The Office of the Inspector General closed 1,470 investigations of alleged employee abuse or neglect of DHS facility residents and community agency residents in Fiscal Year 1998 and 1,124 in Fiscal Year 1997.

Overall the quality of OIG investigations has improved since our last audit. Case file documentation is more thorough, and final case reports are generally comprehensive, follow Investigation Guidelines, and address the allegation of abuse or neglect. There are, however, still areas for improvement.

Timeliness of cases closed has deteriorated in Fiscal Year 1998 with 86 percent of cases not completed within the 60 days allowed by DHS Policy. In Fiscal Year 1996 and 1997, 50 percent and 59 percent of cases respectively were not completed timely.

There was also a significant increase in the number of cases not completed within 200 days of being reported-- 211 in Fiscal Year 1998 and 13 in Fiscal Year 1997. Many of these cases in our sample lacked documentation of substantive reasons for delay.

Further, OIG Investigation Guidelines in effect during this audit eliminated many of the incremental case investigation timeliness requirements applicable in the last audit. For example, our sample of cases noted a median of 33 days for case review. Previous requirements allowed 3 days for case review.

Case file documentation has improved since the last audit. However, we found that 18 percent (34 of 186) of OIG investigations were missing one or more required documents. In our prior audit, 44 percent of case files were missing required case file documentation.

We continued to find problems with documentation of supervisory review. Of the cases requiring a supervisory case review form and status reports in our sample, 16 percent (30 of 186) did not have the review form and 48 percent (51 of 106) did not contain status reports.

New requirements established in statutes have not been fully implemented by the OIG. Statutes now require facilities and community agencies to submit a written response to the OIG in substantiated cases. In addition, the OIG is required to establish an appeals process to resolve differences between the OIG and the facilities and community agencies, and to report all substantiated cases to the Secretary of the Department of Human Services within ten days of a case becoming final.

Again in Fiscal Year 1998, the OIG has not imposed or defined sanctions against facilities although the OIG has had statutory authority since January 1990.

The number of OIG investigators who received all required training has improved. However, 12 of the 30 investigators (40%) were still lacking one or more of the 15 required courses. Our prior audit noted that 17 of 19 (89%) investigators were lacking one or more courses. In addition, the OIG has not monitored the training received by facility investigators who conduct facility investigations and the preliminary investigative steps in OIG investigations. Facility staff training should be monitored to ensure thorough and effective investigations.

OIG and other DHS employees are not reporting to the Department of Professional Regulation (DPR) as required in statutes. We found one instance in our sample of community cases where a private physician misdiagnosed a patient’s condition, but we found no evidence that the instance was ever reported to DPR as required.

The OIG closed investigations conducted by facilities and community agencies which did not meet the standards the OIG uses in their investigations. OIG Investigation Guidelines contain criteria for approving community agency investigation protocols. OIG will begin approving community agency protocols when draft administrative rules are adopted.

The OIG continued to operate as part of DMHDD through Fiscal Year 1997. Effective July 1, 1997 the Departments of Mental Health and Developmental Disabilities, Alcoholism and Substance Abuse, and Rehabilitation Services were merged into the newly formed Department of Human Services.

In Fiscal Year 1998, the Department of Human Services (as successor to DMHDD) operated 19 facilities Statewide. In addition, DHS licenses, certifies, or provides funding for over 350 separate organizations that provide services to the developmentally disabled and the mentally ill in community settings within Illinois.

In 1995, statutes clarified the role of the Office of the Inspector General expanding it to include the authority to investigate reports of abuse or neglect at facilities or programs not only operated by DHS, but also those licensed, certified or funded by DHS. This gives the OIG the authority to conduct investigations at community agencies. The amendment does not require the community agencies to report all allegations of abuse and neglect to the OIG; therefore, there are likely incidents that go unreported.

There are certain important components of an investigation into abuse and neglect. They include: whether the investigation is timely, whether the investigation is thorough, and whether corrective action is taken.

The effectiveness of an investigation is diminished if it is not conducted in a timely manner. Timely completion of investigations is critical for an effective investigation, because as time passes, injuries heal, memories fade, or witnesses may not be located. DHS policy requires that investigations be completed as expeditiously as possible and should not exceed 60 days absent exceptional circumstances.

We recommend that the OIG develop a process to ensure the timeliness in investigations and to ensure that case reports are reviewed in a timely manner. (pp.15-19)

Essential components of an abuse or neglect investigation include thoroughness in the collection of evidence, adequate supervisory review, and a clear and comprehensive final case report. The investigator’s primary responsibility is to collect facts and information in order to accurately determine the manner in which the incident occurred.

Documentary evidence collection has improved since the last audit. However, improvement in overall case file thoroughness is still needed as was also cited in our four previous audits. In our sample of Fiscal Year 1998 cases, we found that 18 percent (34 of 186) of investigations conducted by OIG were missing one or more required documents. In our prior audit, 44 percent of case files were missing required case file documentation. Digest Exhibit 3 shows the percent of documents missing in Fiscal Year 1996 and Fiscal Year 1998. The OIG has improved in many areas.