Alaska’s outsourcing of guardianship led to dysfunction and debt

When the state of Alaska transferred dozens of public guardianship cases to a nonprofit last year, the results included extended hospital stays, thousands of dollars in debt and lapses in public benefits for some of Alaska’s most vulnerable residents.

That’s according to a recent story in the Anchorage Daily News. 

ADN reporter Iris Samuels says the state has been swamped with public guardianship cases in recent years, which led them to outsource dozens of them.

Listen:

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This interview has been lightly edited for clarity.

Iris Samuels: We’ve known for a while that the public guardian section in the Office of Public Advocacy is just buckling under way too many cases. They basically have so many cases that they can’t really handle them the way they should be handled. So that’s why they say that they transferred, or requested that the courts transfer, some of the cases that they were handling to this new private agency and this person who’s running it, Tom McDuffie, who said, “I can take these cases.” And this all happened last year in 2022. So Tom McDuffie started this new agency called Cache Integrity Services. And ultimately, all told, this private entity handled 110 cases or so. Some of them were taken from OPA. Some of them were people who would have otherwise paid for a private guardian.

Wesley Early: So what exactly went wrong with McDuffie’s clients?

IS: Basically, what we learned in this reporting is that he just bit off more than he could chew. And he would say that; that’s what he said to me when I spoke with him. And what that means is he had so many cases, and he just didn’t have the staff to handle it. He, at various points, didn’t have any staff at all. And with these guardianship clients, you have to be filing paperwork to get these public benefits that these people rely on. And when you have too many people, you just cannot file that paperwork fast enough. And in some cases, it seemed that no effort was made to reach out to these people.

So these are people for whom, again, a guardian is like their parent. The guardian makes all the decisions when it comes to health and finances. And when that paperwork isn’t filed, those decisions aren’t made. In some cases, clients were left in the hospital for months at a time when they should have been discharged because there was no one to discharge them. There’s no one to sign to approve a discharge.

WE: And I imagine that had a financial toll on some of them, too.

IS: Yeah, there were also cases where, you know, people had certain assets that needed to be sold, or the kinds of financial decisions that are made in the course of someone’s life that weren’t made. And when you push off these important decisions, it does lead to debt in certain cases. It prolongs debt in some situations where people were in debt and that debt needed to be resolved. And it wasn’t because, again, those decisions weren’t being made.

WE: So, is there any legal action related to this issue?

IS: Yeah, we already know there’s a couple of different cases, at least. Last year, the Northern Justice Project, which is a civil rights firm here in Anchorage, filed a lawsuit against the Office of Public Advocacy, basically saying that when OPA requested that all these cases be transferred to Cache Integrity Services, they did so in a way that violated the law, because they didn’t assign clients an attorney and didn’t accurately, or even in any way, explain to them the meaning of their care being transferred from someone who’s an employee of the state to someone who’s a private actor who may charge different fees, or just may act in a different way from what the public guardian might do.

And an Anchorage Superior Court has already determined that, at least in one case, the state is at fault for not appointing an attorney and not following the law. There is also another case where Cache Integrity Services was sued by one of their clients for failing to do what they’re supposed to do. And then several instances where judges have basically said, “We can see that Cache Integrity Services isn’t doing what they’re supposed to be doing, that Tom McDuffie didn’t do what he told the court that he would do,” and then Cache Integrity Services was removed as guardian. So there’s several fronts of legal action, but not really an overall solution to all of these people that the courts appointed MacDuffie to be a guardian in.

WE: We’ve heard reporting about backlogs at the Office of Public Advocacy with some blaming a lack of staffing there. Is that what’s going on here with guardianship, and what’s being done to fix the problem?

IS: Yeah, I think that’s a good question. The Office of Public Advocacy has said, actually, that they don’t think this is a staffing issue, that what they think is this is an issue with high turnover in the public guardian section.

So basically, it takes two years to train a public guardian. It takes a long time to learn all the things that a guardian needs to be able to do, and they can’t keep that staff long enough. I do think that this has to do with the staffing in the Office of Public Advocacy. And it may be a fact that you just cannot recruit the kind of people, the kind of skilled people, that you need to do this job well, for whatever reason. And I don’t know if that’s because the salaries aren’t commensurate with the work that needs to be done, or for other reasons of kind of mismanagement within the Office of Public Advocacy. That’s an open question, but I do think that, sort of like with other issues of social services the state needs to provide, there’s a question here of is the state investing enough resources to make sure that these services are provided effectively?