Marquis v. Maine Department of Health and Human Services

Superior Court of Maine·Decided October 4, 2022·No. CUMap-21-007·Unpublished

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

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.)

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

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:

[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.

On March 13, 2020, through counsel, Ms. Marquis appealed the substantiation by submitting a Level I Substantiation Fair Hearing Form. (CR 130-31.)

After a three-day hearing in November 2020, the Hearing Officer issued a detailed Recommended Decision concluding that the Department had correctly found a Level I Substantiation. (CR 12, 33.) His conclusions and factual findings were adopted in a Final Decision by the Department. (CR 1.) The Final Decision concluded: "Ms. Marquis' actions and failures to act support a substantiation for abuse or neglect at a Level I." (CR 3.) Ms. Marquis now asks this Court to rescind or reduce the substantiation.

SOC STANDARD OF REVIEW

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