A legislative committee Friday signed off on Gov. Paul LePage’s pick to run the Maine Department of Health and Human Services.
In a 10-1 vote, the Legislature’s Health and Human Services Committee approved Ricker Hamilton as the next commissioner of Maine’s largest state agency. Hamilton has served as DHHS’ acting commissioner since May, when Mary Mayhew left the post to run for governor.
The state Senate is expected to vote on the nomination when it convenes in Augusta early next week.
During several hours of questioning by committee members Friday morning, Hamilton said his initial response to a federal audit that found DHHS failed to investigate the deaths of 133 people with developmental disabilities from 2013 to 2015 was “not satisfactory.”
Hamilton said Friday that many of the deaths were of people already in hospice care or in hospitals and were not suspicious. Still, he said, DHHS had a responsibility to investigate them.
“Regardless, we did not do the oversight that we should have on that,” he said. “The OIG have given us an opportunity to improve our program. We accept full responsibility.”
The Office of the Inspector General for the U.S. Department of Health and Human Services in August published an investigation into Maine’s system for serving residents with developmental disabilities. The OIG found that Maine’s Adult Protective Services unit failed to investigate more than 15,000 suspected cases of people being physically, verbally or sexually abused; neglected; or subjected to medication errors while in the care of community service providers across the state, who receive Medicaid funds to care for people with disabilities, often in group homes.
The OIG found that DHHS wasn’t referring reports of suspected abuse, neglect or exploitation to district attorneys, as state law requires. And auditors found that DHHS didn’t investigate the deaths of 133 people who died while in the care of community service providers during that two-and-a-half year period. DHHS is obligated to investigate those deaths under the terms of an agreement it has with the federal government that allows the state to receive Medicaid funds to care for people with developmental disabilities in community settings, rather than in institutions.
In a written response to the audit, Hamilton — who oversaw the DHHS office responsible for Adult Protective Services before becoming a deputy commissioner under Mayhew — attributed the lack of investigations in part to a departmental reorganization. He said DHHS had improved its practices in the two years that had passed since the end of the audit period. Hamilton’s response also disputed some of the OIG’s findings, claiming that the state did in fact investigate many of the deaths and that cases of suspected abuse and neglect “underwent an assessment.”
The OIG said the state provided no proof that it actually performed investigations.
“We felt as though we had been descended upon,” Hamilton said Friday, saying he was suspicious about why Maine had been selected for an OIG audit. “And that’s how we reacted, and that’s how I wrote the letter.”
Hamilton on Friday also acknowledged that the state’s system of crisis services — including for people with intellectual disabilities experiencing behavioral crises that put them and those they live with in danger — “is in stress.”
For nearly four months, the state has lacked two-thirds of its capacity to serve adults with disabilities in crisis. The state lost 16 of its 24 crisis beds on June 30 when its contract with a nonprofit organization to provide those beds ended. DHHS hasn’t yet issued a request for proposals seeking a new crisis bed provider, although Hamilton said the department has funding for the service.
“We need to move quickly on that,” he said. “My intent is to move quickly on that.”
Hamilton, in response to questions from committee members, touched on a number of other topics during his confirmation hearing.
He said his preference was to locate a “step-down” psychiatric facility for former forensic patients of Riverview Psychiatric Center in Augusta, not in Bangor, as the LePage administration has been planning. But as the department moved ahead with plans to build the facility in Augusta, “I felt, every step of the way, we were being thwarted.
“At the last second, some statute or regulation that hadn’t been used in 10 years stopped us,” Hamilton said, citing Democratic legislative leaders’ refusal to approve the building project late last year, exercising a seldom-used law that requires approval from the Legislative Council for state building projects in the area of the state capitol.
The Legislative Council is made up of the 10 House and Senate leaders from both parties.
Legislators, as well as Augusta city officials, had long been pressing DHHS for more information about the step-down facility, as the department was proposing to build and fund it without legislative approval. The administration ignored many requests for information and gave partial answers to others, spurring concerns about the new facility.
With the proposal to build the facility in Bangor pending earlier this year, Bangor City Manager Cathy Conlow requested a meeting with state officials so they could answer questions, such as who would own the facility and how it would be managed. In response, LePage simply told Conlow to look at a request for proposals and request for qualifications posted on state websites, which have few of the details lawmakers and city officials have been seeking.
According to Hamilton, DHHS still plans to build the psychiatric facility in Bangor, although LePage said in September he was considering a neighboring town instead after the Bangor City Council passed a six-month moratorium to delay the project.
Also on Friday, Hamilton said DHHS is planning to implement a recently passed state law requiring that the state restore its public health nursing program, which has shrunk during the LePage administration from about 50 nurses to about 15 or fewer today.
He called the nurses, who respond to disease outbreaks and public health emergencies, “important” and said the department has a plan for restoring the state program.
Hamilton also said he wants more communication with lawmakers and an end to negative comments in news stories. DHHS officials have often shared little information with legislative committees charged with oversight of the department and declined to appear before them.
He pledged to build trust with lawmakers, “and I’ll see if the things I tell you are in the paper four hours after we talk.”
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