State officials considered fining a center for people with developmental disabilities in Enid more than half a million dollars after inspectors found threats to residents’ safety last year. But instead, the state paid a consultant to visit the facility in April and suggest changes. 

And despite continued citations at the Robert M. Greer Center this spring that found clients faced harm, injury or risk of death because of policy violations — one client was sexually assaulted by a peer and another ran away and was later found walking along a highway — the Oklahoma Health Care Authority says it has not referred the facility for new penalties for those violations either.

The Health Care Authority notified the Greer Center in March that the facility could face $10,000 in fines per day for a period between November 2023 and January when it was out of compliance with rules to keep residents safe. 

States have the power to revoke licenses, impose fines or cancel contracts when facilities caring for vulnerable adults and kids aren’t able to follow rules and keep clients safe. Multiple state agencies in Oklahoma have a role in the oversight of these facilities.

But leaders from those state agencies decided against fining the Greer Center, officials said. Instead, Oklahoma Human Services contracted with Benchmark Human Services, an Indiana-based company, for up to $1.5 million to assess the situation at the Greer Center and help with oversight. The contract began on April 15, while the facility was again deemed to be out of compliance with state health standards to keep residents safe. 

“Assessing fines as a penalty can sometimes add to the financial burden of a facility, resulting in reduced quality of care for the residents,” the Oklahoma Health Care Authority said in a statement. The state decided an outside consulting company would have a “more immediate and substantial impact on the quality of care provided.” 

Revoking a facility’s license could have serious implications for residents, the Oklahoma State Department of Health said in a statement. 

“Working with a willing license holder to achieve compliance and assure quality care can be far more beneficial for the residents,” the statement says. 

Benchmark has no authority to require the company that manages the Greer Center to change its policies or practices, a spokeswoman for the consulting company said. But the facility has followed recommendations intended to improve staffing levels, hired new behavior analysts and increased communication with Oklahoma Human Services in the last six weeks, according to Benchmark. Oklahoma Human Services also told The Frontier that the Greer Center has implemented many of the recommendations from Benchmark.  

Benchmark’s review in April found that the facility was seriously understaffed. To keep residents safe after policy violations, the center had to constantly revise its procedures, but management didn’t communicate those changes well to staff, the review found. The consultant also reported that a lack of oversight was a problem at Greer. The facility’s governing body, which should help to coordinate the overall management of the facility, was not functional, according to Benchmark’s report. 

“The facility continues to face significant challenges in making major changes in operational structure and creating and sustaining a ‘culture’ that recognizes the positive attributes and worth of everyone – residents and staff alike,” the report said.

Staff were frequently required to work double shifts multiple days in a row, contributing to exhaustion and increasing the risk of abuse or neglect, Benchmark’s report said. Follow-ups to make sure staff understood new policy changes didn’t happen, and the facility didn’t have enough ways to consistently monitor the services provided to individuals. 

“During this period, the facility paid an average of 2,267 hours of overtime each month to provide sufficient staff in each home on each shift,” the report said. “This equates to an average of 13 employees being required to work 16-hour shifts every day.”

And even with an ongoing declaration from state inspectors that residents at the facility were at risk because of serious safety violations, only one administrator was at the facility for three days over a weekend in April, the report said. The only people at the facility to monitor how staff were implementing remediation plans were two Benchmark consulting staffers.

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Liberty of Oklahoma, the private, for-profit company that has a state contract to manage the Greer Center, did not respond to multiple requests for comment from The Frontier.

Hiring a consulting company to improve operations at facilities like Greer is not uncommon, said Cory Bernstein, a staff attorney with the National Disability Rights Network. Figuring out how often facilities are fined is less straightforward, he said. 

Lawmakers could do more to ensure accountability and oversight of care for vulnerable adults, including new legislation that would require disability advocates to be alerted if abuse is reported at certain facilities, Bernstein said. A bill that would have required that stalled in the Senate earlier this year. 

Recent state inspectors find more serious violations

The Oklahoma State Health Department found a lengthy list of violations late last year that had or were likely to cause serious harm, injury or death to residents, putting the Greer Center at risk of losing state and federal funding. 

During the first two months of this year, state inspectors continued to cite the facility for missing deadlines to report abuse and neglect to the state.

And in April, two separate state investigations found serious safety violations, state records show. 

In those investigations, state surveyors cited Greer again for failing to submit abuse allegations to the state on time. Inspectors also cited the facility for failing to train staff and for lacking adequate policies to care for juveniles, even though the center has housed some people under 18 since 2023.

One resident who was known for trying to run away from the facility went missing after a staffer went to the bathroom and left the client alone, according to one of the investigative reports. Police found the resident the next morning after someone reported seeing them walking along the highway. 

In another instance, a staff member went to lunch while residents watched a movie, leaving a client alone who had a known risk for sexually assaulting peers. The client sexually assaulted a peer while the staff member was gone. A resident told staff about the sexual assault but Greer staff didn’t report it because the client had “made multiple reports about multiple clients, and they did not personally witness the behavior,” according to a state report. The sexual assault victim waited to tell state investigators what happened when they visited the facility a week later. 

In another incident, a staff member allegedly watched while a client banged their head on the floor after being told they couldn’t have an item they wanted. Eventually, the client bit the employee, and the employee “forcefully” pushed them to the floor, a coworker told state inspectors. The employee who pushed the client was later terminated. 

Liberty of Oklahoma responded to state investigators, saying it had fired some employees accused of abuse, retrained staff and had demoted an investigations manager for failing to turn in reports on time. 

Oklahoma Human Services continues to have a halt on new admissions to the facility, the agency said.