Marquis v. Maine Department of Health and Human Services

CourtSuperior Court of Maine
DecidedOctober 4, 2022
DocketCUMap-21-007
StatusUnpublished

This text of Marquis v. Maine Department of Health and Human Services (Marquis v. Maine Department of Health and Human Services) is published on Counsel Stack Legal Research, covering Superior Court of Maine primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Marquis v. Maine Department of Health and Human Services, (Me. Super. Ct. 2022).

Opinion

STATE OF MAINE SUPERJOR COURT CUMBERLAND, ss. CIVIL ACTION DOCKET NO. AP-21-007

) ANGIE MARQUIS ) ) Petitioner ) ) V. ) ORDER ON PETITIONER'S SOC ) APPEAL MAINE DEPARTMENT OF HEAL TH ) AND HUMAN SERVICES, et al. ) ) Respondents ) ) )

Before the Court is Petitioner Angie Marquis' appeal of a final agency action brought pursuant to

Maine Rules of Civil Procedure SOC. For the reasons set forth herein, Petitioner's appeal is

DENIED.

PROCEDURAL POSTURE

This case comes before the court on appeal of a final agency decision pursuant to M.R.

Civ. P. SOC. Petitioner filed an SOC appeal with the court on March 2, 2021, after a decision by

the Department of Health and Human Services' ("Department") Office of Administrative Hearings

("Hearing Office") to affirm Adult Protective Services' ("APS") Level I Substantiation of

Petitioner for abuse and neglect ofN.F. ("Mr. F."), a dependent, incapacitated adult.

FACTUAL BACKGROUND

The following facts are taken from the record. Residential Community Support Services

("RCSS") is a Medicaid provider pursuant to Chapter II, Section 21 of the MaineCare Benefits

1 Manual. See 10-144 CMR ch. 101 ("MBM"), Ch. II,§ 21. (Certified Record ("CR") 1633, 2159.)

In June 2019, RCSS hired Angie Marquis as its Director of Planning, Crisis, and New

Development. (CR 18.) In August 2019, Ms. Marquis also served as RCSS' Acting CEO. (CR

2095.)

Mr. F. was a 62-year-old man with intellectual disabilities and a significant diabetic

condition that required close monitoring and insulin injections several times per day. ( CR 18, 1877,

1879-82.) Mr. F. also had other complex medical, behavioral, and ambulatory needs. (CR 1877.)

The State of Maine was Mr. F.'s legal guardian. (CR 1980.) Mr. F.'s primary State contact was his

"guardian representative," Patrick Bourque. (CR 1980.) His services and benefits were also

monitored by his case manager, Kelsey Best. (CR 1875.)

Before he became an RCSS client, Mr. F. lived independently with in-home support

services. (CR 1898.) On August 20, 2019, Ms. Best contacted RCSS for a potential Section 21

placement because Mr. F. had been discharged from his home support program. (CR 1904.)

Without home support, Mr. F.'s blood sugar levels had been unstable, and there were concerns

about his diet and whether he was taking his medications and insulin consistently. (CR 1898-1900.)

Ms. Best and Mr. Bourque determined that it was not safe for Mr. F. to continue living without

direct supervision. (CR 18.)

On Thursday, August 22, 2019, Ms. Best and Mr. Bourque went to Mr. F.'s home and

persuaded him to go to the emergency room for an evaluation. (CR 1901-02.) Ms. Best again

contacted Ms. Marquis to ask whether RCSS had found an available placement that would be

appropriate for him. (CR 1908.) Ms. Marquis confirmed with Ms. Best that RCSS had a home

available that would meet Mr. F.'s needs. (CR 2102.) Ms. Marquis then went to the hospital to

complete the intake process. (CR 2154.)

2 Ms. Marquis briefly met with Mr. F and Mr. Bourque before sitting down with Ms. Best to

complete the intake. (CR 1908-09, 2155.) Ms. Best provided Ms. Marquis with information

pertaining to Mr. F. 's complex medication needs, his need for frequent insulin injections, and his

need for regular blood sugar level testing. (CR 1877, 2155, 2157.) Ms. Marquis assured Ms. Best

that RCSS' nurse would train the staff in Mr. F.'s group home on how to monitor and manage his

diabetes, including how to provide regular insulin injections. (CR 1882.) Ms. Marquis said the

training would happen prior to Mr. F's arrival. (CR 1882-83.)

Ms. Marquis then informed Flora Mugeni, RCSS' Registered Nurse, that Mr. F. would be

arriving at RCSS' 11 Humboldt Street home the next day and that all staff at that location would

require diabetes training to be able to administer his insulin. (CR 2108.) Ms. Mugeni responded

that she would prefer to wait until Mr. F. arrived at the home so that she could train the staff based

on the specific insulin and blood sugar testing machine that he used. (CR 2109-10.) Ms. Marquis

agreed to that timing. (CR 2110.)

The transition into RCSS care was difficult. Mr. F.'s transport to RCSS was delayed until

Saturday because his blood sugar levels were not stable. (CR 1891, 2115, 2117.) He was met with

fewer staff than intended. (CR 18.) He arrived without doctor's orders, which meant that the staff

could not administer his medications. (CR 1669.) He arrived without insulin. (CR 2139.) There

was no food at the home for him. (CR 2121.)

Within a few hours of his arrival, Mr. F. began exhibiting symptoms of low blood sugar.

(CR 2123.) RCSS' nurse remotely instructed the staff to give him soda, but she did not go to the

house to test his blood sugar levels, nor was she instructed by Ms. Marquis to do so. (CR 2123,

2184-85.) The situation with his missing insulin was not resolved, and he continued to go without

3 insulin on Sunday. (CR 1685.) Although Mr. F. missed at least five doses of insulin over the

weekend, no missed doses were reported to the Department, as is required. (CR 18, 32.)

On Monday, August 26, 2019, Ms. Marquis learned that Mr. F. had not received any insulin

since he arrived at the RCSS group home. (CR 2138-39.) She decided to step back from the

situation and allow her staff to decide on a course of action. (CR 2175-76.) The course of action

they chose was to wait until Mr. F. could see his primary care physician on Tuesday morning,

allowing him to go another day without insulin and without RCSS' nurse observing him or testing

his blood sugar levels. (CR 1685, 2137, 2143.)

On Tuesday, August 27, 2019, at 8:56 a.m., Ms. Marquis learned that Mr. F. was refusing

to go to his doctor's appointment. (CR 2146-47.) At 10:31 a.m. she learned that Mr. F. was "just

rolling over on the floor and not saying anything." (CR 2149.) RCSS' nurse asked Ms. Marquis if

she should contact Crisis. (CR 2149.) Ten minutes later, Ms. Marquis responded that Mr. F.

"probably needs to go to the ER." (CR 2150.) Ms. Mugeni responded that she had just spoken with

RCSS' Director of Nursing, who was out on medical leave, and that the two of them had decided

that Ms. Mugeni would call Crisis and let them arrange rescue services. (CR 2150.) Ms. Marquis

responded, "Okay." (CR 2151.)

At 12:30 p.m., Ms. Mugeni informed Ms. Marquis that Mr. F. had lost his pulse, that CPR

was being performed, and that 911 had been called. (CR 2152.) The next communication Ms.

Marquis received was that Mr. F. had passed away. (CR 2152.)

On August 27, 2019, APS received a referral regarding possible abuse or neglect of Mr. F.

by RCSS facility staff leading to his death. (CR 377-82.) APS conducted an investigation, and on

March 4, 2020, it issued a Notice of Level I Substantiation to Ms. Marquis. (CR 129.) Specifically,

APS concluded:

4 [T]he facts support a finding by a preponderance of the evidence that Angie Marquis failed to ensure that Mr. F. received necessary medication, failed to ensure that his health and welfare were appropriately monitored, and failed to initiate an emergency response. As a result, Angie Marquis knowingly or recklessly caused a threat to Mr. F. 's health or welfare and engaged in abuse or neglect that resulted in serious harm to Mr. F.

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