevate our game to meet the expectations of all our physician colleagues. I know you guys are working hard, but I am asking each of you to pay attention to the finer details.

“As Dr. (redacted) aptly said to me last night, our physician colleagues are our customers; we need to put ourselves in their shoes, be their voice, the voice of our customer.

Dr. (redacted)”

The email to which he referred read:

“I had a very irritating call last night from the ER. It bothers me that the environment around our hospital is deteriorating into a stereotypical dysfunctional training facility that we are all too familiar with and probably chose to go into private practice to avoid.

“I received a call at about 11:30 p.m. The answering service informed me who the call was about. When I called back a resident picked up and started telling me about ‘an endostent that had an endoleak with pain, transferred from Lake Charles.’ Knowing I was on city call, I figured I’d investigate this to expedite patient care. The resident told me they had already spoken to a doctor but it didn’t make sense when I couldn’t get the specifics I was asking for. At that point, I asked to speak to the attending whom (sic) was able to figure out they got the wrong guy. However, it’s a little disheartening that he didn’t readily know who the surgeon was they had spoken to that was assuming responsibility for the patient. He did mention ‘Dr. (redacted)” who is our resident (redacted)—but I’m not sure he knew it was a resident. It’s my feeling that in a patient potentially critical as this one—the attending should have his finger on the pulse a litter better than it appeared last night.

“After those 15 minutes I again informed the attending I was Dr. (redacted)…returning a page. At this point the attending gave me to ‘Dr (redacted), first year (emergency room) resident.’ The resident reports a consult on a patient with WBC (white blood cell) 19, blisters on cellulitic foot…When I ask asking info, it turns out the patient ‘has been on the board over 7 hours.’ When I ask to speak to attending who saw the patient—no longer working. At this point, I’m given back to the same attending who gave me to the first year resident he was covering. This attending was covering the resident, had taken sign-out, and expected the resident to call me and report but had never seen the patient. This reminds me of something I would get from the old ER at Mid-City, not what I would have received from OLOL in first 12 years of practice.

“I do realize we are a training facility but you and I both recognize that happens to a private practice service when run by residents. I’m sure the ER has exploded with new personal (sic) during this growth phase, but part of their responsibility is to know who the doctors are that routinely admit to this facility. To say the least, I was discouraged at the attending’s ‘finger on the pulse’ of what he was responsible for last night.

“This email is not to condemn any individual but to raise flags over the environment. Please forward to the appropriate people.”

(Sender’s name redacted)

Such is life in the aftermath of Bobby Jindal’s grand state hospital privatization scheme.

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It was bad enough Friday when Gov. John Bel Edwards announced that career politician and former national chairman of the American Legislative Exchange Council Noble Ellington as his legislative director.

But at the same time, he announced the appointment of Marketa Garner Walters as secretary of the Louisiana Department of Children and Family Services (DCFS) at $129,000 per year.

Ellington, besides serving as national chairman of ALEC, was twice named Legislator of the Year. He left the legislature to take a cozy $150,000-a-year job as Chief Deputy Commissioner of the Department of Insurance in 2012 even though he had no background in the insurance industry.

And it was during his tenure as ALEC’s national chairman that Bobby Jindal was presented the organization’s Thomas Jefferson Freedom Award (you may want to check with the descendants of Sally Heming on that freedom part). http://www.alec.org/press-release/hundreds-of-state-legislators/

It’s beginning to look a lot like business as usual for the new administration. Like pro football and major league baseball, Louisiana’s elected leaders seem to keep recycling the same old familiar faces in and out of various state offices. The problem is, they are the ones who helped create the problems. So what makes anyone think they have the solutions now?

Take Garner Walters, for example, who served as Assistant Secretary for the Office of Community Services within DSS (DCFS) from January 2004 until November 2008, when she went by the name Marketa Garner Gautreau.

“A national leader in the field of children and family services, Marketa Garner Walters has worked for more than 20 years to improve the lives of children,” the governor’s announcement said. “As a public servant, a national consultant, and an advocate with deep roots in her home state of Louisiana, Walters has been able to create meaningful change in the lives of family and children over the years.”

So what’s so wrong with that?

Well, not much. Unless one considers her explanation for an incident in which a 17-year-old mentally challenged boy raped a 12-year-old boy in a group home during the time she served as assistant secretary for the Office of Community Services.

“Retarded people have sex—it’s what they do,” she said, sounding more like a GEICO commercial than someone responsible for children’s welfare. That bit of wisdom was imparted during her testimony before the Juvenile Justice Implementation Commission in 2008.

The Office of Community Services is a sub-office of the Department of Children and Family Services, formerly the Department of Social Services (DSS).

A former employee of the Office of Juvenile Justice (OJJ), then the Office of Youth Development, witnessed Gautreau’s testimony.

“In late 2008, DSS and OJJ were called before the Juvenile Justice Implementation Commission about a situation at a Baton Rouge group home housing both OJJ and DSS youth (and) where a 17-year-old mentally challenged boy raped a 12-year-old boy,” the former OJJ employee said.

“OJJ removed our youth from the group home at once and put a moratorium on placement there. DSS, the licensing agency for group homes, left their kids there,” she said.

When questioned by JJIC members, including (then) Lt. Gov. Mitch Landrieu and (then) Louisiana Supreme Court Chief Justice Kitty Kimball, Garner Gautreau offered a bizarre explanation. She said it was really not rape because the youths were of similar mental capacity.

When asked why there was not better staff security to keep the children from roaming around and molesting others, she replied, “Retarded people have sex. It’s what they do.”

The former OJJ employee was aghast. “I told my colleagues I’d wring their necks if they ever made statements like that in public hearings.

“We figured that (Gautreau’s testimony) was a career-limiting speech and we were not surprised when Ms. Garner Gautreau was shortly looking for another job,” the former OJJ employee said.

She added that OJJ stopped placing children in the same facilities as DCFS children.

There was “a consistent pattern of DSS failing to properly monitor and supervise group home operations and looking the other way when deficiencies were noted,” the former OJJ employee said. “Group homes were even re-licensed when still deficient and corrective actions plans were not being followed.

“The DSS review committee was a joke – the agency’s monitors looked the other way and ignored problems at the group homes, even when OJJ removed kids and notified DSS of deficiencies,” she said.

The intent is for private group homes to provide a safe, homelike setting for abused and neglected children who have been removed from their families. But the safety factor appears to have come up far short. Four rapes were reported over a 15-month period at two Baton Rouge group homes.

The Advocacy Center, a nonprofit organization, released a 41-page REPORT ON GROUP HOMES in early 2008 that described filthy conditions and neglect of children’s education and medical needs at many facilities. Additionally, a 2007 report by the legislative auditor found that 90 percent of the group homes had deficiencies when their licenses were renewed.

Garner Gautreau, however, told the Baton Rouge Advocate that she had “a high level of comfort” in the knowledge that 80 percent of homes scored at an acceptable level.

Its report included problems that staff members observed themselves but also cited violations found in previous inspection reports filed by the state from 2004 to August 2007. Those include failure to assure proper medical care at 53 percent of the facilities and failure to assure proper physical environment in 69 percent of homes.

State inspectors cited 18 facilities for failing to have sufficient staff and found cases where homes failed to provide criminal background checks and in some cases knowingly hired people with criminal records, the Advocacy Center report noted.

“In some cases, we found evidence that the Bureau of Licensing had identified the same problems and cited the same facility over and over again. However, nothing changed,” said Stephanie Patrick, who oversees visits to homes for the Advocacy Center.

“I started following DSS failures when our staff consistently documented problems that DSS ignored,” the former OJJ employee said.

“Louisiana’s licensing statute for these facilities fails to provide an adequate framework for assuring the health, safety, and welfare of children in these facilities,” the Advocate Center report said.

What?!!

The state doesn’t assure the safety and welfare of children it is charged with protecting?

Among the deficiencies of the statute, the report said were:

  • That it grants final authority over residential facility licensing regulations and standards to two committees, none of whose members is required to be an expert in child residential care and treatment, and many of whose members are providers.
  • That it allows the issuance of licenses without full regulatory compliance.
  • That it requires the Department to seek the approval of the relevant committee before denying or revoking a facility’s license, and gives the committee veto power over such action.
  • That it does not permit DSS to assess civil fines and penalties when facilities violate minimum standards.

The Advocacy Center requested DSS’s Bureau of Licensing reports for the years 2004-2006 and up to August 2007. “A review of these reports shows that a shocking number of the facilities had serious violations of minimum licensing standards, including:

  • 38% of the facilities had violations relating to staff criminal background checks;
  • 62% of the facilities were found to violate minimum standards regarding children’s medications;
  • 53% of the facilities failed to assure that children received proper medical and/or dental care;
  • 33% of the facilities were cited for not following proper procedures or violating procedures pertaining to abuse/neglect;
  • 62% of the facilities were cited for not assuring their staff received all required annual training;
  • 69% of the facilities were cited for not assuring that children were living in a proper physical environment;
  • 36% of the facilities were cited for not having appropriate treatment plans or for inappropriate execution of children’s treatment plans;
  • 33% of the facilities were cited for not assuring that sufficient qualified direct service staff was present with the children as necessary to ensure the health, safety and well- being of children.

“Many facilities were found to be in violation of minimum standards on inspection after inspection,” the report added.

LouisianaVoice has been receiving unsettling reports of inadequate inspections of foster homes by unqualified DCFS employees. Those reports are currently being investigated by us and will be reported in future posts should they be substantiated.

Meanwhile, we can take comfort in the knowledge that Marketa Garner Walters nee Gautreau will be watching out for the children as the new secretary of DCFS.

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