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Has anything changed as a result of Anderson Guest House fire?

— By Derek Spellman and Melissa Dunson
news@joplinglobe.com

ANDERSON, Mo. — Even now, almost a year later, Lawrence Henson gets mad when he thinks about it.
“It should not have happened,” he said of the Nov. 27, 2006, fire that gutted the Anderson Guest House, killing 11 people, including his sister, Patricia Henson. “I got aggravated with myself for not saying anything.”

At least once a week, Henson drove to the Guest House to see his sister. Patricia Henson lived a simple life of coloring and needlepoint inside the Guest House, a single-story, cement-block home for the mentally disabled.

During his visits, Henson said, he noted little things indicating problems if the home’s inhabitants needed to evacuate. Many residents were medicated, and there did not appear to be many ways to quickly exit the building.

Even now, he can’t say whether any one person or entity is at fault, and there is still a debate about what has changed since the fire. Henson noted that laws have been toughened and added, “I believe they are making strides.”

But he also said it’s too soon to know if any good has come from the tragedy.

That problem is one of human nature, Henson said, and he is not sure how it could be addressed.

“Every day, we see little things and we don’t say anything,” he said.

The problem is particularly troublesome for the mentally ill, he said, who are left on the edge of society, “out of sight, out of mind.”

“There were so many of them there (at the Anderson Guest House),” he said. “They were put in there, and then they were forgotten.”

Oversight

Jane Drummond previously was general counsel for the Missouri Department of Health and Senior Services.
It was in that capacity that she met with other department officials on Jan. 17, 2006, to discuss how Joplin River of Life Ministries could continue operating group homes in Anderson, Joplin and elsewhere despite a history of violations, and whether the state could shut down those operations.

Referring to that meeting in a Jan. 24, 2006, e-mail to Drummond, Bill Toenis, then the program manager for the department's long-term-care section, wrote that the department should deny applications for the Anderson Guest House and two other homes run by Joplin River of Life Ministries.

Despite the concerns, all three homes ultimately received renewed permits or temporary permits.
Nanci Gonder, a spokeswoman for the state department, has said the agency lacked enough information to deny licenses at that time.

Two weeks before the Anderson Guest House fire, Drummond was named director of the Department of Health and Senior Services.

Today, Drummond said, things have changed with the agency.

Hard look

The department took a hard look at all its procedures in the hope that Missouri will never again be home to such a tragedy, Drummond said.

Two days after the fire, Gov. Matt Blunt ordered the health department to work with the Department of Mental Health to examine oversight of homes such as the one in Anderson. The departments turned in a report and recommendations last December. It was used to encourage legislative action.

Laws have been enacted tightening regulations for residential-care homes like the Anderson Guest House. The health department also added staff, cracked down on noncompliant homes, and changed its annual review and complaint policies.
Drummond said the department will file additional regulations in December or January to enforce new sprinkler legislation for homes with more than 20 residents and other requirements regarding fire-alarm systems. She said the department also is working to better identify consistently noncompliant homes or managers.

And, in the wake of the fire, the agency started checking all managers and owners against the federal list of those excluded from such positions. It makes those checks a part of the department’s regular procedure when granting or renewing a license.
Drummond said no other federally excluded individuals have been found running Missouri homes since the fire.
The state stripped Joplin River of Life Ministries, which operated the Anderson Guest House and three centers in Jasper County, of all operating licenses in December 2006.

It based that decision on evidence that Robert J. DuPont, 62, of Joplin, allegedly continued to play a central role in operating several group care homes — including the Anderson Guest House — despite a previous conviction for Medicare and Medicaid fraud. Federal and state laws prohibit anyone convicted of Medicaid- and Medicare-related crimes from acting as operators of licensed Medicaid homes or participating in any federal health-care program.
There have been other changes.

In the past year, the health department has gotten more rigid with application deadlines and will grant homes only one 30-day extension. Drummond said that in the past, the department was too generous with deadlines, but it now expects owners to complete applications correctly and get them in 30 days before the license expires. She said the stricter guidelines have caused deadline compliance to significantly increase.

Debra Cheshier, administrator of long-term-care regulations for the agency, said officials look at all the information available on a home or owner/manager before approving a license.

“We were not looking at the overall compliance history of facilities,” she said. “And if you don’t do that, you’re only looking at one snapshot, and you don’t get a look at the overall problems of that facility.”

Homes with consistent problems are reviewed and either forced to comply, disciplined or given training. Since the Anderson fire, Drummond said, the department hasn’t closed any homes, but there are several at which that possibility is pending.

Manpower is still a problem, Drummond said, but the department did hire 32 additional staff members in the past year, paid for by a 2005 departmental appropriation in Blunt’s budget. Cheshier said the department has about 170 surveyors and inspectors, up from about 150 last year.

Lawmakers act

Last year, Missouri lawmakers passed measures aimed at strengthening fire safety in residential-care homes and at increasing accountability.

Among the provisions is a requirement that existing residential-care and assisted-living centers with more than 20 residents install residential-grade sprinkler systems by 2012, unless they already conform to certain safety standards. The state offers a low-interest loan program for the sprinkler systems.

Another provision requires that all homes have fire-alarm systems connected to local fire departments or dispatch services.
The sprinkler bill was sponsored by Rep. Kevin Wilson, R-Neosho, whose district includes Anderson.
The original legislation proposed by Wilson called for all homes to be outfitted with sprinklers, regardless of size.

“I would have felt better if all had sprinklers,” he said in a phone interview last week.

The provision was altered after some lawmakers raised concerns that the new requirements would cost homes, especially smaller ones, so much that they would either be forced to close or to pass on the costs to their residents.

Still, Wilson said the exemption applies only to the sprinkler requirements. The requirement for the integrated fire-alarm systems is “the most crucial part” and applies to all the homes, large and small, he said.

Asked whether he plans to propose expanded legislation, Wilson said that will depend on what state fire officials recommend.
The Division of Fire Safety will monitor the new laws to see how they play out, he said. He said that if fire officials think additional legislation is needed, he would revisit the measure.

Companion legislation passed earlier this year raises the reporting requirements and the fines for violations.
That measure calls for final reports of investigations into abuse and neglect to be published, and for daily fines to be increased to $10,000 from $100 for homes that do not correct problems cited in inspection reports.

‘Giving in’

But at least one critic of the state’s oversight machinery argues that changes in regulations do not address the larger issue of whether the state has the will to enforce its laws, new or otherwise.

“There are laws on the books,” said Phyllis Krambeck, secretary for the Missouri Coalition for Quality Care Inc., an advocacy group for the elderly and disabled. “We just feel that they are not always enforced.”

Krambeck said calls for sprinklers in group homes had been sounded years before the Anderson Guest House fire, and that it took a tragedy for the state to act.

She also criticized the exemption granted to smaller homes from the sprinkler requirement and questioned the state’s providing low-interest loans for homes to install safety equipment.

“They just keep giving in more and more,” she said.

She contended that the state has been reluctant to crack down on homes where violations are cited. Even the fines assessed for infractions can be negotiated down, she said.

Aside from the loss of licenses, though, much of the punitive action has been requested in the courts.
DuPont now faces a federal criminal charge of Medicaid fraud because of his alleged role with River of Life Ministries between 2003 and 2006.

And, the state is suing DuPont and the ministry in an effort to recoup about $689,000 in Medicaid payments that the ministry received since DuPont was paroled from federal prison in August 2004.

DuPont; his wife, LaVerne DuPont; Shirley Brannon, administrator of the Anderson Guest House; and River of Life Ministries are defendants in nine wrongful-death lawsuits filed on behalf of fire victims or their surviving family members.
The state’s culpability also is being explored in the wrongful-death lawsuits.

The Department of Health and Senior Services in September was added as a co-defendant to those nine suits for its alleged failure to inspect and certify the electrical and fire-alarm systems in the Anderson Guest House.
The department is asking that the petition against it be dismissed.

Drummond said the fire was “an absolute tragedy,” but she thinks the department did its job and the state will be exonerated by the case’s end.

“It was a tragic accident, but as far as we can tell, it’s not something that could have been prevented,” she said.
Krambeck, with the Missouri Coalition for Quality Care, criticized the state for what she considers a failure to take responsibility for its mistakes.

“It’s the blame game,” she said. “They just lay the blame on another department, another person, another agency.”