Suit seeks to reduce prolonged hospital stays for those with developmental disabilities

Shawn Murinko needed less than two months of medical necessary care at Harborview Medical Center in Seattle, according to a lawsuit, but he spent eight months there.

When he got out, Murinko joined with Disability Rights Washington to sue the leaders of the Department of Social and Health Services and the Health Care Authority in an effort to prevent other developmentally disabled Washingtonians from getting stuck in hospitals for months at a time, instead of receiving supportive services in the community.

Before going to Harborview, Murinko, who has developmental disabilities and requires support and care, was receiving 24/7 residential services at his home, living with his wife and two children as well as working, the lawsuit states.

But that changed last Halloween, when he suffered an injury while trick-or-treating with his children and broke both of his legs. He was hospitalized but was ready for release by early December. He could not be released, however, because the Developmental Disabilities Administration stopped paying his supported living services provider, which in turn stopped his services, the lawsuit alleges.

DDA and DSHS deny this claim in court documents, though they do acknowledge that Murinko was not discharged from Harborview until June 28.

DDA officials would not comment on the pending litigation.

Murinko’s attorneys filed a motion Thursday that says he is still not receiving 24/7 services at his home, as he was before his hospitalization, placing him “at imminent risk of another prolonged hospital admission.”

Sarah Eaton, an attorney with Disability Rights Washington, said there is no mechanism currently in place to keep providers on hand to continue providing coverage for a person who is discharged after a foreseeable hospitalization occurs. Currently, contracted care providers for DDA clients are not required to accept a client or can terminate them at will, she said.

“One protection we’d like to see is the ‘no reject, no eject,’ ” she said. “There’s lots of ways this could happen.”

Court documents show that Murinko spent most of his time in the hospital trying to piece together his care again so that he could be discharged. When a DDA-eligible person needs to apply or re-apply for services, it can be a lengthy process, said Betty Schwieterman, the state ombuds at the Office of Developmental Disabilities Ombuds.

“They have to start a whole process where they put out a packet of information about the person and put it out to all the providers and see who has an opening. … So you’re starting that whole process, which can take months and months,” she said.

In some cases, this has led to unnecessary or lengthy hospital stays, according to a 2018 report from Schwieterman’s office. Nurses and social workers told the ombuds that some DDA clients were even brought to the hospital when they did not have a medical problem.

“Sometimes, people with developmental disabilities are transported to emergency departments, even when they don’t have a medical need, because they don’t have anywhere else to go,” one registered nurse says in the report.

The problem is statewide, Schwieterman said, and it impacts DDA clients of all ages. The report makes several policy recommendations to address the issue, including tracking more data.

“We know it’s a bigger problem than what we see and what is in the report, and we wanted to know more about why people were ending up in the hospital,” she said.

Working with the legislature, the ombuds were hoping legislation would pass to authorize DDA to collect more data in order to get a broader picture of the problem.

“Through the legislative process, it was pretty frustrating because what we ended up with was this little bit of data collection (but) it’s not going to give us the full picture,” Schwieterman said.

The Ombuds report recommends requiring incident reports from service providers when they have a client go to the hospital or emergency department. It also recommends that providers file incident reports when they terminate services or discharge a client.

Schwieterman said her office has received numerous complaints from around the state in the last year about prolonged hospitalization of people with developmental disabilities. There are 48,356 Washingtonians enrolled with the DDA, including both adults and children as of July 2019.

The majority of people with intellectual and developmental disabilities in the state receive care at their homes and live with their families. About 34,000 children and adults who are enrolled with DDA residing in the community receive a paid service, data from the department show.

The 2018 “Stuck in the Hospital” Ombuds report suggests expanding services and increasing wages for care workers. The Community Residential Services Association of Washington reports a 49% turnover in community residential care workers.

“We want a stable workforce, because you get to know a person, and if they are having a kind of medical issue, you want to have people who know that person to see if something is different today,” Schwieterman said.

The report also suggests an increased financial investment from the state, so the providers can hire and maintain their workforce.

As for Murinko, his attorneys are asking the state to provide his support services either permanently or until they can find a permanent provider to offer the same care.

Most DDA clients in the state are served through contracted companies, but the state does offer state operated living alternatives, or SOLA, that serve a couple hundred people.

“We’ve asked for SOLA for Shawn, and systemically we see that as a way forward because it’s a program that there’s a need for,” Eaton said.

Attorneys representing Murinko and Disability Rights Washington have requested oral arguments on their latest motion for injunctive relief on Sept. 20.