BY FAX AND FIRST CLASS MAIL
Hon. John B. Mattingly
City of New York
Administration for Children’s Services
150 William Street
New York, NY 10038
Dear Commissioner Mattingly:
I write to express deep concern regarding the tragic death of Marchella Pierce and to request information regarding the circumstances that brought her family to the attention of the Administration for Children’s Services (“ACS” or the “Agency”), the services her family received in the months before her death, and preventive services more broadly. The heartbreaking circumstances surrounding Marchella Pierce’s death raise troubling questions about ACS policies and practices and the possibility of systemic problems that could leave an untold number of children at risk.
The circumstances surrounding services provided to the Pierce family are unique, but their case unfolded in the context of a broader set of changes to the City’s preventive services system. Earlier this year, I monitored with deep apprehension ACS’s plans to downsize the preventive services system by 3,000 families and the Agency’s actions to award new contracts to providers in the system. As the downsizing plans unfolded throughout the spring and early summer, providers and ACS made difficult decisions about how to handle cases -- which could be closed, which needed to stay open and, for agencies that were either downsizing or eliminating their contact preventive services programs, be transitioned to another agency. The results of this process are startling. Between the initial announcement of recommended awards under the Request for Proposals for preventive services in April and July of 2010, the number of active preventive cases fell by over 2,000 families. This translates to a total of well over 5,000 fewer children receiving services. The sudden, dramatic decrease in the preventive services caseload raises a number of questions.
● Who was responsible for making decisions regarding closure or transfer of cases?
● What criteria formed the basis for those decisions?
● How were the initial decisions documented?
● If ACS staff were not responsible for making those decisions in the first instance, how did the Agency review decisions made by its contract providers?
● Did ACS review decisions with respect to all cases that were closed during this time period?
● If not, how did ACS make determinations about which decisions to review? How many decisions made by contract providers of preventive services were reviewed?
● In how many of the cases reviewed did ACS arrive at a different decision than that made by the contract provider and reopen cases that had been closed by a provider?
● How many cases were transferred from one contract provider of preventive services to another such provider?
● Does ACS have a formal protocol to ensure continuity of service when cases are transferred from one service provider to another? If so, please provide a copy of the protocol and explain how the Agency monitored transfers to ensure that the protocol was followed. If not, what guidance, support and oversight did the Agency provide throughout the transfer process?
● How many cases were transferred from a contract provider of preventive services to child protective services staff or other ACS staff? Under what circumstances did these transfers occur?
● Has the Agency determined that additional review of cases that have been closed since April is necessary? If so, who is conducting or will conduct that review and what criteria will they use to review the decisions? How many cases will be reviewed? What is the time frame for completing such a review?
In addition to the systemic issues raised above, the Pierce case itself raises a number of important questions. As I understand, the Pierce family came to the attention of ACS on more than one occasion over the past four years. Please describe in detail each instance where ACS became aware of the family.
● For each instance, please explain what the Agency did and what conclusions were reached regarding the family’s circumstances.
● What services were offered to the family?
● What services did the family accept?
Based on media reports, I understand that the Child Development Support Corporation (“CDSC”) began to provide services upon or shortly after Ms. Pierce gave birth to a third child in November 2009.
● What services was CDSC providing to the Pierce family? Please describe formal requirements ACS has for casework contacts or family visits based on the services provided to the family.
● Please explain how ACS exercised oversight over CDSC to ensure that these services were provided to the Pierce family.
● Please provide a detailed description of what happened to the Pierce family’s case after CDSC stopped providing services to family at the end of June 2010.
Media reports have made clear that Marchella Pierce had serious health conditions that required hospitalization for much of her life prior to her release in February 2010. In particular, reports suggest that the child had a tracheotomy and may have been oxygen dependent. At the time she was released, she had an infant sibling who was approximately three months old and an older sibling who was under the age of six. The family already was receiving preventive services, which presumably resulted in regular contact with a case manager. However, following Marchella Pierce’s release from the hospital, it does not appear as though the family received additional services to meet the needs of a medically fragile child or ongoing services from a skilled nurse or other home health care provider.
● Please describe the formal mechanisms that exist to ensure that ACS and its contract agencies coordinate with hospitals and other health care facilities to ensure that appropriate services are in place to ensure ongoing safety of all children in a household that receives preventive services and to ensure that families follow steps for follow up health care set forth in hospital discharge plans, where relevant.
● What formal coordination is there between a hospital or other health care facility preparing to discharge a medically fragile child and the Agency or a contract provider of preventive services that is already working with that child’s family?
● Did that coordination occur in this case? If not, why not?
● What protocol does ACS have for preventive services providers to determine whether families are receiving all supportive services that they need to ensure the safety of all children in a household and call for additional services, where necessary? Was that protocol followed in this case? Is that protocol currently under review?
Comprehensive answers to the questions set forth above will lay the groundwork for:
● Consideration of the broader context within which the case unfolded, in particular the dramatic decrease in the preventive services caseload, criteria upon which decisions to close or transfer cases were made, as well as the mechanics of transfers that occurred;
● An analysis of services provided to the Pierce family by ACS and other relevant institutions;
● An assessment of the process through which families are referred for and obtain specialized preventive services tailored to meet the needs of medically fragile children; and
● A review of the mechanisms through which ACS communicates with hospitals and other long-term care facilities to coordinate care and services for children with extraordinary medical needs who are released to homes that already receive supportive services.
When Nixzmary Brown died in 2006, the Bloomberg Administration to its credit rapidly took responsibility for gaps that left her at risk, reformed its policies to protect the thousands of other children served by ACS, and dedicated additional resources to strengthen child protective and preventive services. Marchella Pierce’s tragic death similarly calls for accountability, scrutiny and reform. I urge the administration to begin taking these steps immediately. Please contact me or my Counsel, Jackie Sherman, to firther discuss issues raised by this letter. Thank you very much for your prompt attention to this matter. I would appreciate a complete response to this request no later than September 24.
Bill de Blasio
Public Advocate for the City of New York
cc: Hon. Linda I. Gibbs, Deputy Mayor for Health & Human Services