SOUTH CAROLINA

Almost a third of DDSN providers didn't use meds training

Tim Smith
tcsmith@greenvillenews.com

COLUMBIA — More than 30 percent of providers last year chose not to use a program to train and certify workers to give out medications to intellectually disabled consumers, the state Department of Disabilities and Special Needs disclosed Thursday.

The Department of Disabilities and Special Needs office in Columbia.

But officials cautioned that those numbers, while a key piece of data in determining just how many providers are doing what they should with medications, does not mean 30 percent were violating the law or using untrained employees to hand out pills. They said in some cases nurses could have been used or providers could have used certified medication assistants.

However, DDSN's quality review agency still found problems with the way medications training occurs in the DDSN network. Oversight of medications training by providers lacked sufficient documentation, some providers that did use the training curriculum changed it to give fewer hours than required, and the frequency of the training "varied significantly from one provider to provider," according to a memo released Thursday.

In addition, DDSN said in the memo, "anecdotal information gathered from multiple communications between various DDSN and provider staff suggested implementation of the program was not across all settings and the determination of consumers' ability to self-administer medications was too broadly defined."

The information came two months after DDSN Director Beverly Buscemi sent a directive to providers telling them that they should not use untrained workers to hand out medications to consumers or to assist consumers who want to self-administer medications.

DDSN director warns providers over medication training

The agency cares for thousands of intellectually disabled consumers, those with autism, brain or spinal cord injuries, many in group homes.

Since then, Buscemi has told commissioners that she did not know how many providers were using untrained employees but that she saw the problem as a serious one.

On Thursday, she briefed commissioners on the issue and said she has learned anecdotally that some providers have been training every month and make certain that they have a certified medications technician in every group home and on every shift.

"Other providers may have only been doing it for these two homes or these three homes and not across the board," she said. "To be blunt, we figured out that we had a need to make sure that we maintained consistency."

Former DDSN Commissioner Deborah McPherson told commissioners Thursday that the 30 percent figure is "inexcusable."

She told The Greenville News afterward that even if some of the 30 percent are using nurses, the figure is still a "biggie."

"Because the policy has been there and they have chosen not to do it," she said.

Lawmakers voice concerns over DDSN medications training

Commissioner Vicki Thompson of Seneca, who had pressed for the number of providers without trained workers, said even with the 30 percent number, the agency still does not know how many untrained workers there are so commissioners "don't know how prevalent the problem is."

"I think we have to know how prevalent it is and how we went wrong before we do it again," she told The News.

Thompson said she doesn't believe providers are purposely defying the agency or the law.  She said she believes the past directive on the issue was confusing and unclear.

"It goes back to we need to communicate better what our expectations are because that's a lot of people misunderstanding what we're saying," she said of the 30 percent number.

Buscemi said the agency held a meeting with providers, including nursing staff, on Oct. 3, and feedback was solicited. That prompted a revised directive which is still being tweaked, she said.

Thompson said she is concerned with allowing providers to use LPNs instead of registered nurses to oversee the medications process because the law requires registered nurses to provide oversight.

Buscemi said the directive is using language that mirrors that used by the state Department of Health and Environmental Control, but that she would look at the RN issue.

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Lois Park Mole, a DDSN spokeswoman, said afterward that requiring RNs for each provider might be impractical because of their availability.

A final version of the medications technician directive is expected to be ready next week, officials said.

New rules suspended

In other action Thursday, the commission suspended controversial rules for commissioners it had enacted this summer, and received a briefing on a new system that will allow members of the public to go online early next year and view ratings and other information about DDSN providers.

The provider reporting system will calculate scores using various key indicators and assign providers a certain number of stars. The system will offer a bevy of data for consumers, including whether a provider has been sanctioned. Currently, the only way a member of the public can know whether a provider has been sanctioned is if the provider has been removed from the provider list on DDSN's website.

Many other state and federal agencies are reporting provider performance through the use of scores or report cards, according to the agency.

McPherson said she is pleased the agency plans to roll out the system, which has been talked about for years. She said she hopes it will eventually include the number of allegations concerning abuse, neglect and exploitation and the number of critical incidents for each provider.

DDSN board adopts rules for commissioners, including no recording meetings

The commission also voted Thursday to suspend rules for the commissioners approved in August to allow the board's policy committee time to revise them.

Among the rules, which proponents at the time explained were meant more as guidance, was a requirement that commissioners not tape record meetings. Thompson had been using a tape recorder because she said the board does not and she wanted to have a definitive record to review what happened.

In a recent opinion requested by Sen. John Scott in response to the DDSN rules, the state Attorney General's Office said the state Freedom of Information Act allows anyone at a public meeting to use a tape recorder.

The rules also required a rotation of where commissioners are to sit each month, that cell phones be silenced, no texting be allowed, and that commissioners could use the phrase "ELMO," for enough, let's move on, to stop a discussion that has bogged down. For those in the audience, the rules required cell phones be silenced and that there be no "side conversations."

Thompson had asked the board's policy committee to rescind the rules in their entirety, arguing they were unnecessary and were causing problems.

Commissioner Eva Ravenel of Charleston, who chairs the policy committee, largely agreed Thursday, calling the ELMO provision an "embarrassment" and saying the tape recorder ban violates the FOIA. Ravenel and Thompson had voted against the rules in August.

DDSN officials said that commissioners using a tape recorder would have to maintain the recordings for any FOIA request, something they felt commissioners would want to avoid.

Commissioner Sam Broughton, a member of the policy committee, said he still wanted to keep some rules, such using the small board version of Robert's Rules of Order, but later suggested the board just pull the rules and "put more thought into it."

The full board later agreed without debate.