A federal agency has warned Georgia officials that it will end Medicaid payments to an Augusta facility for the developmentally disabled unless the state improves conditions there.

The Centers for Medicare and Medicaid Services (CMS), in an August report, said the state-run Gracewood Developmental Center has repeatedly failed to ensure the safety of patients, who have been subjected to physical and verbal abuse.

Gracewood patients “sustained physical injuries of unknown origin and/or verbal abuse that were not thoroughly investigated,” the inspection report stated. “The facility continues to not have a system in place to ensure that the clients were not subjected to physical, verbal, and/or psychological abuse.”

The feds also described inadequate employee training and frequent failure to investigate possible instances of abuse.

The head of the facility has resigned, said Frank Berry, commissioner of the state Department of Behavioral Health and Developmental Disabilities (DBHDD), at an agency board meeting Aug. 28.

DBHDD, meanwhile, is overhauling its processes regarding people with developmental disabilities whom it serves.

The Aug. 26 letter from CMS comes as the state agency is under pressure over its care of these people, including moving patients out of state hospitals.

Unexpected deaths raise concerns

Moving people with developmental disabilities out of mental hospitals and into lodgings in the community is a priority for the state, under a settlement agreement with the U.S. Department of Justice.

But this summer, media outlets reported that almost 10 percent of the 480 Georgians with developmental disabilities who have moved out of state hospitals since July 2010 have died after being placed in community residences.

An AJC article described horrific incidents of abuse or neglect following the transfer of these patients into group homes. Forty patients placed in group homes died, with 30 of those deaths classified as unexpected, the AJC reported. Many of the deaths appeared to be from natural causes.

The state agency said in June that it contracted with an independent organization for external reviews of all deaths of developmentally disabled individuals transferring from hospitals to community settings.

Earlier this year, an independent reviewer reported Georgia was failing to provide adequate supervision of individuals with developmental disabilities who had been moved from state hospitals to community group homes.

That report, by Elizabeth Jones, came as an update to a groundbreaking 2010 settlement between the state of Georgia and the U.S. Justice Department. Under the terms of that pact, Georgia agreed to establish community services for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization.

By all accounts, the settlement agreement has worked out better for people with mental illness under state supervision than those with developmental disabilities.

The state is still out of compliance with the settlement agreement on the developmental disabilities side.

DBHDD has halted such placements of people with developmental disabilities from hospitals into community settings, citing concerns about the quality of care provided. About 290 people with developmental disabilities remain in the state’s institutions in Augusta, Milledgeville and Atlanta.

Reforming administrative functions

Agency officials emphasize that they are “re-engineering” the department’s processes involving developmentally disabled Georgians.

DBHDD last week announced its intent to award a $7.7 million contract to ValueOptions to help the agency with administrative functions, including data management. The agency has also contracted with another company to help with developmental disabilities issues.

And Judy Fitzgerald, deputy commissioner, told GHN, “We are asking more from the provider community.”

Many individuals remaining in state hospitals “are medically fragile or complex,” she added.

Before resuming community placements, Fitzgerald said, DBHDD wants to ensure that the providers are in place to deliver quality services, and that medical care will be available.

The agency plans to focus on one region at a time, starting with Augusta. “We are putting a lot of time, energy and resources there to ascertain needs of individuals and capabilities of existing providers,” said Dan Howell, interim assistant commissioner of the Division of Developmental Disabilities.

‘System . . . does not work’

Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities, told GHN on Friday that he welcomes the agency overhaul.

“They have to rethink the way things are being done,” Jacobson said. “These are the most vulnerable of folks.”

“Anything they can do to improve those processes and create a more supportive system is positive,” he added. “This is a system that does not work. It doesn’t meet people’s needs. We’ve been saying that for 20 years.”

Regarding Gracewood, the agency has until Wednesday to submit a plan to correct the problems at the facility.

Georgia Regents University has a partnership with DBHDD to run Gracewood as well as East Central Georgia Regional Hospital in Augusta

“Patient safety is extremely important to us, and we are working diligently with our partners at DBHDD to resolve the issues raised in the CMS letter,” a GRU spokeswoman said last week in an email to GHN.

Fitzgerald said of the Gracewood situation, “We are reviewing all our options.” But she added that currently, “We do not have any concerns about the safety of individuals residing at Gracewood.”