Monthly Archives: March 2011

Two Slices of Bread

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Today a very early morning walk downstairs to the kitchen wondering what I have left to eat to absorb the day’s first cup of coffee, though, as always, there are several bags of frozen vegetables to cook-up. Funny how when things get tight the diet gets healthier.

Walking now through the living room I smile, comforted by the sight of books stacked on the side table next to my reading chair:  “The Great Bridge: The Epic Story of the Building of the Brooklyn Bridge” by David McCullough,  the complete collection of Bernard Malamud’s short stories along with his “The Assistant” and “Dubin’s Lives.” And then there is “Steinbeck: A Centennial Tribute” by Stephen K. George and last and anything but least, a remarkable biography of Oscar Wilde by Richard Ellman. I am not alone!

In the kitchen now I hit the button on the coffee machine. I nearly always prepare it the night before and that magical morning push of the button is one of my favorite moments of the day. I open the refrigerator knowing there is not much in there now at the end of the month but you never know. Seconds after seeing two tomatoes which will do the trick I spot a crumbled package containing two slices of bread. I toast up both slices, slather them with strawberry preserves, and now I’m in early morning heaven, made all the more so by pouring my first cup of coffee and quietly sipping it as I watch two Canadian geese at the edge of the pond, both still, enjoying the morning just like me.

After a few minutes of drinking in this delicious moment I head back upstairs to my writing room, making a mental note as I climb the stairs to buy extra bread after my disability check comes in so I can share some with the geese.

NY State DOH & Southern Tier Independence Center: a $1 million relationship

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The Southern Tier Independence Center (STIC) out of Binghamton, New York landed three contracts with NY State’s Department of Health totaling more than $1 million in taxpayer dollars.  Two of the contracts run from January 1, 2010 to December 31, 2010 and one of the contracts runs from April 1, 2010 to December 31, 2010. One question, yet to be answered despite the question being sent directly to Mark Kissinger, the DOH’s deputy commissioner for the Office of Long Term Care, is why all these contracts are still active even though they appear to have expired. It is, after all, 2011.

Another question is this. How is it that STIC managed to land all three contracts? While the answer to this question may well be a perfectly reasonable one, the fact STIC and the DOH entered into one contract knowing full well that the work was going to be given to a company led by an individual both parties knew misrepresents his educational credentials to everyone can do nothing but cast a cloud of suspicion over all three contracts.

Here are the three programs covered by the three contracts (the program description is taken directly from the contract itself):

  • Money Follows the Person (MFP) Demonstration of & Outreach to Nursing Home Residents Contract
    • Contract runs from January 1, 2010 to December 31, 2010
    • Funding amount: $100,000
  • Statewide Neurobehavioral Resource Project (Work given to School and Community Resource Inc. headed by Timothy J.Feeney who misrepresents his credentials)
    • Contract runs from April 1, 2010 to December 31, 2010
    • Funding Amount: $300,000
  • Regional Resource Development Center for the NH Transition and Diversion & Individuals w/Traumatic Brain Injury Home and Community-Based Medicaid Waivers
    • Contract runs from January 1, 2010 to December 31, 2010
    • Funding Amount: $610,000

One has to wonder how many bid on all the above contracts and how as it STIC managed to land all three? Past emails to STIC Executive Director Maria Dibble have not been responded to and the current email to Kissinger has not received a response to date.

 

NY State DOH Communicates but…

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If material presented by the New York State Department of Health  is to be believed, no DOH employee has ever mentioned Medicaid Fair Hearings in writing and the DOH has absolutely no policies and procedures when it comes to Medicaid Fair Hearings, not even one.

It is hard to imagine that the absence of any Medicaid Fair Hearing policies and procedures and the absence of any mention of them in writing by anyone in the DOH is anything but a willful act on the part of the DOH.

Some background. In December of last year this writer filed a FOIL (Freedom of Information Law)  request with the DOH seeking, and I quote:

– Any and all policies and procedures and any and all emails or other forms of written or recorded communications that are related to Medicaid Fair Hearings.

– Any and all policies and procedures and any and all emails or other forms of written or recorded communications that are related to the state’s traumatic brain injury waiver, the RRDCs ( Regional Resource Development Centers) and RRDSs (Regional resource Development Specialists) and assistant RRDSs and their role in Medicaid Fair Hearings

– Any and all policies and procedures and any and all emails or other forms of written or recorded communication that are related to directives from DOH (and or contract employees of DOH) that relate to TBI Waiver providers and their role in Medicaid Fair Hearings

– Any and all information that relates to DOH Policies and Procedures that apply to Medicaid Fair Hearings

In response to this request I received only a training binder for fair hearing officers, that’s it.

A case in point: DOH employee Maribeth Gnozzio has a seemingly well-earned reputation for, with rare exception, not returning phone calls or emails. Nevertheless, she communicates rather frequently with the the Traumatic Brain Injury Waiver’s RRDCs  she is charged with overseeing across the state. The RRDCs oversee waiver providers and participants in different regions.

However, it seems that despite sending in the neighborhood of 3,658 emails to RRDCs in 2010, she too never mentions Medicaid Fair Hearings once. A remarkable feat indeed since several sources say it was Gnozzio who told RRDCs during a phone conferences last year that waiver providers are not to appear in support of waiver participants in Medicaid Fair Hearings, a nasty Machiavellian directive to say the least and a directive that can only be designed to undercut a waiver participant’s chances in a fair hearing. The results have no doubt  been brutal for more than one person living with a brain injury since it no coincidence that this rather sadistic DOH directive was issued at a time when there seems to be a wide-ranging effort to discharge people from the waiver or notify them their services are being cut. To send some of us who live with brain injuries into a Medicaid Fair Hearing without our waiver case managers can be like asking someone to climb Mount Everest without oxygen, and the DOH knows it.

Here is a regional breakdown of the approximate number of emails sent by Gnozzio to RRDCs in 2010:

Capital District – 226

Buffalo – 236

Long Island – 886

Lower Hudson Valley – 506

New York City – 704

Adirondacks – 244

Rochester – 140

Binghamton – 260

Syracuse – 130

Sent to all RRDCs – 326

A Short Story: The Heart of Sidney Chest

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Sidney Chest sits erect in his custom made Ermenegildo Zegna suit made by Mr. Kelly at La Rukico Tailors, joking that the blue dress shirt he has on is his least favorite but it was the only clean one he had left in his lambskin overnight bag. He has, after all, stayed over an extra night in the city of Patch Falls to help guide his company’s handling of those Sidney Chest refers to as my TBI people. TBI meaning traumatic brain injury, injuries sustained from a blow to the head, falls, assaults, car accidents, bicycle accidents and so on. Sidney Chest owns and runs a company that provides supportive services, or so they are called, to men and women who live with brain injuries so they might continue to live in the community rather than in institutions. Their injuries have robbed them of their peoplehood in the eyes of many, including the hazel eyes of Sidney Chest, who feigns caring about those poor TBI people who are viewed by Chest and his ilk as a plethora of cottage industries – profit makers.

Leaning back in his leather desk chair, Sydney Chest makes a mental note to have the chair cleaned. It was given to him by his wife Alice on their fifth wedding anniversary. "So what is the issue here with Allen Small?"

"He’s not happy with his staff. Says they talk to him like he’s a child." These words come in bored tones from Sally Stipple, a rather rotund woman with two strands of thick black beads around her neck and matching earrings. Her lips are large, pasty and pointless, like two dollops of silly putty hastily applied. She wears no make-up save for bright red lipstick. She wears a nose ring. She is 44 years old, looks 60, is divorced, no children, and, is a former nursing administrator. She sees the TBI people for what she knows they were. Needy, often misguided beings who are, if not entirely absent any purpose in life, entirely absent any real future in life. These people, though they aren’t really people any more, at least not completely, are stuck in place, damn lucky to get the services they are getting, and would do themselves a bit of justice, yes they would, if they’d just learn to show a little gratitude. They are forever complaining they are being talked too like they are children when they ought to be glad people are talking to them at all.

Sally Stipple runs a tight ship and Sidney Chest likes her for it and will go on liking her for it as long as Sally Stipple’s dictatorial streak keeps the billing up to speed which keeps the money coming in. In Sydney Chest’s world, Sally Stipple is what health care is all about, at least the health care his company is about if he has anything to say about it thank you very much. the company he boisterously calls the best of its kind in Patch Falls and the surrounding area.

Sydney Chest keeps the stress on billing by crying poverty (he’s actually very wealthy) at all times. He knows it was important to instill in his employees the fear-producing belief that the company is always one billing cycle away from total collapse, that if it wasn’t for his willingness to infuse the company’s coffers with his own personal money and the money of his darling wife Alice for that matter, the entire operation would collapse into a pile of dust and be swept away by the day’s first breeze.

His feigned poverty  underscores the hideously misguided belief that his is a generous heart when he deigns to take a survivor of brain injury out for breakfast or lunch and feigns listening with genuine interest and concern, sending the survivor back into the day program that, like many other programs of its kind, proves there is such a thing as community-based warehousing. Sadly, if there is naiveté or perpetual hunger in the heart of the survivor, quite a few, not all mind you, find themselves blinded by the wondrous portions of food just consumed, thanks to the beneficent Mr. Chest, and  Mr. Chest’s willingness to even order him or her a coffee to go. They return to the confines of the day program and talk about how kind Mr. Chest is, not realizing, at least in the moment, that the heart of a cadaver has more warmth than the organ that beats greed in the bosom of Sydney Chest.

The Faceoff

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The four of them are locked in fierce vocal combat. It’s two against two. Two on land, two on water, yet they are no more than 20 yards apart, bellowing at each other with all their might and welded into a staring contest on top of that.  This has been going on for more than half an hour and neither side is backing down. One wonders what would happen if they got within reach of each other.

However, in this particular instance, the land duo is suffering the indignity of having to operate from within a restricted space that precludes them from reaching the water in the first place. That, and were they somehow to reach the water they are clearly no match for the two water-going vessels. This is just as well because it is clear that both duos are very aware of what their combat strengths and weakness are. Neither pair would be a match for their opponents were the current faceoff happening on their opponent’s turf.

There are moments when the two water-going vessels move away in unison and sail out of view of their land-based opponents. For a moment, only a moment mind you, there is quiet, as if both sides have, without speaking a word, decided to take a break from the fray. The quiet doesn’t last however. The two water-going vessels sail back into view and point there bows directly at the two landlubbers and the roaring begins again.

None of this makes any sense to me, other than I suppose this is what happens when two Canadian Geese and two penned-in American dogs decide to get into a shouting match.