A meeting with Tennessee's Deputy Gov. Claude Ramsey and Department of Intellectual and Developmental Disabilities (DIDD) chief Jim Henry yielded no headway for Manchester disabilities agency Now I Lay Me Down To Sleep in its attempt to keep the doors open.
Now the supported-living agency for the disabled is closed permanently.
The Manchester Times first reported in late September that the agency's contract was being terminated by Henry for "convenience" and not for cause. But in an Oct. 2 meeting in Nashville several alleged causes surfaced, and agency operator Joyce Harris wasn't given the opportunity to present her case, which she claims proves that the state is wrong in its reason for termination.
Terminating a contract for convenience is a way for the DIDD to end the contract without providing a cause. A cause would need to be proven and could lead to litigation, Henry said.
In a letter penned by Henry and dated Oct. 5, Henry wrote that his decision to terminate Harris' contract stood despite her pleading her case.
A portion of the letter to Harris reads, "I very much appreciate the opportunity today to discuss the decision to terminate for convenience the contractual agreement between you and DIDD. Even though the discussion today was appreciated, DIDD stands by the decision to terminate Now I Lay Me Down To Sleep's contract for convenience."
Although the letter was dated Oct. 5, the word "today" in the letter indicates it was actually written the same day of the meeting. Henry's office confirmed that it was written the same afternoon of the 2 p.m. meeting.
"I have determined the letter dated on Oct. 5 was initially drafted the afternoon of the meeting," said Missy Marshall, director of communications with DIDD. "The word 'today' was probably an oversight in editing."
The Manchester Times obtained a recording of that meeting in which Ramsey stated he was not interested in a petition provided by Harris or in seeing alleged proof that the state was treating her unfairly.
"We don't have time to prove anything," Ramsey could be heard saying on the recording when Harris offered proof that a recent quality assurance survey was tampered with.
The survey scored Harris' agency with a 36 and as having "significant concerns," a downgrade from a "fair" rating in 2011. A score of 38 would have moved Harris' agency to a "fair" rating.
Harris also tried at the meeting to distribute a petition with 1,200 signatures in support of her agency and she was stopped by Ramsey.
"If we could, let's concentrate on why your con-tract was terminated," he said on the recording when Harris offered to pass out the petition.
When asked by the Manchester Times in September why Harris' contract was being terminated for convenience, Henry offered no comment on the record, only saying it was in the best interest of the state and the agency. However, Ramsey indicated early in the Oct. 2 proceedings that the quality assurance survey was the reason.
"I think that's (survey) the basis for the contract being stopped," Ramsey is heard saying.
The survey in question gets disputed when it reaches the last two categories: provider capabilities and qualifications; and administrative authority and financial accountability. In her 2011 survey, Harris scored a six and a four in those categories, respectively. In 2012, she scored a zero in both. In the other seven domains, Harris' score either remained the same or improved from 2011 to 2012.
A six signifies substantial compliance - the best score a category can receive. A four is defined as partial compliance, a two is minimal compliance and a zero is noncompliance.
"In a year's time, how did this happen?" Harris asked in the Oct. 2 meeting. "Did I lose my qualifications and abilities? I improved on everything except the last two. I'm just as capable and my qualifications are just as good right now as they were in 2011."
Henry followed by saying that it wasn't a new problem.
"This has been a problem since the agency start-ed," Henry can be heard saying on the recording. "The timeline is there. In May of 2011 survey issues include no vehicle inspections, background and registry checks done inappropriately, inadequate health care services, inadequate self-assessment and deficiencies in staff training.
"In April of 2012 there were four open investigations."
Harris replied, "I actually had five [investigations]. They were all unsubstantiated. But during that time these investigations were going on the survey team came in and did the survey so they were tainted against me from the beginning."
Harris told the Times the investigations were unsubstantiated and closed.
"Those are old investigations caused by disgruntled employees at a home I once had in Winchester," said Harris. "They were all unsubstantiated and closed. [Henry] should not even have mentioned them. He was just trying to look good in front of [Ramsey]."
The Times obtained copies of the investigations and each claim was marked "unsubstantiated."
Harris went on to explain some of the deficiencies Henry pointed out.
"Two people I hired in August  - someone made a typo error and put down the training was done on August of 2012 and I got that here if you want to see it. [Surveyors] are human, too. They make mistakes. But when they make mistakes I have to pay for it and there is nobody to listen to me. I can prove to you this is not true. There were not medical errors.
"[In one instance] in the Winchester home our employee pushed [medicine in a bubble pack] out of the wrong date. That does not hurt the client. A medical error is giving the wrong medicine to the wrong person. Because the care-giver had pushed the medicine out on the wrong date, the nurse said this is a medical error and it will be out of sequence for the rest of the month. So for the rest of the entire month my workers had to turn in a medical variance. If you take the pill out of the bottle it's no different."
The 2012 quality assurance survey points out several deficiencies, but most Harris refutes and has documented proof that some claims by the survey are not accurate.
In the domain of health, the survey claims annual physicals for patient Jessica Harris were completed late and documented information was not presented to the prescribing practitioner for psychotropic medication review. But documents obtained by the Times show that Jessica Harris visited the doctor for physicals on March 2, 2010, June 23, 2010, May 19, 2011, Oct. 27, 2011 and Nov. 23, 2011. She isn't due for another physical until next month and only one is required per year, according to Harris.
The Times also obtained doctor visit records that indicate that on at least six separate visits information was provided to the prescribing practitioner involving psychotropic needs and concerns.
In domain nine, regarding provider capabilities and qualifications, Harris was scored a zero for non-compliance. But the survey shows she was compliant in eight of the 14 subcategories. A score of minimal compliance (two) would have pushed Harris into a "fair" rating.
The Times reached out to quality assurance director Michelle Smith for explanation of the survey and to verify only one physical is required per year but was redirected to Marshall's office.
How it works
In Harris' supported-living program, grown individuals with disabilities are basically given the freedom to stay in their own homes. In the case of Joyce Harris' daughter, Jessica Harris, she has her own home and can share it with up to two more individuals. Jessica Harris has her own customized bedroom and bath-room, living room, kitchen, a spare room for special equipment and more rooms for a room-mate. She is handicapped with a severe case of cerebral palsy that leaves her unable to talk, walk or feed herself.
The home is staffed day and night by nurses and caregivers hired by Harris and paid by TennCare.
Harris has supported as many as eight clients at one time and accounted for 30 jobs. She had two clients at the time of her closure.
"When I had eight [patients] I was taking care of I was staffing 30 people," said Harris. "That brought a lot of jobs to this area. It was about a $500,000 impact and 84 percent of that goes into wages."
At the time of her con-tract termination, Harris leased two homes for the agency. The individuals she provides for pay for their own food, rent and utilities with their disability checks.
"DIDD provides for care," Harris said.
Those interested in having a family member sent to an agency like Harris' must be approved by the state and, according to Harris, the waiting list is about 6,000 deep. Once approved, Harris is paid through TennCare based on the person's level of need.
"I get so much per individual depending on the level of need," she said. "My daughter requires one-on-one attention. She can't be left alone. There can be people less severe where one caregiver takes care of two people. So it depends on the level of need."
The closest agency to Manchester that provides the same services as Now I Lay Me Down To Sleep is located in Murfreesboro - Pauline and Thomas Healthcare, Inc. It received a "fair" rating in its last Quality Assurance Survey.
Jessica Harris and other area patients approved for the service will need to be relocated.