You asked about the laws governing how deaths of Department of Mental Retardation (DMR) clients are investigated and how they developed.

The law (which comprises statutes and an executive order) currently requires DMR to review the death of anyone for whom it has direct or oversight responsibility for medical care. The review must cover the events, overall care, quality of life issues, and medical care preceding the death. DMR must report all such deaths to the Office of Protection and Advocacy for Persons with Disabilities (OPA), which determines if abuse or neglect was involved. It must also report certain deaths to an Independent Mortality Review Board (IMRB) for its review.

These procedures arose after a December 2001 Hartford Courant series on DMR group home deaths led both the Executive and Legislative branches to review how such deaths were investigated. At that time, several agencies shared responsibilities in a complex investigatory process.

The Executive Branch review led to Governor Rowland establishing a new investigatory procedure. His Executive Order 25, issued on February 8, 2002, required DMR to report to OPA when anyone under DMR care died and established the IMRB to review the circumstances surrounding any death resulting from abuse or neglect. The order also established a Fatality Review Board to investigate the death of anyone with a disability when the OPA director believed an independent investigation was warranted.

Soon after this order was issued, the Legislative Program Review and Investigations Committee studied the issue and proposed legislation, which was enacted in 2003 (PA 03-146). (The committee's complete report is available at DMR Client Safety 2002. ) This act built on the Executive Order's IMRB, creating additional requirements for DMR when clients or people whose medical care it oversaw died. It also directed the OPA director to determine whether allegations that abuse or neglect could have led to a death were substantiated.

This law was amended in 2004 (PA 04-12) to establish a deadline for DMR to report deaths to OPA and shorten the time in which mandated reporters of abuse and neglect of people with mental retardation had to report to OPA. This year, the legislature is considering HB 5199, which codifies the Executive Order's Fatality Review Board and makes other changes to investigatory procedures.

INVESTIGATION PROCEDURES BEFORE FEBRUARY 2002

Before Governor Rowland issued Executive Order 25, the laws and agency policies governing how deaths of people with mental retardation were investigated involved multiple agencies with somewhat overlapping responsibilities in a complex investigatory pattern. The law required OPA to determine if a report of abuse and neglect of a person with mental retardation warranted investigation and, if it did, provide for the investigation. It also required DMR to conduct or monitor investigations and file reports when the agency responsible for conducting or overseeing the investigation (e. g. , OPA or the State Police) asked for them. In addition, the Chief Medical Examiner's Office was involved when a death was sudden or unexpected.

DMR policy called for one of its regional mortality committees to review all client deaths and develop corrective action, where appropriate, and refer certain deaths (e. g. , those involving abuse and neglect or for which the Chief Medical Examiner's Office took jurisdiction) to a state-level Independent Mortality Review Board.

EXECUTIVE ORDER 25

Executive Order 25, issued on February 8, 2002, established a new investigatory procedure. It required DMR to report to OPA when anyone under its (DMR's) care or treatment died, regardless of whether abuse or neglect was suspected. It established an IMRB to review the medical care and other circumstances surrounding such a death that either DMR or OPA believed was caused by abuse or neglect. The IMRB could also decide on its own to investigate a death.

The order also established a Fatality Review Board to investigate the untimely death of anyone with a disability, not just people with mental retardation, that the OPA director believes warrant an independent investigation.

PA 03-146

This act codified much of the Executive Order's procedures. It delineated DMR and OPA's responsibilities in cases when either the DMR commissioner or OPA director believes abuse or neglect caused the death of a person with mental retardation or the IMRB determines a thorough review of the person's care is warranted.

DMR Responsibilities

The act requires DMR to conduct a comprehensive and timely review when a person for whose medical care it had direct or oversight responsibility dies. These could be people in group homes or other community living arrangements or nursing homes. The review must cover the events, overall care, medical care, and quality of life issues that preceded the death. The act requires DMR to provide information and assistance to the IMRB at its request.

The act requires DMR to report to the IMRB on any death (1) involving an abuse or neglect allegation, (2) for which the chief medical examiner has accepted jurisdiction, (3) in which an autopsy was performed, (4) that was sudden and unexpected, or (5) about which the commissioner has questions following his review concerning the appropriateness of care. It requires the board to review any death DMR reports to it.

OPA Responsibility

Unless a court orders otherwise, the act requires OPA to investigate to determine the veracity of allegations that abuse or neglect caused the death of a person for whose medical care DMR had direct or oversight responsibility. It requires OPA's executive director, in consultation with the DMR commissioner, to establish investigatory protocols.

PA 04-12

This act changed how the DMR commissioner reports, and OPA investigates, deaths of DMR clients to which abuse or neglect could have contributed. It codified Executive Order 25's requirement that DMR report to OPA deaths of people placed or treated under the commissioner's direction. But it narrowed the statutory standard for when DMR must report. Specifically, it directs him, when he determines that there is “reasonable cause to suspect or believe” that the death of a DMR client was due to abuse or neglect, to notify the OPA director within 24 hours.

Under the act, OPA must investigate deaths of clients over the age of 18. Previously, it investigated deaths only of individuals between the ages of 18 and 59. All other OPA abuse or neglect investigations (i. e. , those for which there is no death) continue for clients in the narrower age group.

2006 HB 5199

The General Assembly is currently considering a bill that essentially codifies the Fatality Review Board (FRB) created by Executive Order 25. The bill constitutes the FRB with the following six members: (1) the OPA director; (2) the chief state's attorney; (3) and four members the governor appoints, one law enforcement professional with a forensic investigations background, one mental retardation professional, and two medical professionals. The DMR commissioner or his designee serves as a nonvoting liaison to the FRB. The OPA director chairs the board and can assign agency staff and hire experts to help it investigate. Executive Order 25 already requires this composition and respective roles for agency heads.

In addition to its mandate under the executive order to review referrals from OPA, the bill allows the FRB to investigate deaths of people for whom DMR has direct or oversight responsibility for medical care and whose deaths it believes were caused by abuse or neglect. Paralleling the executive order, it requires DMR, whenever someone for whom it has such responsibility dies, to report the death promptly to OPA, regardless of whether abuse or neglect is suspected. To facilitate prompt investigations of untimely deaths, the bill allows the OPA director to refer cases to the FRB before the IMRB finishes its review of medical care and other circumstances surrounding DMR client deaths. This authority already exists in the executive order.

The bill also requires the Department of Mental Health and Addiction Service (DMHAS) promptly to report to OPA the death of anyone (1) who has a psychiatric disability, substance abuse disability, or both and (2) for whom DMHAS has direct or oversight responsibility for medical care and treatment because he is receiving inpatient treatment at a state-operated or –funded hospital.

Finally, the bill requires the FRB to report annually on its investigations beginning February 1, 2007 to the governor and the Human Services and Public Health committees. Executive Order 25 requires annual reports to the governor and Public Health committees.

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