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The Case of Carl DeBrodie: Checking The System

The investigation into Carl Debrodie’s death is still underway by state and federal law enforcement agencies.

The 31-year-old, developmentally disabled man was found dead in a Fulton storage facility after being reported missing days earlier.

Investigators say evidence suggests Debrodie had died long before he was reported missing, leading them to believe there was a coverup involved.

ABC 17 News reported on May 19 when a case manager with Callaway County Special Services was fired after it was alleged that the required monthly face-to-face visits with Debrodie were not being performed.

According to the Missouri Department of Mental Health’s Division of Developmental Disabilities, the monthly support monitoring visits are one of three ways cases are reviewed and monitored on the individual level.

Debrodie’s service provider, Second Chance Homes in Fulton, underwent a licensure and certification process that involved the DMH checking to make sure the facility is able to care for its clients based on their individual needs.

The recertification process occurs every two years and doesn’t require direct contact with the individuals.

The division also performs quality enhancement reviews each year, during which documents from 400 randomly selected cases are supposed to be requested and reviewed.

If the cases involve increased medical needs, a registered nurse is supposed to perform a medical review on an annual basis.

“We have quality enhancement nurses and those nurses will review individuals, specifically individuals that have really high medical needs, about 65 percent of the 8,377 with comprehensive waivers,” said Valerie Huhn the division’s director. “Those cases would warrant this annual nurse review.”

While other oversight systems exists within the division, none of them require consistent, face-to-face contact with clients like Debrodie.

The Missouri Developmental Disabilities Council shared an office building with the Department of Mental Health but it is a separate entity.

The 23-member council is federally funded and at least 60 percent of its membership have a direct connection to people with developmental disabilities.

“We don’t delve that deep into oversight,” said Vicky Davidson, the council’s director. “We provide advice on the services systems, on how families believe the service system should be driven.”

One tool the council uses is a victimization task force, something Davidson said will examine the Debrodie case closely.

“The victimization task would like to look at what systems might have broken down and work to address those and change that to make sure that doesn’t happen again,” Davidson said.

The task force is only able to submit recommendations to the Department of Mental Health, meaning it’s up to Gov. Eric Greitens’ administration to change or update policy.

In a division that serves more than 36,000 people across the state, all of them with different needs, Huhn says it can be difficult to keep the system individual-driven.

“It can be challenging making sure all those needs are met and those rights are protected,” said Huhn. “The system always evolves because the individuals evolve and the ways we can find to care for individuals.”

ABC 17 News is closely following the Debrodie investigation and will publish updates on air and in a special section of this website: “The Case of Carl Debrodie.”

Check out the below links to our two other July special reports:

“The Case of Carl DeBrodie: The Investigation”

“The Case of Carl DeBrodie: The Guardians”

“The Case of Carl DeBrodie: Complete Coverage”

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