BOSTON — Three years after the state launched a registry of providers found to have abused individuals with intellectual and developmental disabilities, some advocates warn that too many workers are slipping through the cracks and staying employed in the human services field.

Meanwhile, another advocacy group and lawmakers say they are focused on expanding the reach of the registry, with the aim of ensuring that more vulnerable people in state-run or state-funded programs are shielded from abuse and neglect.

The Disabled Persons Protection Commission (DPPC), an independent agency tasked with investigating caregiver abuse and neglect of people ages 18 to 59 with intellectual and developmental disabilities (I/DD), says it received just over 40,600 complaints over a nearly three-year period, according to data shared with the News Service.

Among complaints within DPPC’s jurisdiction, officials say they screened in over 7,400 allegations for investigation that were “inclusive of all victims with a disability,” and issued 266 notices that substantiated provider abuse of a person with an intellectual or developmental disability. But those notices do not always lead to placement on the registry.

Providers are listed on the registry after officials investigate and confirm the abuse allegation — and in some instances, after officials uphold abuse findings through the petition process.

Some advocates, pointing to a subset of the 266 initially substantiated abuse cases that did not ultimately put providers’ names on the registry, say more workers potentially belong on the platform to bolster the state’s protection efforts.

“There’s a lot of cases where these people are not doing their jobs,” Jeanne Cappuccio, whose daughter has an intellectual disability, said, as she emphasized the need to address systemic problems with workers, including by providing support, training, incentives and oversight to ensure vulnerable individuals receive the care they need. “You complain, you file a complaint and it gets screened out. It reinforces that they don’t have to do their job, and it’s OK to treat people with disrespect, and it’s OK to be abusive, and it’s OK to mistreat.”

Providers whose names appear on the registry, created after the passage of Nicky’s Law in 2020, are barred from working for the Department of Developmental Service or DDS-contracted employers for at least five years. Before Nicky’s Law, only individuals with criminal convictions faced hiring barriers.

The platform is not publicly accessible, but it is available to DDS and contracted employers to check whether prospective new hires are on the registry.

Cappuccio, who said complaints filed on behalf of her daughter have been screened out by DPPC, told the News Service, “I think there’s no validity to Nicky’s Law. It’s not working.”

Even after officials initially determine that providers’ conduct constituted abuse, the majority of those workers are not placed on the DPPC Abuser Registry, according to a recent blog post from the Massachusetts Coalition of Families and Advocates (COFAR), a nonprofit that advocates for people with intellectual and developmental disabilities. Providers have the right to petition for their cases to be reviewed, which in most outcomes enables their names to avoid registry placement, COFAR found.

There were 266 cases of “initial registrable abuse substantiations” for fiscal years 2022-2024, according to COFAR, based on data the group obtained from DPPC through a public records request. Across 161 petition decisions, officials affirmed abuse in 132 cases — and reversed abuse substantiations in 29 cases, according to COFAR.

Among those 132 cases where abuse was affirmed through the petition process, only 47 providers ended up on the registry, COFAR said. In 85 cases, the DPPC determined the abuse was not registrable, COFAR said.

“I don’t think that people realize that there is this situation that appears to provide a possible loophole,” David Kassel, COFAR’s research and communications director, said. “I think it raises some questions about how effective this registry is in terms of preventing abusive caregivers from continuing to work.”

Through the petition process, officials decide whether to uphold the abuse finding and determine if the incident warrants placing a provider on the registry. The DPPC considers criteria including whether the incident was “isolated” and “unlikely to reoccur,” and if the provider is “fit to provide services or supports to persons with intellectual or developmental disabilities.”

Due to the confidentiality of DPPC investigations, Kassel said it is difficult to understand the logic behind the DPPC’s decision-making and how officials apply those criteria. But as COFAR sees it, the due process protections embedded into Nicky’s Law disproportionately favor providers over individuals with disabilities, Kassel said.

“It seems to be an incentive there, that if you are found to have abused somebody — if it’s been substantiated — the best thing you could do is appeal it because chances are you will beat the system that way,” Kassel said. “We think the regulations need to be examined as to whether they should be tightened.”

Andrew Levrault, DPPC’s deputy general counsel, said 107 providers have been removed from the workforce after having their names entered into the registry. Providers placed on the registry can petition to remove their names after five years.

The registry logged more than 30,000 searches last year, Levrault said.

“We’ve had a number of positive matches, where individuals have tried to gain employment in the field and they’ve been obviously excluded from doing so because of registry placement,” Levrault said. “We think it’s really lived up to its goal to bridge that gap between individuals who would have otherwise had a clean CORI, nothing on their Criminal Offender Record Information, which prevents them from working in the field where they really shouldn’t be because of past abusive conduct.”

In some cases, DPPC does not put providers on the registry when there is an opportunity for re-training, including for those who make medication errors, Levrault said. In cases of intentional physical or sexual abuse, Levrault said those providers will be put on the registry.

Levrault cautioned against using raw data to gauge the success of the registry and Nicky’s Law. While COFAR sounded the alarm over only 36% of cases with affirmed abuse deemed registrable following petition decisions, Levrault argued the statistic itself lacks context.

“At least as far as I’m aware, they’re not pointing to any specific cases where they feel that we’ve mishandled the criteria that’s provided in our regulations and the statute,” said Levrault, who noted Massachusetts’ registry is on par with New Jersey’s, which is adding just under 50 individuals each year.

Sen. Patrick O’Connor, who sponsored initial legislation that led to the registry, said he is worried by COFAR’s findings and that it may be time to fine-tune Nicky’s Law. O’Connor said he intends to learn more from DPPC about cases in which providers are permitted to stay employed despite committing abuse.

“It’s definitely a cause for concern, and I will for sure be calling for meetings with DPPC to try to get specific examples of why this is happening on both ends to try to figure out how we can make the law better,” said O’Connor, who acknowledged Massachusetts has made progress protecting vulnerable Bay Staters through the registry.

“Now it’s making sure that we get the abuse registry bill correct — we fix some of these circumstances where people may be slipping through the cracks,” the Weymouth Republican continued.

Sen. Michael Moore, who sponsored Nicky’s Law, said COFAR’s blog post was the first time he heard such complaints about the registry.

“To say the program is not working and not having a full understanding or knowledge of other providers or other families, I don’t know if that’s really an appropriate review or opinion of the program,” Moore said of criticisms leveled against Nicky’s Law by Cappuccio, whose daughter has struggled to receive adequate care through DDS.

Cappuccio said “the registry in and of itself is not effective,” though Moore said that assessment is “unfair.”

Moore defended the due process protections in Nicky’s Law, comparing it to a court case in which providers have the opportunity to defend themselves and not be falsely accused of abusive conduct that could imperil their future job prospects.

The Millbury Democrat expressed a willingness to review concerns about Nicky’s Law, with an emphasis on expanding the registry to hold more providers accountable beyond DDS. Moore, DPPC officials and disability advocates say they want providers in MassHealth day habilitation programs to also be subject to the DPPC Abuser Registry.

But Sullivan said her focus is primarily on pressing lawmakers to advance legislation (H 4393) that would make MassHealth day rehabilitation programs use the registry, seen by advocates as a gap for thousands of individuals who rely on a mix of support services. People with intellectual and developmental disabilities may be protected at their DDS-run group homes at night, but not during the day at MassHealth programs.

“The worst thing we can do is hire people that don’t belong working with individuals with I/DD, and so I’m very nervous that we won’t close this gap and we will have yet another session of people possibly being hurt or neglected,” Sullivan said. “We heard early on that any bill that doesn’t have opposition or isn’t contentious truly has a chance in the informal session, so I’m not giving up hope.”

The bill, which also makes some terminology and procedural changes at DPPC, was reported favorably by the Committee on Children, Families and Persons with Disabilities on Feb. 15. It’s since been lodged in the House Ways and Means Committee.