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Missouri audit hits Mental Health agency

The Missouri Mental Health Department's system of handling problem workers is
so lax that it placed thousands of mentally ill and disabled clients at risk of
abuse inside care centers statewide, a state audit says.

Mental Health Director Dorn Schuffman said in his written response to the audit
that he concurred with all of the findings and his department was taking
corrective steps to address the problems found.

He said through his spokesman that he would let his written responses to the
audit speak for him.

The performance audit was released Wednesday in Jefferson City by State Auditor
Claire McCaskill.

"This department has not taken seriously its responsibility to protect those it
serves," McCaskill said. "And someone at the top needs to be held accountable."

A performance audit looks at how well a public agency does its job. McCaskill
ordered the audit after the Post-Dispatch last year reported that workers and
parents accused the state of covering up abuse cases.

The Mental Health department oversees the care of 140,000 mentally ill and
disabled people in Missouri.

Without such an audit of the department, the public may never have learned
about the department's failure to protect the state's most vulnerable people,
McCaskill said. Mental Health Department officials keep abuse and neglect
reports secret, citing an exemption in the state Sunshine Law. McCaskill's
auditors, however, were allowed to see them.

Three of the key problems cited in the audit were: not having a good system for
investigating complaints of abuse and neglect; failing to put abusive workers
on a list barring their employment or using people on the list; and failing to
screen prospective workers. The audit did not give the locations of the
incidents cited.

No good system

The audit said the department allowed workers to investigate their coworkers,
causing a potential conflict of interest.

The audit also found that workers who investigated complaints failed to follow
protocol by not requiring physical exams of injured residents and not obtaining
photographs of their injuries.

In addition, individual facilities were left to develop their own forms to
report and track investigations.

All of that led to an inability to track trends in abuse and led to workers
clearing some workers, while finding that others with almost identical evidence
had abused a client, McCaskill said.

To address the problem, Schuffman has promised to standardize reporting forms
and have an independent agency investigate all complaints by December.

Not listing barred workers

The state is supposed to put employees found to have abused or neglected a
client on a list disqualifying them from working with other clients. Yet, the
auditors found that over a two-year period ending in April, the department sent
clients to private homes where 38 workers were on the banned list.

The lag time in getting employees onto the disqualification list troubled the
auditors. In one case they cited, the department waited nearly two years to
place a worker on the list. During the lapse, a private home for the mentally
disabled hired the worker, who neglected a resident there.

Another case cited involved the owners of a privately run home for the mentally
disabled who had been disqualified since March 1999 after the state found they
choked, kicked, slapped, pushed and threatened to kill clients.

The department continued to send clients there. It did not shut the home down
until April, after auditors told them they had the authority to do so. Eleven
cases of neglect, including the death of a client, were substantiated in the

Schuffman wrote that the list is now handled by the Office of General Counsel,
and names are added in a systematic way.

Not screening employees

The department and the private contractors it uses are required to do criminal
background checks on potential employees before allowing them to care for

The audit cited instances in which department employees and contractors allowed
workers with criminal records to care for people in state care.

Key Findings of the Performance Audit

The audit showed the mental health department...

Allowed workers to investigate their coworkers who were accused of abuse or
neglect, and had no uniform system for conducting investigations.

Waited to ban abusive workers from caring for mentally ill and disabled
clients, as state law requires. The lapse exposed other clients to abuse.

Placed clients in the care of workers known to have violent criminal histories
despite state rules that such workers undergo background checks.

SOURCE: The Missouri State Auditor
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