Excerpts from email exchanges (March 20 to April 1, 2025) between Spotlight PA and Department of Aging spokesperson Karen Gray on fatality reviews.

Statement from Karen Gray, Department of Aging spokesperson:

“Under the Older Adult Protective Services Act, the Department of Aging does not have the jurisdiction to investigate the circumstances behind a death, nor the authority to access critical records needed to conduct an investigation. The type of fatality review process you describe never existed and was never authorized by the Department prior to Secretary Kavulich’s tenure. In the last two years, the Department has provided significant guidance to AAAs [county  Area Agencies on Aging] on how to create robust policies for improving protective services – and is in the process of rolling out a new monitoring system that will include significantly more transparency. “The Department would welcome the opportunity to discuss further solutions with the Legislature, as evidenced by our work with Rep. Schmitt on

HB 372

.”

Q:

 Why doesn't the department want to know why so many older adults are dying during open investigations?

GRAY:

T

he Department cares deeply about older adults and would welcome additional resources to help ensure older adults in protective services are taken care of – but as we have explained to you numerous times, we do not have the authority to conduct such investigations at the Department level. The Department is not a law enforcement agency. The Department is not a coroner’s office. Those types of entities are better suited to make such determinations on causes of death, not a social services agency like the Department of Aging. Additionally, the Department is working to implement a process where the AAAs work with law enforcement agencies and community stakeholders, leveraging the expertise of those professionals, in cases where there is a possible nexus between services provided and the older adult’s death to address any potential gaps in the AAA’s processes. Through this collaborative approach, the Department can review findings to better understand factors contributing to these deaths and identify areas to improve protective services.

Q:

 Does the department currently have a written policy, crafted under Secretary Kavulich, on conducting fatality reviews for older adults who died during an open protective services investigation? If yes, could you provide me with a copy or point me to where I can find it?

GRAY:

The Older Adult Protective Services Act (OAPSA) does not provide the Department with  jurisdiction to investigate the circumstances behind a death, including access to medical examiners’ reports or police reports. Investigations to determine the cause of death of an older

 

adult are not handled by the AAA or the Department, but rather by local law enforcement, the coroner, medical examiner or district attorney. In February 2024 the Department issued the Older Adult Suspicious Death Multidisciplinary Review Team (SDMRT) as guidance to the AAAs in the creation of their own internal process to review cases where there is a potential nexus between an older adult’s death and the need for protective services, with the goal of identifying any gaps or barriers in the AAA’s internal system, and making corrective recommendations to improve or enhance delivery of victim services.

Q:

 More specifically: does the department’s fatality review policy require Triple As to create multi-disciplinary teams (SDMRT)? If yes, who is on the team and who selects who serves on it? Does a Triple A have to refer all fatalities of older adults to that team?

GRAY:

The Department is taking action with the release of the Suspicious Death Multidisciplinary Review Team (SDMRT) guidance to better support AAAs; it was not and is not a requirement. Rather, it was designed to both identify any gaps or barriers in the system and make corrective recommendations to improve or enhance delivery of victim services. The intention of the SDMRT guidance is for AAAs to be trained, pilot, and eventually implement SDMRT teams. The guidance includes suggestions of local level team members to include such as district attorneys, law enforcement, coroners/medical examiner, long-term care ombudsman, court administration, victim witness advocate or medical specialist. Unfortunately, the Department does not have authority to mandate or require SDMRT. 6 PA Code §15.46 requires the AAAs to do the following: If the death of an older adult reported to need protective services occurs prior to the AAA’s investigation of the report, during the investigation or at any time prior to the closure of the protective services case, and there is a nexus between the death and the need for protective services, the AAA shall immediately report that death to law enforcement and the county coroner.

Q:

 Why did the department cut itself out of the fatality review process and instead relegate it to the counties? Doesn’t that weaken accountability?

GRAY:

The Department did not “cut itself out” of the process. As described in previous responses, the Department maintains accountability by ensuring AAAs comply with all laws and regulations regarding the reporting of suspicious deaths to law enforcement. The Department does not have, and has never had, jurisdiction under the Older Adult Protective Services Act to investigate the circumstances behind a death. The Department is a social services agency, not a law enforcement agency or a medical examiner. Investigations to

 

 determine the cause of death of an older adult are not handled by the AAA or the Department, but rather by local law enforcement, the coroner or district attorney.

Q:

 Why does the department not require Triple As to review for a nexus between the older adult’s death and the quality of the protective services investigation?

GRAY:

Neither the Department nor the AAAs have, nor have they ever had, jurisdiction under the Older Adult Protective Services Act to investigate the circumstances behind a death. The Department is a social services agency, not a law enforcement agency or a medical examiner. Investigations to determine the cause of death of an older adult are not handled by the AAA or the Department, but rather by local law enforcement, the coroner or district attorney. 6 PA Code §15.46 requires the AAAs to do the following: If the death of an older adult reported to need protective services occurs prior to the AAA’s investigation of the report, during the investigation or at any time prior to the closure of the protective services case, and there is a nexus between the death and the need for protective services, the AAA shall immediately report that death to law enforcement and the county coroner.

Q:

I have documentation that backs up the description of the 2021/22 fatality review practice prior to Secretary Kavulich, so I want to give you the opportunity to revise your statement that the practice never existed, and provide an answer as to why that process was halted.

GRAY:

Our previous response stands. The Department is not aware of any

authorized 

 death review process in place that predates the current administration. Regardless of whether such a department-level review process existed previously, it is not within the scope of our authority – under the Older Adult Protective Services Act, the AAAs are required to report any such investigations to law enforcement who have both the statutory authority and expertise to conduct these kinds of reviews. The Department does not, nor has it ever had legal access to the necessary information to conduct a fatality report. That necessary information to conduct such a review is maintained by relevant law enforcement organizations who work with AAAs to conduct fatality reviews. The Department only has access to the cause of death. Without more information, any death review that was conducted was not only outside the scope of the Department’s authority, but both impossible and incomplete. Further, the official 2019 OSIG report you mentioned did not contain any recommendations about establishing a fatality review process. Additionally, while prior staff at Aging requested and received confidential death data from the Department of Health, there is no indication the data was being used appropriately or for its intended purpose. Currently, the Department uses the data within the scope of our authority, to ensure that the AAAs are fulfilling their duties to report deaths properly to those that

do

 have the authority to investigate them. The current practice