Abuse, neglect and death: How Texas fails thousands of disabled residents
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The harder Kristi Michelle Norris struggled to break free of the thick, striped belts that secured her to the high-backed wheelchair, the tighter they squeezed her neck and chest. She couldn’t scream for help; the 36-year-old with cerebral palsy couldn’t speak. Alone for nearly two hours in her pastel-colored room, the petite brunette thrashed desperately until finally the belts cut off her breath, government records show.
When Norris’ caregivers at the Fort Worth group home finally found her unconscious with a belt lashed around her throat, they immediately set about concealing her cause of death.
They untied Norris’ lifeless body, dragged her onto the beige shag carpet and stuffed the bloodstained belts at the back of her closet. When one caregiver dialed 911, 12 minutes later, she wailed hysterically, saying that Norris had been crushed by a wooden dresser.
“I wonder how long Kristi suffered,” Joann Pierson, Norris’ mother, said tearfully. “Was she in pain during those moments? What was she thinking in (those) moments? And my mind wanders to why. Why would she ever have to die this way?”
Norris’ death is one of thousands of abuse and neglect cases that state investigators verified in the last two decades in Texas’ beleaguered Medicaid waiver system for individuals with disabilities, according to state data. The horrific incident and her family’s arduous journey to find justice expose deep and perilous failures in how the state and private companies manage the care of some of Texas’ most vulnerable residents.
Norris was one of over 100,000 disabled Texans who receive Medicaid-funded care at home or in residential settings through a system established three decades ago as an alternative to hospitals, nursing homes and state-run institutions. The “waiver system” was supposed to allow them to flourish through personalized services in small settings that better suit their complex needs.
During a yearlong investigation, the American-Statesman found that the system is disastrously underfunded, resulting in an underpaid, overworked and often unqualified workforce that is charged with caring for some of the most defenseless and voiceless disabled Texans. Government records and court documents obtained during the investigation also show the deeply complicated, sometimes secretive, system is severely lacking in oversight from the Texas Health and Human Services Commission. Even as companies struggle to find workers, abuse and neglect complaints climb, and some companies reportedly threaten staff who try to report violations, the state is encouraging care providers to expand to meet the skyrocketing need for care for disabled people.
Drawn by promises of safety and life-affirming care for their loved ones, tens of thousands of families wait years – sometimes a decade or more – to receive these services. Once they do, relief too often turns to tragedy.
Since 2010, state agencies have investigated nearly 80,000 allegations of abuse, neglect and exploitation in the waiver system. About 41,000 of those cases were reported in Norris’ waiver program alone – one of six in the state – resulting in an average of nearly two reports for every individual receiving services in that program, a Statesman analysis of government data reveals. About 10% of allegations were confirmed, but that likely only represents a fraction of legitimate complaints.
The Statesman’s investigation found waiver providers regularly fail to report abuse and neglect cases and notify families of investigations. In some cases, like the Norris investigation, HHSC has failed to punish abusers and the companies who employ them, allowing them to continue serving profoundly disabled clients, records show.
The state’s complex regulatory system enables repeat offenses by allowing abusers to retain access to disabled clients for months and sometimes years, and often forces families seeking accountability for their loved ones’ suffering to sue wealthy, well-lawyered corporate providers.
Combing through thousands of lawsuits filed against waiver providers since 2007, the Statesman found dozens of detailed accounts of sexual and physical abuse, some of which involved cover-ups and resulted in critical or fatal injuries. HHSC declined to provide information about these incidents, but state records indicate that in most cases the providers were not sanctioned.
Among the cases:
In March 2019, a deaf and nonverbal woman with acute Down syndrome was sexually assaulted by another client at a day habilitation facility in Collin County. The staff left the victim unsupervised for 45 minutes despite explicit instructions to keep her in sight at all times. Caregivers initially told the victim’s mother that her daughter had tripped. Only after video and medical evidence emerged days later did the staff admit what had happened.
Another waiver client with severe disabilities was beaten and strangled by his caregiver at a day habilitation center in Fort Bend County in November 2019. The caregiver waited 30 minutes to an hour before calling 911, then fled. Records show he was arrested in February for murder.
In February 2018, a 14-year-old girl with Down syndrome was repeatedly sexually assaulted by her caregiver’s husband in Corpus Christi. The girl was left unsupervised with the man after the caregiver insisted on providing care at her own residence instead of the client’s home, as state regulations require. The caregiver is currently facing three felony counts of sexual performance by a child, court records show.
As hundreds of voiceless victims suffered, lawmakers repeatedly ignored advocates’ appeals to invest in the safety of disabled individuals whose lives depend on quality care, the Statesman found after reviewing thousands of pages of government records and collecting accounts from advocates, families and attorneys.
The leaders of Texas Senate and House committees tasked with overseeing HHSC, Sen. Lois Kolkhorst, R-Brenham, who has served on the committee for nearly a decade, and Rep. Frank James, R-Wichita Falls, did not respond to repeated requests for comment.
In a statement, Rep. Terry Meza, D-Irving, said, “The (Texas House) Human Services Committee is very concerned and interested in identifying solutions and providing better funding.”
“I urge the Chairman to convene a hearing to fully vet these disturbing allegations of neglect and abuse in yet another agency,” Rep. Gina Hinojosa, D-Austin, said in response to the Statesman’s findings.
Hinojosa was the only one of 18 lawmakers on the committees to comment on the Legislature’s decades of inaction.
“It is very difficult to keep up with the level of dysfunction in our state agencies right now – everything is broken,” she said. “Absent a change of leadership at the very top, our Legislature remains in a crisis-responsive mode, plugging holes in a dike to avert disaster."
Lawmakers’ inaction is, in part, due to a profound lack of awareness of the magnitude of the suffering, even among officials and advocates tasked with monitoring the unfolding crisis, more than a dozen interviews conducted by the Statesman revealed. Many were shocked when presented with evidence the Statesman compiled.
“I don’t think that anyone is saying anything about the issue,” said Ashley Ford, public policy and advocacy director at the Arc of Texas, one of the state’s largest disability rights nonprofits. “I don’t think that advocacy groups are; I don’t think that (the Texas Health and Human Services Commission) is. It’s just a topic that has gone dark. There are just so many other issues with the system that this just gets glossed over.”
The byzantine and often ineffective regulatory system under which HHSC and care providers operate keeps much of the wrongdoing out of the public eye. For more than four months, the Statesman reached out to the agency in attempts to better understand the system and obtain data and records. HHSC representatives declined multiple interview requests, insisting on providing written statements. In emails, the agency cited legal standards and agency policies, but did not comment on concerns expressed by victims and their families. The agency took months to provide basic information and withheld many requested records, citing confidentiality laws.
“The health and safety of Texans is of the utmost importance to HHSC,” Ty Bishop, an agency spokesperson, said in an emailed statement, adding that, according to the agency’s interpretation, state law prevents it from commenting on abuse and neglect cases.
HHSC Executive Commissioner Cecile Erwin Young turned down an interview request. Gov. Greg Abbott did not respond to requests for comment.
Providers also appealed to privacy laws or company policies in declining to discuss or release information about allegations of abuse, neglect and exploitation of their clients.
D&S Residential Services, the provider responsible for Norris’ care when she died, declined to comment on the case — and dozens of others at its facilities — citing ongoing litigation. In legal filings, the company denied any wrongdoing in the Norris case.
Seeking safety
About this project
A yearlong Austin American-Statesman investigation into a system aimed at providing community-based services for hundreds of thousands of disabled Texans found it on the brink of collapse.
Hundreds of thousands of Texans wait years on some of the nation’s longest waitlists to receive Medicaid-funded services that provide an alternative to institutional care. But often when they do, they face a system plagued by disastrous underfunding, dire staffing shortages and a profound lack of oversight, which is placing both consumers and workers at risk of injury and death.
Kristi Michelle Norris had her first seizures at 9 months old, but as a toddler she was vocal and carefree, her parents said. Her light eyes and long chestnut curls would often turn heads, and she reveled in strangers’ attention, demanding kisses and hugs, her mother said.
By age 3, Norris had as many as 15 “massive” seizures in a day and, then, Pierson said, “it was like turning a light switch off.” She lost the ability to speak that year and was later diagnosed with cerebral palsy, ADHD and other disabilities.
Norris remained a keen observer, drawn by colorful items. She sought out puzzle pieces and studied them, and ripped through magazines, passionately clutching shreds that sparked her imagination. She developed her own language of sounds to communicate her needs and wants, and she laughed often, her parents said.
By age 12, Pierson struggled to contain Norris’ energy and began to fear for her daughter’s safety at home. She initially admitted Norris to a 50-person center for children with disabilities in Denton, and then moved her to a smaller facility closer to their home when the center closed a couple of years later.
There, in 2002, the 18-year-old was sexually assaulted by one of her caregivers, state investigators found. The assault left her with bruises, dark green and purple abrasions across her body, and herpes. Traumatized, her parents applied for waiver services soon afterward. Around 2004, Norris moved to a community home, Pierson said.
By then, most people with disabilities in Texas received care in smaller, home-based settings through waiver programs – the result of a four-decade national advocacy campaign to deinstitutionalize disabled individuals, according to a 2011 report by the Texas Legislative Budget Board.
Experts hoped smaller community settings would shield disabled individuals like Norris from spiraling rates of abuse, neglect and exploitation documented over the years in institutional settings, according to the report.
But the waiver system did not keep Norris safe. Between 2007 and 2018, she was named as a victim in 38 investigations into abuse, neglect and exploitation, HHSC records show.
HHSC declined to provide details about the outcomes of those investigations. However, documents collected by Pierson show that, in at least three of them, investigators confirmed that Norris was neglected by her caregivers.
Abuse and neglect are prevalent in the waiver system, according to data from HHSC and the Department of Family and Protective Services, which oversaw provider investigations until 2017. In Norris’ waiver program alone – one of six offered in Texas – investigators received an average of 3,000 allegations of abuse, neglect and exploitation every year from 2010 to 2021. At least 650 caregivers have been banned from the waiver system for putting their clients in harm’s way or causing their death since 2010, according to a misconduct registry maintained by HHSC that lists some caregivers found guilty of serious offenses.
Pierson tried to protect and advocate for her daughter. In 2009, she called My Health My Resources of Tarrant County, a state-run community center managing her waiver services, and demanded to know why the center “has not held staff accountable for their actions and provided a safe environment for Kristi that is free from abuse and injury,” a letter obtained by the Statesman shows. Yet, a year later, Norris was mistreated again, state investigators found.
MHMR Tarrant Chief of Staff Catherine Carlton declined to comment, citing privacy and confidentiality concerns.
Hope dashed
After years of abuse, trauma and constant worry for their daughter’s well-being, Norris’ parents found a ray of hope in 2017 when they met D&S Residential Services representatives who promised safety and security for their daughter. Norris would be supervised round-the-clock in comfortable housing and cared for by an all-female staff, they assured.
They "made us feel great,” said David Norris. “Turns out, they didn’t have their act together.”
With no heating in 20-degree winter weather, Norris’ D&S home was anything but comfortable for days after she moved in, her father said.
Even more concerning was information he didn’t have: State investigations had found that at least 68 D&S caregivers abused, neglected or exploited their clients in the previous 10 years, state data shows. Since 2017, D&S also has been cited repeatedly in inspections for failing to properly train staff and prevent the illegal use of restraints and seclusion.
On Oct. 5, 2020, Norris became a victim yet again.
That morning, Stephanie Denise Jones, the caregiver who was supposed to keep Norris in her line of sight at all times, left her restrained in her wheelchair behind a closed door, investigative records show. Leola Thomas, the only other caregiver in the four-person home and Jones’ subordinate, saw the closed door – which violated company policy and state regulation – but didn’t take action.
The caregivers entered the room nearly two hours later when they noticed Norris was quieter than usual. They found her unconscious with dark abrasions across her neck, chest and left arm, where the restraints still pressed on her skin.
“She's gone, her lips are blue, she's gone! What am I gonna do, what am I gonna say," Jones screamed as she devised the caregivers’ cover-up story about an overturned dresser, Thomas told investigators. At one point, Jones “took a pencil to paper and went through a diagram and showed me how the dresser could have (fallen) on her like that,” Thomas told the Statesman.
Through her attorney, Jones, who is facing criminal charges in the case, declined to comment.
Pierson said she learned about her daughter’s death from Norris’ service coordinator nearly an hour later. By the time she arrived at the home, Norris’ body was battered by medical intervention and law enforcement personnel kept Pierson away as she begged to see her daughter, she said.
“I just wanted to touch her,” she said, sobbing.
‘It was a sham’
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HHSC investigators were the first to learn that the caregivers’ story about an overturned dresser killing Norris was false, records show.
On an Oct. 22, 2020, phone call — 17 days after Norris’ death — Leola Thomas, fearing jail time for lying to law enforcement, told investigators that she wanted to come clean.
In the following week, a D&S case manager and a detective from the Fort Worth Police Department corroborated Thomas’ confession. Four staff members who worked with Norris said that she was regularly restrained in her wheelchair, according to investigative records.
But the agency did not include any mention of restraints or the wheelchair in an official investigative report filed that November that largely exonerated the caregivers. It did not release any information to Norris’ parents until their attorney, Michael Sawicki, got involved around December 2020.
“It was a sham,” David Norris said.
HHSC officials declined to comment on Norris’ case, citing privacy concerns.
In Norris’ case, the truth was eventually revealed, and, in July 2022, the agency released a corrected investigative report to her family.
But data released by the Department of Family and Protective Services shows that hundreds of abuse and neglect allegations are not investigated every year. Between 2010 and 2017, more than 15,000 or nearly 40% of cases involving waiver clients were closed without inquiry or referred back to providers to take any action they believed necessary because the allegations didn’t meet the investigators’ definitions of abuse, neglect and exploitation, according to a department spokesperson.
Countless other incidents are never reported. Violations related to underreporting ranked among the top two most common legal violations among providers offering Norris’ types of waiver services for the past three consecutive years, according to annual HHSC reports. Some providers, such as D&S, have allegedly instructed employees not to report incidents and threatened to retaliate against those who abide by state laws, according to state records and families of former D&S clients.
“The higher ups … (said) staff were not to report any incidents to anyone,” one D&S caregiver told an HHSC surveyor who discovered six months of unreported injuries among D&S clients in a 2019 inspection, state records show.
“She believes the provider will retaliate against her since she has been informed to ‘not say anything they are not supposed to,’” the surveyor added in her notes. A follow-up inspection found that the caregiver was “retrained,” records show.
Pierson said that while Norris received D&S services, caregivers, including Thomas and Jones, described similar company policies and would sometimes call her in secret to report injuries and abuses.
Kelli Nitsch, the mother of one of Norris’ housemates, said she had a similar experience.
“D&S did not want direct staff to be communicating any details to the parents," she said. "They (the caregivers) would be in big trouble if they did.”
Attorneys representing other families also said they are often left in the dark about their loved ones’ sufferings, and that some investigations are superficial or one-sided.
Pierson and David Norris said D&S never notified them of the agency’s investigation into their daughter’s death. State law requires care providers to notify families of such investigations within 24 hours of an incident, and D&S was cited six times for failing to do so between 2019 and 2020, according to HHSC.
The agency issued 70 similar citations to other providers in those years, records show. Most of the 15 attorneys contacted by the Statesman who are suing providers on behalf of victims said their clients were never notified of state investigations.
Other attorneys who were aware of pending investigations questioned their efficacy. Enrique Chavez, a lawyer who represents a client in El Paso County, said the state’s investigative process was “one-sided,” only relying on statements from care providers and their employees.
Aaryce Hayes, a policy specialist at Disability Rights Texas who provides training to HHSC investigators, said advocates have been increasingly concerned about some of the agency’s practices.
“I see them skipping individuals (with disabilities) without an explanation,” Hayes said. Investigators should make efforts to communicate with all witnesses, “even if they are being told by staff members that the person is nonverbal,” she added.
Norris’ lawyer, Sawicki, echoed those concerns.
“A lot of the victims are defenseless,” he said. “They're either unable to communicate because of (the) condition they have or they don't have a strong advocate to promote their rights. And (HHSC) doesn't do that either. They are more, in my opinion, aligned with the (providers) that they serve.”
In an email, the agency declined to comment and asked the Statesman to refer attorneys with concerns about agency practices to their investigative and legal teams.
Lacking accountability
In its final investigative report for the Norris case, HHSC found Jones guilty of abuse, and both Thomas and Jones guilty of neglect. They were fired for “gross negligence.” Their employer, D&S, was cited for 12 violations of state law, including failure to protect Norris from abuse, failure to provide her family with essential information about her health, and failure to properly train staff to prevent illegal uses of restraints and seclusion, state records show.
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Yet, the agency has allowed the caregivers to continue working in the system and, due to legal restrictions, could not impose fines on D&S, records show.
Across the waiver system, yearslong delays and regulatory gaps allow caregivers with serious infractions such as sexual or physical assault to continue working with vulnerable clients. And providers like D&S face few, if any, consequences when people are hurt or killed.
HHSC is federally mandated to regularly update its misconduct registry, an online tool providers use to screen new hires. But two years after Norris’ death, the agency has not yet added Jones' and Thomas' names to the database.
Because she was not on the registry, Thomas was hired as a caregiver by MHMR Tarrant less than two months after Norris died, she said. She was suspended in early August 2022 after the Statesman contacted MHMR Tarrant to inquire about her employment.
“Although MHMR is required to complete a search on EMR (the misconduct registry), HHSC determines who is placed on the registry,” MHMR Tarrant spokesperson Catherine Carlton said.
Incidents are entered in the registry with an average delay of 15 months, and lags have been as long as eight years in some cases, a Statesman analysis found.
In an email, HHSC said the registry is not backlogged and attributed delays to a lengthy review and adjudication process. Officials said that only cases involving “reportable conduct” – behavior that “causes or may cause death or harm,” according to state regulation – are listed on the registry. They would not explain why a dozen caregiver misconduct incidents identified by the Statesman, which resulted in a brain bleed, broken hips, sexual and physical assaults, and deaths, remain unlisted.
The Statesman identified at least four repeat offenders who only made it onto HHSC’s do-not-hire list after years of delays, including Bonnie Lou McGee. The agency found her guilty of sexually assaulting a client in May 2015, but she was not added to the registry until late 2017.
In 2016, McGee allegedly forced herself on another client receiving services in Central Texas from Girling Health Care, a multistate provider also known as Kindred at Home, according to a lawsuit filed by the victim’s lawyer, Todd Kelly. McGee is currently facing third-degree felony charges, court records show.
In an email, a Girling spokesperson said all new hires are “screened and vetted,” but would not comment on routine background checks the provider is required by law to conduct after employees are hired. Girling was never cited or fined in relation to the incident, according to the spokesperson.
Until recently, HHSC had no authority to impose penalties on companies offering the types of waiver services Norris received at D&S. The agency’s only recourse was to terminate or suspend provider contracts, according to state regulations.
But faced with a deluge of individuals in need of services and a shortage of providers, in the last three years HHSC only terminated five minor contracts, or less than 1%, and suspended none. When something went awry, most providers like D&S were required only to file a report promising to take corrective action.
HHSC maintained its contract with D&S even after the provider failed to uphold promises made in corrective action reports. In nearly every state inspection from 2017 to late 2020, the agency found that D&S employees were severely undertrained, and that the company failed to report abuses and notify families of them. Surveyor notes show HHSC believed D&S was placing its clients’ health and safety at risk but continued allowing the company to provide services to thousands, records show.
Just months after Norris’ death and after D&S said it would conduct extensive employee training, the company violated the “right to live free from abuse and neglect” of yet another client – Norris’ housemate, according to an inspection report. An HHSC surveyor found that the caregiver responsible for the man, whose care plan included the use of belts similar to the ones that killed Norris, didn’t know how to use the restraints, or under which circumstances she should call 911 or medical staff, state records show. But D&S was given another opportunity to take corrective action.
In March 2021, Texas expanded HHSC’s authority, allowing the agency to impose disciplinary fines of up to $5,000 per day in all waiver settings. The fines accrue each day that providers fail to address violations.
“One would assume that (these fines) would deter repeat violations. I think from an advocacy perspective, that's the hope,” said Susan Murphree, a policy specialist at Disability Rights Texas, a nonprofit which advocates on behalf of waiver clients. But “I do not know if the severity of the fines (is) going to prove" sufficient.
Since the new penalties were enacted last year, D&S has been fined $2,100, records obtained by the Statesman show. Another large provider, Fort Worth-based Caregiver Inc., was fined nearly $40,000, but it is currently appealing the penalties, a company spokesperson said in a statement.
Overworked, underpaid, undertrained
Norris’ caregivers knew she required constant supervision and that strapping her into the wheelchair was dangerous, Thomas said. She had almost strangled herself in front of them at least three times before.
But like thousands of low-paid, overworked caregivers across Texas, they were short-handed and exhausted that October day. The two women were caring for three other clients who also needed continuous care. They both regularly worked 17-hour shifts.
“We were both working. It’s not like nobody was working,” Thomas said.
In Norris’ case and dozens of other lawsuits reviewed by the Statesman, abuse and neglect were linked to inadequate staffing or training, largely a result of lawmakers’ failure to sufficiently fund the expanding waiver system, attorneys litigating those cases said.
Since 2010, as the waiver population has doubled, surpassing 100,000 clients, lawmakers have approved only a 17% increase in appropriations for waiver services, from $3.1 to $3.6 billion, government records show.
The base hourly wage for caregivers is $8.11, and the average is about $10.80 per hour, well below Texas’ poverty baseline, according to an HHSC workforce report. Workers are fleeing the system in droves, and vacancy rates in 2022 are at a record high of 30%, according to the Providers Alliance for Community Services of Texas, a networking and lobbying organization for companies that offer community care.
Caregivers regularly work extreme overtime, sometimes going days without sleep while caring for clients whose lives depend on them. Some are inexperienced, untrained or have histories of misconduct, lawsuits show.
Attorneys working with victims said that larger providers that invest tens of millions yearly in growth initiatives could choose to invest more to address low caregiver pay and understaffing, but instead prioritize profitable expansion plans.
Despite the underfunding and dire staff levels, state officials have encouraged providers to expand their operations, said Sandy Frizzell Batton, executive director of the Providers Alliance. Lawmakers and HHSC face federal pressures to provide services to the growing population of individuals in need. The waiting lists for waiver services in Texas are some of the lengthiest in the country, with wait times averaging seven years in 2022.
“Any expansion of the waiver program is a decision for the Legislature,” HHSC said in an email. Lawmakers on the Senate and House committees charged with decisions about waiver program expansions declined to comment.
“It's a double-edged sword,” Batton said. The state needs “to make sure services are at capacity, but, on the other hand, there's not the direct care workforce out there or the funding to adequately pay quality staff.”
“It's just basic economics that we can't advocate for (an expansion) without ensuring that the folks that are currently in the program are being adequately supported,” she added.
Yet, some companies have grown significantly.
Between 2005 and 2021, D&S grew from a single-state provider with revenues around $29 million into a multistate corporation with over $200 million in revenues, according to a résumé published online by a former company executive. Last year, the company was acquired by national community health care giant Sevita in a deal valued around $250 million, according to private equity publication PE Hub. D&S has also received over $2.5 million in federal COVID-19 grants in the past two years, according to state records. Today, the state contract for D&S is worth nearly $900 million and is the second-largest in the state among similar waiver providers, government records show.
During the pandemic D&S, which was paying some caregivers less than the state minimum of $8.11, lost more than 1,600 caregivers in Texas. The company has since increased average hourly wages to $11.60, according to state records. D&S declined to comment about growth initiatives or about issues of understaffing or low pay.
Caregiver – which already operated about 800 facilities in Texas, Tennessee, Indiana and Ohio with revenues nearing $200 million in 2019 – is also pursuing “an aggressive growth strategy,” investing in acquisition deals worth $40 million to $100 million each, Caregiver’s CEO Mark Lashley told the Dallas Business Journal.
Its existing Texas facilities face severe understaffing, and, in back-to-back 2021 and 2022 inspections, HHSC found that the company repeatedly fell short on staff training, records show. A company spokesperson said Caregiver promptly addressed those infractions.
Girling, the subsidiary of one of the largest home health providers in the country with ambitious growth plans, already paid caregivers some of the lowest wages in the industry in 2020. But last year, as the company faced dozens of care quality violations, Girling lowered hourly rates from $9.41 to $8.90, state records show. The provider declined to comment.
‘What’s it going to take?’
For years, lawmakers have ignored warnings that pointed to increasingly dangerous conditions in the waiver system.
A 2016 Senate report said HHSC disciplinary actions were “insufficient … to incentivize facilities to … improve quality of care.” A 2020 national inspection found that state agencies routinely failed to track death and allegations of abuse and neglect in the waiver system. Between 2017 and 2021, state inspector general surveys consistently reported hazards and undertraining in waiver facilities. Last year, provider and advocate groups reported that “92% of providers are struggling to achieve quality (care) standards.”
The Statesman contacted each of the 18 members of the Texas legislative committees charged with overseeing HHSC. Four members of the Senate and House committees responded. Of those, two declined to comment. Others pointed to HHSC, saying the agency did not sound the alarm about abuse and neglect
Meza, the Democrat from Irving, said HHSC “tended to be defensive” when the committee inquired about abuse and neglect.
“I know of no reports or briefings that we have received indicating a pattern of abuse and neglect in this specific program,” said Austin's Hinojosa, who joined the House committee in 2019.
HHSC has done little to ensure the public or lawmakers are aware of the system’s abuse and neglect problems. In its latest budget request, the agency reported “an increase in the number of complaints” for all entities providing long-term services – state-run facilities, nursing homes, and waiver and nonwaiver providers. But HHSC has not raised concerns about rates of abuse and neglect in the waiver system, specifically, in biennial budget requests or reports to the Legislature for at least a decade.
In a 2018 report to the Legislature, HHSC found that about one in four judges, attorneys, police officers and victim services workers believed the agency did not “ensure the safety and dignity of vulnerable adults.” Still, the report concluded agency services and community efforts were “effective.” A 2020 follow-up report presented the results of a 3-year-old survey of waiver and nonwaiver clients that indicated “very low” rates of abuse and neglect.
HHSC took several months to release data and documents to the Statesman, citing confidentiality laws and in some cases providing incomplete records. HHSC also discontinued the release of provider investigation data that its predecessor, the Department of Aging and Disability Services, published online for years. Agency representatives repeatedly declined the Statesman’s interview requests, insisting on email communication only. Executive Commissioner Young also declined to be interviewed.
In a written statement, an agency spokesperson said HHSC “works closely and continually with providers, advocates, and other stakeholders to encourage providers to improve their quality of care … (and) protect client health and safety.”
Also largely unaware of abuse and neglect patterns, policy specialists and spokespeople at nonprofits working on waiver issues such as the Arc of Texas and Disability Rights Texas said they never pursued public outreach initiatives on the issue.
Meanwhile, pleas for justice and change remain unheard, and abuses and deaths continue. And Kristi Michelle Norris’ family continues to grieve.
After her death, Pierson collected all of her daughter’s “babies,” stuffed animals she liked to carry by the dozen everywhere she went. Each member of her family chose one to remember her by.
Pierson kept a small plush flamingo worn out by hours of play. “It fit perfectly in her left hand. … I’ll just hold that because I know her hand was around" it, she said, tears filling her eyes.
“I loved Kristi more than anything in the world, and every day I tell her I am so sorry for my decisions, to please forgive me,” she said.
“What’s it going to take?” David Norris asked as he held a furry pink rabbit, “a floppy little thing” his daughter had kept on her bed. “You're putting a very precious part of our life in their hands, and there is not enough concern.”
Meet the team behind this series
Reporting Caroline Ghisolfi, Tony Plohetski and Nicole Foy
Editing Brandi Grissom Swicegood
Photography and video Sara Diggins and Jay Janner
Photo and video editing Nell Carroll, Briana Sanchez and Nate Chute
Video production Sara Diggins
Social and promotion Robert Gutierrez and Sarah Duenas
Design Emily Nizzi and Andrea Brunty
This article originally appeared on Austin American-Statesman: Medicaid waiver system for disabled Texans plagued with issues
