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YELLOW SHEET Office of the State Auditor of Missouri |
August 25, 2003
Report No. 2003-86
Safety aspects of some state mental health residential
clients left to contractors' judgment as to whether abuse incidents are
reported, hence fully monitored
This report reviews oversight practices of the
Department of Mental Health's Comprehensive Psychiatric Service division, which
monitors 30 private contractors receiving state funds to care for more than
53,000 clients. �This division also
contracts with private residential care facilities, which provide supervised
living arrangements for an additional 4,500 clients with chronic mental
illness.
All alleged incidents of client
abuse and neglect are not reported to division
State law entitles each mental health client to safe
housing, free from verbal and physical abuse. �As a result, division officials require
contractors to report incidents of staff physically abusing division clients or
sexual abuse between clients. �However,
division officials interpret their regulations to mean contractors do not have
to report incidents of physical or verbal abuse between clients unless those
incidents are serious.� In addition,
contractors do not have to report medication errors or suicide attempts among
clients, unless abuse allegations are involved.�
Contractors are allowed to judge when such incidents are serious enough
to report.
In reviewing incident reports among 8 of the 30
contractors for fiscal year 2002, auditors found 140 unreported incidents,
which contractors did not deem serious enough for an investigation.� Examples of unreported incidents included a
client's attempted suicide requiring hospitalization and a client allegedly
raped by another client. �Division
officials reviewed the unreported incidents and said most did not meet the
criteria to need reporting, but said the attempted suicides should have been
reported.� (See page 3)
Some medication errors are
not reported
Auditors found 20 of the 140 unreported incidents
involved medication errors. �One unreported
error landed a client in the hospital for 2 days. �Documents from the contractor's internal
investigation showed the responsible employee did not disclose the error. �In addition, a Division of Senior Services residential
care facility examiner said her investigations showed residential care
facilities do not document all medication errors. Incomplete reporting leaves
the exact number of medication errors unknown. �(See page 6)
Increasing quality control's
authority could boost contractor bill accuracy
