Serious incidents prompt review of Winnipeg agency contracts for vulnerable adults

The Winnipeg Regional Health Authority is overhauling the way it deals with some of the city's most vulnerable adults in the wake of three serious incidents, the CBC I-Team has learned.

Over the last 18 months, two clients were involved in fires in their rooms and another was found dead in his suite, all while the WRHA was supposed to be helping them cope in the community. The health authority had contracted Teskey & Associates to provide support services for all three.

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WRHA incident reports into the two fires obtained by CBC News raise questions about the level of support the clients received. Teskey & Associates received per diems for each client in care but both reports note"funds paid do not correlate to services provided."

"It really made us rethink and re-look at how we were managing this program and the due diligence we were applying," said Real Cloutier, chief operating officer of the WRHA.

The health authority is now in the process of reviewing the contracts for some 50 agencies that provide services to more than 300 adults at an annual cost of $23 million.

Cloutier said the client group is largely comprised of people in their 40s and 50swith complex mental health and behavioural issues who, up to 15 years ago, may not have survived into later adulthood and who might otherwise be homeless.

They don't fall under existing programs, Cloutiersaid, so the WRHA has had to hire outside agencies to care for them under "special contracts" as a harm reduction measure to ensure the adults are off the streets and not clogging up emergency rooms.

Teskey & Associates is one of the larger agencies involved. The WRHA paid the company $4.4 million in 2015 to support roughly 50 adults in the community.

'Not as good as it could have been'

"I'd be the first to admit to you that the contracts and the funding that went with the services that were identified, was not as good as it could have been," said Cloutier.

"We're also doing a care and financial review," hesaid. "That will take a little bit more time."

While the WRHA review is underway, the health authority is not placing any new clients with Teskey & Associates.

The provincewhich also has separate contracts with Teskeytold CBC News it is not referring any additional clients to Teskey & Associates until the WRHA review is complete.

In 2015 Manitoba Justice and Family Services paid the agency $1.5 million. Justice hired the company to provide services to youth with mental health needs who have been convicted of a serious offence. Family Services contracts the agency to help people with mental disabilities who have a history of run-ins with the law.

The province said it is not aware of any additional serious incidents involving the agency but is prepared to arrange alternate care plans for clients if needed.

Client charged with arson

The first fire occurred in the late evening in October 2014 in a Young Street rooming house which, at the time of the report, housed eight of Teskey's clients. Police charged the 32-year-old client with three arson-related counts. The blaze caused $25,000 in damage.

The WRHA report stemming from that fire notes there were no agency staff on site at the time of the fire and questions the level of staffing present given the amount of money the health authority was paying the agency in per diems for each client in the building:"If there could be at least 3.0 EFTs[full-time positions]for 24 hrs staffing, why is there significantly less staff presence for this vulnerable population?"

The report questioned whether having a trained staff person in place might have defused the situation.

"There were several points identified as opportunities for intervention which may have prevented the incident," the report stated."A professional staff person out on the floor, may have reacted faster, or consulted with on call staff."

While there were no staff people onsite at the time of the fire there was a security guard present.

"Using Security Guards may be problematic because they may not have the training or capacity to work with such a high risk, high needs population," saidthe WRHA incident report. It also said it isn't clear whether the use of a guard had WRHA authorization or not, but later states "it must be considered as permitted under the Agreement for Services."

Client plans 'vague or non-existent'

The report also states the "client contracts and their respective individual program plans are vague or non-existent."

Despite no clear contractual obligations, Teskey&Associates was receiving differing rates per client. The report noted,"it was nearly impossible to justify the varying levels of per diem costs that were being paid."

The report makes five recommendations to improve the service, including greater clarity in the contracts.

The second fire occurred in March 2015. The early morning fire was ruled accidental but involved a client suspected of solvent abuse. This time three people were sent to hospital and other tenants were trapped in their third floor apartments. The report notes there were no Teskey & Associates staff on site at the time of the fire.

That report echoes most of the same concerns and recommendations as the report from the first fire six months earlier.

"Quite frankly the gaps were the same," said the WRHA's Cloutier.

Significantly, the report on the second firelike the first one, said: "Contracted funding paid does not correlate with actual services provided. Given the funding in this case, it appears there could be at least 3.0 EFTs[full-time positions]for 24/7 staffing but there are significantly less staffing present for this vulnerable population."

"If we're paying for support," Cloutier said, "what kind of support was being provided? And that really gets to the heart of the issue."

If we're paying for support ...what kind of support was being provided?- RealCloutier, COO WRHA

"If we're paying a per diem for somebody to be looked after, what's the plan to look after that person?" said Cloutier.

Teskey & Associates declined an interview but in an email to CBC News, the company's president, Harris Teskey, said the WRHA's fire incident reports "are not factually accurate, and were materially in error with respect to some of the key items reported."

Teskey told CBC News the agency "has decided not to accept referrals for support to any person with a history of arson and/or arson-related activities."

Teskey said that in both fire incidents the WRHA never requested he provide overnight supports. One of the fires happened at about 6:00 a.m.and the other was around 10:00 p.m.

In his email to CBC News, Teskey maintained the support services provided "always match what is billed to the WRHA."

"Teskey & Associates Inc. deeply cares about the clients that we serve and their well-being," he wrote. "We are constantly striving to evolve and improve the delivery of our supports."

We are constantly striving to evolve and improve the delivery of our supports.- Harris Teskey, president, Teskey & Associates

The CBC I-Team obtained a copy of the contract between the WRHA and Teskey & Associates under a freedom-of-information request, but it contained no specific requirements around the expected level of service or oversight.

The third incident that prompted the WRHA program review involved a client Teskey&Associates was hired, in part, to help with his medication.The 57-year-old autistic man often refused his diabetes medication and ultimately died of complications as a result.

In addition to reviewing the service purchase agreements, the WRHA will now require agencies to take part in a formal reporting process for incidents like fires or missed medication. Significant unexpected events must be reported to the health authority within 24 hours. The WRHA's electronic records system will eventually be expanded to include reports from special contracts agencies.

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