KEY POINTS:
An unlikely advocate for residents at homes for the disabled has shaken up the system.
"Approximately two years ago one of the clients tried to commit suicide by putting her head in a bucket of water. The bucket was only half full so she was not successful. During a discussion about this ***** said: 'She should have used a full bucket.' I was shocked about this remark so I went to the CEO and told her about it. She said she would deal with it. Later the CEO came to me and said: 'We need to allow staff to speak their minds without being politically correct." - Report into alleged mismanagement and possible serious misconduct by senior managers at Focus 2000, compiled by Eddie Mann, September 29, 2006.
The above excerpt is from an investigation into staffing at homes run by Focus 2000, Auckland's largest disability services provider. As well as showing a lack of proper management and supervision of staff, it uncovers allegations of abuse, neglect and intimidation of disabled residents. "I don't think clients are well treated here," says a section of the Mann report covering claims of bullying and assault of clients. "Clients have told me they are scared. They are too frightened to speak up because they will be punished."
The independently compiled report, obtained by the Herald, was commissioned by Focus management when it was alerted to problems by the residents' newly appointed advocate. It comes after extensive audits by the Ministry of Health last year largely gave the company a clean bill of health.
But although last year's ministry audits - which followed widespread concerns about the standard of care provided by Focus 2000 - were blind to continued abuse of Focus residents, the ministry did require some changes, among them an overhaul of complaints procedures and the appointment of an independent person as an advocate for the residents.
Enter, in June last year, the unlikely hero of this story - John Carbutt, a 68-year-old former teacher who has cerebral palsy. "The auditors said to Anne Murphy, 'You must get an advocate'," recalls Carbutt. Murphy was chief executive of Focus 2000 but resigned in February. "I'm just five foot one and a half. Anne, I think, saw me as a nice little fellow who would be compliant and do exactly what she wanted. She found different."
For the first five months Carbutt worked as an unpaid volunteer, visiting residents at Focus' 13 Auckland houses. At first the "clients" were cynical.
"A client who was very verbal said: 'What's the point of talking to you? We've talked to everybody over the years and nothing ever changes'."
But Carbutt took his time, having cups of tea or meals with clients to win their trust. Many of the residents, who are at the severe end of the disability spectrum with very limited mobility and unable to talk, use keyboards and screens to communicate.
"The essential thing is that many of clients have cerebral palsy and so do I - that's a bond that we have," says Carbutt remembering a client who burst into tears in frustration at being unable to explain her predicament. "She stopped crying and said, 'I don't have to tell you, because you know'."
"Five clients have complained about ******. They are scared of her because she intimidates them. Now they are so scared they will not complain any more. Some now say far to say go so far as to say they like this caregiver." - Mann report.
What Carbutt heard shocked him. Clients spoke of being frightened, neglected, badly treated and punished. But it was also treatment that Carbutt wasn't entirely unfamiliar with. "This is what I found in my three years in hospital as a kid. It happens in institutions. It's endemic."
Something had to be done. But with many clients afraid to speak, and management seemingly not interested, the way forward was difficult.
"When I first started, I made some direct complaints to the management about certain staff and what was happening to the clients and nothing changed."
Carbutt persisted, widening his sphere of influence to both staff and families of clients. "The staff suspected the clients were talking to me about them - which was quite right. The staff thought I was a spy, but I made a point of getting to know the staff and listening to them and listening to their complaints. And also the complaints of family members." By now he had seen enough. Two staff in particular he felt had crossed a line.
"I have heard **** say to a client, 'If you don't do this I will take your wheelchair away'." - Mann report.
The final straw came after Carbutt had been looking for ways to improve the quality of life for clients sitting in wheelchairs all day. Pets were suggested and after much discussion it was suggested a bird might be suitable. Focus management agreed and residents were excited at the prospect hero. Then Carbutt got a call from one of the house team leaders. "She roared at me: 'What I'm saying is no pets'. I thought: 'You've got no right to decide these things'."
The team leader then took matters into her own hands. "She got on to the clients and she terrified them. She said 'no pets' because they would make more work for the staff. She intimidated the clients to the point where they decided they wouldn't have a pet, and they still don't want them, even though that woman's gone."
Carbutt became increasingly appalled at the behaviour of two key staff. "I can best describe them as marauding elephants. Their tactics were Nazi-like."
He took his concerns to Cathy Sangster, the newly appointed quality manager at Focus. "I said to Cathy, 'This isn't good enough. It's not on. We've got to get rid of these people. The clients are afraid of them."
"I went to Puhinui Rd to see how a client was doing. He was sitting outside. The staff told me they had put him outside because he had been playing up. I later found out this client had been punished by being locked in the garage. I looked in the medication book and found that he had not been given his proper medication for the three previous nights." - Mann report
By now Focus was taking the allegations seriously. It commissioned Eddie Mann from Elm Human Resources to investigate. The proactive response was in sharp contrast to how the company had treated complaints in the past.
In February last year when concerns about the quality of care in Focus homes surfaced, then board chairman Walt Beanland told the Herald: "We have a complaints procedure. It works very well. In 10 years of my being on the board not one complaint has reached board level. Whatever complaints were there have been sorted out."
Mann's report, completed at the end of September, painted the disturbing picture of "a climate of fear and intimidation" within parts of the organisation.
It outlined problems with lack of staff supervision, bullying of staff, inappropriate behaviour towards clients, failure to follow proper procedures, and bullying and assault of clients. The report concluded some of the actions of two staff constituted serious misconduct.
Mann found the company at fault, too. "I also conclude that the company has contributed to this situation either through inadequate supervision, lack of training, and a failure to follow comprehensive management practices."
He said the company had little alternative other than the dismissal of the two managers. Faced with the evidence, one manager resigned. The other was dismissed but is contesting the dismissal.
"I heard **** say,'What will I do with this accident and incident report?' **** said, 'Shred it'." - Mann report
"This board won't tolerate poor levels of care and the management in Focus won't tolerate that level of care either," says Craig Hobbs, the new chairman of a replenished Focus board.
Hobbs was sent, anonymously, a copy of the Mann report when he was made chairman in November. At that stage, Murphy hadn't resigned. So was someone in the company still concerned that the problems weren't being addressed?
Hobbs said the issues had largely been dealt with when he arrived. "When you have about 800 employees, there are always one or two who don't appreciate the systems or the way we would like things to be done."
He is circumspect about Murphy's departure. "Some of that was to do with differences with the board. She handed in her resignation and it was accepted."
Hobbs is adamant that processes are in place to ensure what the Mann report outlines doesn't happen again.
"We have an independent advocate within the homes now. We have a quality manager and we have a process and systems handbook which outlines clearly how staff should operate."
Hobbs says that as well as having a proper complaints procedure, the company is spending more on training to ensure staff fully appreciate what their roles entail.
Carbutt says that although the moves are steps in the right direction and much has improved for residents in the Focus homes, there is more to be done.
He points out that the problems at Focus affected staff as well - with allegations of bullying and not following proper procedures.
"More than one of the staff told me they were afraid of some of the management. We lost some very good carers because of that. They resigned."
He says the disability services industry has yet to face up to some fundamental problems. "Staff get very little basic training. They are paid very low wages throughout the caring industry. When you pay peanuts you sometimes get monkeys."
Carbutt says some progress is being made at government level to set standards and develop a formal educational structure for caring professionals.
He is quick to point out that Focus does have some very good staff and that "the best carers there are magnificent".
"One client complained about a caregiver who did not handle their needs when they wanted to go to the toilet . If they asked to go, the caregiver would get annoyed and would put them on the bathroom floor and leave them there. When they wet themselves she would get angry at the clients and refuse to change them. Also, the caregiver would leave clients in their wheelchairs so long they would wet themselves. I advised the CEO of this, but I do not believe anything was done about it." - Mann report
As submissions to Parliament's Social Services Committee disability inquiry attest, what has happened at Focus is not unusual. The inquiry was in part prompted by concerns about mistreatment by Focus staff which surfaced a year ago.
Such problems are widespread. The National Party's disability issues spokesman, Paul Hutchison, says submissions to the inquiry show the Government disability strategy, which aims for those with disabilities to lead an ordinary life, isn't working.
Hutchison says that deinstitutionalisation of disability services, which began in the 90s, has been a process of re-institutionalisation into smaller units throughout the country.
The Focus houses are just one example of mini-institutions with their attendant rules and regulations.
Submissions to the inquiry also demonstrate just how vital the role of the advocate is for the industry.
"A lot of these people can't speak for themselves so having strong advocates is fundamental," says Hutchison. "What the submitters are saying is that the advocacy groups have not been given the support and are not being listened to properly."
The point is underlined at Focus, where Carbutt is still negotiating to be properly compensated for what he does.
Another theme emerging is that care providers such as Focus are "audited to death". Different Government agencies, each with their own preoccupations - such as finances, safety and health - conduct a stream of "tick box", seemingly meaningless audits that have little emphasis on individual quality of life.
In Focus' case, despite regular auditing procedures going back to 1997, the Ministry of Health has been unable to stop abuse and neglect.
Asked if it was doing anything to improve its auditing, deputy director-general for disability services Geraldine Woods said the ministry was satisfied with the robustness of its auditing processes.
Asked why the Mann report was able to uncover present and historic problems of abuse, neglect and intimidation by Focus caregivers when 10 years of ministry audits failed to do so, Woods said the ministry was aware of the Mann report but had not seen its contents so could not comment.
Building on success
To visit Focus 2000's offices in Coyle St, Sandringham is to see an organisation rebuilding - literally. A $2 million building programme to house rehabilitation, conductive education and administration services is nearing completion.
Inside, specialist Hungarian-trained "conductors" work with parents teaching children with cerebral palsy "to learn to learn". On slatted wooden plinths, children as young as 6 months follow the structured programme - repetitive movements and activities with songs, chants and rhymes designed to stimulate and awaken the child senses. Early intervention is crucial says lead conductor Erzsebet Zatrok. "If a child can start to learn early they can reach their full potential."
Conductive education is one of the many faces of Focus 2000, a $20 million-turnover company that provides home-based as well as community living services for people with disabilities.
Much of what Focus has become is attributable to the work of former chief executive Anne Murphy who despite her iron-fisted management style is credited with developing the company's conductive education section and its multimillion-dollar business.
But she has attracted criticism because almost all Focus funding comes from the Ministry of Health, which contracts the company to provide disability services. Since its formation in 1996 as a tax-exempt business of the Cerebral Palsy Society, Focus has consistently accrued operating surpluses and by using them for investments has accumulated a cash pile of almost $10 million. Some is wisely put aside as a contingency fund for unforeseen events.
About $2 million is being used for the new building and $5 million is earmarked for an endowment fund for people with cerebral palsy.
But some have questioned whether this is a correct use of taxpayer-provided ministry funds, and whether the accrual of excessive surpluses for empire-building has diverted money away from providing proper care for Focus' disabled clients.
"The ministry has been clear with Focus that its funding is for its clients," says deputy director-general for disability services Geraldine Woods. But she is less than forthcoming when asked about the $5 million endowment fund, the subject of a dispute in the High Court between members of the former and present Focus boards.
The Herald sought comment from Murphy but was told through her lawyer that she was out of the country until June. Lawyers for the other parties in the litigation opposed the Herald seeking access to the court file, saying that disclosure of the documents could jeopardise settlement attempts.
