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MALTREATMENT INVESTIGATION MEMORANDUM Minnesota Statutes, section 626.557, subdivision 1 states, “The legislature declares that the public policy of this state is to protect adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment.”
License Number and Program Type: 1068661-H_CRS (Home and Community-Based Services-Community Residential Setting) Investigator(s): Scott Broady 651-431-6557 Suspected Maltreatment Reported: It was reported that a staff person (SP) took funds belonging to a vulnerable adult (VA). Date of Incident(s): Multiple between May 3 and May 18, 2023 Nature of Alleged Maltreatment Pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (b), and Minnesota Statutes, section 626.5572, subdivision 15, and subdivision 9, paragraph (b), clause (1): In the absence of legal authority a person willfully uses, withholds, or disposes of funds or property of a vulnerable adult. Summary of Findings: Pertinent information for this investigation was obtained remotely, including documentation from the facility and law enforcement records; and through interviews conducted with the VA, an administrative staff person (P), and a family member (FM) of the VA. Attempts to reach the SP for an interview were unsuccessful. The VA’s support plans stated that the VA’s diagnoses included a mild developmental disability. The VA was not subject to guardianship. The VA was at risk for financial exploitation and the FM coordinated the VA’s financial matters. The VA enjoyed activities out in the community. The VA was required to be supervised by staff persons when out in the community. A police report stated: · The FM noted several suspicious transactions when reviewing the VA’s finances. There were several automated teller machine (ATM) transactions that occurred at Kwik Trip and one at Walgreens. The transactions totaled $680. The FM stated that no one was authorized to use the VA’s debit card. The following were the transactions: o May 3, 2023, $60 Kwik Trip in North Mankato o May 4, 2023, $60 Kwik Trip in New Ulm o May 6, 2023, $140 Kwik Trip in New Ulm o May 7, 2023, $80 Kwik Trip in North Mankato o May 9, 2023, $60 Kwik Trip in New Ulm o May 10, 2023, $63.25 Walgreens in New Ulm o May 17, 2023, $60 Kwik Trip in New Ulm o May 18, 2023, $160 Kwik Trip in New Ulm · A law enforcement officer (LEO) obtained video surveillance from the Kwik Trips and Walgreens (the time of the May 7, 2023, transaction did not show a person at the ATM). Apart from the transaction on May 7, 2023, the videos showed the same person making all of the withdrawals. A still shot from a video was shared with an administrative staff person who confirmed that the person was the SP (the SP was also wearing a company shirt). · The LEO interviewed the SP and the SP admitted to being the person in the videos and admitted to making all the ATM transactions with the VA’s debit card. The SP said that one time the VA let the SP use his/her debit card and the SP paid him/her back but added that it was “wrong” for the SP to use the VA’s debit card for the other transactions. The SP stated that s/he returned the debit card to the facility and that s/he did not use any other consumer’s debit cards. The VA told this investigator that s/he kept this/her debit card in his/her bag, but at the facility, the bag was not always next to him/her. The VA stated that someone could take his/her debit card without the VA’s knowledge, but the VA did not know how they would have obtained his/her personal identification number (PIN). The VA stated that s/he did not make any withdrawals from Kwik Trip Stores. The VA said that on a couple of prior occasions, s/he gave her debit card to a supervisory staff person (not the SP) to purchase items for the VA, but that person returned the card and brought the items purchased to the VA. The P stated that the VA took care of his/her own money and managed his/her finances with the assistance of the FM. The VA kept the debit card in a basket by the VA’s bed. The FM stated that the facility did not handle the VA’s finances. The FM discovered the transactions when s/he was checking the VA’s bank statement and thought that the balance was low (the FM provided a copy of the bank statement with the ATM transactions). The ATM transactions were something that the VA did not typically do. The VA also had not been to Mankato and a couple of the transactions were made there. The VA moved to a transitional care facility and one of the transactions was after the VA moved to the transitional care facility. The SP provided the following information to the P. The SP initially denied using any of the VA’s funds and denied knowing where the VA’s debit card was located. When the SP was asked about video footage showing him/her going into a gas station with the VA’s debit card, the SP said that the VA loaned the SP $40 for gas and the SP paid the VA back. This investigator attempted to contact the SP for an interview via telephone and written correspondence, including a certified letter, but the SP did not respond to the requests. Facility documentation showed that the SP received training on the Reporting of Maltreatment of Vulnerable Adults Act. Conclusion: A. Maltreatment: The FM noticed several suspicious ATM transactions (a total of eight between May 3 and 18, 2023) when reviewing the VA’s financial statements. The LEO reviewed video footage of the person making the transactions who was then identified as the SP. The SP admitted to the LEO making all the transactions showed on the video footage. There was no information that any of the money was spent for the benefit of the VA. Because video footage showed the SP making the withdrawals with the VA’s debit card and the SP admitted to making the withdrawals, there was a preponderance of the evidence that a staff person, in the absence of legal authority, willfully used funds of the VA. It was determined that financial exploitation occurred (in the absence of legal authority a person willfully uses, withholds, or disposes of funds or property of a vulnerable adult). B. Responsibility pursuant to Minnesota Statutes, section 626.557, subdivision 9c, paragraph (c): When determining whether the facility or individual is the responsible party for substantiated maltreatment or whether both the facility and the individual are responsible for substantiated maltreatment, the lead agency shall consider at least the following mitigating factors: (1) whether the actions of the facility or the individual caregivers were in accordance with, and followed the terms of, an erroneous physician order, prescription, resident care plan, or directive. This is not a mitigating factor when the facility or caregiver is responsible for the issuance of the erroneous order, prescription, plan, or directive or knows or should have known of the errors and took no reasonable measures to correct the defect before administering care; (2) the comparative responsibility between the facility, other caregivers, and requirements placed upon the employee, including but not limited to, the facility’s compliance with related regulatory standards and factors such as the adequacy of facility policies and procedures, the adequacy of facility training, the adequacy of an individual’s participation in the training, the adequacy of caregiver supervision, the adequacy of facility staffing levels, and a consideration of the scope of the individual employee’s authority; and (3) whether the facility or individual followed professional standards in exercising professional judgment. The SP received training on the Reporting of Maltreatment of Vulnerable Adults Act. The SP was responsible for maltreatment of the VA. C. Recurring and/or Serious Maltreatment: The Office of Inspector General is required to evaluate whether substantiated maltreatment by an individual meets the statutory criteria to be determined as “recurring or serious.” Individuals determined to be responsible for recurring or serious maltreatment are disqualified from providing direct contact services. Minnesota Statutes, section 245C.02, subdivision 16, states: “Recurring maltreatment” means more than one incident of maltreatment for which there is a preponderance of evidence that maltreatment occurred and that the subject was responsible for the maltreatment. Minnesota Statutes, section 245C.02, subdivision 18, states: "Serious maltreatment" means sexual abuse, maltreatment resulting in death, neglect resulting in serious injury which reasonably requires the care of a physician whether or not the care of a physician was sought, or abuse resulting in serious injury. For purposes of this definition, "care of a physician" is treatment received or ordered by a physician, physician assistant, or nurse practitioner, but does not include diagnostic testing, assessment, or observation; the application of, recommendation to use, or prescription solely for a remedy that is available over the counter without a prescription; or a prescription solely for a topical antibiotic to treat burns when there is no follow-up appointment. For purposes of this definition, "abuse resulting in serious injury" means: bruises, bites, skin laceration, or tissue damage; fractures; dislocations; evidence of internal injuries; head injuries with loss of consciousness; extensive second-degree or third-degree burns and other burns for which complications are present; extensive second-degree or third-degree frostbite and other frostbite for which complications are present; irreversible mobility or avulsion of teeth; injuries to the eyes; ingestion of foreign substances and objects that are harmful; near drowning; and heat exhaustion or sunstroke. Serious maltreatment includes neglect when it results in criminal sexual conduct against a child or vulnerable adult. It was determined that the substantiated financial exploitation for which the SP was responsible was not serious maltreatment because it did not meet the definition but was recurring maltreatment because the SP used the VA’s debit card to withdraw money on more than one occasion. The SP was disqualified from providing direct contact services. Action Taken by Facility: The facility completed an internal review and determined that their policies and procedures were adequate but not followed by the SP. The SP no longer worked at the facility. Action Taken by Department of Human Services, Office of Inspector General: The SP was disqualified from a position allowing direct contact with, or access to, persons receiving services from programs, organizations, and/or agencies that are required to have individuals complete a background study by the Department of Human Services as listed in Minnesota Statutes, section 245C.03. The determination that the SP was responsible for maltreatment and the disqualification of the SP are each subject to appeal.
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