DHHS kept critical internal CDC review to itself

An internal review last spring by the Maine Department of Health and Human Services uncovered some of the very same problems at the Maine Center for Disease Control that were flagged last week in a state investigation.

But that internal review — released this week by DHHS in response to a Sun Journal Freedom of Access Act request — was not shared with the public or with frustrated lawmakers who had spent more than a year raising questions about the CDC. The review was shared only with DHHS leaders and kept within DHHS for eight months as the department considered changes to the CDC.

Many people didn’t know the internal review existed until last week when it was mentioned in a report from the state’s investigation.

“I brought (the CDC issue) up publicly several times and it was clear I was very concerned about this, so the fact there was (an internal review) and it wasn’t shared with us is troubling to me,” said state Rep. Peggy Rotundo, D-Lewiston, who has questioned problems with the CDC for a year and a half and had met with DHHS Commissioner Mary Mayhew to discuss those concerns.

And while the internal review found some problems, it did not look into broader allegations that have long troubled lawmakers and have caught the attention of the Attorney General’s Office.

At issue is the way the CDC in 2012 distributed more than $4 million to 27 community health organizations that were part of the Healthy Maine Partnerships program. In response to state budget changes, the CDC had cut funding to 18 of those organizations and had named the remaining nine “lead HMPs,” giving them more money and more responsibility.

Surprised by some of the HMPs that were chosen to become lead agencies, lawmakers and others questioned how the CDC made its decision. Then, last April, a CDC division director alleged that CDC officials had played favorites with HMP grant recipients and had ordered the shredding of public documents connected to it.

Mayhew, who oversees the Maine CDC, requested the internal review around that time.

The review was done by the DHHS Office of Continuous Quality Improvement, then known as the Office of Quality Improvement Services. The office was asked to gauge the integrity of the CDC’s scoring system and its methodology.

The office talked with top CDC officials involved in the HMP grant process and reviewed scoring sheets and other documents. It released its report on April 26.

The review found strengths in the grant process, including that a collaborative team was established to come up with scoring, multiple measures were used to assess HMPs, multiple questions were used to rate HMP performance and CDC employees were separated from each other during the survey period so they could rate the HMPs independently.

It also found weaknesses, including:

* Scoring that over-emphasized subjective ratings from DHHS employees rather than objective measures of performance.

* Scores that could have been skewed to favor HMPs that cooperated and collaborated with the CDC rather than HMPs with a capacity to serve the region and support public health infrastructure.

* At least one rating was not well-defined, potentially leading to inconsistency and unreliability.

* Scoring procedures were “overly complex and convoluted.”

* Data was missing for the HMPs that served Western Maine.

In all, the report said, “These shortcomings substantially increase the potential for bias in the selection process and raise difficult questions about the overall integrity and credibility of the selection process.”

Unaware of that internal review, state Sen. Margaret Craven, D-Lewiston, urged her fellow Government Oversight Committee members to seek a state investigation of the CDC through the Office of Program Evaluation and Government Accountability. The committee agreed on April 26, the same day the internal report was dated.

“If we had seen this report, with an added plan of correction, we would probably not have asked to have an OPEGA review,” said Craven, a member of the board of Healthy Androscoggin, one of the HMPs that lost more than half of its funding because it was not named a lead agency.

OPEGA spent months looking into the way the CDC had chosen lead HMPs and whether the CDC had maintained documents supporting those choices. It presented its own report to the Government Oversight Committee last week.

OPEGA echoed the concerns raised in the DHHS internal review. It also found broader issues, including that CDC supervisors ordered the destruction of public documents, funding criteria was changed during the selection process, HMP funding scores were changed just before the final selection of a lead agency, a $500,000 tribal contract seemed to appear out of nowhere and a critical HMP scoring sheet had vanished.

DHHS spokesman John Martins said the internal review didn’t turn up those additional issues because its mission was limited. It sought only to “‘understand and evaluate the methods and process used by the (Maine) CDC to evaluate and select the lead HMPs,” he wrote in an email. “The report is reflective of the direction.”

He said the allegations of document shredding were handled separately, “through personnel and human resources channels.” He declined to provide more details, saying it was a confidential personnel matter.

It appears that handling didn’t result in any on-job reprimands. Disciplinary letters are public documents. In the past, the Sun Journal has requested to see any recent disciplinary letters for the CDC leaders at the heart of the shredding allegations, but the CDC has said there were no letters to provide. Martins said this week that those CDC leaders remain employed in the same positions at the CDC.

OPEGA’s report mentioned the DHHS internal review and said OPEGA investigators looked at that review and relied on its results.

But until OPEGA had mentioned it, many people said they didn’t know an internal review existed. Of the seven HMP directors reached this week, only one said he had heard of it, one wasn’t sure and five said they didn’t know anything about it. The head of the Maine Public Health Association, a nonprofit organization of nearly 400 public health professionals, hadn’t heard of the internal review. Rotundo and Craven, who had raised questions about the CDC’s handling of HMP funding for more than a year and had met with the DHHS commissioner about their concerns, didn’t know anything about it.

Gov. Paul LePage spokeswoman Adrienne Bennett said the governor knew of the internal review, but she could not say when he became aware of it.

Martins said the review was shared only with DHHS leadership precisely because it was an internal review.

“This was an internal management review of the process, conducted by the DHHS office, which focuses on continuous quality improvement, as we are always looking at our processes and ways to improve them,” he said. “It was presented to DHHS leadership for review and potential improvements to the process in the future.”

Asked what those improvements were, Martins pointed to a letter that Mayhew wrote to OPEGA and that OPEGA included in its final report.

In the letter, Mayhew said DHHS was using the internal review to “ensure that all future efforts to create a selection or scoring process are sound in their methodology.” She said the CDC would use a formal, competitive grant process next time it gives money to HMPs and it is working with the Maine State Archives office to review and update records management policies and practices.

Lewiston lawmakers Craven and Rotundo said they would have liked to have known that long before now.

Rotundo said she and Craven met with Mayhew last year to point out problems with the way the CDC chose the lead HMPs. Mayhew, she said, didn’t see the problems and told her they would have to agree to disagree on the subject.

“I would have been very interested in knowing what they had found, so I’m not surprised they chose not to share it with legislators,” Rotundo said.

Bennett said the governor had a different take on it.

“He considers mismanagement when you learn about an issue and then you hide it,” Bennett said. “What (Mayhew) did was she learned about the issue, she tried to address it internally and correct it. He does not believe that was mismanagement. That’s, in fact, good management.”

ltice@sunjournal.com

Review of Healthy Maine Partnership (HMP) Selection Process and Scoring Matrix