Starvation case shows abuse in state system

Dayton girl’s death leads to a review of policies protecting the disabled.

HANDOUT Mary Kilby, an RN who oversaw the care plan and Medicaid eligibilty of 14-year-old Makayla Norman.

HANDOUT Angela Norman, mother of 14-year-old Makayla Norman who died March 1 from neglect.

HANDOUT Kathryn Williams, an RN who supervised the care of 14-year-old Makayla Norman.

Makayla Norman's case highlights the holes in the safety net of a system where officials say fraud is a massive and growing problem. While a criminal investigation is on-going officials also say they are looking into how the girl was lost in the system.

HANDOUT Makayla Norman's case highlights the holes in the safety net of a system where officials say fraud is a massive and growing problem. While a criminal investigation is on-going officials also say they are looking into how the girl was lost in the system.

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By Josh Sweigart and Doug Page
Staff Writers Updated 12:00 PM Sunday, January 8, 2012

DAYTON — In the year leading up to 14-year-old Makayla Norman starving to death in her home, the home care agency responsible for feeding her received nearly $1 million in Medicaid funds caring for Makayla and 112 other disabled clients.

Makayla was caught in an extensive bureaucracy where officials say fraud is a massive and growing problem, and where regulators are swamped with thousands of allegations every year. Government officials say they’re reviewing their systems to determine how she got lost.

Makayla, stricken with severe cerebral palsy and unable to speak, walk or feed herself, was cared for at home under a program intended to keep her safe with her family rather than in a more expensive nursing home, saving taxpayers money.

State officials, citing state and federal privacy laws, declined to say how much taxpayers paid for Makayla’s care through Medicaid.

At her death March 1, Makayla weighed 28 pounds, her unwashed body covered with open bed sores, some packed with her own feces.

The Montgomery County Coroner ruled her death a homicide by reason of medical and nutritional neglect. Her only source of nutrition was the five to six cans of Ensure — an over-the-counter dietary supplement — she was to get daily through a feeding tube.

Her mother, Angela Norman, and three nurses — Molly Parsons, Kathryn Williams and Mary Kilby — charged with Makayla’s care, are facing criminal charges. Parsons and Williams worked for Exclusive Home Health Care of Huber Heights. Parsons provided the daily care, and Williams — a registered nurse — supervised that care and reported back to Exclusive monthly the state of Makayla’s health. Williams was to see Makayla every month.

Kilby worked for CareStar of Ohio as case manager for Makayla to ensure her eligibility for the program, to develop her care plan and to check that the care plan was followed. Kilby was to see Makayla every six months.

Both Exclusive and CareStar worked as proxies for Ohio Department of Job and Family Services under separate contracts. ODJFS had no face-to-face contact with Makayla or any of the other disabled children for which it is responsible.

Despite the oversight of two health care providers and a state agency, Makayla lived the last year of her life in horrific conditions.

“We don’t get cases like this. She was the worst malnourished child I think we’ve ever seen,” said Ken Betz, director of the Miami Valley Regional Crime Laboratory and Coroner’s Office.

Home care

Parsons, 41, of Dayton, a licensed practical nurse for Exclusive, had cared for Makayla for 11 years, Dayton homicide Detective Rebecca Rose testified at Parsons’ bond hearing. The grand jury indicted Parsons with involuntary manslaughter. She remains in the Montgomery County Jail on $250,000 bond.

Parsons filled out daily nursing reports, showing she worked up to 48 hours a week, caring for the child. Rose testified that witnesses, however, reported seeing Parsons at the family home only three to four times a month.

Those daily reports were given to Williams, 42, of Englewood, a registered nurse hired by Exclusive to supervise Parsons’ work and monthly check on the care given Makayla. Williams’ reports on Makayla’s care — based on Parsons’ reports — were forwarded by Exclusive to ODJFS. None of the reports indicated weight loss, bed sores or any abnormal physical problems for Makayla. The grand jury indicted Williams on charges of failing to report neglect or abuse.

Makayla’s mother, Angela Norman, 42, of Dayton, like Parsons, was indicted on charges of involuntary manslaughter and remains jailed on $250,000 bond.

Exclusive was the subject of 20 investigations by the Ohio Department of Job and Family Services, in 2010 and 2011, according to a Dayton Daily News analysis of state data. Only three were substantiated. By comparison, the data had 10 other home care agencies in this region with more than a dozen substantiated complaints in the past two years.

A spokeswoman for Exclusive owner Sheila Grubbs said Grubbs cannot comment during the ongoing investigation. Dayton police detectives have praised the cooperation of Grubbs and Exclusive in the police probe of Makayla’s death.

Oversight

The Ohio Department of Job and Family Services, meanwhile, is reviewing the strength of its safety net, and how it failed to protect Makayla.

ODJFS pays CareStar of Ohio roughly $30 million annually to act as its proxy to oversee various Medicaid programs, including the one that covered Makayla.

ODJFS relied soley on reports prepared by CareStar and Exclusive that Makayla was getting the care for which taxpayers were paying.

Mary K. Kilby, 62, of Miamisburg, Malayla’s CareStar care manager, was responsible for ensuring Makayla received the proper care by reviewing Exclusive’s reports and visiting the child every six months. Dayton police detectives said Kilby had visited the home five days before Makayla’s death. A Montgomery County grand jury indicted Kilby on a charge of failing to report abuse or neglect.

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Some issues reported by CareStar in home care programs statewide July-September 2011:

Alleged violations
Abuse	84
Neglect	81
Abandonment	14
Exploitation	45
Inappropriate service	242
Theft of money	50
Theft of property	85
Theft of meds	97

Amount of criminal restitution orders and settlements for Medicaid fraud secured by the Ohio Attorney General’s Office last year:


$30 million	Roughly the amount paid annually to CareStar to administer home care waiver programs for the Ohio Department of Job and Family Services.
$933,607	Amount paid to Exclusive Home Care Services of Huber Heights to care for disabled individuals in 2010.
6,963*	Number of investigations of providers handled by CareStar and ODJFS this year and last statewide.
3,665	Number of allegations found to be substantiated.
536	Number of substantiated allegations in the Miami Valley in 2010 and 2011.
20	Number of substantiated neglect and abuse allegations in the Miami Valley in 2010 and 2011.
14	Age of Makayla Norman, who died in her home on March 1, reportedly due to neglect.