AUGUSTA, Maine — A state investigation has found a host of problems with the way the Maine Centers for Disease Control distributed millions of dollars to Healthy Maine Partnerships programs last year.
Problems include supervisors who ordered the destruction of public documents, funding criteria that was changed during the selection process, HMP funding scores that were changed just before the final selection, a $500,000 tribal contract that seemed to appear out of nowhere and a critical HMP scoring sheet that has vanished.
Money, the investigation found, may have gone where it shouldn’t have.
“There were multiple problems with the process that undermined the integrity and credibility of the results and created an opportunity for Maine CDC to manipulate the final outcomes in the lead selection,” Beth Ashcroft, director of the Office of Program Evaluation and Government Accountability, told the Legislature’s Government Oversight Committee on Thursday.
“And there are strong indications, we found, including accounts from multiple interviewees,” she said, “that such intentional manipulation may have occurred in the selection of the lead HMP for the Penquis district.”
Healthy Maine Partnerships are community health organizations that receive funding through the Maine CDC. That money largely comes from the Fund for a Healthy Maine. Historically, the CDC has funded 27 or 28 HMPs through a competitive grant process.
In 2012, the state cut a third of the HMP program’s funding. To compensate, the CDC decided to name nine lead HMPs, one in each of the eight public health districts and one HMP that would serve Maine’s tribal nations. The tribal HMP was required by law.
Lead HMPs would get dramatically more money and more responsibilities, while the others would see their funding slashed
But the selection process immediately raised questions. Those questions turned to allegations when, earlier this year, Sharon Leahy-Lind, then-director of the CDC’s Division of Local Public Health, sent a complaint of discrimination to the Maine Human Rights Commission. She alleged, among other things, that her CDC bosses ordered her to shred documents that showed the scoring results for the HMPs. She said the scoring was manipulated to favor certain HMPs.
This fall, at the behest of the Government Oversight Committee, OPEGA looked into the way the CDC handled HMP scoring and funding. In its report released Thursday, OPEGA found:
* CDC leaders, who were planning to cut the HMPs from 27 to nine, asked the Maine Department of Administrative & Financial Services whether they needed to go through the formal, competitive grant process to award funding as they had in years past. The department said they didn’t have to because the HMPs’ scope of work was being reduced, not expanded. Rushed for time because the state’s budget decision came late, the CDC did not go through the competitive process. But CDC officials also didn’t tell the department when they later changed their plan and decided to fund all HMPs and make nine of them leads.
* The criteria for choosing leads and the weight given to that criteria changed during the selection process. That affected the integrity of the final results.
* The CDC did not look at how well lead HMPs dealt with subcontracting, monitoring subcontractors or collaborating with other HMPs and schools. It also didn’t consider whether potential leads had the capacity to serve their entire districts. OPEGA considered all of that key information.
* The scoring system was overly complex and inconsistent. It also emphasized subjective criteria, including which HMP had the better relationship with the CDC.
* Scoring was possibly adjusted to influence which HMP would become lead in the Penquis area. According to the report, some of the CDC staffers interviewed by OPEGA said there was a “specific discussion and directive that Bangor (Regional Public Health) should be the lead, although it did not have the highest score at that time, because the Co-Chair of the Statewide Coordinating Council was closely affiliated with that HMP and had been a good partner with the MCDC.”
* There was no indication that scoring was changed to influence the choice of lead in Western Maine, a concern that had been raised by lawmakers and had helped prompt the OPEGA review.
* CDC supervisors told two workers to destroy documents. The workers, including Leahy-Lind, asked two other staff members — including a senior manager — what they should do. The senior manager advised one of the workers to do “what they thought was right.” The workers did not destroy the documents and later provided them to OPEGA. CDC managers told OPEGA that they believe workers were told to destroy documents in “a desire for version control or to keep survey responses confidential, rather than an intention to cover something up.” The report added that DHHS and CDC managers also told OPEGA that “they considered these to be working documents, and did not have the expectation that they should be kept.”
* The CDC didn’t maintain sufficient documents to support its key decisions.
* Documents to justify scoring and provide the basis for ratings were created after the lead selections had already been made and announced to the public.
* A key scoring document is missing. As the next-to-final scoring sheet, it was reported to show a different lead HMP in the Penquis area.
* No one could say who came up with the HMP contract that gave the tribal district more than $500,000. OPEGA ultimately found an email that confirmed the CDC’s Office of Health Equity developed the contract, though the director of that office — who signed the contract — said she wasn’t sure who developed it. The DHHS Contracting Group said it has never seen a tribal contract, though it processes all other HMP contracts.
Members of the Government Oversight Committee said they were stunned by the report’s finding, calling the CDC’s actions “unacceptable,” “disturbing” and “unbelievable.”
“I can barely contain my frustration,” said Sen. Margaret Craven, D-Lewiston, a member of the committee and a member of the board of Healthy Androscoggin, the Western Maine HMP that lost out on lead.
“Mainly because that even when there is misconduct or whatever discovered, there doesn’t seem to be any recourse to having people held accountable for that,” Craven said. “It’s like, if you are awarding $4 million in grants, who doesn’t keep documentation?”
“I’m really stuck on why they didn’t know they were supposed to keep documents,” said Sen. Emily Cain, D-Orono, senate chairwoman of the committee.”I’m just really struck by that. I’m struck by there somehow not being an expectation of that. Where, to me, that seems what we do everywhere else. Whether we’re in Appropriations looking at budgets, it’s a matter of, ‘What did it look like then? How did you arrive here?’ Particularly when you’re dealing with state resources.”
Ashcroft, OPEGA’s director, said her people couldn’t find any rules or guidance about what paperwork should or shouldn’t be kept in such a circumstance. Official requests for proposals have such rules, but the CDC didn’t award the money under a formal, competitive grant process. If OPEGA had been able to find such guidance, Ashcroft said, OPEGA’s report recommendations would have been stronger.
“We were using our own professional judgment in terms of saying, ‘You know, if it’s supporting key decisions that you made, even just for the sake of being able to answer public questions or have some transparency, one would expect that maybe that (document) should be retained,” Ashcroft told the committee. “We’ve made a recommendation that they set up some sort of clear guidance about what should be retained.”
In its report, OPEGA recommended that the CDC:
* Gather relevant performance data on the HMPs so it can measure their performance better in the future.
* Adhere as closely as possible to the rules for formal, competitive grant processes, even if it’s awarding money outside of that process.
* Get guidance on document destruction and retention from DHHS, which oversees the CDC.
* Clarify the roles and responsibilities for the tribal HMP contract and make them consistent with the other HMPs.
In a statement released Thursday, DHHS thanked OPEGA for its work and said its report affirmed many of the findings of its internal investigation.
“We have learned from this process and have taken several steps to address systemic and process concerns relating to selection and funding decisions that both the department and OPEGA identified,” the statement said. “We are working with the State Archives Office to ensure that our staff is well-informed regarding the proper handling and management of documents and other department records. We are also working with our quality improvement staff to ensure that all future efforts to create a selection or scoring process are steeped in sound statistical methodology.”
Leahy-Lind, who quit her job at the CDC earlier this year, has filed suit against DHHS and the CDC for harassment and defamation, among other things. Her lawyer, Cynthia Dill, said Thursday that she would like to see people in the CDC held accountable for what OPEGA found.
“Why are the people who worked at the CDC, who directed people to destroy public documents, why are they still working there?” Dill said. “Why is my client having to start a new career when all she did was work hard and tell the truth?”
A spokesperson for the Attorney General’s Office said officials there planned to read the report Thursday and decide whether to pursue action against anyone at the CDC. However, Ashcroft told the committee that OPEGA had spoken to the AG’s office and the AG’s Office hadn’t yet identified any violation of law.
“It’s in a gray area here in terms of, ‘What’s the public document that’s required to be kept?’” she said. “The CDC has taken the position that as long as they had all the documentation of their final results here, that’s what they would have been expected to keep. Is that everybody else’s expectation is not really laid out too clearly.”
The Government Oversight Committee plans to hold a public hearing and a work session on OPEGA’s report, possibly at its next meeting in January. The committee could decide to introduce legislation to fix some of the problems OPEGA found, such as the lack of guidance around which public documents should be kept. It could also make its own recommendations to the CDC and DHHS, though those recommendations would not have the force of law.