Connections 'intentionally limited' patient care advocate's access to records

Article by: Amanda Fries
As Featured on Delaware News Journal | DelawareOnline.org

Connections Community Support Programs is once again blocking key records from being released - this time regarding quality of care to thousands of patients.

Much like the roadblocks U.S. Attorney David Weiss was met with during his quest for records and documents from the nonprofit, Eric Huebscher, of Huebscher & Co. in New York City, was prevented from accessing records that would allow him to monitor the quality of care Connections provided to clients while embarking on a Chapter 11 bankruptcy.

Huebscher was appointed as the patient care ombudsman in late April as the nonprofit embarked on the bankruptcy procedure seeking to sell the majority of its assets to pay down its debt and transition operations to a new owner.

The ombudsman is responsible for ensuring that quality of care doesn't suffer during a business's bankruptcy declaration - a role required for health care businesses that file for bankruptcy.

But in a June 28 report, Huebscher said Connections' management barred access to full patient records as well as its dosing system; denied a request for the addresses of 400 residential facilities Connections' owns or rents; and was forbidden from speaking to patients about their care.

"In summary the (ombudsman) found that access to patients and records was intentionally limited, resulting in both an inefficient and incomplete discharge of responsibilities," Huebscher wrote in his report filed in bankruptcy court. "The lack of engagement by the debtor is concerning. The (ombudsman) believes that the issues identified in this report were substantially existent prior to the Chapter 11 filing."

Connections' executives in recent years have been less than cooperative with officials' seeking records from the nonprofit, which prompted Weiss to call on the federal courts in June to deny the nonprofit's request to delay the federal proceedings against it over fear that the records wouldn't be turned over.

During Weiss' civil investigation that led to the federal charges, Connections' executives requested "repeated extensions of its obligation to produce documents in response to civil investigative demands and then produced its documents piecemeal over a period of many months." The nonprofit then delayed providing requested financial information and "abruptly cut off further discussions," Weiss said in court documents.

The nonprofit quietly filed for Chapter 11 bankruptcy in April, less than two weeks after the federal government slapped Connections and its top executives with lawsuits saying the nonprofit defrauded the government out of more than $4.5 million and failed to adequately document its narcotics distribution.

FEDS ALLEGE FRAUD: Feds sue Delaware nonprofit Connections for false claims, inadequate record keeping

NONPROFIT BANKRUPT: Amid fraud allegations, Connections files for Ch. 11 bankruptcy

FEDS FEAR STONEWALLING: Feds fear missing records if Connections given 120-day postponement on fraud charges

The latter lawsuit seeks civil penalties under federal laws that require organizations like Connections to keep strict records and accounts of their controlled substances they are licensed to dispense. The suit claims that Connections engaged in a long history of failing to maintain such records and in some cases created and doctored records after the fact to appear compliant.

The lawsuit specifically lists former CEO Cathy McKay, current CEO Bill Northey and Connections' general counsel Steven Davis as defendants, claiming the executives failed to adequately train employees and ensure compliance of state and federal regulations.

Connections blamed a culmination of unsustainable lawsuits, federal allegations, the loss of a $60 million contract to provide behavioral and physical health in Delaware's prisons, and the COVID 19 pandemic for the bankruptcy.

Since then, the soon-to-be-defunct nonprofit has pushed for postponements of the federal charges, citing the need to focus on the transition to its new owner, Conexio Care, Inc. The sale of Connections' assets for $12.75 million was approved June 15 in bankruptcy court.

CONNECTIONS SOLD: Pa.-based nonprofit Inperium Inc. to buy Connections for $12.75 million

Attorneys for Connections continue to decline to comment on the case. A woman who answered the phone at Chipman Brown Cicero and Cole, the law firm representing the nonprofit, said on Thursday that they don't talk to press.

When asked for comment on the ombudsman report, and whether any of Huebscher's findings are concerning, Jill Fredel, spokeswoman for the Delaware Department of Health and Social Services, said that the department's "priority during this transition period is to ensure that our clients continue to receive services and care that are safe and of high quality."

Bankruptcy impact unknown

Tasked with ensuring consistent patient care while Connections undergoes bankruptcy, Huebscher struggled to determine whether treatment was negatively impacted by the filing.

Bankruptcy code empowers a court-appointed patient care ombudsman to oversee the "quality of patient care" provided by the debtor during the bankruptcy process, including speaking with patients and doctors, and filing a report on that care quality.

But Huebscher was prohibited from speaking to patients and denied full access to records, which prevented him from independently verifying the totality of patients under Connections' care and determining if each of them had access to their electronic records. He also was denied access to the nonprofit's dosing system, which Huebscher took issue with given the federal lawsuit alleging mishandling of controlled substances.

He also was unable to monitor a key state program Connections participates in – Assertive Community Treatment (ACT) services – because management wouldn't provide addresses to 400 rental units housing Connections' clients. However, audits conducted by the state of Delaware "revealed consistent and unresolved issues with the appropriate staffing levels over the ACT programs," Huebscher wrote.

Of the records he did receive – which included state survey results and corrective action plans, policies and procedures, grievance and complaint logs, and COVID-19 incidence rates, among others - Huebscher couldn't determine whether care had worsened during the bankruptcy.

While the ombudsman was barred from speaking to patients, he received several complaints mostly related to Methadone dosing. He also received some related to housing issues, including fears over whether rent would be paid, and a few about employee conduct.

The ombudsman also expressed concern for the number of overdose deaths occurring in Connections' care. According to the June 28 report, in the previous 30 days Connections had reported five overdose deaths. The nonprofit reported 28 and 77 deaths in the past 180 and 365 days respectively, the report states.

"Based on discussions with several professionals in similar clinical settings, it would appear the in house death rate incidence at debtor facilities is high," Huebscher wrote.

Despite the roadblocks, Huebscher visited a handful of Connections' service sites and spoke with employees who were "engaging and committed to their roles and responsibilities. None of the employees interviewed voiced any level of concern regarding their ability to render care."

Issues uncovered existed pre-bankruptcy

What Huebscher did find were many "alarming" issues that existed before the bankruptcy declaration and continued to persist, including insufficient staffing, a lack of functioning corporate compliance, a lack of internal independent medical chart reviews, and a lack of checks and balances.

During the monitoring period, Huebscher asked Connections management whether any reviews were conducted internally to ensure compliance with state regulations.

No records were furnished, and Huebscher was informed that the nonprofit "relied on the state to provide feedback as to whether the debtor was in compliance."

The extent of the state's oversight of Connections' operations or handling of millions of state and federal tax dollars remains unknown.

A Freedom of Information Act request to the state Auditor of Accounts for any audits of Connections turned up empty. The state Office of Management and Budget told the News Journal on Thursday that individual departments are responsible for management over their third-party contracts.

A FOIA request to the Department of Correction yielded one report - the one conducted by Christiana Care following extensive reporting by Delaware Online/The News Journal of inadequate prison health care, which also prompted the state Department of Justice to investigate. A similar request to the Department of Health and Social Services is pending.

Typically, businesses have robust corporate compliance programs that ensure rules and regulations - from internal compliance measures to federal laws - are followed by all employees. But even though Connections had a program, Huebscher said it lacked any detail on how the nonprofit would monitor its compliance, nor did management provide evidence that employees had been trained or understood their compliance obligations.

Connections also was "unable or refused" to provide evidence that its corporate compliance program had been reviewed internally; found any issues; conducted analysis on the reason for any issues; or whether any correction actions were taken, according to the report.

The ombudsman concluded the nonprofit's reliance on the state to ensure compliance was a "significant and material deficiency in the overall operations" of Connections. Corporate compliance programs are critical and mandatory in order to participate in federally-funded programs, Huebscher said.

The nonprofit's policies on patient rights, how to file a grievance and how to provide input regarding care also were half-baked. The policies outlined requirements, methods for reviewing clinical practices and recordkeeping and described committees responsible for oversight, yet Connections couldn't provide records that the committees existed, Huebscher said.

The ombudsman's "review of many other policies and procedures revealed a similar gap between the requirement and the underlying policy and actual practice," he wrote.

Contact Amanda Fries at afries@delawareonline.com.